Over half of the adult population in the United States suffers from a chronic disease, and $0.86 of every healthcare dollar is spent on a patient with at least one chronic disease. Finding the right formula for effectively managing a chronic disease can make a world of difference in improving a patient’s quality of life, preventing the onset of multiple chronic conditions, and reducing hospitalizations. Because spending on those with chronic diseases represents such a big piece of the national health expenditure pie (roughly $2.7 trillion), strategies that effectively manage chronic diseases at scale have the potential to make a big impact on healthcare expenditures in the US.
With this in mind, business models that help patients and physicians build a community around the goal of managing their chronic disease show promise in improving patients’ quality of life and minimizing medical costs associated with their chronic condition. This is arguably the case for individuals in the Netherlands suffering from Parkinson’s Disease, a neurodegenerative chronic disease that affects roughly 50,000 people in the Netherlands and up to one million people in the US.
The definitive cause and cure for Parkinson’s Disease (PD) still eludes medical experts. Finding an effective strategy for managing PD’s symptoms and preventing the onset of comorbidities is the most we can do to improve quality of life among sufferers. While there are numerous therapeutic options including deep brain stimulation, drugs, speech and physical therapy, a common struggle that patients face is finding multidisciplinary specialists who have PD-specific knowledge.
With that challenge in mind, a new tool called ParkinsonNet emerged, and after disrupting traditional care management of Parkinson’s Disease in the Netherlands, has recently made its way to the United States. ParkinsonNet is an example of a facilitated network business model. As described in Clayton Christensen’s The Innovator’s Prescription, facilitated network institutions operate platforms in which customers buy and sell, and deliver and receive things from other participants. Uber is another example of a facilitated network—its platform acts as an interface between drivers and passengers, coordinating payment, pick-up/drop-off, driving directions, vetting of drivers, and in some cases the control of in-car audio for each trip.
Professor Christensen proposed the facilitated network as an ideal business model for institutions in the business of helping patients manage chronic conditions, and ParkinsonNet is a great example of the promise this model holds. ParkinsonNet connects PD patients with certified PD physicians who first had to be trained in the nuance and standards of PD treatment before joining the network. The physician training and vetting process is a key step, since it can be challenging to find physiotherapists, neurologists, and other specialists who have PD-specific knowledge. The network organizes information exchange between patients and their team of physicians, ensuring adherence to evidence-based standards and patient-centered care coordination. Just like Uber, the platform caters to the preferences of the patient. Physicians co-design their care plans with patients so they receive care how, when, and where they want it.
During the first three years of operation in the Netherlands (from 2003 to 2006), ParkinsonNet nurses, on average, saw their caseload double. By 2010—a mere seven years later—their network spanned the whole of the country. Today, 70% of PD patients in the Netherlands use ParkinsonNet therapists—clearly disrupting what was business as usual.
But can this model work in the United States? Until now, the predominant business model for treatment of PD in the US, and most other chronic conditions, has been a solution shop. In healthcare, solution shops depend on specialist physicians as the repository of information in solving unstructured problems. A solution shop is an effective answer for many patients, but the downside of this business model is the high price specialized knowledge demands, and how difficult it can be to gain access to a specialist.
Fortunately, the facilitated network business model has shown potential to disrupt solution shops. Facilitated networks disrupt solution shops by connecting what is often sparse and fragmented resources to a community of members who have a common goal—acting to centralize the medical knowledge of specialists and the experiences of other members on a single accessible platform. The platform, then, organizes information and acts as an interactive resource for physicians and patients, upon which new insights and best practices are shared widely. In the case of ParkinsonNet, we even see the platform playing a role in coordination of patient care.
For families affected by Parkinson’s Disease in the U.S., a structured way of connecting with other patients and specialists could make a world of difference. The ParkinsonNet model is already being piloted by Kaiser Permanente, and the next step is extending the model to be utilized more broadly for other chronic conditions. In doing so, widespread adoption of similar innovative networks may prove to be a powerful tool in the fight against rising healthcare expenditures, while encouraging a sense of community around progress among those affected.