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August 11, 2014  |  Monica E. Oss

Monica E. Oss

Last week in my session, From Strategic Planning To Tech Strategy – How To Select, Implement, & Leverage The Technology Your Organization Needs To Succeed,at the Florida Conference on Substance Use Disorders and Mental Health, the discussion about the potential of e-health to transform behavioral health treatment was punctuated by the question: “If we have e-health, won’t we have outsourcing? Won’t we start having mental health and addiction treatment services delivered by professionals in other countries?”

My answer to that is “yes” – it is inevitable. The “disruption” of e-health to the health and human service system has two important dimensions. First, it provides a level of consumer access to professional services (at home, on demand, etc.) that is faster and far greater in options than the past. Second, it eliminates geography as a barrier to providing consumer services. The elimination of geography as a limiting factor in market supply is, by definition, a form of outsourcing – “to obtain goods or a service from an outside or foreign supplier, especially in place of an internal source.”

The drivers of this move to outsourcing are apparent – lower cost and “quality” that is equal to in-person, face-to-face services. What does this lower cost look like? MDLIVE offers, with free sign up for their services, a pay-as-you-go plan advertised at $49 for doctor visits, and $79 for one-hour therapy sessions. And for $49, American Well will offer you access to a doctor online.

And the delivery of e-health services will also serve as a robust connector for the expanding medical tourism market – another form of outsourcing. The article, Health Insurers Turn To Medical Tourism Strategies To Bypass Obamacare, cited a California consumer who paid a $16,000 bundled rate for extensive reparative surgery at Cosmed, in Tijuana, instead of the $45,000 or $50,000 at Palo Alto Medical Foundation. Websites like, which is managed by the Medical Tourism Association (MTA) provide additional prices comparisons such as:


Add to this picture developments such as the Indian multi-hospital chain Narayana Health (NH) building a $2 billion, 2,000-bed health care system in the Cayman Islands to serve U.S. consumers willing to make that short flight (see Will Your Market Be Disrupted By ‘Frugal Innovation’?). Patients Beyond Borders reports that 1.2 million Americans will seek overseas medical care in 2014 – and, the Deloitte Center for Health Solutions projects this trend will cost U.S. provider organizations over $200 billion total by 2017 (see Bon Voyage? The Complexities — And Costs — Of Medical Tourism).

And this isn’t just an “out-of-the-USA phenomenon” Some companies such as Wal-Mart and Lowe’s are sending employees to specific providers within the U.S. who agree to fixed fee for all the care, rather than open-ended fees for service, according to the article, Corporate medical tourism raises quality, lowers costs.

The inevitable question is – will all services be “online” or delivered in a foreign country? Will all health and human services be delivered in the style of the American Express 800 number customer service line?   Personally, I hope not and I don’t think so. There are still bookstores in the era. Antique stores exist outside of People still use travel agents to plan vacations. Banks still provide in-person transactions to people in addition to on-lien banking and ATM services. Lawyers and tax accountants still have on-going practices that extend beyond the self-serve and online services for creating wills and preparing tax returns.

But, all of these fields have changed significantly following the introduction of disruptive technology – and health care will as well. Health and human service provider organizations will need to understand what consumers and payers want, and sharpen their value proposition to those customers to find a sustainable market position.

To continue the discussion on the future of the health care service delivery system, join futurist and thought leader Simon Dudley, Video Evangelist, LifeSize Communications in November in Washington, D.C. at The 2014 OPEN MINDS Technology & Informatics Institute, where he will take a look back at the past 10 years of innovation – and a look forward to what the future will bring for America’s health care system in his opening keynote address, Innovative & Disruptive Technologies – How The Power Of Technology Is Transforming Service Delivery Around The World.


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2) The Importance Of Selecting The Right EHR Partner: An EHR Return-On-Investment Analysis
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3) A New Approach for People with Complex Service Needs: The Behaviorally-Focused Medical Home
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4) Texas Medicaid To Establish Mandatory Managed Care Program For All Youth With Disabilities
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5) Making Health Homes Work – Advice From The Field
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