I wrote yesterday about the considerable potential benefits of organizational innovations in health care and then I ran right into one today. I realized that my prescription for glasses had become outdated and I wasn't seeing well out of my right eye. So I went down to the Kaiser Permanente Capitol Hill Medical Center today for an eye exam. Before I saw the optometrist, they sent me to a room where a lesser-credentialed person (a nurse of some kind, I suppose) did a brief medical history, a glaucoma test, and took my blood pressure. Blood pressure? I asked her why that was, and she said that when someone comes in they pull their file and if the patient hasn't had a blood pressure test recently they do the blood pressure test. It doesn't matter what you come in for. Kaiser feels it's beneficial for people to have frequent blood pressure checks, and they're cheap to perform, so when you come in the door they check your blood pressure.
It's a pretty brilliant idea.
And it also speaks to the problems with organizational innovation. If you invent a better pill for high blood pressure, you just distribute it to everyone in need. But Kaiser's organizational improvement here only works because of Kaiser's unusual structure. The Kaiser managed care concept is to internalize all the benefits of maintaining good patient health. Kaiser wants to manage my blood pressure, because in their role as my insurance company it's bad for them if I develop chronic medical problems. And Kaiser can manage my blood pressure so effectively because they have all different kinds of providers—including optometrists—working under one roof. But in the fee for service delivery model that predominates in the United States, this doesn't work. Each provider is trying to deliver the specific service he's been asked for. And the particular organizational innovation about sweeping everyone possible up for occasional blood pressure tests can't spread outside the context of a larger structural change.