In this week’s New York Times, columnist Thomas Friedman makes a great observation regarding the emergence of what he calls the “sharing economy.”  This is the peer-to-peer, internet enabled economy where ordinary citizens rent car trips and unused rooms.  It’s an area that has exploded in recent years, a trend fueled by the 80 million members of Generation Y– many who prefer to rent services than to buy things like homes and cars.

The critical point:  Friedman suggests that the key ingredient in these peer-to-peer transactions is the transparent reporting of the quality of service provided by the independent provider (and also the quality of the customer).

…if someone created the trust platform to bring [buyer and seller] together, huge value could be created for both parties. That was Airbnb’s real innovation — a platform of “trust” — where everyone could not only see everyone else’s identity but also rate them as good, bad or indifferent hosts or guests. This meant everyone using the system would pretty quickly develop a relevant “reputation” visible to everyone else in the system.


I’ve been thinking a lot about consumer trust in healthcare.  It seems to me that the key to growing marketshare for most physicians is assuring patients that they will receive the care and service that they expect once they make the decision to send their business your way. In other words, trust.

Trust, in healthcare, can be earned over time, say by long-standing experience getting care at a small primary care office.  Or it can be assumed through the imprimatur of a large and well-known brand (particularly in cases of life-threatening and infrequent illnesses. Consider how some patients dial the MD Anderson Cancer Center within hours of being diagnosed with cancer).

Large health systems have evolved partly due to benefits of scale, but also because being tied to a large organization is good for many doctors.  They cloak themselves in white lab coats embroidered with their health system’s logo: referrals frequently depend on the reputation of the system, not necessarily on their own personal reputation.

Howard_Johnson's_Motor_Lodge_-_Penns_Grove,_New_Jersey

A parallel, in the lodging business, is this:  at one point the US had thousands of independent motels.  By the 1950s chain motels emerged which offered standard, sterile, beige rooms because consumers had grown weary of the unpredictable conditions in the independent motels.  This was a trust problem which led to large chains which extended their reputation to independent hotels.  Holiday Inn began in this way:

 

In 1951, residential developer Kemmons Wilson returned to Memphis, Tennessee disillusioned by motels encountered on a family road trip to Washington, D.C… He would build his own motel … Every new Holiday Inn would have TV, air conditioning, a restaurant, and a pool; all would meet a long list of standards in order to have a guest in Memphis to have the same experience as someone in Daytona Beach, Florida or Akron, Ohio. (wikipedia)

With Airbnb and other sites such as Tripadvisor, independent lodging is back in style and boutique hotels are big.  The “trust platform” has reversed the homogenization of Holiday Inn and individual reputation increasingly trumps the reputation of any group to which you belong.


It’s a question of time before somebody develops a physician “trust platform” with meaningful rankings and ratings.  To date efforts such as healthgrades, Angie’s List and and vitals.com have been amateurish and incomplete.

But, at some point somebody will crack this nut and I’ll make the argument that a functional online “trust platform” for healthcare will seriously disrupt the US healthcare market.  When legitimate physician reputations become available, the importance of being imbued with the imprimatur of a large system will shrink. Consumers will seek out the star players from various specialties, irrespective of which who their employer might be.

Along the lines of the “star clinicians on a skinny platform” phenomenon I wrote about a few weeks ago: reputation will increasingly be an individual thing.  Mediocre physicians won’t be able to hide in large healthcare organizations and star performers won’t need the endorsement provided by membership in a larger group.

It’s a further blow to the concept of a vertically integrated healthcare system.  One possibility: as long as the technology for recording and reporting physician performance is nimble enough, membership in the “group” will matter less and less.

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