Say a word enough times and it loses all meaning. There's a term for that. Psychologists refer to it as "semantic satiation," when the repetition of a word causes the listener to perceive the speech as repeated meaningless sounds.
The same could be said for industry buzzwords. Outside of the medical sphere, healthcare is famous for failing to define its terms, and it's also a high-dollar business.
Healthcare Dive has collected a few of the most maddening ones. Cue the buzzwords! The industry is rife with this kind of language:
Once, in a very quaint time a million/15 years ago, when people were ill—or even when they weren’t—they went to a doctor, who referred to them as a patient. Now, not only insurance companies but healthcare providers are referring to people as "consumers" of healthcare.
No matter where you stand ideologically on this one, it's weird. The concept of getting a flu shot or getting your hip replaced is not the same experience as trotting down to Best Buy to get a new TV. Some people love it. Theranos' Elizabeth Holmes calls "consumerizing" the healthcare experience a "huge element" of the company's mission—making care accessible to those who want it. Others think the change in semantics puts the patient/consumer at risk of losing the right to receive care. "A patient deserves health care as a right. But does a consumer?" asks Dr. Leana Wen.
Originally, patient consumerism meant the patient challenged the physician's right to make unilateral decisions. Now it's about the availability and accessibility of care. This second movement is in large part connected to the rise of what your dad probably calls "doc in the boxes"—urgent care clinics that make convenient care accessible on your street corner—but it's also a political one, encouraged by the Affordable Care Act and born under George W. Bush's "ownership society" push in the early 2000s.
"That's when you started hearing terms like 'skin in the game,'" said Carolyn Engelhard, MPA, from the University of Virginia School of Medicine.
So is "consumer" an appropriate word for a person who is receiving care from a trained healthcare professional? Jury's out. Says Engelhard, it may be appropriate in some cases—like the purchasing of coverage—but in others, people will always remain patients.
"I still think when your mother, father, child gets that incurable cancer and there's only a 1% chance of them surviving, [healthcare] loses its value," Engelhard said. "It’s valueless."
For a word that instantly raises fear in the breast of every healthcare IT professional, there's some irony in the fact that in 1975, "interoperability" basically didn’t exist. Then computers became affordable, the digitization of the universe began and everyone abruptly lost his or her mind (that's one theory, anyway). The use of the word "interoperability" went through the roof.
Per the government, interoperability is "the architecture or standards that make it possible for diverse EHR systems to work compatibly in a true information network." Like with ACOs, however, nobody is in agreement about how this should happen, and so instead, the word is bandied around like a catch-all cure for everything that ails the healthcare industry. Harness the unicorn that is true interoperability and we will improve access, lower costs and probably cure at least cancer, and maybe even a couple orphan diseases that would otherwise languish in KickStarter campaigns.
Maybe true, but without a clear path to harness that particular unicorn, the word itself is what is languishing.
If ever there was a word with a vague and undefinable meaning that gets brandished in the conference room and Twitterverse, it is "disruptive innovation." Everyone is disrupting healthcare. It’s extremely fashionable, kind of like doing Crossfit and hating on Taylor Swift.
A term both coined and championed by management expert Clayton Christensen, it refers to "a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors," its author states.
In an unwieldy and expensive system like American healthcare, this sounds good, right? Probably, but if you read Christensen’s definition carefully, a lot of things people call "disruptive" actually aren’t. As investor Maxwell Wessel writes in the Harvard Business Review, "If a start-up starts launches a better product, at a higher margin, to an incumbent’s best customers—that’s not disruption. That's just … innovation."
Are wearables, for example, a Christensen disruptor? They rely on complicated technology, not a simple model, and in reality, that technology isn't quite there yet -- so probably not.
Disruption as a model also has its detractors. Jill Lepore penned a 6,000-word hate piece on the entire movement, complaining that ever since Christensen published The Innovator’s Dilemma in 1997, "everyone is either disrupting or being disrupted. There are disruption consultants, disruption conferences, and disruption seminars. This fall, the University of Southern California is opening a new program: 'The degree is in disruption,' the university announced." Lepore tries to both discredit the academic methods behind Christensen's theory and rein in the willy-nilly use of the word.
There’s room for debate on the usefulness of the theory, but the almost-random use of the word to describe just about anything any company wants to do at any given moment is beyond dispute.
"Accountable Care Organization"
The Centers for Medicare and Medicaid Services defines an ACO as a group "of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients."
They offer three different ACO programs for hospitals to participate in, programs that have met with varying degrees of success (the Pioneer program, for example, has seen drop-out after drop-out this year). Still, the model is gaining traction: A Parks Associates study released July 23 predicts that more than 130 million Americans will receive care from ACOs by 2017, more than triple the estimated 40 million in 2015.
The study, however, defines ACO "in the broadest sense." This means it includes Medicare ACOs, patient-centered medical homes in the private sector and providers accepting pay-for-performance arrangements with private and public payers in its analysis.
Spoiler alert: That is a lot of really different models.
So seriously, what does ACO mean? There is a ton of variation between organizations in terms of scale of operations, risk-sharing capabilities, level of information-technology sophistication, etc, etc, ad infinitum, ad nauseum. In the end, this leaves uncertainty as to whether ACOs actually are doing the job well and, you know, transforming the US healthcare delivery system or whatever—no matter how many millions of Americans are expected to get care from some second-cousin twice-removed version of them.