Health care is ripe for innovation, especially in the realms of health care services and information technology (IT). This situation is one of the main reasons there has been such impressive growth in digital health funding over the past few years. However, much of that investment and many new companies in the health care delivery [1] space are not truly adding value or addressing fundamental problems.

Having worked in health care from both the business and clinical perspectives, I've heard countless companies -- big and small -- talk about revolutionizing health care. Many of the newer companies even use the word "disrupt," borrowing from the concept of disruption made famous by author and Harvard Business School professor Clayton Christensen. Let's clear up what disruption actually entails. The below graphic highlights the key points.

In disruption, an innovation starts by providing a meaningful but lower value service than what currently exists, thereby creating a new market of customers who were previously not served. A recent example of disruptive technology would include the iPad as compared to traditional laptops. As disruptive innovations evolve, they climb the performance value chain. Ultimately, they can become the preferred service/technology and displace the incumbent -- or at the very least take significant market share.

In New York and several other major cities, Uber has disrupted the taxi industry by providing a more convenient service often at a lower price than standard taxis, recent legal action and surge pricing notwithstanding. Recently, I became aware of Pager, a New York-based company started by one of Uber's co-founders, Oscar Salazar, as well as a similar company in South Florida named Medicast. Both have been profiled on CNN and are trying to bring back the storied concept of the doctor house call -- albeit for the concierge market. In late October, Uber began a partnership with Pager for its own UberHealth initiative.

As a practicing physician with several years of clinical experience, I can say that there are only a small number of illnesses I can treat confidently without referring a patient for basic labs, imaging, or monitoring. House calls traditionally had the most benefit in rural/underserved locations where access to health care is limited -- not in major cities with ample resources. Furthermore, in a major metro area like NYC, there is no shortage of urgent care centers and retail clinics with late hours that offer a wider array of services for the $199 price tag of a house call. Although it may be possible to generate revenue, serving a concierge population with a lower value service is hardly disruptive. And in the broader context of health care, it does not address a major problem, lower costs in the long run, or improve societal health. So those issues leave me asking, what benefit does the premium option of a house call have beyond convenience? How does it truly advance health care or fulfill an unmet need?

The aforementioned questions got me thinking about the broader topic of recent health care innovation. When we think about U.S. health care economics, it's important for people to realize that 1 percent of the population accounts for more than 20 percent of overall health care spend (and an average annual mean expenditure greater than $90K per patient), with the top 5 percent of health care users representing almost 50% of health care expenditures [2]. Given that current health care spending is approximately $2.9T (and more than 17 percent of the nation's GDP), 5 percent of the population currently requires almost $1.5T of health care resources. High intensity users of health care are those with chronic illnesses, and often elderly. Per the Agency for Healthcare Research and Quality (AHRQ), they likely have some combination of heart disease, trauma-related disorders, cancer, mental illness, and asthma/chronic obstructive pulmonary disease (COPD). In addition, these patients receive care in the inpatient setting far more frequently than the general population.

To improve health care dramatically and bend the cost curve, entrepreneurs and innovators need to help create better methods to treat the chronically ill and utilize health care resources more efficiently. Further upstream, they also need to identify those most at risk and help them maintain health. In a recent Wired article by J.C. Herz titled "Wearables Are Totally Failing the People Who Need Them Most," Herz discusses how the wearables [3] market is insufficiently focused on the elderly and chronically ill who could benefit most from such medical technology. One particular line from the article was rather scathing:

From Silicon Valley and San Francisco to Austin and MIT, young, healthy, highly educated, mostly male entrepreneurs are developing marginally useful apps and gadgets for people just like themselves.

Clearly there are some health care startups that will meaningfully improve health care. But there is justifiable concern that too many are focused on the wrong patients and wrong problems using technology with limited applicability.

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Uber for Health Care? Think Again | Saquib Rahim