Care Delivery

The Inevitability of Telehealth and Care in the Home: The Decentralization of Everything

Care Delivery
March 30, 2023
4.5 minutes
Phil Gibbs

It is widely recognized that the adoption of telehealth and virtual care and the movement of care to the home were dramatically accelerated during the pandemic. As we move forward, the potential transformative impact of this acceleration on the industry has become the subject of much dialog and debate among healthcare leaders.


The scale of the emerging opportunities and potential for disruption are attracting new entrants form predictable sectors like big tech, including Google and Amazon, and unlikely sectors like big box retail, including Best Buy and Walmart, and even grocery chain Kroger, among others.


The truth is, the only real question related to the transformation we are experiencing in the delivery of care is the timing. The adoption of virtual care and movement of care to the home has been and continues to be inevitable.


What we are now experiencing in healthcare is simply part of a trend that can be labeled “the decentralization of everything” or “mass decentralization”. In fact, healthcare lags virtually every other sector in the race to decentralize.


The shift occurring across sectors goes much deeper than suggestions by cynics who accuse consultants of advising clients one year to centralize operations and a couple of years later advising them to decentralize. Nor is it anything like the wild swings we see in sectors like fashion, attributable to the marketing prowess of designers who influence the fashion conscious to cycle between extremes—wide tie/narrow tie swings, or maybe no tie.


This ubiquitous trend is grounded in the natural maturation of technology which forms the basis of Clayton Christensen’s widely accepted theory of disruptive innovation. When new technologies are first introduced, they tend to be large, complex, expensive and require a high level of expertise to operate, resulting in centralization.  


The first computers were large, complex, expensive, and required a high level of expertise. Only universities and large corporations had these mainframe computers. Companies built computer centers and employees brought computing jobs for the experts to run. As the technology began to mature, computers became smaller, less expensive, and easier to operate. Individual departments began to get their own computers and it was no longer necessary to go to the central computer center. This evolution continued with minicomputers, desktop computers, laptops, and smart phones, as well as other mobile devices like watches that today make computing available anywhere, anytime, by anyone.


Copiers followed a similar path. Early copiers were large, complex, expensive, and required expertise to operate. Organizations had a central copy center where the copier might take up a whole room. Over time as technology advanced, copiers became smaller, easier to operate, and less expensive, and each department acquired its own copier. It was no longer necessary to take copy and print jobs to the central copy center. Later, every desk had a small, inexpensive copier/printer that anyone could operate. And of course, the process has continued with most copying today being digital and available anywhere, anytime, by anyone, and basically free.


But this trend is not limited to just core technology sectors. It applies to all sectors that are enabled by technology, with retail being an obvious example. Years ago, customers shopped at small, local stores near where they lived. Over time with advances in technology, brands like Sears, JC Penny, Woolworths, Kmart, Borders, and ultimately Walmart, centralized much of retail. And many of these dominant retailers clustered in malls. As technology evolved, the dominant retailers were challenged by thousands of merchants on sites like eBay, Etsy, and Shopify. And as we all know, Amazon and other online sites have made every computer and smart phone a store.


The hospitality sector is another example. Years ago, when people traveled, they stayed in bed and breakfasts or small inns. As technology developed for reservation systems, supply chain, and operations, larger and larger motels and hotels replaced the small inns, and the industry became dominated by large chains like Holiday Inn, Hilton, Marriott, and Hyatt. Early technology led to centralization of hospitality, but as the technology progressed through the maturity cycle, it became simpler, more accessible, less expensive, and easier to operate. Browsers and apps enabled new entrants like Airbnb to dramatically decentralize hospitality to the point that millions of home and condo owners became innkeepers.


We see similar patterns in how we work, specifically the office. In the agrarian society, people tended to work where they lived. Farmers lived on their farms and merchants above their shops. The industrial revolution led to the development of large factories, and the advent of the “office” and office building. Work had become centralized. With advancing technology including the internet, cloud computing, and mobile devices, some workers began experimenting with work in coffee shops, coworking spaces, and even the home. Now, especially postpandemic, many of us are able to work anywhere, anytime.


A part of the pattern that is important not to overlook is that a hybrid model usually emerges. There are still large physical box stores, large hotels, and large office towers, but the industries have been disrupted and transformed.


The story of healthcare, unsurprisingly, is similar. Pictures of county doctors in horse-drawn buggies arriving at patients’ homes are iconic. Technology consisted of the crude instruments in the doctor’s bag. Care was delivered in the home. Hospitals developed to care for indigent patients. Early technology was large, complex, expensive, and required an expert to operate.

X-ray machines and other diagnostic equipment were located at the hospital along with the expert technicians. Patients were required to go to the hospital for tests and healthcare became centralized. It only made sense for patients to go where the technology and expertise were located, but this centralization was accompanied by access issues and high overhead costs, along with other issues like safety related to hospital acquired infections.


Many have argued that healthcare would not follow the path of other industries. It is highly regulated. It has a financial model where the customer and the payer are generally different entities. It has a unique business model.


The technology for delivering healthcare, however, is following the patten of every other sector. What was initially large, complex, expensive, and required great expertise, has in most instances become smaller, simpler, less expensive, and easier to operate, if not intuitive. With the touch of a button, a person can visit with a clinician, and can easily read and report the results from a pulse oximeter. With remote patient monitoring, the reporting is even automated. Living rooms are again becoming “exam rooms” and bedrooms are becoming “hospital rooms”. When products become smaller, simpler, less expensive, and intuitive, decentralization is the natural and inevitable outcome .


In the case of healthcare, all the forces resisting decentralization, including regulatory and reimbursement challenges, can not stand up to the forces driven by maturing technology. Adoption of telehealth and virtual care and the movement of care to the home, including hospital at home, were accelerated during the pandemic and are having a transformative impact on the delivery of care and the healthcare industry.


It was never really in doubt. It was inevitable.