Bridging to the Future of Healthcare

The #healthcare system is not broken. I repeat: the health care system is not broken. The system as we know it is working pretty much as it was designed and built. Our healthcare system funnels trillions of dollars, handles billions of transactions, serves millions of consumers, facilitates millions of encounters, and pretty much gives all Americans a pathway to getting care.

The institutions built to deliver care are able to deliver care. The systems built to manage all of it are engineering marvels. The companies serving the entire ecosystem do an effective job at keeping it all going; some of them are fantastically profitable, employ hundreds of thousands of people, and give tons of money to charities and their communities. All of this is financed through an unbelievably sophisticated array of payment mechanisms, subsidies, and plan structures.

Yes, our healthcare system is working and by some measures, is working incredibly well.

And yet, despite the phenomenal industrial muscle and throughput of our healthcare system, about 70% of us believe our healthcare system is in crisis .

A recent article posted by Medifind summarized 8 major problems with the U.S. healthcare system today:

1. Medical errors - now the third leading cause of death.
2. Mortality rates - the U.S. consistently ranks lower than other industrialized nations.
3. Lack of transparency - fraud, cover-ups, and hidden deals are rampant in our system.
4. Difficulty finding a good doctor - anecdotal but a likely reality for many.
5. High costs of care - we spent 10% of GDP in 2018 on healthcare and that percentage is expected to grow to 19.7% by 2028.
6. Lack of health insurance coverage - no data shown here but medical debt levels are quite real; 100 million Americans with medical debt, 12% over $10,000 .
7. Nursing and physician shortage - by 2033, expected shortages of between 50,000 and 139,000 physicians.
8. Inefficiencies - at least one study ranked us last in administrative efficiency.

That's a serious list with some serious numbers. We can argue the details but the reality is that most of us, as consumers, acutely feel many of the issues, and those of us working within the system wrestle with the problems every day. Even those recognizing immense profits from it all recognize the need for improvement - preferably not at the expense of their shareholders.

The healthcare system is working, just not how most of us want it to work. We need new ideas. We need innovation. We need improvement. We need change. And, we need it all pretty much across the entire healthcare ecosystem.

We know we need #innovation but the reality is that "large scale" innovation scares most everyone touched along the way, and incumbents will always chase incrementalism as a means of protecting what's in place, while passionately affirming their desire to innovate. There is a desire to change but there is an equal or greater resistance to it. And, naturally, we all have preferences for how and where those changes occur.

Our healthcare system is akin to the interstate #highways crisscrossing the U.S. The infrastructure is old, the routes are fixed, repairs must be incremental and done with the same old technology, and any meaningful change requires massive capital to tear-down and replace because it cannot be augmented with new #technology .

Meaningful change will have to be made one #community , or system, at a time and the bridge to it will need to be built over a long horizon. By the way, that bridge to change can't melt the current state down while it's being built. Few have the stomach for such long-range visioning, which will entail many setbacks, uncertainty, and resistance along the way. Not to mention the fact that some will have to give something up as things change.

Because the system is so massive and the problems so pervasive, it is easy to become overwhelmed by it all and retreat to the known, the easy, or the predictable, in the silos to which we all belong. The large, entrenched institutions double-down on what they know and what they can control. The innovators appear with single-threaded products, services, and technologies clamoring to solve our problems. When we do get a truly innovative idea, product, or technology, we get lost amid the money as we ask: who is going to pay for this great idea?

Right now, there are a lot of smart people trying to solve many of the problems facing our healthcare system. There are good ideas. There is a lot of #money . There are plenty of opportunities. Many, many options are appearing that offer innovation. New #health plans. Direct primary care models. New products, new #drugs , new procedures. Much of it is incremental. Much of it is focused on short time-horizons, small #niches , and race-to-the bottom me-too-ism, centered on cheaper. Always cheaper.

Where are the big ideas? Where are the #bold plans? Where is the moxie to chase something profoundly innovative? Where are the game-changers?

There is a better version of our current healthcare system waiting to be discovered. It is not going to be built on the same roads on which we are currently driving. Addressing even a few of the 8 major problems listed above is going to take more than one organization, one idea, one model, one drug, one service, or one small window of time. We need big thinking, big #goals , and more than a touch of boldness to push past the entrenchment holding us in place.

Yeah, that's a lot. Time to close this post and go back to the issues of the day.

Still here? Then let me offer a few ideas on where to start.

1. Focus on the #experience - the existing structures and systems holding our healthcare system in place cannot be modified in any meaningful way. However, some of them can be repurposed and redeployed in a new version, or versions, of our healthcare superhighway. Start with the critical stakeholders: #patients , payers, and #providers . What would a better experience look like? Follow that thread to find the best place to start.
2. Follow the money to find the value - where are the buckets of dollars being consumed? What are the cost problem areas? Now, look beyond the single thread and beyond the concept of "cheaper." A huge issue with healthcare #costs is that we get stuck on transactional costs and miss the forest for the trees. Getting my drugs cheaper is a silly solution until I know that what I'm getting is working. Putting barriers in health plans to avoid costs is foolish if they create bigger problems in productivity or cause downstream emergent events. Look at the money from a horizontal rather than a vertical perspective and follow it to value.
3. Don't boil the ocean - we get overwhelmed when we try to tackle too many issues, too fast. Start small and reorient how you start. We don't need more silo solutions - shiny object, point-solutions, may be part of the mix but they will only yield incremental results on the front-end. Think in terms of communities of individuals, geographic or organizational, and focus horizontally. Our obsession with using information technology to do everything, everywhere, all-at-once, sounds great in an investor pitch but healthcare system innovation must start in analog mode and center on the community of interest and their particular needs.
4. #Create in segments - a corollary to #3 above is that we need to recreate our system in segments. This makes sense because we've got assets and systems that can potentially be redeployed. By starting with our community and the redesigned experience, we center our healthcare focus on stakeholders rather than institutions. Connect to the old system where it makes sense and use it within the framework of the new.
5. #Build bridges - there is no shortage of ideas for ways we might improve or even redesign our healthcare system. Often, the most brilliant notions break down as we try to envision getting from here to there. Blowing up the current system would be frightening and irresponsible - resulting disruption would be worse than the disease. With this thinking, we get an either/or approach - those who want to blow it versus those who fight to protect entrenched interests. Workable ideas will include pathways to bridge from today to tomorrow, offering stakeholders a way to safely (relatively) get from here to there. The bridges should also help get some key pieces of our current system from here to there. There will be some pieces that must necessarily be left behind but the goal should center on bridging to the new experience as smoothly as possible.
6. Bring others along - the only way to reinvent the mass #industrial complex of U.S. healthcare is to create a new #ecosystem to support new measures and mechanisms of value. Like our current structure, it will need massive collection of innovators building it out but it will need to happen alongside what we've got and be built differently. All daring enough to undertake the venture will need friends...lots of them. Enemies will abound. Resistance will be fierce. Some can eventually be converted, many will stay behind. Most will fight. Find your co-conspirators and envision a future where many more can win.

In the coming weeks and months, I'll share how we're executing on the approach laid-out above as well as what we're seeing others doing. We see the future being driven by a Nexus of Care model - a #primarycare -driven model for reworking the experience of each stakeholder on the path to better care for patients, lower costs for #payers , and, ultimately, greater value for all in the ecosystem.

Follow along, join-in, push-back, or sit on the sidelines. We all have a role to play.