Sickcare USA cannot be fixed from inside
Arlen Meyers, MD, MBA
President and CEO, Society of Physician Entrepreneurs, another lousy golfer, terrible cook, friction fixer
The American "healthcare" system is really a sick sick care system of systems (SOS) masquerading as a healthcare system. The fact is that 85-90% of the $4.3 T spent is used to take care of sick patients, not preventing illness or promoting wellness or building our public health infrastructure. The rules reward doing things to take care of sick people, not rewarding health, disease prevention and wellness goals.
Most agree that sick care is sick and needs to healed. Who will do it and pay for it, and how is another story.
Some healthcare executives think that the biggest opportunity is leadership and that, while there are big challenges, they are in control. Yet, of the 50 Most Innovative Companies, none are in the health services industry. Ironically, most of those companies have created solutions to problems applicable to the woes that beset sick care. They suffer from the expertise trap.
Some think Silicon Valley can cure sick care, but others have their doubts Judging from the unvalidated froth Sand Hill Road has created, I tend to agree. There is simply too much that is different about sick care and preventive medicine that outsiders don't understand. Just ask all those smart people who created and then folded Haven.
It looks like health care in the United States is ripe for disruption. Digital technology advances have the power to help address the shortcomings of care delivery: It costs too much, its quality isn’t what it could and should be, and millions of people live hundreds of miles from the nearest hospital and/or don’t have a primary care doctor. But for many reasons, the incumbents — established health systems — will be extremely hard to displace. Instead, claims this author, the winners will be health systems that team up with digital tech companies.
Massachusetts-based health system Wellforce?recently?appointed its first ever chief consumer officer, tapping an executive from a well-known sneaker brand. The move comes amid a rising trend in healthcare: executives sourced from outside the industry, and in particular from consumer brands, to lead innovation strategies.
Innovation rarely comes from within an existing industry and recently surveys seem to support the notion that it is no different in sick care.
?When it comes to strategy, one way to meet radically new expectations in your industry is to draw from the impressive and surprising strategies that are being used in other industries. Why can’t interacting with an insurance company be as responsive and transparent as interacting with Uber? Why can’t checking into a hospital be as seamless as checking into a hotel??These are the sorts of questions that more and more customers are asking, and the questions that a winning business strategy must answer. You won’t find those answers if you limit your strategic vision to what other companies in your field are doing. Remember, your competitors aren’t always who you think they are.
Ever since the late 1990s, social psychologists have known a surprising truth: If you want to maximize someone’s satisfaction with a choice, don’t give them unlimited options. Instead, you should give them?some choice but with clear constraints. This added structure is crucial for picking a desired option with confidence. This research also translates to innovation, which often results from 1) identifying a big problem to solve; 2) breaking it down into sub-problems; 3) identifying how those subproblems had been previously solved; and 4) combining the subproblem solutions in a unique and novel way. This process, which the author calls “choice mapping,” adds helpful constraints to your process.
Where should you look for sick care ideas outside of sick care?
18, FedTech :
Even NASA conducts economic analyses of metropolitan areas and regions.?Why??It’s working to license its patents to startup founders, for free.
Though the NASA mission is to pioneer the future in space exploration, scientific discovery and aeronautics research, and the agency is congressionally mandated to pursue this mission, the agency recognizes that it can play a role in fostering startup companies and ecosystems.
Looking outside one’s own industry has resulted in many remarkable innovations and disruptions. But all too often managers lack the mandate, authority, or confidence to make it work. They can overcome these obstacles by building a team to execute the search for outside ideas; providing it with strong, empowered leaders; and carefully preparing the sales pitch. In the case of sick care, medical exceptionalism gets in the way.
But, as research from Kellogg has demonstrated,?the majority of successful entrepreneurs are actually middle aged . And?while that finding garnered the bulk of media attention , there is another important conclusion in the research: the most successful entrepreneurs have extensive experience in the industry or sector where they end up competing. Steve Jobs dropped out of college to join the team at Atari while still in his teens. That's why physician entrepreneurs need to play a role in the process.
According to this HBR article, the traditional process of making strategy is about managers finding a way to align a company’s capabilities with its opportunities and environment. That works well enough when environments are relatively stable, but not in highly unstable ones. In this situation, the solution is to treat strategy as a discovery process. Identify your stakeholders and find out what they expect of you. This engagement should be made by senior executives with strategic responsibilities; what they learn often surprises them.
I don't believe sick care can be fixed from inside for a few reasons.
1. History tells us that very few industries have solved the innovator's dilemma, yet alone one that touches every person in the US and accounts for almost 20% of the economy.
2. The culture of medicine is elitist, arrogant, exclusionary, and extremely resistant to change. "To embark on a career in medicine is like moving to a foreign country where you do not understand the customs, rituals, manners or language. Your main concern on arrival is how to fit in and avoid causing offense. This is true even if the local customs seem backward or cruel. What’s more, this particular country has an authoritarian government and a rigid status hierarchy where dissent is not just discouraged but also punished. Living happily in this country requires convincing yourself that whatever discomfort you feel comes from your own ignorance and lack of experience. Over time, you learn how to assimilate. You may even come to laugh at how na?ve you were when you first arrived"
3. Sick care is one of the most highly regulated industries and any efforts to make change are subject to political, economic, and legal threats.
4. The rules that presently exist don't allow innovation external to healthcare to penetrate. Televideoconferencing used for telemedical care is an example. It took a pandemic that killed 1M Americans to disseminate. Now that COVID has entered the next phase, the exemptions and rules are being withdrawn.
5. Sick care design, financing and delivery is much too complicated for any one group to fix it alone.
6. There are multiple stakeholders, each feeding at the present $4T trough. They are embedded deeply in the system to protect their interests.
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7. Sick care, like any industry, has blind spots. New entrants will come from places off sick care's radar.
8. Medical education is anti-entrepreneurial and, in some instances, seeks to find and destroy "disruption".
9. Few doctors have an entrepreneurial mindset.
10. Sick care is myopic. Few have figured out how to bridge the now with the new.
11. Those who pick ideas to fund have a hard time seeing around corners. They focus on then now, maybe a bit on the next but little on the new.
12. Sick care is unlikely to be radically transformed by technology only. Rather, major change will happen as a result of policy and rules changes and business model experimentation. We are more likely to learn more from the fintech industry neetings than we are from medical conventions. Or, how about what will result from innovations in the transporation industry?
13. Academentia
Associating is part of the innovator's DNA
The researchers found that the best predictor of associating skills was how often people engaged in the other discovery skills=questioning, observing, networking, and experimenting. Try the SCAMPER method.
Open innovation is anathema to sick care. Yet, open networks and cross industry knowledge exchange are the key to innovation and industry progress. Unfortunately, those interface industries are having difficulty finding the right formula for understanding doctors, how they work and the morass of health technology commercialization. Many, though, are trying.
Physician entrepreneurs and non-healthcare entrepreneurs need to do a better job
of communicating and being open to new ideas learned from each other's industries.
Provincial arrogance is getting in the way. We need to move from sickcare to healthcare to coherentcare.
Outside in examples include GPS, telemedicine, teleconferencing, vaccines that took advantage of 20 years of genomics to create a vaccine in one year. Future technologies outside of medicine, like battery storage, quantum computing, nanotechnologies, and renwable energy will do the same.
1.?MICRONEEDLES COULD ENABLE PAINLESS INJECTIONS AND BLOOD DRAWS
2.?SUN-POWERED CHEMISTRY CAN TURN CARBON DIOXIDE INTO COMMON MATERIALS
3.?VIRTUAL PATIENTS COULD REVOLUTIONIZE MEDICINE
4.?SPATIAL COMPUTING COULD BE THE NEXT BIG THING
5.?DIGITAL MEDICINE CAN DIAGNOSE AND TREAT WHAT AILS YOU
6.?ELECTRIC AVIATION COULD BE CLOSER THAN YOU THINK
7.?LOW-CARBON CEMENT CAN HELP COMBAT CLIMATE CHANGE
8.?QUANTUM SENSORS COULD LET AUTONOMOUS CARS ‘SEE’ AROUND CORNERS
9.?GREEN HYDROGEN COULD FILL BIG GAPS IN RENEWABLE ENERGY
10.?WHOLE-GENOME SYNTHESIS WILL TRANSFORM CELL ENGINEERING
It's time for myopic Sick Care USA to get their eyes checked. But they shouldn't count on their vision insurance to pay for the visit since it is an uncovered benefit, and you will get a surprise bill for using someone out of network.
Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack and Editor of Digital Health Entrepreneurship
You're Never Ever Too Old to Learn
3 年Spot on assessment of the space and the need to break down the existing infrastructure and introduce measures, methods and technologies that can finally free up and enable what Doctors and Patients really want and need
Surgeon, C-Suite Clinician Executive
9 年Brilliant article! As Medics, we ought to have the freedom to think and act out of the box for the greater good.
Senior Provider Network Manager | Business Development | Clinical Provider Recruitment | Sales | MSO/ACO Physician Contracts | Physician Network Recruitment | Healthcare Business Investor | IC Freelance Journalist
9 年Hi again Dr. Meyers. I just forwarded your article to one of my graduate school professors. We were discussing this in class. The state of FL requires for us to take the US Healthcare Systems (ACA) class. From an experienced physician recruiter point of view this is all very interesting as we hear the hard truth from doctors.... Patients are also confused as doctors are dropping out of the ACA and when the patients go, they need to see or pick a new provider. From a physician's wife point of view, I know doctors are rather upset, confused and truly discontent, as your said "business" is not what they teach in medical school. I am currently reading much of the ACA regulations for my graduate class and I am often perplexed.... time will tell the truth but in my opinion some of these changes will take time IF they are even fully implemented. I don't think we in America were ready for ACA. THANK YOU again for sharing your article!
Retired after 38 years on Mainframe and Client/Server
9 年"Nothing should impede us from doing whatever is necessary to bring the best possible health care to those who do not now have it--while improving health care quality for everyone--at the earliest possible time." said in 1972 by that liberal President Richard Nixon. https://www.presidency.ucsb.edu/ws/?pid=3757 Congress had near 40 years to come up with Healthcare but saw no urgency to do it. No one should believe a word of any Congressman who says 'repeal the ACA and we will replace it with something better'. But voters have shown to be gullible so who knows.