The Future of Health Will Be Local, Open & Independent

It's time to replace the extractive healthcare era community by community

At a recent social impact investing forum, I was asked to expand on the attributes of the Health 3.0 era that will replace the current extractive era of healthcare (see article below). I responded that it will be local, open and independent. This approach addresses the core problem that the care delivery industry has become an extractive industry: it harms the social determinants of health that drive 80% of health outcomes while producing inconsistent quality.

Previously, I shared our theory of change and how we're following the template that lifted 10's of millions out of poverty, remade rural health care and is now remaking the U.S. food system (see article below).

The comments below are from Chris Brookfield's paper on system change, in general. We're adapting them for how we accelerate the transition to Health 3.0 that was addressed in the Theory of Change piece. See Brookfield's paper in Appendix C The Opioid Crisis Wake-Up Call: Health Care is Stealing the American Dream. Here’s How We Take it Back. (click for free download) as well as Chapter 16 that expands on the theme of this piece.

Local: By focusing on local, a number of intrinsic advantages are often overlooked. First, by decreasing scale, solutions can appear to problems that seem too complicated to solve at global scale. For instance, re-engineering the food system or decreasing poverty really are intractable when viewed at the global scale. Even the basic atoms of these systems - people - are invisible. By dialing into local, new features and relationships emerge.

It is striking to me how healthcare's value creation is a fundamentally local interaction. That is, local individuals receive care from local clinicians yet less than 25 cents of every dollar spent goes to the clinicians. Between 50 and 75 cents of every dollar is extracted from a local community into the hands of health systems/plans headquartered outside their community. This is at the heart of how the sick care industry has extracted resources that would otherwise be going to social determinants of health that are fundamentally local (e.g., schools, social services). The slide below is from a deck we shared with Health Rosetta backers which gives a high level approximation of where every dollars go (the orange bubbles are examples of how the extractive tactics have been thwarted).

Open: Openness is an advantage; largely because information networks have coalesced over the past 15 years and have exponentially increased the flow of information to local communities. There is no way to transmit proprietary ideas at anywhere near the speed and coverage that open sourced ideas move. As information networks have grown, so has the relative advantage in propagating open ideas as compared to contracting proprietary property.

One of the failings of the wildly under-performing status quo system is how poorly insights and breakthroughs get disseminated. Research shows that it takes 17 years for breakthroughs that achieve the Quadruple Aim to become mainstreamed. This is why a central focus of the Health Rosetta is to create an open "hivemind" that makes it much easier to understand and deploy the approaches that outperform on the Quadruple Aim objectives. We take inspiration from many realms such as open source software and LEED but inspiration can come from anywhere -- craft brewing is one example.

Independent: [Brookfield uses next generation wheat mills in this example of how to get scale advantages in an independent model.] As with scale, we are hybridizing our approach to system design to incorporate the best of both local and conglomerated infrastructure. By integrating business models with existing social movements, we achieve network connectivity beyond the local watershed allowing the sharing of resources, information and values. By allowing each of these businesses to function autonomously within this fabric and grow to their fullest individual potentials, an individual mill can utilize the control and hierarchical scalability typified by corporation. While at the same time, the fabric as a whole achieves quick responses, flexibility, and adaptability – responses which are inhibited by corporate concentration.

While very little about the Health Rosetta is employer or U.S. specific, like any triage scenario, one must focus on where the condition of "patient" is most dire. In the developed world, I don't know of group that has been more harmed by the wildly under-performing status quo sick care system than the working/middle class of America that is suffering through a 20 year long economic depression (longer than the Great Depression) overwhelmingly caused by healthcare waste (details in the article below).

Thus, our first application of the local, open and independent model is the vanguard benefits advisors we're working with that are the torchbearers of the Health 3.0 era. Perhaps no job is more under-estimated in all of healthcare in terms of its potential to help (or hurt) the working/middle class of America. After all, if you aren't old or poor, overwhelmingly you get your health benefits through your job. Evidence suggests employer-based healthcare is durable (it's actually increased since the ACA passed despite the expectations of the ACA framers) and growing outside the U.S. America's neighbor to the north sees employers get more involved in healthcare by the day. It's becoming more common for other countries to provide catastrophic care coverage and varying degrees of primary care but more and more health benefts are covered by employers.

Our mission remains broadly replicating the proven approaches that rebuild communities to restore the American Dream. Replication is the key word. Most efforts focus on scaling mega healthcare entities. Given that the primary value creation in healthcare is fundamentally a local endeavor tuned to local dynamics, we believe replication is the way change will happen versus massive top-down programs. We believe an approach that emphasizes local, open and independent is the path forward. Our experience has echoed what Brookfield has experienced and thus why we've become collaborators.

One indicator that a movement is ready for development in the commercial sphere is indicated when the movement ceases to be perceived as political within the relevant communities. While movements remain politicized, there is insufficient agreement; when the community itself is split in its support, this method of commercial development is doomed at the outset. On the other hand, it was obvious in the case of both microcredit and local food, that virtually everyone in the local communities agreed with the underlying premise. When the commercial values aligned community business models were tested, they were able to attract nearly unanimous support.

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Dave Chase is the co-founder of the Health Rosetta (a LEED-like organization for healthcare), and author of the book, “The Opioid Crisis Wake-up Call: Health Care is Stealing the American Dream. Here's How We Take it Back.” Follow the link to the book for a free download of the book. Chase's TEDx talk was entitled "Healthcare stole the American Dream -- here's how we take it back." See the Health Rosetta website for how to get involved, resources and how to join others to support its mission.

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