The Human View – The Healthcare Revolution Will Not Be Televised

by Mark Head

Founder, Curata Health
July 1, 2016

The scale, scope and rapidity of change happening in healthcare today are the most profound of our lifetimes. Compared to how we’re set up today, the roles and relationships among all of the below healthcare stakeholders will be nearly unrecognizable in 10 years:

• health systems, hospitals + physicians
• employers, benefit consultants + health plans (group insurance)
• wellness + disease management programs
• the employee-patient-consumer-human

We are experiencing wholesale, tectonic shifts in how healthcare is manufactured, delivered, consumed, and paid for. Among the technological advances that are impacting healthcare (and virtually every other industry on the planet) are:

• genomics
• artificial intelligence
• cognitive computing
• 3-d biological printing
• advanced robotics
• nanotechnology
• virtual + artificial reality

These technological advancements will in and of themselves drive price reductions, and many costs will be lower tomorrow than they are today.

Tomorrow’s liver transplant
In the not-too-distant past, if you needed a liver transplant, we’d run a bunch of lab tests, pinpoint the tissue-matching requirements, put you on a waiting list, and say, “Good luck!”

Tomorrow, we’ll of course do the lab tests and tissue matching requirements, but we’ll also sequence your genome, feed all the data into Watson Health or one of his buddies, pipe the outputs into an advanced 3-D biological printer, print you up a perfectly-tissue-matched, fully-functioning brand new liver, roll you down the hall to an advanced robotic surgical unit where a flawless transplant operation will be performed, and you’ll be back at work in two weeks.

Or, perhaps we’ll bypass invasive surgery altogether, and simply have you swallow a nano-bot and stem cell cocktail, and you’ll regenerate a new liver from within your own body. Whoa!

And, this will happen within ten years – maybe sooner.  Yeah.  

Underneath the radar
Even though change across the planet is now happening at exponential rather than linear rates (think compound vs. simple interest), the scale and scope are so large that it’s very difficult for individuals actually to discern what’s really happening, or how it may affect them – much less what it may mean for entire industries. 

Several major trends are converging and beginning to dislocate the entrenched structures and interests that have long held sway over healthcare delivery, and that have operated as a single system within which cost increases have been relentless and intractable, with real solutions nowhere to be found.

• Disintermediation – this is likely to be a compounding dynamic.
  • Transactional brokers of group health insurance are pretty much “done.” (Sorry, Charlie). But even larger group brokers and sophisticated consultants are at risk as more and more powerful automated processes via platforms reduce the necessity for specialized human involvement and curation of health plan design and procurement.
  • The standard model of buying a health plan from the BUCA’s to process claims, manage complex plan designs, negotiate fees paid to hospitals and physicians, etc. already faces direct competition from provider-sponsored health plans where health systems themselves negotiate pricing and contract directly with employers, while managing the risk that their treatment costs exceed what they expect by buying their own stop-loss coverage. Sounds like a self-funded plan, huh? Yep; and ACO’s are simply a stop along the way.
  • How many employers would, from any number of perspectives, be thrilled to be out of the healthcare/health insurance business altogether? Eventually, with health systems beginning to work directly with employees through direct contracting with employers, will the employer even need to offer a health plan?
  • Will the idea of defined contribution come to fruition because employees will just pay health systems directly to handle all their care needs? Can you say institutional concierge medicine?
• Volume to Value – the fee-for-service pricing structure for healthcare is giving way to value-for-service. This isn’t really “news,” but most folks don’t fully grasp the deep dislocations this trend is driving.
  • Wellness and disease management (DM) companies may eventually partner primarily with health systems to provide their services via physicians, clinics, and nurse practitioners, directly to patients, vs. via employers to employees.
  • Corporate wellness programs aren’t likely to disappear, however; there are many reasons why employers will want to continue to promote the health and well-being of their people, as they also seek to evolve their cultures.
  • Many people think government can’t be innovative, but the payment changes that government is of necessity prescribing for Medicare and Medicaid have been the harbingers of risk-based care and value-for-service by increasing the providers’ burden to produce healthy outcomes.
  • Government will continue to expand its model of paying for health maintenance rather than open-ended treatment.
• API-based platforms – these are the fulcrum points upon which virtually all of the trends hypothesized about in this article will turn. An API is an Application Programming Interface.
  • I like to think about API’s as translation engines. If I want to talk to someone in Chinese, I don’t really need to learn Chinese, I just need a translator.
  • Platforms will also greatly reduce the perceived need to lift humongous amounts of data from “system A” and FTP it to “data warehouse B.” The coming health models will rely far more heavily on real-time or close-to-real-time data.
  • It’s not that “big data” warehoused in a single repository isn’t a good thing, with its own kind of value, but for many day-to-day health purposes, all that warehoused data gets “stale” fairly quickly.
  • So, there will be both data warehouses and platforms, with the currency of platforms being that they can simply call for a piece of data when it’s needed for a real-time algorithm and a currently-running process.
    • If I’m helping you manage your blood pressure today, I don’t really need to know what it was last spring, I need to know what it is right now.
    • So via the API, my process will call to whatever system has your most recent BP reading (say your wireless BP cuff and smartphone app), and your app will send me your current reading, and that will inform whatever next step needs to be followed.
  • Platforms function as hubs. In an ideal deployment, they are plug ‘n’ play. Platforms are designed to create, and are necessary to realizing, what technologists call network effects.
  • Facebook, Google, AirBnB, Uber, and dozens of other companies have generated multi-billion dollar market valuations because their business model is platform-based. The network effect is simple: the more connections, the more value; the more connections, the more utility.
  • What healthcare platforms are beginning to do – and what is fundamentally necessary to breaking the logjam of crazy costs and poor health – is to connect all of the stakeholders (eventually) who have any kind of role in the holistic physical, mental, emotional and spiritual health of the human being.
    
  • Today, most of the players in my health have no idea what the other players are doing, what data the other players have on me, and how much better they might be able to perform if all that data was accessible, and if a series of handoffs in a course of treatment, or coaching, or other forms of lifestyle or clinical interventions could be coordinated, curated, managed, and accessible to everyone who has a hand in helping me enjoy the best health I can – every day of the year.
  • Platforms will present a versioned, relevant, actionable real-time view of what’s up with me, at the precise moment my doctor needs to know, or her nurse, or the case manager, or the health plan actuary.
  • HR executives will get real-time dashboards with heat-map type displays of aggregate data to quickly zero in on emerging challenge areas, and the platform will automatically suggest responses and solutions.  
• Platform curators, the new consultants – if you consider the highly-specialized roles of all the stakeholders in the above diagram, and if you consider the specialized technology systems that have been intentionally designed to support each stakeholder in performing their function, it becomes pretty clear, pretty quickly, that:
  • Wellness program providers aren’t ever really going to be able to do payroll, and
  • Physicians aren’t ever really going to be able to do BenAdmin, and
  • EAP providers aren’t ever going to manage provider-sponsored health plans.
    • But aren’t all of these functions periodically inter-related, and wouldn’t the human experience of the employee-patient-consumer (ME) be better if I didn’t have to figure out how all these pieces fit together, who does what when, what my responsibilities are, and if the “next” button in any given process was automated instead of manual – which stresses me out?
  • Connected – the real revolution. As more and more discrete systems and roles become connected to platforms, far more sophisticated workflows and processes can be designed that create automated next step prompts for me, so that if I’m diagnosed with diabetes, the next step prompts would be that I might want to access the EAP, that I should enroll in a disease management program, and that I ought to be automatically furnished with wireless glucose and a1c monitors.
  • Artificial intelligence, machine learning, and cognitive and quantum computing – designing all of these workflows and processes will require a facilitated, collaborative effort among many stakeholders. 
    • No one platform curation specialist or sophisticated algorithm designer can, by themselves, possibly fathom how everything fits together. Multiple, virtual communities of collaborative healthcare futurists will form.
    • As the renowned Buddhist/Christian monk Thich Nhat Hanh said, “It is possible that the next Buddha will not take the form of an individual.The next Buddha may take the form of a sangha (a community) – a community practicing understanding and loving kindness, a community practicing mindful living. This may be the most important thing we can do for the survival of the earth.”
  • Platform curators – the new consultants – will facilitate these new, cross-role and multi-system processes and workflows.

Personalize me
I have long come from a world view that stipulates “we are humans first.” Before we are even male or female, parents and children, wives and husbands, and certainly before we’re employers and employees, or patients and doctors, we are human.

If we design systems and roles to that foundational truth, any system so designed stands a greater chance of succeeding in its purpose. I’ve also said that every organization, every company, exists first to serve human needs – not to make a profit.

Profits are necessary to any sustainable enterprise, but they’re not why the enterprise exists; shoemakers exist because humans need shoes.

Capitalism operates on such ideas as Adam Smith’s “invisible hand,” that we all operate in our own self-interest. It suggests that we design systems and governments based on that truth. And yeah, the truth is, I want what I want, when I want it, my way.

When it comes to the consumer experience, companies are getting better and better at understanding what I want, in advance, and designing experiences that delight me.

I now buy almost everything in my world from Amazon because I click a button and my stuff shows up on my doorstep in 2 days. In some cases, like with Amazon Now, it shows up on my doorstep in 2 hours!

Without platforms, healthcare will never be able to design and evolve that kind of delightful human experience. But platforms alone won’t make it happen. Humans collaborating with real-time data will.

The last word
As humans, we value life. Our quality of life is directly related to our quality of health. What will health means to humans if we all live to be 120?

As Gil Scott-Heron might have sung 46 years ago, “the healthcare revolution will not be televised, will not be televised, will not be televised. The revolution will be no re-run, brothers. The revolution will be live.”