It is always difficult to release constraints of the present when imagining the future.
Say you took a couple of tech workers strolling through the Marina on a Friday afternoon in the fall of 2006 for a ride in a DeLorean Time Machine to modern day San Francisco. Their entire perspective of what’s possible would be transformed at once. The modern ubiquitous display of personal connectivity and computing power would no doubt astound them — What’s with all those tiny TV thingies? How do they even type without a keyboard?
Recall that the iPhone wasn’t introduced until 2007.
Now imagine a similar futuristic journey focused on healthcare ten years from now. We’d surely see tremendous marvels — same-day hip replacement and recovery, oncology patients living 20 years longer, LVAD-based wonders that replace heart transplants, or personalized CRISPR services for selectively editing a genome. Truly revolutionary transformations are surely possible. But the constraints of the present and our current care delivery model make it difficult to envision how we will get there.
We’re saddled with a care-delivery state frozen in the last century — endless waiting rooms in hub-based brick-and-mortar systems, limited data sharing (if any), nearly absent mobile experience, sporadic visits for chronic and continuous conditions. This IS your grandpa’s healthcare model. When asked to dream up innovations, the best we can muster, often, is an autocomplete function in drop-down menus for diagnosis codes in the EMR. Or maybe the ability to digitally schedule an appointment…
We have little concept of exactly what the future will hold, but it must be fundamentally different than it is today.
We know that disease burdens are shifting and that current providers are not equipped to manage the change. Demographics and a need for a continuous engagement model present care requirements at odds with the capital-intense approach of our current delivery system. Advancing automation and health consumerism give rise to a more informed and tech-savvy patient. All of these factors require adaptation and should fuel a technology-intensive evolution in the medical profession.
And as was the case with the smartphone, it is this evolution that will ignite new healthcare payment conventions and revenue flows. The impact will be monumental.
Imagine the impressive state of healthcare delivery if you could combine the design, creative user interface, and hardware integration model of Apple; the logistics, consumer analytics, and continuous business-model innovation approach of Amazon; the data-driven heuristic techniques of Google, the mobile engagement and digital connectivity of Facebook, the permissions and rights management of Netflix; the sharing-based real-time supply/demand service delivery of Uber? A new world will exist beyond the horizon. But we are limited in seeing it because of a biased view generated by too many years of limiting, incremental innovation.
Apple, Amazon, Google, Facebook, Netflix, and Uber all harnessed technological innovation to disrupt the status quo, thus spearheading entirely new revenue streams through digital transformation. Truly transformative solutions applied to healthcare will also spawn massive shifts in how revenues flow. Payments will move to accommodate new models and the tsunami of change will stand in stark contrast to the slow-moving impact we’ve seen from the value-based care policies of the government or new regulations around MACRA. Sure, those are great, but standards and regulatory-driven innovation in this space will not move us any faster toward the future than is evidenced in the narrow progress in delivery we have experienced to date.
The incremental change we have experienced is stifling. It is dimming our future and limiting our potential. It lowers our expectations for breakthroughs. It dampens imaginative potential and leaves our system mired in stagnation. It nullifies incentive.
The opportunities to capitalize go to the innovators who create groundbreaking models. Google did this with the monetization of search, Facebook with mobile engagement and advertising, Uber via the sharing economy, Amazon through online purchasing, and Netflix through content collection, development, and streaming. They drove the innovation that led to change in human behavior and tectonic payment shifts.
In healthcare, if we see this level of innovation from the leading thinkers and organizations, we may actually get somewhere beyond the oxymoronic “hospital without walls” concept. Health and care in the future will go where the people go — and they are drawn to what is modern and connected and digitally enhanced even without the aid of a DeLorean Time Machine. That is where the new payments will flow and significant value will be captured. The winners will be the patients and their physicians, along with the innovators who shatter our expectations of what’s possible.
We must think big and go bigger for a better future state of healthcare.