Shooting for the moon: Rules for audacious innovation in healthcare

James L. Madara
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History will record the dawn of the 21st century as an era of unprecedented change. Driven by rapid and profound technological advancement, nearly every existing profession has been irrevocably altered by digitalization. This intense metamorphosis continues unabated and impacts all human endeavor — including the practice of medicine.

To serve this new age, the American Medical Association (AMA) has shifted from a body centered on convening to a body actively partnering to attack dysfunction in healthcare by removing obstacles and burdens that interfere with patient care; to reimagine medical education, training, and lifelong learning for the digital age; and to confront the increasing chronic disease burden to improve the health of our nation. We’ve redefined how 21st-century associations operate because that is the only way we will be able to overcome the urgent and growing challenges facing U.S. healthcare.

We believe it is imperative to develop a flourishing innovation ecosystem that will drive the future of medicine — which is reflected in our relationship with Health2047. Health2047 synthesizes physician and technology expertise to rapidly roll out transformational solutions for intransigent health-sector problems. Its mission is focused in four distinct areas:

• Enabling data liquidity protected by world-class security
• Realigning healthcare systems around chronic care
• Producing radical productivity at all levels of care and support
• Facilitating value-based payments

These are moonshot-level challenges for U.S. healthcare. Success demands audacious effort and uncompromising commitment, which we achieve by investment that adheres to six principles.

1. Focus on North Star
The AMA’s mission is to promote the art and science of medicine and the betterment of public health, our North Star. When calibrating strategic investment, this North Star creates a double bottom line. We can generate terrific financial returns on AMA-backed innovation ventures, but this alone does not meet our success criteria. Our investments must also supply improvement in approaches to chronic disease, health data organization and flow, physician productivity, and value. A typical investor may seek a 3X financial return to compensate for the risk premium. The terms are purely financial. But our double bottom line is drawn under the AMA North Star, so advancing our mission also weighs greatly in measuring return on investment.

2. Touchdowns, not field goals
The demands of principle #1 dictate that any supported venture will be both pre-competitive and transformative by nature. There are worthy health technology ventures that are connected, evidence-based, clinically validated, and critical to some specialization of medicine. But these attributes alone do not satisfy our rules — they aren’t aiming high enough. To warrant inclusion in our innovation ecosystem, ventures must demonstrate broadly transformational impact.

3. Saving lives takes more time than developing theories on how to do so
Our perspective is devoted to enabling practical application and we know it’s a long game. Consider that, after launch, it takes 12 years on average for a biomedical startup to exit. Or consider that we’re currently facing 35 years of market-driven applications focused on administrative needs (a market that comprises $3.5 T/18% of GDP). This has to be corrected and we feel the urgency, but urgency must be tempered with innovations that are evidence-based, validated, and actionable.

4. Pursuit of the perfect is the enemy of the good
Variations of this concept have been attributed to Voltaire, Confucius, and Shakespeare. If we follow our North Star, make touchdowns, and do more than we theorize, we can initially shape the direction of ventures, iteratively move along, and attract other investments. But as these ventures mature, our influence will become diluted. To have an important role in a larger ecosystem — comprised of interconnected players with specific roles of contribution and consumption — we must be a real part of that ecosystem, and that means we won’t always be 100% in control of our investments. We are in the space of good, let’s not think it has to be perfect.

5. Fuel is fuel
We can’t 100% control what happens years after our backed ventures launch and companies develop through additional rounds of investment. But we can very much bias them toward our North Star by the act of creation and early guidance — and later partnership. Consider how the AMA generates revenue and income: Its “fuel” comes from a combination of membership, products, digital content, and publishing. We appreciate these many revenue streams that allow us to accomplish our mission. Likewise, if Health2047 ventures benefit from AMA operating funds, seed support, capital partners investment, customer capital infusion, IP licensing…It’s all is good. Fuel is fuel and variation is healthy.

6. Turn the pathetic into the enviable
Just as the USSR’s Sputnik triumph in 1957 launched the space race and the magnificence of NASA, the dismal state of healthcare technology can be turned to advantage. Medicine lags far behind in using tech advances now common in parallel industries (our data problems alone are piteous). But this pathetic state can be made enviable, as we apply others’ hard-won approaches, developed over decades, to remediate our lag. Much of the technology sector and its R&D dollars are focused on creating the next big thing. The healthcare industry can strategically take the best existing technology (already developed, tested, proven, and refined) — and judiciously apply it to modernizing medicine following principles 1–5!

Establishing a thriving innovation ecosystem is hard work and requires patience. Pause and reorientation are sometimes necessary, and mindset can be more important than footprint. But as evidenced in our investment principles and in the crown jewel that is Health2047, disciplined application of sophisticated technology and sophisticated thinking to system-level problems can and does produce laudable solutions. This belief underpins our shared vision — and it will chart the course for American medical practice in the modern age.

— James Madara is Chairman of the Board at Health2047.

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