Transforming Healthcare – Wheelbarrows and Ferraris

Changing healthcare is a slow process. It requires patience and courage.

Patience because despite the large number of people trying to facilitate some element of change, the list of things that need to get addressed is also very large. We need help to address interoperability / FHIR, to advance patient and population engagement, to continue to explore and develop digital health / mobile health opportunities, to continue to evolve and develop disease management platforms and clinical remediation solutions, and in the technology that assists directly in the physician practice and associated clinical services, and so on. Coordinating all care needed, efficiently doing so across an entire population, and in a consistent manner is the challenge.

The incumbent industry is still using wheelbarrows while more advanced technology and data emerges almost daily.

Any attendee at HIMSS will tell you there is no shortage of enterprises chasing these opportunities and challenges. The various CB Insights innovators maps that track digital health solutions, mobile health solutions, data analytic solutions, and insur-tech based solutions can barely keep up with or track all the firms now on the field. Innovators are selling solutions akin to Ferraris. It will take a long time to upgrade those wheelbarrows to a Ferrari. Patience is indeed a virtue is this circumstance.

And courage.

It takes a lot of courage to step forward against the status quo and commit yourself to the effort of changing something as complex as healthcare. It is made particularly difficult when there is so much inertia, and perhaps a lack of motivation to adopt change. Fee for service, for example, is a prime example of how the incentives reward volume, not quality of care. Having legions of insurance staff aligned to a process that works but uses technology from the 1990’s is another example of how the best intentions of change can be mired down in the practical reality.

Healthcare is complex. To be on the front line requires courage and passion to wade through that complexity, to face the fear of rejection time and again. Perhaps there is a bit of Don Quixote mixed in there, an undying and relentless pursuit of an ideal goal despite the apparent obstacles, challenges, and naysayers.

The fundamental need is straightforward. We know we need to be more efficient and better at the coordination of care across all member interactions, not just in the silo of one physician, or one trauma, or one digital health solution. The patient journey as a whole must be managed and coached in a proactive, thoughtful and empathetic manner.

Will the large, established insurance companies stand-up to this task, given their access to all the data and resources that can be leveraged against the issue? I do not believe they will, at least not on a whole population level like we need the change to be. The opportunity then becomes one for companies like Evry Health, Oscar, Clover, and Devoted Health.

Will employers fill the gap and create the financial pressure and imperative to accelerate the momentum? If they do there will be opportunity for companies like Collective, Artemis Health, Bind, Connect Healthcare Collaboration and Empyrean.

Will hospital systems and the physicians and the ACOs / MSO type organizations be the ones to corral the resources and establish the tools and technology necessary to clinically team and coordinate care along clinical pathways? Some may but I believe it will be inconsistent. Population based coordination at the physician and care delivery level has so many agents that cohesion is difficult at best. FHIR may address data, but process and implementation are just as difficult. The opportunity becomes one for companies like Athena Health, Evolent, Nuna, Geneia, Sano Surgery, PatientBond, MAP Health, Health Catalyst, Zeomega, and so many more.

Will Government and the State legislatures stand up to facilitate their part of the dialog and foster and support change? CMS has been rolling out small innovations in payment models, but the responsibility for compliance is falling on the physicians and insurance companies. “Medicare for All” conversations have a variety of approaches to achieve population-level reach. Maybe the opportunity here is in the data aggregation and development of health information exchanges, companies like NextGate, Mulesoft, Inxite Health, Mint, BurstIQ, Redox, Azure/Microsoft, AWS/Amazon, etc.

With the corporate, venture and angel capital investors have the stamina to ride out this slow transition? Excellent question. We may see a spike in antacid usage.

Truth is, I think all the parties play a role, not one or the other. Its more of a team effort across all of these fronts. I salute all those with the courage and leadership to stand up and say this is the time for that change, regardless of which aspect they are working on. The data is ready. The technology is there. We know what process changes are needed. I love the energy and excitement that the mere possibility of change creates. I, for one, as part of the Evry Health team, love what we are doing, and along with our fellow innovators am anxious to put the pedal to the metal to get this wheelbarrow moving.

Mark Jamilkowski

CFO and Chief Actuary, Evry Health

www.evryhealth.com

Managing Partner, G.O Strategic Advisors LLC

www.GOStrategicAdvisors.com