A few lessons about healthcare (part two)

Over the past few months, I have been asked quite a few times about my thoughts on building a startup in the healthcare industry. It’s true that after 4 years in hardcore healthcare, I have come to a few conclusions about its dynamics, stakeholders, disruption potential (and speed at which change can happen). I feel that we’re at a crossroads and critical mass for change has been met: this time it is really different, I think. As I said before, I am at a junction right now and as I am wrapping things up, this is part two of my thoughts on healthcare and the few lessons I have learned along the way.

Revolution is coming:  I think we are at a moment when even all the various stakeholders themselves in the healthcare industry have understood that costs aren’t going to rise forever while outcomes remain stagnant at best without a revolt – the perfect storm is coming, it will be destructive but the realignment is necessary. As a very simple, self-experienced, example, It’s mind blowing to me that, in 2019, I can’t schedule an appointment with my ophthalmologist without having to call a number, be put on hold for 45 interminable minutes and given the run-around by front desk employees who couldn’t care less about the negative value they are bringing to the equation.  

The empowered customer
In my personal example, I simply brought my business elsewhere: if as a provider you are not consumer-centered (read very carefully: I am using the term “consumer”, not the industry term “patient”) then you are bound to be disrupted due to two primary drivers: 1) increasing costs and 2) increasing expectations. As a business owner, your demand (the Consumer) is paying more out of their pocket than ever before. As a result of all this rising cost, individuals have now a vested interest (if not forced) to take more ownership in their healthcare decisions. 
This leads me to new consumer expectations: we are all increasingly looking for on-demand solutions in healthcare in the same way we use apps to order a ride, book a flight and buy food. A new kind of healthcare customer is rapidly emerging, who takes a great interest in managing their health care on a daily basis, and actively look to leverage new technologies and health information. And yes, coming back to my ophthalmologist example, we’re challenging the status quo by seeking care outside of the traditional hospital and doctor’s office. 
And they are already challenging the status quo by seeking care outside of a traditional hospital and doctor’s office. Changing consumer demands have created an expansion of new care delivery models centered around easier access, lower cost, and a richer experience. Already, there is a range of entirely new ways to “see your doctor”: one survey showed that 60 percent of consumers with employer-based insurance have received care in an urgent care center, 25 percent in a retail health clinic and 11 percent by video visit. New entrants capitalizing in primary care — One Medical, Forward Health, Paladina, and others — offer a range of “on-demand” online services like same day appointment booking, immediate virtual doctor visits, accessible medical records, and prescription renewals. Healthcare is already increasingly being offered at consumers’ fingertips, with consumers accessing medicine (or telemedicine) with a simple app.  

Tech natives are inevitably going to disrupt traditional incumbents
Over the past 4 years, I have seen the fallacy of using tech to automatize inefficient and outdated care models as historically, industry incumbents are looking for ways to incorporate technology into their existing systems and workflows – resulting in poor results: this is the wrong way of looking at the problem. 

Successful new entrants in healthcare are increasingly being built from scratch with technology baked into the DNA of the company – and (of course!) with a consumer-centric sensibility. We are also seeing tech-natives getting into healthcare like Apple and Amazon. We’re not very far from a world were Amazon can deliver our drug prescriptions same-day via PillPack and also offer low-price telehealth services for Prime members.

These new entrants are creating increased and rapidly disruptive and wide-ranging competitive pressure with an acceleration of competitive pressure on traditional providers and insurances’ margins as well as a customer base that is increasingly shopping for superior user experiences at a lower cost. 

Dissolving the payor/provider silo
With so many different stakeholders all acting in their own silo with disconnected incentives, often not driving for value at all. But these silos are beginning to dissolve, creating a new opportunities to rethink how we deliver, pay, and experience high level care. 
One particular silo that is increasingly facing disruption is the payor/provider paradigm. In a traditional “fee for service” system, hospitals and clinics are incentivized for volume and not necessarily for outcomes and even less for the total cost of care. But in order to better align incentives and address the gaps and fragmentation in care, we are beginning to see the lines between payors and providers start to blur. A few weeks ago, for example, Blue Cross and Blue Shield of Texas opened ten “advanced primary care centers” in partnership with Sanitas, a global healthcare network of hospitals and clinics. This partnership creates a new value-based care delivery model that is takes a holistic approach to improving one’s health: from primary care, urgent care, lab and diagnostic imaging services, to wellness and disease management programs, these medical centers accelerate the ability to coordinate care across one patient’s journey while reducing costs and improving outcomes. 

Today is (finally!) a great time for healthcare
As a conclusion, it seems almost certain to me that the winners of this new world order will be those who are focused on comprehensive, end-to-end solutions that win on outcomes, cost, and experience. I think we are in the middle of major shifts in our healthcare ecosystem, all of which have the potential to completely transform both the demand and supply side of the healthcare landscape. These shifts are creating a rare and powerful window for new entrants to define that landscape in the coming years. 

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Let me know what you think! DM me @philippemora
​My name's phil mora and I blog about the things I love: fitness, hacking work, tech and anything holistic. 
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