Date: 2024-05-15 Page is: DBtxt003.php txt00023759
US HEALTHCARE
A BROKEN SYSTEM ... EXCUSES, EXCUSES!
Here’s why big tech has failed to disrupt healthcare.
Healthcare is the problem of our generation, and we need to fix it.
A BROKEN SYSTEM ... EXCUSES, EXCUSES!
Here’s why big tech has failed to disrupt healthcare.
Healthcare is the problem of our generation, and we need to fix it.
[Source photos: Suzy Hazelwood/Pexels; Dan Cristian Pădureț/Pexels; Sound On/Pexels; Rawpxiel]
Original article: https://www.fastcompany.com/90825288/heres-why-big-tech-has-failed-to-disrupt-healthcare
Peter Burgess COMMENTARY
To be honest, I didn't learn anything new from this essay, but it was a useful reminder of the massive dysfunction of the American enviro-socio-economic system at this point in history. This overall dysfunction is effectively hidden by the amazing performance of a part of the system that produces an 'acceptable' level of average or total economic performance.
From my perspective and a quite deep understanding of management metrics the system of measuring economic and social performance has been 'gamed' by the rich and powerful in their own interest, and this has been going on for around 70 years ... since not long after WWII.
One of the flawed economic metrics that has been in use for a very long time is GDP or Gross Domestic Product. Something like this was used by both Keynes and Kuznets early in the days of collecting national economic data, but they both wanted a better metric. For some reason, a better metric was never put into use, though better metrics were designed.
I participated in a conference in Washington almost 30 years ago when this subject was on the agenda. Several staffers from the Congressional Budget Office and other parts of the Washington data establishment were in attendance and while it was acknowledged that GDP was a flawed metric, it was argued that change to something better would be difficult and costly. The sad reality that GDP was sending a significantly wrong signal about enviro-socio-economic performance was completely discounted ... or was it something a lot more sinister.
In retrospect, it seems pretty clear that there is a big part of the 'economic top' that has been a beneficiary of the flaws in the GDP metric ... and a change to an coherent, comprehensive and effective system of management metrics would be wuite disruptive to the present 'business and usual' set-up that is making it look like the rich and powerful are being 'successful' when a better system would show that their success is coming at the expense of much of society not to mention nature and the environment.
By world standards, the health sector in the United States is very costly and the health oucomes not very good. Why is this?
I was disappointed when I read this article that there is rather little that gets anywhere near answering this question in a way that sets up a dialog that might get us to an actual improvement.
I won't pretend to have the answer ... in part because I don't know enough, and in part because the healthcare system is very large and very complex and there cannot be a single 'silver bullet' solution that will solve the zillion problems that must be addressed.
But the lack of anything like a coherent, comprehensive and relevant management framework must be part of the problem. I get the impression that the goals within the system are in conflict with the goals of the general public and society at large.
Yes ... there is some amazing technical progress in the healthcare sector ... in mdeicine ... but what true value does it have if it cannot be used at scale because the system is essentially bankrupt. Even though the demand is there and the technology is there, the money economics do not fit the social value equation. This issue has been around for decades, and the top people in the health sector have done rather little to move the system towards something that works in a coherent, comprehensive way.
Bits of the health sector are very profitable ... some individual doctors and specialists ... the drug companies ... the health insurance industry ... some hospitals. But as a whole many of the key things needed for a healthy populace simply do not exist because they are difficult to make profitable and in an economy like that in America, if it is not profitable it isn't going to get done. This is a cruel and untenable situation in any civilized modern country, especially one that has as much wealth as the USA.
A complete reorganization of the health sector is needed ... but before that can be successful, there is a need to revisit, review and reform hown the enviro-socio-economic system of the United States ... and perhaps the West generally ... is managed and especially the metrics that are used to monitor performance, progress and success. This starts by making social and environmental impacts as important as conventional money profit results.
Most of the tools to implement a system of better metrics are available ... but change is not easy, especially when those with wealth and power are not going to benefit from the change.
Peter Burgess
Healthcare is the problem of our generation, and we need to fix it. But how we go about doing that matters.
Fast Company POV ... Compass: Our Daily Newsletter
Written by OLIVER KHARRA
12-16-22
Since I founded Zocdoc in 2007, I have watched the world’s biggest tech companies enter the healthcare space like lions, only to retreat like lambs. Microsoft HealthVault aimed to revolutionize personal health records. Google Health aimed to do the same. Apple HealthKit aimed to revolutionize collecting and centralizing clinical data, and Amazon’s Haven aimed to revolutionize . . . something?
As Silicon Valley’s giants continue to impact every corner of our lives, their lack of traction in healthcare feels even more pronounced. And yet, the show goes on. Last month, Amazon announced a new healthcare venture aimed at message-based prescriptions for a limited set of conditions.
To be clear: I believe that healthcare is the problem of our generation, and if we don’t fix it then it will break the bank, our health or both. And I believe it deserves the world’s best and brightest minds working on fixing it. But how we go about fixing healthcare matters.
WHEN YOU ARE HOLDING A HAMMER, EVERYTHING LOOKS LIKE A NAIL
When I look at the strategic common denominator across big tech’s ventures into healthcare, it is that they are not primarily solving for what healthcare needs. They are primarily solving how to make money with their respective core businesses: Apple is focused on driving adoption of its hardware (Apple Watch), Google on big data applied to clinical questions (Verily), and Amazon on leveraging its supply chain in areas like pharmacy (Pillpack, Amazon Clinic).
Retrofitting these core competencies into healthcare may improve elements of it, but they will not meaningfully change healthcare’s root problem: a uniquely disconnected ecosystem that consistently fails patients and providers.
For patients, almost nothing connects: The place with lists of in-network doctors is different to the one for scheduling, is different to the one for benefits information, is different to the one for payments, is different to the one with outcome data, is different to the one with medical records, and so on. It is a similar disjointed maze for providers and their staff. Their days are spent navigating antiquated, separate systems for scheduling, patient records, insurance approvals, and more. It is the disconnection of systems that is the source of frustration for both sides.
As a former physician, I know that treating symptoms is often easy but getting to the root diagnosis and curing the disease is much harder. Fixing healthcare is no different. It is tempting to fix the symptoms, but ultimately, we must address the underlying cause.
HEALTHCARE NEEDS BRIDGES AND TUNNELS, NOT HAMMERS AND NAILS
Big tech companies have failed because they have either attempted to change healthcare from the outside in, or they have tried to force their solutions upon the many players and systems within the space.
Successfully changing healthcare requires taking all of the component parts that already exist and finding ways to make them work together. Companies that make a lasting mark on healthcare will be unifiers that build the connective tissue necessary to bring together existing participants, technologies, and applications.
This is the road less traveled because it is the harder and slower road. I know this because it is the road my company has taken. Instead of asking providers to switch EHRs, we have done the difficult work of building calendar integrations that pull real-time appointment availability from more than 150 systems. Instead of being limited to cash pay or specific insurances, we facilitate bookings across more than 12,000 plans. Instead of asking patients to fill out the same forms over and over, we have a longitudinal record that stays with them when their insurance changes or they move to a different city or provider. Instead of only allowing bookings through our marketplace, we enable other participants to use our network through an API.
The likes of Google, Apple, and Amazon are not set up to do this type of hard, slow, connective work that requires a deep understanding of the system’s complexities and how to change it for the better. Rather, they are set up to launch new business lines that leverage their core competencies to help grow their market caps. There is no bigger opportunity for them to do that than in healthcare—whether their core competencies are relevant or not—and so try, they must.
SMALLER HEALTHTECH PLAYERS HAVE ALSO STRUGGLED TO DELIVER
It is not only the large tech players who have failed to deliver impact at scale in healthcare. Newer healthtech entrants—who collectively received more than $40B in venture funding in 2021 alone to fuel their respective efforts to “fix” healthcare—have also struggled to make their mark. And while their approaches are different to the tech giants’, the underlying reason for their lack of traction is the same: they are unwilling to deal with the complexity of the healthcare system on the whole.
Instead, these newer entrants set out to fix the fragments of a fragmented system: They offer telehealth-only services while the vast majority of healthcare interactions take place in person. They offer cash pay solutions only while the vast majority of healthcare interactions are funded through insurance. They only target the “worried well” population while ignoring the vast majority of patients who have acute problems. They offer ephemeral solutions that were only relevant during the pandemic, a once-in-a-century event. The result is that they fail to address the vast majority of patients’ needs, and so they cannot reach the critical mass needed to scale.
The outcome of this is a dizzying, disjointed solution space that puts the onus on patients to navigate hundreds of disparate apps, logins, and systems for each specific care need. Not only is this an untenable patient experience, it is also making healthcare’s fragmentation even worse.
THE BIGGEST COMPANY IN THE WORLD
In their hour of need, patients are asked to call down outdated insurance directories. Then wait on hold. Then wait weeks for the privilege of a visit. Then wait to fill out the same forms in a room solely designed for waiting. Before waiting for a surprise bill.
All the while, providers—who went to medical school to care for patients—must become digital marketers and bureaucracy managers. They must manage listings and endless phone calls to fill a schedule. Then chase patients and other doctors to get info they need and forms filled out. Then haggle with insurance about treating a patient only to wait months to find out what they earned for their troubles.
In any other category, such poor experiences are unthinkable. From airlines to hotels or food delivery to online retail, consumers and suppliers benefit from open marketplaces with hundreds of transparent options, fixed prices and an understanding that information moves seamlessly. Our opaque healthcare system is the exception—with no place to see, compare, and book options across care types and geographies, with information and health records that are trapped, and costs that are almost never clear or upfront.
I believe that the company that ultimately solves these complex, systemic healthcare problems will be a unifier at its core. And I agree with Andreessen Horowitz that the biggest company in the world will be a consumer health tech company. It just won’t be one of the biggest companies in the world, today.
Oliver Kharraz, MD, is the cofounder and CEO of Zocdoc.
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