Disruptions on the Yellow Brick Road

April 28, 2015
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Part I: Cyclone

Cyclones or tornadoes are awesome forces of nature. Winds spin into funnel clouds, roaring across the landscape, wreaking destruction. Dorothy and her dog were whirled from Kansas into the Land of Oz by such a tornado in L. Frank Baum’s classic The Wonderful Wizard of Oz. Dorothy and Toto traveled the yellow brick road, collecting friends and adventures along the way.

Part I: Cyclone

Cyclones or tornadoes are awesome forces of nature. Winds spin into funnel clouds, roaring across the landscape, wreaking destruction. Dorothy and her dog were whirled from Kansas into the Land of Oz by such a tornado in L. Frank Baum’s classic The Wonderful Wizard of Oz. Dorothy and Toto traveled the yellow brick road, collecting friends and adventures along the way. Eventually they found their way back to Kansas, Auntie Em and Uncle Henry.

Dorothy and Toto were lucky. Tornadoes powerful enough to lift houses off Kansas prairies kill people and upend lives. Few trapped in these storms are left unscathed. The disruption to their communities, families and livelihoods is profound.cyclone toto dorothy

No one brings such disasters on themselves by choice.

Except American health care.

Cyclones, Uncle Sam, And Entrepreneurs

American health care is caught in a cyclone. Every patient, every doctor, every hospital is buffeted by gales blowing hard from the whirlwinds. Lives are upended. Reportedly people have died.

And many folks couldn’t be happier about it. Downright gleeful.

Uncle Sam

The Office of the National Coordinator for Health Information Technology (ONC) unleashed the storm. It published Federal Health Information Technology Strategic Plan 2011-2015 in 2011. (The agency with the Orwellian name first seeded the clouds in 2008.) The ONC diagram below reckons by now individuals will be “empowered”. The feds predicted care will be efficient and Health Info Technology (HIT) will make it easier to skimp on cost. All by 2015.empowered patients, disrupt care

HIT entrepreneurs were flush with venture capital and Uncle Sam’s blessing. They raced to cut destructive paths across health care’s landscape, indifferent to the harm already caused by poorly designed technologies.

The Consultants

Oliver Wyman (OW) is a management consulting outfit. Management consultants sell expensive advice to help corporations make more money. Oliver Wyman’s clients range from the automotive industry to travel businesses. The health and life sciences field is an Oliver Wyman specialty. Eager to help clients grab money swirling by in the storm, two OW partners cranked out a paper. Tom Main and Adrian Slywotsky wrote The Patient-To-Consumer Revolution last year.

The report is a utopian (or dystopian) scheme. It calls for transforming patients into self-monitored, overspent, overcontrolled consumers who will be blamed when they get sick. Their plan “embraces disruption” and gives tips for “surviving creative destruction”:

 

The odds are there will be multiple models from fast-moving disruptors. The “gazelles” could be V[enture]C[apital]-fueled startups or incumbents hungry for a new profit/growth opportunity. But each will provide integration to a tornado, destruction, sick peoplechaotic… industry….

Every other industry has gone through a similar phase of creative destruction, which left many incumbents struggling to keep pace before dropping out of the race. If hospitals and insurers want to survive, they need to step on the gas.

Accenture is another management consulting shop. It concentrates on helping organizations use technology and outsource business functions. Their consultants “uncover the key ingredients to help our clients become high-performance businesses”—make lots of money.

Accenture published a paper last year entitled “Fueled by Healthcare IT Start-Up Funding, Digital Disruption is Knocking.” Accenture predicts investors will plow $6.5 billion into “digital disruption” by 2017. Company analysts list five “digital health funding drivers.” The biggest driver is “system waste.” They don’t mince words about the cause of system waste: aging and chronically ill populations.

Six and half-billion dollars have…or will be…spent on digital disruption. Health analytics, virtual care, telehealth, patient engagement, behavior change, remote monitoring and wearables like Fitbit. (Think twice before asking your health insurer to spring for your Apple Watch.)

The Think Tank

Management consultants aren’t the only writers encouraging disruption and destruction. Jonathan Rauch is a senior fellow at the Brookings Institution, a Washington, DC think tank. The Center for Effective Public Management at Brookings published a Rauch paper last month: “Disruptive Entrepreneurship Is Transforming U.S. Health Care.” He introduces this paper by pointing out the obvious: the economics of health care have changed. Now “value and health” are prized, not “cost and treatment.”

Making all this possible, according to Rauch, is a new “ecosystem” populated by:

[A]n influx of creative value-seeking entrepreneurship, often led by insurgents from outside the traditional health care sector…[and] an investor infrastructure that is eager to bankroll value-seeking startups. In short, health care is beginning to taste the disruptive culture of Silicon Valley, retailing, and many other American sectors

He concludes with a nod to reality, “The ultimate effects are impossible to predict.” But Rauch is confident that change “points to business models that keep people healthy, rather than by treating them when they’re sick.”

Maybe Rauch can’t predict but docs and nurses can: Leaving sick people untreated will increase suffering and death.

Cyclones in Your Future

Think tanks, policy shops, venture capitalists. Creative destruction and digital disruption have transformed American medicine, according to this herd. They boast about chaos. They brag they’re outsiders with no health care background. They congratulate themselves for their yet-to-be-proven strategies.

The whole mob is indifferent disruption’s harm. They’re heedless of the implications of calling ill and elderly people “system waste”. Or favoring “ecosystems…that value health rather than…treatment”.

Because most of us will get sick. All of us will get old. Assuming we can still get treatment when we’re ill. If you see their destructive tornado swooping down, follow the advice of Tom Main and Adrian Slywotsky. Step on the gas and get away fast before you get ditched as waste.

Next – Part II: Winged Monkeys