Clayton Christensen, as many of our readers know, pioneered a theory of disruption in business models and a three-step cycle of innovation (empowering, sustaining and efficiency, now quite broken indeed). With two other writers, he applied these theories to healthcare in the 2009 book ‘The Innovator’s Prescription’ which this Editor heard co-author Jason Hwang, MD present in 2009 at the Connected Health Symposium and at a private meeting in 2011. One would think that we’d be well into disruption, which is part of the empowering innovation cycle and which the authors championed in the book as underway.
The surprise at the end of this Mobihealthnews article on his recent presentation at “Better Health” in Boston, a McKesson-sponsored meeting series, was not what constitutes disruption, but that it has not really started yet, four years later. This will be much to the surprise of many successful and unsuccessful companies (Misfit Shine, ZocDoc, Zeo, 23andMe) and health plans which have stoutly touted their products and services as The True Disruptors. Sorry, you may be only a part of the Big Shift: decentralization. Decentralization will push out parts of healthcare off the hospital and doctor’s office to clinics, retail sites, the workplace and the home. The three parts of the hospital function–diagnostics, acute care/surgery and chronic condition management–which presently have three warring business models can then sort themselves out. Telehealth and care management–even senior housing and home care–all have roles particularly in this last area. And whither the patients? Are they drivers or passive consumers? [Ed. note: Innosight, Mr. Christensen’s commercial arm, is working with McKesson.]
This Editor’s partial defense of why disruption is The Dog That Failed To Bark in healthcare is that we in the US are living through an externally imposed Pearl Harbor-style disruption: the Affordable Care Act (ACA), only part of which is insurance with expensive, ineffective health coverage generally classified under Healthcare.gov, but so much more. The real disruption underway in 2009-10 was shunted off to a detour and the car’s gone off a cliff. In the UK, the causes may be different, but the end result is the same–business and care models at war with each other, costing too much; patients shortchanged.
Related article from the Clayton Christensen Institute on the primary care business model.
There are $2.7T reasons why healthcare innovation has stalled.
Arlen,
Interesting statement, would you expand?
Donna, I suspect that Arlen is referring to the monies currently spent on delivering healthcare. There is a large investment in keeping that money train rolling, and by large, entrenched enterprises and organization. If “innovation” is seen as a disruption to that revenue stream there is little motivation to accommodate it, but high motivation to figure out how to cover declining revenues by participating. Until those business models emerge I’m afraid we will continue with the localized pilots, POC’s, and regional deployments. A larger participant will need to enter the market to drive the change if it is to scale quickly. Without that, the change will occur but we’ll only recognize it by looking in the rear-view mirror in 10 years time and seeing where we were.
I think Arlen’s comment centers around the massive wealth transfer that is the US healthcare system status quo, since our collective spend is +/- $2.7T annually on healthcare. But I’ll let him tell me if I’m right or wrong there.
On the “when will the clock start on real disruptive innovation in healthcare” front, I’ll give a short answer: when patients are full partners in the system.
Of the four companies you mention, all of them empower(ed) patients to collect, analyze, and share information about their health status and engagement therein/with. But the healthcare system itself has exhibited no capacity – NONE – to incorporate this user-generated data. 23andMe had the most potential, but … oops, FDA!
People (commonly called “patients”) perform really well as meat-based mainframes. Too bad the system that purports to help us manage and maintain health doesn’t see the value of fully interacting with us. Now THAT will be some disruptive innovation right there …
Mighty Casey, please see our latest on 23andMe and why their strategy may not be at all about patient empowerment. (I also corrected the gender on Arlen Myers)
In the Drive-in movie scene in Twister, Philip Seymour Hoffman runs out of a van to the character played by Bill Paxton saying “a Twister is heading straight for us!”, to which Paxton replies “It’s already here”.
Disruptive innovation in healthcare is already here, it’s not visible on NASDAQ or the NYSE, it’s in small start-up’s that scratch the itch. //tom