Open Sourcing What Works in Health & Wellness
Health Too Important Not To Open Source
Few argue that we have a fully optimized healthcare system. In fact, many argue the opposite. The horrible under-performance of status quo health benefits points out just how bad it is. So bad, that many of us believe that healthcare's status quo is the single greatest immediate threat to our countries. However, I have good news for you. All of the components of a high achieving health ecosystem have not only been created — they have been proven with solid evidence backing them up. When an organization employs components of the Health Rosetta, the results are breathtaking. For example, a small manufacturer saved 30% per capita on health benefits costs versus their peers while a hotelier saved 50% per capita versus their peers. It's not limited to the private sector. Teacher unions prove they can work collaboratively with their school board management to spend nearly 50% less on benefits compared to their peers.
[Update: Since originally publishing this piece, the Health Rosetta has become the call-to-action for a documentary being directed by an Academy Award nominated filmmaker, investment thesis for a venture fund, featured in a USA Today magazine insert reaching millions (online version here) and business coalitions have structured their annual conference agendas around the Health Rosetta. There's also a growing virtual team determined to help shift the health ecosystem so it performs to its potential.]
For examples of how the Health Rosetta would flesh out a particular area, see Transparent Medical Market, Value-based Primary Care or Concierge Style Employee Customer Service. These three examples were prioritized first as they have the shortest ROI period and can be layered in at any point during a benefits period (i.e., no need to wait for annual benefits changes). In addition, there is an ERISA plan checklist to ensure that Plan Administrators adhere to their legal duty to operate as a fiduciary.
Who would have thought that a benefits plan could not only provide amazing benefits for the employees and their family, but it could directly lead to a fall in crime and dramatic rise in high school graduation rates? Yes, it is possible. In contrast, not deploying a Health Rosetta approach has led to nest eggs being crushed by healthcare's hyperinflation. Teacher unions and school boards are realizing they should be on the same side of the table to fight the collateral damage (see graphic below on how healthcare costs have devastated education and other social determinants of health) from a terribly wasteful healthcare system. Community leaders and business coalitions are realizing that it's time to move to Economic Development 2.0 - Playing the Healthcare Card. Forward-looking employers and unions are recognizing that the Cadillac Tax will be the catalyst to a rethink of their benefits approach that has under-performed.
The future is here. It is just unevenly distributed. — William Gibson
Mr. Gibson could have been speaking about healthcare when he made this oft-cited quote. Unfortunately, while we have the components to fix health and healthcare, they are scattered all over the country and world. Healthcare, in it’s present state, is a design failure given the money, smarts and compassion that we invest. Put simply, it rewards the wrong activities. We pay for illness and treatment, and we get more illness and treatment. Even if we had a perfectly designed health ecosystem, the convergence of new genomic insights, smartphones and mobile Internet, the Internet of Things, sensors, wearables and changed reimbursement models creates an enormous new challenge.
Half of Amazon's Servers Don't Add Value
Imagine if that statement were true. Jeff Bezos wouldn't stand that for a second if every other server Amazon purchased didn't add value. Yet, we are doing the equivalent of that for the biggest thing the government pays for and typically the second biggest item corporations pay for (after payroll). August organizations such as PwC have stated that 50% of what we spend on healthcare doesn't add value. Imagine all the ways we could better use that money (examples here). [As a side note, I've heard nothing about Amazon's health benefits that suggests they aren't making the same mistake as crusty old-line companies in their healthcare purchasing so they should also heed the turn of phrase Tech Industry, Heal Thyself.]
Convergence of Factors Demands Open Sourcing the New Health Benefits Stack
In looking at the root cause of several issues, you work back to the root problem. It comes back to a package of health services that is radically under-performing. Rather than starting with what works best for the key dimensions of health, the bundle of health services that are purchased create what looks like Mr. Potato Head gone awry with a collection of disjointed services. It has resulted in a Gordian Knot designed by Rube Goldberg with tremendous misapplication of resources.
Each of the major issues outlined in the Healthcare is the Single Greatest Immediate Threat to America can be addressed if we design the health ecosystem in a rational way.
A New Health Ecosystem Stack
I believe it is impossible for any one person or organization to make sense of all of the converging new technologies, legislation and medical protocol changes. Rather, it demands an effort that utilizes the ethos of open source. In the technology world, we are well aware of an entirely new technology “stack” that takes advantage of the collective wisdom of millions of individuals around the world. World-changing organizations such as Amazon, Facebook, Google and others have leveraged and contributed to the open source stack. At the same time, they have built highly successful enterprises (read Chris Anderson's book Free - The Future of a Radical Price for the many examples of how great business models can be built around free components). Even though the tech industry was well-established, the pace of innovation has dramatically escalated by having distinct components that can be rapidly assembled to deliver value that simply wasn’t possible before.
Just as the next generation of technology companies required a new technology stack, the health ecosystem needs a new health plan stack. New incentives and payment structures for providers, along with better access to information with new consumer technologies, and an array of new technologies are enabling the shift. Various pay-for-value incentives are driving us to look for ways to optimize health and prevent illness. A key component of the emerging, more democratic, landscape is a commitment to openness, feedback and learning. To rapidly innovate, we need open source and open innovation to drive our a learning health system.
The idea behind the Health Rosetta is build an open, standards-based platform to decode what works and what doesn’t work in this new environment. It will be initially focused on health benefits design as it provides the broadest umbrella. Over time, the intent is to extend into improving the access and efficacy of new healthcare delivery models and define units of value beyond what underpins legacy payment systems (“Relative Value Units”). For example, a concept such as “Patient Value Units” should develop out of this that captures the elements identified in the Quadruple Aim (Triple Aim items -- better outcomes, better patient experience and lowered costs plus a better health professional experience as the 4th, and overlooked, “aim”).
Those health plans that are unnaturally comfortable given the high degree of consumer dissatisfaction would do well to not underestimate players such as Collective Health (addressing the self-insured market), Clover Health (addressing the Medicare market) and Harkin Health and Oscar (addressing the rest of the individual market). Both organizations are massively funded by some of the smartest and most aggressive investors, have whip-smart teams and have no loyalty to the status quo. Those same sorts of dynamics existed when another local/regional oligopoly business (newspapers) discounted an array of at-the-time small players like Google, ESPN.com, Monster, Cars.com, eBay, and many others. More on that here.
For those offering technology and services, Leonard Kish and I curated input from the leading thinkers in the health ecosystem to provide a set of guiding principles for how to deliver services in the new health ecosystem. The Health Rosetta principles are a byproduct of being frequently asked by organizations developing new technologies, health plans, healthcare delivery models, health benefits packages, service offerings and more for a set of guiding principles for how to proceed. Even before the health plan stack has been fully defined, the principles can provide useful information. The can help innovators assess how well positioned their organization's products and services are for the future.
This will be an organic, grassroots project so it will evolve and improve like many open source projects in healthcare and beyond. Naturally, all constructive help is appreciated. Special thanks to benefits consultant, Jim Millaway, who is one of the most innovative minds in the benefits world and is the content expert to make this actionable for purchasers. As you read this, he's helping many organizations transition from under-performing benefits stacks to high value. Also instrumental are Leonard Kish and Nate DiNiro who are experts in open innovation.
To date, this has been a side project for a few of us. Naturally, for this to take off it will need additional resources in the form of additional people willing to contribute their time. However, that will have its limits. We are investigating underwriting sources such as industry associations aligned with this mission as well as crowdfunding. This goes hand-in-hand with the need for assistance with stories (and funding) for the documentary. A prime goal of the documentary is to enrage and then give people optimism about how big a difference they can make. This open source project is one of the calls-to-action. Please leave comments here or reach out to me via LinkedIn if you can provide help.
Naturally, anything this paradigm-shifting will garner a lot of resistance. As mentioned in Healthcare’s Original Sin & Source of Redemption one of the best ways to fight that is openness and transparency. This is the best inoculation against the "FUD" I spoke about in that article. Of course, if components of this aren't the best at achieving the Quadruple Aim, that's the beauty of an open source project -- it's always evolving. If critics have something better to offer that is superior on Quadruple Aim objectives, this is really an ongoing "king of the hill" exercise. However, if they criticize without evidence, that's all the "evidence" one needs as to whose interests they are serving.
A parting quote from Buckminster Fuller who could be talking about the existing flawed model:
"You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”
Upcoming travel/speaking schedule present opportunities to get on Dave's speaking calendar:
- Week of April 25: Orlando
- Week of May 10: New York
- Week of June 13: New York
- Week of July 4: Toronto
- Week of July 25: Montana
- Week of September 6: Pittsburgh
- Week of September 19: Northern Europe