My objectives for this writing are threefold:
- Inspire and influence leaders (leadership does not equate to a title) to prioritize the practical build of pathways and platforms that measurably move us from our current sick care model to a future model of actual healthcare.
- Invite an increasing engagement of talents, resources, technology, ideas, and influential networks to shift our focus from perpetuating our sick care model to stepping into a concrete vision of true healthcare.
- To spark conversation and amplify the message: we can do better.
Step into the following words – lift them from the page. Debate, share, and put them into action. Discuss them in a board meeting, during a podcast, as a class assignment, in a team meeting, or while sharing a meal with friends. Lift them from the page and bring them to life.
Many will resonate with these concepts. Others will not understand them or perhaps choose to disagree. There will also be those with no interest, being too stressed by waves of daily disruptive change. Some walk that tricky line of being rewarded financially yet are experiencing burnout from the sick care system they serve. I respect each position and each individual.
As you can, I ask that you participate in envisioning a better way. Today, that’s the invitation offered by our children and our future.
Singularity
The term singularity is defined as the state, fact, quality, or condition of being singular. Similar terms are “unique”, “distinctive”, and “particular”. In physics or mathematics, the term singularity reflects a point at which a function takes an infinite value. In the study of unstable systems, James Clerk Maxwell in 1873 was the first to use the term singularity in its most general sense: it refers to contexts where arbitrarily small changes, commonly unpredictably, may lead to arbitrarily large effects.
It refers to contexts where arbitrarily small changes, commonly unpredictably, may lead to arbitrarily large effects.
The term singularity offers a glimpse into an unfolding journey of true healthcare transformation. I believe it will not be what most envision or expect. It will start small (quite possibly already underway in corners of the world) and capture the vision and passion of the greatest minds and hearts. Those excelling in technology, design, social theory, behavioral science, cognitive computing, ethics, and economics will be drawn into the vision and will eventually steward a future of infinite value and exponentially large effects. Before we go there, however, we must first visit the ground on which we currently stand.
Our Present Reality
According to Silicon Valley Bank, for the full year 2021, a record $86B of venture funding was invested in health sector companies in the U.S. and Europe. In just Q1 of 2022, that number was $19.6B. That’s $105,600,000,000 in fifteen months. These investments in venture-funded health sector startups are happening while many large health systems are hemorrhaging. For example, according to Beckers Hospital Review, nationally recognized Cleveland Clinic reported a net loss of $786.9M for the second quarter of 2022 and a $1.07B loss for the year’s first half. They are not alone. In an article published one week ago, Beckers highlighted the need for health systems to shrink executive teams as costs rise.
In a recent briefing, Fitch Ratings warned it could take years for provider margins to recover to pre-pandemic levels. Those moves include steeper rate increases (read rapidly rising prices) and “relentless, ongoing cost-cutting and productivity improvements” over the medium term. Further out, “improvement in operating margins from reduced levels will require hospitals to make transformational changes to the business model,” Fitch emphasized.
Our sick-care system is killing us and killing our economy. Transformational changes are required. In the recent blog post titled “Prime Health,” Professor Scott Galloway stated it this way.
“The U.S. Healthcare industry is a wounded 7-ton seal, drifting aimlessly, bleeding into the sea. Predators are circling. The blood in the water is an unearned margin: price increases, relative to inflation, without a concomitant improvement in quality. Amazon is the lurking megalodon, its 11-foot jaws and 7-inch teeth the largest in history. With the acquisition of One Medical, Amazon is no longer circling…but attacking.”
Professor Galloway allows facts to speak for themselves (I strongly suggest you read his full blog here):
- Per capita, U.S. healthcare spending went from $2,968 in 1980 to $12,531 in 2020 (both in 2020 dollars), resulting in an industry with 13% of the nation’s workers and total spending accounting for a fifth of U.S. GDP.
- Two-thirds of personal bankruptcies in the U.S. result from sick-care issues (medical expenses and time off work).
- Forty percent of adults in the U.S. have delayed or gone without needed sick care because it’s too expensive.
- The U.S. has one of the highest infant mortality rates among developed nations.
Professor Galloway provides an additional summary opinion; “No industry has better demonstrated the dis-economies of scale. If we received the same return on our healthcare spending as other countries, we’d all live to 100 without getting sick … U.S. healthcare is the worst value in modern history.”
U.S. healthcare is the worst value in modern history precisely because it is not healthcare – it is overburdened sick care.
A Growing Discontent
Improving the future in no way diminishes the past or disparages the present. For the last few decades of my career, I have served within the same industry reflected in the data above. Most recently, as market COO in a national health system with a portfolio of provider services exceeding $1.2B in gross revenue, facilitated and supported by a team of thousands. I’ve worked with exceptional physicians, extended care team members, non-clinical leaders, and a host of others that are passionate about their mission, skilled in their craft, and seeking a better tomorrow.
Over a decade of consulting nationally, I’ve also been privileged to support founders in startups, early-stage launches into healthcare, middle market provider organizations, physician-owned national practices, and the household names of multi-billion dollar health systems. All these experiences have taught me this truth: serving the sick with grace and compassion is a worthy calling. It is a vital necessity in our nation’s infrastructure and required for a flourishing society.
It has also taught me another essential truth. Though our current sick care industry is necessary, it is not sufficient. I’m thankful for access to world-class sick care, but we can do better. We must do better. Physicians and nurses are burnt out and quitting in mass. Executives and leaders at all levels are also under extreme pressure and joining the “great resignation.” Our talented and caring front office team members are quitting and going to work at Costco or Chick-Fil-A for “better pay and less stress.” There is an ongoing flurry of mergers, acquisitions, bankruptcies, restructuring, and closures.
There is no easy answer to transforming what we are now experiencing. No vested “unicorn” will pull us out of our current challenges. No siloed approach in chronic disease management, remote patient monitoring, hospital at home, or digital innovation will bring us where we need to go. Yes, Amazon buying One Medical is bold. CVS buying Signify Health is bold. Walmart and UnitedHealthcare signing a 10-year collaborative is bold. We all sense it and see it; accelerated and purposeful movement. Things “as is” are changing and must continue to change.
In observing these bold movements, I (and many others) are left with growing discontent. These moves are necessary, but they are not sufficient. Data trends still reflect an unraveling and unsustainable system. These trends we observe both in the headlines and in our bank accounts. Most poignantly, in our and our loved one’s health journeys, we know it. I suggest we need a longer view. We need the courage to amplify the growing voice of “we can and must do better.” We need to move radically and decisively upstream from sick care. We must continue building and making changes of different sorts and in different directions. We must dramatically reduce the need for sick care. Our vision must be bold. Very bold. Fortunately, there are models we can use to inform our approach.
The Model of Megaprojects & Cathedrals
According to The Prepared, in an article titled Building a Cathedral by Nicolas Kemper, “across 217 church and abbey projects in England, construction took an average of 250–300 years.” Cathedrals were megaprojects rooted in community and spanning generations. The emphasis here is not on the cathedral but on the representation of a megaproject model rooted in community, spanning generations, and having an expansive scope. In this fascinating study of building cathedrals, Kemper goes on to highlight the practical work of Virginia Greiman and her survey of megaprojects.
“In her book on the Boston Big Dig, Megaproject Management, Virginia Greiman offers a list of 25 different characteristics, including long duration, multiple stakeholders, ethical dilemmas and challenges, and discontinuous management (the Big Dig, for instance, spanned the terms of five governors). Yet the single most salient feature of what makes a megaproject a megaproject is the scope.”
Unlike other megaprojects, an essential and unique (singular) component of building cathedrals is the realization that all effort is accretive. Cathedrals are distinct from typical megaprojects in a significant way: an unfinished cathedral, even if over decades or centuries, is by no means a failure. Most large megaprojects are binary; they are done or not. For example, a 90% complete bridge is practically useless.
“Cathedrals, on the other hand, are not binary. The aspiration may be much larger, but in essence, a single room could act as a cathedral. Salisbury cathedral took a full century to build, but services commenced almost immediately in a temporary wooden chapel. Cathedrals, Ansar posits, are accretive – they gain value as built, “like a beehive.”
This posture of evolving accretive value (expanding as ongoing components come to life) is one of purpose and patience. It is a model of a broader arc pointing to a future state and more significant benefit. Applied to themes within healthcare, the supposition behind population health is radically different than pursuing short-term profit by launching a digital tool to manage a specific disease state. Seeking accretive value by offering and impacting healthcare is a different journey than harvesting outsized economic return by building the next sick care unicorn.
The resourcing of today’s sick care system is necessary. It is up for debate how it is resourced, at what levels, and to produce what benefits and outcomes. However, what is not up for debate is the importance of one of the most critical and clarifying questions in healthcare: what is the definition of winning, and how do we do it? I believe, quite simply, that we win when individuals are flourishing, and we do it by keeping them healthy. If we’re not lowering cost, improving quality, enhancing access, and measurably moving from “sick care” to improved health of populations, we’re all still losing.
If we’re not lowering cost, improving quality, enhancing access, and measurably moving from “sick care” to improved health of populations, we’re all still losing.
This perspective presents a different view and an expansive definition of success. A model of megaprojects can inform the effort of building a healthcare singularity. Like building a cathedral, the actions and efforts produce accretive value as they develop. Even if judged unfinished five, ten, or twenty years from now, it should not keep us from starting and is by no means a failure.
Even in the most minor initial and incremental steps to keeping people healthy, there is value and worth. The process of building is accretive; the effort will gain value as it develops and evolves, “like a beehive.” Over the coming years and decades, more individuals will become and stay healthy. As a generation learns and then passes on, choices in health flourishing, the future beneficial impact will be incalculable.
The Beehive – Endless Accretive Value
The following components of building this healthcare singularity are worthy of further study, debate, and economic investment. In decades ahead, a few degrees of change beginning today will create an entirely different trajectory and outcome for future populations (resulting in planned and arbitrarily large effects). As the “beehive” evolves, it will also produce lasting accretive economic value. As we step toward building a true healthcare singularity, let’s remind ourselves that all the raw materials we need exist today. All the talent is currently present. We lack nothing to get started. With the hopes of creating a meaningful nudge in turn of our collective health flywheel, these proposed components reflect an aspirational, high-level, and directional view. Over time they can (and will) be proofed, adjusted, and implemented in a foundational and tangible way. Here is what I see coming to life:
- Successive generations begin to learn improved health literacy, improved health behavior, and increased transparency (at scale) in how their personal choices impact the economics of individual and societal health rewards and sick-care expense burden.
- Creation of a meaningful and personal indicator of health (personal health score) that is clinically accurate, always current, accessible in real-time, insightful, and actionable.
- Building of a 24/7 “opt-in” A.I. enabled, digitally designed, and personally influenced healthcare ecosystem (spanning and reconfiguring typical industry boundaries). The health ecosystem will offer an integrated and elegant service bundle to influence and guide individuals on a journey to sustained health, overall wellbeing, and improved health scores. For example, see the recent article Prevention-as-a-Service by Dr. Ramin Rafiei and Dr. Jacob LaPorte.
- An evolving “beehive” of cross-industry and local community connections on the one hand and access to health products, goods, and services on the other, with the intended purpose of reinforcing health literacy and healthy choices at decision points related to food, fashion, exercise/sport, finance, mental wellness, art, entertainment, and connection. As compelling examples, review how Iceland reduced alcohol and tobacco consumption among youth here and how a West Virginia town uses a similar model.
- An offering of an “opt-in” community (locally in-person, virtually connected, and globally networked) that allows community members to encourage, support, and invest in the health scores of one another.
- This “opt-in” community brings a heightened invitation to purposely connect with causes and efforts that preferentially pursue the marginalized, underserved, and those who will most value from deeper connection, practical resources, and new possibilities on their journey to health and wellbeing. As encouraging evolving models, see ChenMed and CityBlock.
- Curated gateways developed within the “beehive” ecosystem that allows for seamless access to growing national and global platforms of health-focused providers and health prevention services (primary care, optical care, dental care, dermatology/skin care, mental health/behavioral health, labs/testing, and discretionary health spend)
- A radically increased investment in developing a strong sense of individual and personal health “agency” at scale (to the strongest degree, I am the one who impacts my health)
- A radically increased investment in building an expanded base of primary care physicians who are digitally enabled and upskilled, health-coach supported, team connected, and fully resourced and rewarded to keep individuals healthy.
- The launch, soon, of a megaproject that will shift, over longer rhythms of time, a legacy sick care system to an integrated and aggregated healthcare ecosystem producing a sustained quality of life (and substantial economic value) for future generations.
- Joining this megaproject will be an increasing number of proven and influential leaders inviting us into a journey of actually walking away from sick-care-centric national models to a healthcare-centric future. Healthcare singularity.
The Long View
While improving how we care for the sick today, we must also strive to make the need for ongoing sick care obsolete.
While improving how we care for the sick today, we must also strive to make the need for ongoing sick care obsolete.
In a parallel path to enhancing current models, we must gather meaningful investment and exceptional talent to create a future foundation of sustained healthcare. This dual process is possible and yet will not be easy. Increasing numbers of individuals and organizations are willing to see and join the long game. It is also a reality that there are constructs of power, control, and profitability deeply rooted in ensuring sick care’s expansion and economic engine continues. To a few, sick care has become the bullseye of profitable investments. There is a better way. For our benefit and the benefit of future generations, we must cast a vision beyond unicorns fueled by individual and societal ills.
I am proposing the long view; a meaningful megaproject per se to move us away from a burdened and unsustainable sick-care model to actual healthcare.
Characteristic of a megaproject, the effort will take a long duration, have multiple stakeholders, present ethical dilemmas and challenges, be stewarded with discontinuous management, and require a massive scope. The building will not be easy. We most likely will not see it complete in our generation. It is for those who possess vision and hope.
Characteristic of a megaproject, the effort will take a long duration, have multiple stakeholders, present ethical dilemmas and challenges, be stewarded with discontinuous management, and require a massive scope. The building will not be easy. We most likely will not see it complete in our generation. It is for those who possess vision and hope.
In casting a vision worthy of both personal and collective investment, an image of increasing health and flourishing for successive future generations, that sounds about just right.
Coda
Each of us can lift the concepts presented from the page. Find others who resonate with this journey. Discuss and debate the bullet points offered and influence how we might bring them to life. Ponder the long view and begin to take small steps. Build prototypes and launch experiments. Co-create with grade school and high school students. If Roblox can be built and grow to engage 202 million monthly active users spanning 180 countries, we can create a healthcare singularity for this (and a future) generation.
Talk with college students about the future they desire regarding health and wellbeing. Think through and discuss the unique profiles and needs of those in their 30’s, 40′, and 50’s. Find a few sages, share the vision, and listen. Really listen. Take the learning and begin to build. Yes, there will be questions we (today) cannot answer. There will be ethical dilemmas and challenges. As we collaborate and move forward, however, we will eventually find answers to all of today’s unanswered questions. The accretive value will bear fruit.
I still support many efforts related to sick care. It is worthy of passion and resources to improve the necessary sick care systems we all need. It is not sufficient. Let’s also spend as much (or more) time, intellect, and resources ensuring coming generations inherit a better future. A future where the vast majority of sick care needed today, with associated economic and societal pain, can be significantly reduced. True healthcare singularity.
