Pop Health Will Never "Arrive"

Come On In, The Water's Fine?

Imagine a sunny day at the community pool, the air filled with the scent of sunscreen and a background of laughter. A group of people lines up by the water's edge, toes curling over the cold tiles. They glance left and right, each person waiting for someone else to take the plunge. But there's hesitation, a collective pause that freezes everyone.

Finally, a brave soul steps forward, muscles bracing, and dives into the shimmering water. The onlookers peer into the pool, eyes wide, as the swimmer slices through the blue, their form perfect, almost professional. "They must be an incredible swimmer," someone murmurs, planting a seed of doubt in the minds of the others. "Perhaps I should wait."

Another tentative swimmer takes their turn, their entry less graceful, more a clash of wills between body and water. "Are they drowning?" the crowd wonders, the image of flailing arms imprinted in their minds. "Maybe it's better to wait."

As some start to feel the warmth of the sun, comfortable and dry, they reconsider the need to swim at all. "The temperature is quite lovely," they think, settling back into their deck chairs, content to stay exactly where they are. Meanwhile, a few retire from the line, their expressions of relief and happiness clear as they walk away. Observing this, others in line nod to themselves, "I better not jump."

The Point: Population health arrives when a critical mass are willing to jump into the pool. We watch the few, the daring try, some succeed & some fail. But as a group it will never make "sense". For this reason Pop Health will never arrive.

Why don't we jump?

Healthcare Doesn't Want to Change

Healthcare is a GDP-eating monster. It's face is ours, but like the shoggoth that circulated popular media recently, it is bigger than us & wants to control everything that anyone connected to it does, how? Through a storm of incentives.

This is what the system wants:

• More GDP. So far so good, just getting started as far as it is concerned, 19% - ha? Not even close it wants 30%+.
• Change in the same direction. It wants change and has changed plenty in the last 15 years, mostly in the wrong direction.
• More sick people. More sick people is great for the healthcare system, more services, more follow up, more billing.
• More managing the healthy people. Not necessarily to keep them healthy but to provide services with little evidence for them would be great.
• More opacity. If sunlight is the best disinfectant, the system wants it dark. Visibility and the accountability that comes along with it is a bad thing for the system as it would put capitalism & competition to work putting downward pressure on prices & preventing it from taking even more GDP.

It doesn't want:

• Healthy people. Healthy people don't consume enough care.
• Effective preventive care. Ineffective? Yes. But if it works it doesn't really help.
• Value-based care. If it did, we'd already have it.

In short, our Healthcare system is perfectly designed to give us exactly what we have.

Disruption?

Giant companies don't disrupt themselves. For instance, consider the ever-commented-on examples: Kodak, which clung to film even as the digital revolution beckoned, or Blockbuster's hesitance towards streaming, which Netflix embraced. An entire industry, especially one as vast and intertwined as healthcare, is even less likely to self-reform, particularly given the incentives for its inefficiencies.

This does NOT mean that healthcare is devoid of good people.
This does NOT mean that its professionals lack integrity.
This does NOT mean that it is unnecessary, in fact we need it.

We need it to keep saving the lives it does.
We need it to be populated with even-more courageous and altruistic clinicians.
We need the beautiful, care-giving mission to flourish in a system that supports the spirit of why so many go into it in the first place.

AND we need to acknowledge it is not on track to be what we all so desperately want it to be for ourselves and our families.

So What Can Work?

What is ferociously motivating is that the healthcare system doesn't need to change at large to make an impact in your local universe. Remember the intrepid swimmers at the beginning?
No one is stopping you from jumping into the water of change. Yes, it is scary. Yes it has a risk and yes, that is the very definition of leadership. Leadership can change things even the face of a shoggoth-like system.

1. Payer Advantage: Payers thrive in this system because they're able to mitigate risk by raising premiums when medical expenses increase. This strategy allows them to drive profitability even in the face of paying for more services. Consider the power a provider organization could wield if it assumed similar risk levels but could directly care for the same patients contributing to those premiums. Many providers have already adopted this strategy by self-insuring their employee base.
2. Technology Transformation: Embrace solutions that serve you best, even if it means breaking away from what everyone else is doing. Such changes can radically transform and improve care delivery. Smaller systems may find themselves at an advantage with the need to be scrappy as they have the ability to test and iterate on tech more quickly. New entrants are eager to start somewhere & it could be with you.
3. Resilience and Vision: As individuals, continue challenging the system. Mission-driven individuals from every arena are crucial in preventing the healthcare system from descending entirely into it's own incentives. Finally, keep an eye to the future, things are changing...

Creating a New System

Make no mistake. A new system will emerge to the core system. It is already starting. Innovative, tech-embracing leaders in the traditional system. Direct Primary Care. Virtual Primary Care. Self-insured Employers. Medical Cost Sharing. Informed patients. Longevity. All come from a deepened awareness that the system we have is not working & we need to keep the necessary and best from the traditional system and let everything else go. This is the new "water" that leaders will start jumping into. For those that are unafraid of swimming that urge to leap is calling you to build the future.