It is only after a revolution concludes that one can clearly look back and fully understand what triggered the revolution. External factors such as technology shifts can create the conditions for a revolution where it may not have been possible before. A generation that has a different worldview than their elders may not accept that status quo. From what I’m observing, I believe we are seeing a revolution’s first phase happen before our eyes.
I’m convinced that the only way there will be a true revolution in healthcare is if there is a partnership between clinicians and individual citizens (aka patients/consumers/people). One without the other isn’t sufficient to unseat deeply entrenched systems. However, I feel doctors will play a unique role in catalyzing the revolution (not to say that clinicians of all types won’t play important roles as well). As I’ve been a Johnny Appleseed of sorts chronicling the far-reaching and transformational work of doc-entrepreneurs, it feeds my optimism that it’s possible to overcome the “Preservatives” who have 3 trillion reasons to protect the status quo.
For those of us who have seen how much better the system can work when goals are properly aligned, it’s “good news” that doctor burnout and dissatisfaction is at an all-time high (see The Quadruple Aim: A Square Deal for Clinicians for more). Why? Dissatisfaction is the seed corn for change and revolution. Make no mistake. There is extremely high level of dissatisfaction amongst a large chunk of doctors who yearn for change. The contrast between those inside of flawed versus optimized care delivery and payment models is stark. One the one hand, I have heard and seen docs who are seeing 30-50 patients a day, dealing with unwieldy/outdated EHRs optimized for billing (vs. care) and getting more bureaucracy thrown on top of an already-flawed model. On the other hand, it’s breathtaking when I visit clinics like CareMore, ChenMed, Iora Health, Qliance, Vera Whole Health and others where the clinicians and patients are both extremely satisfied.
In the video below, Dr. Zubin Damania powerfully captures the sorts of internal dialogue doctors have had one by one with themselves.
When people would talk about their careers or their lives, the ones that were most passionate and were loving what they did always aroused in me an unease. It was almost an anger or jealousy and I would see them and go, “Why is he so happy and fulfilled and doing what he loves to do and I’m doing everything I’m supposed to do but I feel empty?” On the other side of this waking up and being who I am suddenly, I felt like, “Oh my god, that’s me now.”
I suspect all the doctor entrepreneurs/leaders I’ve highlighted below had some similar internal discussions. This is how revolutions begin. By no means is it limited to young doctors but typically it’s the young who foment revolutions and they are then joined by those older than them. As you can see in the picture accompanying this article after the post-Velvet Revolution celebration, it’s all ages who celebrate. It’s worth noting that the Velvet Revolution was triggered by a crackdown on students.
Harvard Medical School students stage a die-in. Photo from Tamara Rodriguez Reichberg, Harvard Medical School student
Ignoring Exponential Growth Has Devastating Consequences for Incumbents
Skeptics may say that these revolutionary practice models are a drop in the bucket and in most places, it’s business as usual. That is true just as it was true that the newspaper business looked fantastic in the late 1990s and early 2000s while digital media was going from tiny to small. However, the mistakes made by newspapers and their Zero Sum Game thinking were happening simultaneous to startups getting funding that would ultimately crush the most profitable portions of the newspaper business, not to mention create new sectors far bigger than the newspaper industry. Sadly (for the newspapers), they could have owned, invested or partnered with these players yet most arrogantly dismissed them.
Those startups were easy to ignore or diminish just as incumbent providers are blind to the exponential growth and funding (figures in parentheses) that organizations such as Aledade ($34.5M), Alignment Healthcare ($125M), Iora Health ($48.3M) and One Medical ($116.5M) are receiving. Further, other revolutionary organizations have already been acquired. CareMore was acquired for $800M by WellPoint and and HealthCare Partners was acquired for $4.4B by DaVita. It’s worth noting that the acquisitions weren’t by traditional providers. Rather, it was deep-pocketed players seeing an easy mark in soft oligopolistic health systems.
Not unlike digital media startups of the late 1990s and early 2000s, the next generation care delivery organizations are focused on adding value and scaling their business and not particularly focused on the incumbent organizations. Yet, the byproduct of their rapid growth and optimization is they devastate the incumbent’s bread and butter business. One of those CEOs of the aforementioned organizations said they observe that at least 50% of the care their patients had been receiving before moving into their model was waste. Or worse, it was harmful. In other words, it’s like shooting fish in a barrel to remove the waste while improving outcomes. They reduce hospital days, ER visits and unnecessary surgeries by nipping issues in the bud before they blow up. Note that each of those items are the profitable lines of business for health systems.
Change Starts at Home
Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has. – Margaret Mead
I put my family where my mouth is and convinced my folks to move into one of these revolutionary practices. They had been going to a well-regarded, large multi-specialty group in Seattle. However, the care they got was typical of our misaligned healthcare system. When my father was diagnosed with a significant chronic condition, he received a couple prescriptions from a specialist and told to check back in 6 months with the doctor. His PCP had no idea he’d been diagnosed with a significant condition. Meanwhile, his world came crashing down and a huge amount of anxiety and stress was thrust on him — surely, not the best “prescription” for his condition.
While it’s rarely easy to get someone to change their doctor, let alone a senior who has a significant condition, I ultimately prevailed in convincing my parents to make the move. Six months into being in Iora Health’s Medicare Advantage program, the change is dramatic. So much so that my dad told me last weekend he’d be happy to be a testimonial for them.
Creating the New Ecosystem
You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete. Buckminster Fuller
In their own way, each of the doctors listed below is contributing to building the new ecosystem and ignoring the Preservatives who are wedded to the status quo. As mentioned above, there are non-physician clinicians and individual citizens having a big impact but I focus on doc-entrepreneurs and intrapreneurs here.
- Dr. Rajaie Batniji co-founded Collective Health in the belief they could help employees receive better care and coverage than what many experience with incumbent health plans
- Dr. Steven Eisenberg for adding love & music to #oncology and humanity to medicine (h/t Bunny Ellerin)
- The late Dr. Tom Ferguson coined the term e-patient many years before others were focused on equipped, enabled, empowered and engaged patients. This is a whitepaper (PDF) finished by his colleagues after his untimely passing.
- Dr. Rushika Fernandopulle founded Iora Health to restore humanity to healthcare. They have proven to take on the most challenging patient populations and achieve outstanding outcomes and even take on individuals not addressed by the new health law with the support of a Nobel Prize winner.
- Dr. Paul Grundy has led IBM’s transformation in healthcare shifting their thinking from healthcare as a soft benefits item left to HR to something that is a critical supply chain cost and source of competitive advantage.
- Dr. Rob Lamberts showed how an independent family physician can strike out on their own and provide better care and be more professionally satisfied
- Dr. Risa Lavizzo-Mourey is leading the Robert Wood Johnson Foundation spearheading their major re-focus on creating a Culture of Health that is impacting communities throughout the country.
- Dr. Harry Leider is leading Walgreens retail clinic and telehealth expansionthat promises to reach half of the country by the end of the year.
- Dr. Geraldine McGinty for her work creating innovative radiology payment models & spearheading payment reform (h/t Bunny Ellerin)
- Dr. Farzad Mostashari described Aledade’s goals as follows: ”It’s to help independent primary care doctors re-design their practices, and re-magine their future. It’s to put primary care back in control of health care, with 21st century data analytics and technology tools. It’s to support them with people who will stand beside them, with no interests other than theirs in mind.”
- Dr. Stan Schwartz saw what Dr. Keith Smith was doing and has been creating a true transparent medical network and making that available to employers — both doctors and patients are saved from excruciating amounts of bureaucracy in a very appealing economic model to both parties. It’s also the first Health Rosetta item to be delineated.
- Dr. Danny Sands co-founded the Society for Participatory Medicine while practicing and famously taking care of ePatient Dave.
- Four years ago, I observed how doctors such as Wendy Sue Swanson, Natasha Burgert & Howard Luks were doing something similar to how Sal Khan had “flipped the classroom”. This led to the Robert Wood Johnson Foundation initiating a major program called Flip the Clinic to improve outcomes and participation by patients.
- Dr. Mike Sevilla for using #hcsm to educate, elucidate and save family medicine #FMRevolution (h/t Bunny Ellerin)
- Dr. Eric Topol has written and spoken extensively about how central the patient will be as a participant in their care compared to traditional practices. He highlights how the smartphone is the equivalent of the Gutenberg Press for medicine
- Dr. Bryan Vartabedian is showing other doctors how to be a “public” physician & the impact that can have on outcomes
- Dr. Sheldon Zinberg founded CareMore creating a national leader in treating the frail elderly.
By no means is the list above complete. Add your comment below on a revolutionary doctor that has inspired you. Let us know what they are doing. Whether it is private practice, venture-backed startups, public health or health benefits, each doctor is contributing to the revolution. In their own way, they are fostering a Velvet Medical Revolution.
Dave Chase: Entrepreneur (2 exits), prof. speaker, new venture advisor, intrapreneur (2 $1B+ businesses), author & aspiring documentarian.
Article link: http://www.forbes.com/sites/davechase/2015/08/05/medicines-velvet-revolution/