Fear and Loathing in the Doldrums

We are sitting astride a stark rupture in the historical timeline, a wholesale destruction of contexts. It’s time for a new category of ideas to enact large-scale system change.

Healthcare’s next cycle of evolution links the ‘production of health’ with economic development as New Strategy for “transformation,” one that happens on a market-shaping roadmap. It’s about assuming Total System Leadership for the ‘common good’ and working with a new philosophy of value. Outcomes and community impact are the organizing ideas to measure strategic success.

Though the US is the world’s largest economy as measured by GDP, writes David Rotman, editor at large of MIT Technology Review, it is doing poorly on indicators such as environmental performance and access to quality education and health care. That’s data from the Social Progress Index, released late this summer by a Washington-based think tank. In the annual ranking (done before the covid pandemic), the US came in 28th, far behind other wealthy countries, including ones with slower GDP growth rates.

“You can churn out all the GDP you want,” says Rebecca Henderson, an economist at Harvard Business School, “but if the suicide rates go up, and the depression rates go up, and the rate of children dying before they’re four goes up, it’s not the kind of society you want to build.” We need to “stop relying totally on GDP,” she says. “It should be just one metric among many.”

Part of the problem, she suggests, is “a failure to imagine that capitalism can be done differently, that it can operate without toasting the planet.”

In her perspective, the US needs to start measuring and valuing growth according to its impact on climate change and access to essential services like health care. “We need self-aware growth,” says Henderson. “Not growth at any cost.”

“Digital” is a Consensual Hallucination

Tech commoditization means strategy is the differentiator.

Competitive convergence is the hallmark of a $400 billion global healthcare technology industry. The vast assemblage of markets (and marketing) is not just similar, but identical, in outlook and approach selling technical potential as a theory of value.

Because anyone can easily match “mass” and “best technology” capabilities, system entrepreneurship is the new skill for leadership development, strategic imagination and creative approaches to market integration.

“Healthcare is now arguably oversaturated with innovations,” say Ryan Vega and Kenneth W. Kizer recently in NEJM Catalyst (see VHA’s Innovation Ecosystem: Operationalizing Innovation in Health Care). “Most have neither produced dramatic improvements in outcomes nor spread at at the pace and scale needed to materially bend the cost curve.”

The Main Drift is painfully apparent.

If the jumping-off point for new direction is premised on the technical potential of technology, if we buy the sell that “transformation” and “innovation” and “progress” should be framed in technological terms, the odds are that a $4 trillion health economy in the United States will stay stuck in the same confused haze that has kept the system operating in “crisis” mode for more than 50 years.

Said bigger, the collapse of a $90 trillion global economy tells us more about the foundational fragility of our strategies and strategic thinking than it does about the future of healthcare. It also shows the infinite power of inertia, the incentives buried deep in the bedrock that reward defending the past, which only calcify the legacy model further into the old industrial cortex.

There’s a commercial withering from communicating in cliche, a vacuum of new words to foresee differently, that threatens to calcify The Collapse beyond anything the thin and threadbare language of “patient centricity” can handle as novel vision. Any realistic appraisal of the next few years of history and action to reshape the American way of healthcare has to be weighted heavily on the side of outcomes, not the magical wave of “digital,” as the orientation for innovation.

A New Systems Ecology

We need to solve for strategic atrophy.

It’s about changing the primary material conditions for creative leadership. It starts with New Strategy born from systems thinking, taking a non-fragmentary worldview to create and compete at a system level. This is about making a new combination of elements where the production of health is the organizing idea for competition, a new gravity field around which ‘continuous health engagement’ is the concept shaping sustainable business strategies.

Brian Eno has made an entire career out of turning convention on its head, from his unique studio methods to his invention of ambient music, a form he describes as a rejection of hierarchy in favor of ecological models of existence.

“To [invent] something is to express a belief in how things belong together,” the producer behind U2 and Coldplay said in an interview in Pitchfork magazine. “So I’m suggesting a funny mixture of bottom-up and top-down, which is actually what I think nature does. It’s a mixture of will and desire with an understanding of ecology — how complex things mesh together, and how much you can interfere with that.”

For the next health care (+ life sciences), the real driver of innovation won’t be lone geniuses working on artificial intelligence and blockchain, but government + industry collaborating to invent structures that turn short-term fixes into inclusive solutions. It’s about sparking generative value, becoming the invisible hand designing new economic systems, working with what theoretical biologist Stuart Kaufman called ‘autocatalytic sets’ as the origin of life. (An autocatalytic set is a collection of molecules and the reactions between them, such that the set as a whole forms a functionally closed and self-sustaining system.)

In 2019, Humana decided to reorganize its operations and create a dedicated business segment focused on the home. “This was done with the intent of allowing us to accelerate toward a broader ambition around the home, specifically related to home-centered care delivery models,” said Susan Diamond, Segment President at Humana, at the Home Health Care NewsFUTURE conference last month. “When we formed the new segment, what we decided to do was set [previous strategies] aside and really take a fresh look with a much wider aperture. We formed a new opinion about the range of services that we wanted to make available, again, with a sort of home-centric ecosystem of care delivery assets in mind.”

Outcomes, not inputs, is the basis for competition.

This isn’t a moral argument about “doing the right thing,” but an understanding that radical forces are changing not just the rules of the game, but the game itself. Advantage goes to whoever is better with strategy at a system level.

It’s the new master storyline to change the subject.

/ jgs

John G. Singer advises business and government on health system vision and market innovation. He is the founder of Blue Spoon Consulting, a leader in Strategy and Innovation at a System Level. Blue Spoon was the first to apply design thinking to solve complex market access and integration challenges in the pharmaceutical industry.