What is an Unbound Future? A New Platform for Healthcare
I’ll be at Healthcare Unbound today and tomorrow. What does an “Unbound” future look like?
Forrester Research coined the term “Healthcare Unbound” to encompass the trends toward technology-aided self-care, mobile care and home care, “technology in, on and around the body that frees care from formal institutions.”
The key word in the above description is “frees.” Unbinding ourselves from formal institutions creates a new kind of freedom such that we can get on with our lives and do things when and where we want to. Few people want to get engaged with the health care system unless they have to, and in an unbound future we will be able to get much more care where we want it, when we want it, and at a lower cost. So logically, “bound” health care is care attached to formal institutions.
Much of the world, then for economic, social and technological reasons, is becoming unbound. In many areas of our lives, we’re already living an “unbound” existence. We can now get our email on our phones. We don’t need institutions to house our communications and our computing, they fit in our pocket. We can order products by entering barcodes into our phone cameras and have something delivered to our homes.
Of course there’s still a need for touch and feel. Shopping malls won’t die anytime soon, we need to know what a lot of stuff looks and feels like in real life. Yet an entire economy has arisen for stuff we don’t need to touch: music, electronics, video. So, my question going into Healthcare Unbound is “what parts of health care don’t require us to ‘touch’ it, which parts will be unbound?”
Vince Kuraitis (@vincekuraitis) said in his Healthcare Unbound keynote that value comes from 1) digital connections and 2) personal connections.
I think of it more as geography and organizational disruption, but the notions are similar. Not only are people freeing themselves from institutions (digital and geographic connections), to work and make care happen remotely, institutions themselves are becoming unbound in how they operate. In addition, new “unbound” institutions are emerging that might replace parts of the old ways.
The second part is the freeing of players within an institution to organize themselves. It’s more about coordination and social connections.
Geography (and Price)
Eric Topol has talked about Massively Open Online Medicine that might look similar to the transition to Massively Open Online Courses like those offered by Coursera, which offers free or nearly free online courses to students around the world. The lectures are recorded, but there’s plenty of online discussion around them.
Now Topol is mentioning MOOH, a tongue-in-cheek piece on Massively Open Online Health.
The Atlantic article on MOOH he mentions is satirical, as both education and medicine can and should at times be “High touch,” but the author misses Topol’s point, which is to imagine a future not where people aren’t bound to physicians for care, but where patients aren’t bound by traditional institutions and geography and time. That’s an important distinction.
We will always need doctors, the same as we might always need to touch some products, but physicians’ time and their presence is a limited resource that needs to be able to scale, and new technologies can help create that scale to provide better care, a better experience and a lower cost.
HealthTap, a company that solicits physician answers, is becoming something like that, as are some of the Startup of the Year companies here at Healthcare Unbound. (HealthTap CEO Ron Gutman spoke at last year’s Healthcare Unbound Conference.)
Companies like HealthTap and others are building a MOOM future to fix the problem of limited physician time and patient power with what Clay Shirky calls “cognitive surplus.” They don’t diagnose and treat, but they do answer questions, and that is sometimes all a patient needs, for free. Future solutions, no doubt, will provide treatment online.
As someone who has taken an online class at Coursera and finished it, yes, I can see the potential. I believe it was as good as many great courses in a “live” experience, particularly for a working father with two young kids. There was great interactions in the chat rooms, and fellow students learned a lot from each other, even more than a classroom-based course.
There’s still a lot of interactions in health care that can happen online. PatientsLikeMe is a great example of MOOM. Patient learn more from each other possibly more than from docs. Patients have a wealth of cognitive surplus, repeating each other’s research, and it’s valuable to share.
Vince Kuraitis previewed his upcoming Healthcare Unbound keynote with the story of when Dwight D. Eisenhower had a heart attack in Denver and was treated at Fitzsimmons Army Hospital as an example of a time when, out of necessity, teams collaborated around care within an institution. Everyone was there.
Institutions exist to organize people toward a purpose, but ubiquitous connectivity and information exchange mean that people can begin to organize themselves far from a physical location, and along with that comes the need to recoordinate around the new reality.
Along with the unbinding effects of technology, payment reform will pay a critical role in “undbinding” us from institutions, when providers will no longer be paid only when people visit them.
An Unbound Future. What will drive it?
The pieces of the puzzle that will drive a freer, unbound future:
- Thermodynamics. Although a money-saver in times of old, centralizing operations requires energy and dollars. Distributed systems often work better because they reduce costs by shifting activities to what Clayton Christiansen calls “low-cost centers” and allowing information flow to organize activities over time and space. Then there are the network effects that Vince Kuraitis describes in his work. Really looking forward to his book on the topic.
- Improved Security. Economics are built on trust, and security is a large part of the currency of trust.
- Standards. Standards are the friction in an unbound model, the better, more open the standards, the more people that adopt them, the faster the unbound health information economy will thrive.
- Incentives. If you pay people for care performed at a high-cost care center, they will continue to provide high-cost care. Incentives must be aligned for payments based on value and/or home care and service provided via the Web.
- Technology (transactions). Technology will be there when there’s a business model to drive it. Changing the incentives will drive the new Unbound future, as I commented on Forbes last week.
- Behavioral Science. Adoption of new ways of doing things relies on motivation. Behavioral Science research will show us the way to get there.
- Patient Enablement. Pioneer ACOs showed that patients are the most valuable members of the care team. I’ve said this many times before, but using behavioral science to motivate and engagement strategies to enable and activate patients will free us to get the care we want, the way we want it. Healthcare will be delivered to our homes like Amazon delivers books when it’s paid for (either by us or payers).
Recognize that the future could be better. Physicians want this (although many may not recognize it) and patients want it — let’s get on with our lives freed from traditional institutions the way we have in so many other areas. It’s only a matter of when.
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