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Written with Jonathan Bush, CEO, athenahealth
Healthcare is broken. Few argue this point. Dr. Zubin Damania (aka "ZDoggMD") is releasing an anthem to unbreak healthcare - it’s a parody of Eminem's critically acclaimed Lose Yourself, with a call to build Health 3.0. ZDoggMD has become an Internet sensation with his musical parodies and characters such as Dr. House of Cards and Doc Vader approaching 100 million views on Facebook and YouTube.
Many consider Lose Yourself to be one of the greatest hip hop songs of all time. Having had a chance to preview ZDoggMD's version, it’s not hard to imagine that it will be viewed as the musical equivalent of MLK’s “I have a dream” speech. He’ll debut it via a not-to-be-missed livestream tomorrow at 2:25 pm local time (5:25 pm Eastern) during the Unbreak Healthcare Talk Show at the Health 2.0 conference in California.
[Disclosure: We will both be participants in the aforementioned talk show. ZDoggMD is creatively involved with The Big Heist, a satirical follow-the-money film in the spirit of Super Size Me and The Big Short that Dave is producing.]
Health 3.0’s is our shot
Hospitals, Nurses, and Docs, this maybe the only opportunity that we got...
Don’t ever lose yourself in the system, the moment, we own it,
We better never let it go
We only get one shot, do not miss this chance to grow
this opportunity comes once in a lifetime YO
We can do anything we set our minds to, doc
ZDoggMD calls on everyone involved in healthcare including nurses and doctors to not lose themselves to the system, but rather to strive towards "Health 3.0," which casts aside the failings of Healthcare 1.0 and Healthcare 2.0. In parallel to ZDoggMD’s call-to-action, and inspired by ongoing conversations with him and others, we’ve formulated a four-point vision for what Health 3.0 should entail and how it contrasts with 1.0 and 2.0 .
As one can imagine with a $3 trillion industry, many players have contributed to its shortcomings. In fact, we recognize that all of us have unwittingly contributed to the broken system. In order to fix healthcare, we need a common vision for the future; one we believe encompasses four key dimensions:
- Health Services (aka:healthcare delivery and self-care): What is the optimal way to organize health services so they build off the respective strengths of each piece of the health puzzle, rather than operating as an unmatched set of pieces as is the case today? Innovative new care delivery models create a bright future (that some are already experiencing) where every member of the care team is operating at the top of his or her license and is highly satisfied with his or her role -- a stark contrast from what many of us observe today in Healthcare 2.0 where only 27 percent of a doctor’s day is spent on clinical facetime with patients. Put simply, they didn’t go to med school to become glorified billing clerks.
- Healthcare Purchasing: At the root of virtually every dysfunction in healthcare is an underlying set of perverse incentives. Various industry players are acting perfectly rationally when they do things that are counter-productive to achieving the Quadruple Aim. We outline the high level blueprint for how to purchase health and wellness services wisely. We've seen how a workforce can achieve what one healthcare innovator has as their tagline: "Twice the healthcare at half the cost and ten times the delight."
- Enabling technology: Once you have the proper organization structure and processes, then and only then, can technology turbocharge a highly functional organizational process. We'll hit the high points but since this is the focus of our jobs (Jonathan as CEO of a health technology platform company and Dave as a venture investor in HealthTech startups), we won't go into great depth here. Rather, we'll highlight a couple examples of technology that address the new norms of Health 3.0. For example, the Health 3.0 vision can’t be attained without connected systems -- sadly, the exception in healthcare today.
- Enabling government: At the local, state and federal level, government can play a tremendously beneficial (or detrimental) role in ensuring healthcare reaches its full potential. There are four main ways that government entities contribute -- 1). as an enabler of health (e.g., public health and social determinants), 2). as a purchaser since government entities are large employers who can accelerate acceptance of new, higher-performing Health 3.0-type care models, 3). as a payer of taxpayer-funded health plans and 4). as a lawmaking/regulating entity.
Failings of Healthcare 1.0 and 2.0
ZDoggMD has struck a nerve worldwide with the entire caregiving team from individual patients to scrub techs to respiratory therapists to nurses and doctors. His last parody video 7 Years (A Life in Medicine) spoke to his journey through the first 20 years of his medical career. It's clear that he's speaking to many other clinicians as the video was viewed over 1 million times in the first week alone. In the article accompanying the video, he tips a hat to the positive facets of Healthcare 1.0 and Healthcare 2.0 but also gives the two earlier eras of healthcare a stinging rebuke.
In the quote below, ZDoggMD describes how the shortcomings of Healthcare 1.0 created the Healthcare 2.0 monster:
The era of Big Medicine. Large corporate groups buying practices and hospitals, managed care and Obamacare, randomized controlled trials and evidence-based guidelines, EMRs, PQRS, HCAHPS, MACRA, Press Ganey, Lean, Six-Sigma. It is the era of Medicine As Machine…of Medicine As Assembly Line. And we—clinicians and patients—are the cogs in the machinery. Instead of ceding authority to physicians, we cede authority to government, administrators, and faceless algorithms. We more often treat a computer screen than a patient. And the doc isn’t the boss, but neither is the rest of the healthcare team—nor the patient. We are ALL treated as commodities…raw materials in the factory
Dr. Damania (aka “ZDoggMD”) goes on to describe Health 3.0 as follows:
Taking the best aspects of 1.0 (deep sacred relationships, physician autonomy) and the key pieces of 2.0 (technology, evidence, teams, systems thinking), Health 3.0 restores the human relationship at the heart of healing while bolstering it with a team that revolves around the patient while supporting each other as fellow caregivers . What emerges is vastly greater than the sum of the parts.
Caregivers and patients have the time and space and support to develop deep relationships. Providers hold patients accountable for their health, while empowered patients hold us accountable to be their guides and to know them—and treat them—as unique human beings. Our EHRs bind us and support us, rather than obstruct us. The promise of Big Data is translated to the unique patient in front of us. Our team provides the lift so everything doesn’t fall on one set of shoulders anymore (health coaches, nurses, social workers, lab techs, EVERYONE together). We are evidence-empowered but not evidence-enslaved. We are paid to keep people healthy, not to click boxes while trying to chase an ever-shrinking piece of the healthcare pie. Our administrators seek to grow the entire pie instead, for the benefit of ALL stakeholders.
Next generation provider organizations such as Iora Health (Damania's Turntable Health clinic partners with Iora) and Privia Health are two examples of the front edge of the transformation that our health ecosystem must embrace for the sake of our country’s future. They embody Health 3.0, a vision to accelerate the shift to a higher-performing healthcare delivery system and broader health ecosystem. They focus on achieving the Quadruple Aim. That is, when you enable a great care team experience that can naturally spill over into an improved patient experience. Time and again, that dynamic can create a partnership between all professionals and non-professionals on a care team – the patient and their caregivers. When this happens, it leads to improved outcomes and that naturally leads to lower costs when there is a proper reimbursement model.
[Disclosure: Dave has family members in an Iora Health practice and a portfolio company of his venture firm has Turntable as a customer. Jonathan's company, athenahealth, has Privia as a client.]
Although healthcare is described as a $3 trillion dollar industry, it has largely operated as a loose conglomeration of 1000's of $1 billion markets. With fee-for-service incentives driving volume, it has been every man (company) for himself. As long as you could convince someone (who lacked visibility into price or quality information) to consume your service, you could thrive economically. Sadly, that has had devastating consequences on the middle class and the country as a whole. Dave has gone so far as to say we've gone to war for far less than what healthcare has done to America.
We believe a person-centered, versus organization-centered, health ecosystem can align the interests of individuals (aka "patients") who desire the best health outcomes at a fair price with economic incentives of the key players in the industry. In a follow-up piece, we’ll share a framework developed from studying the highest performing healthcare organizations as well as speaking with the doctors declaring their independence from the status quo and the purchasers of healthcare such as employers who are also shedding the under-performance of the status quo. This framework is intended for our friends in healthcare provider, technology and government organizations. It might not be perfect, but starting the conversation is the only way we’ll get closer to Health 3.0.
In part 2, we explore the implications of Health 3.0 on provider, startup and government organizations.
