The New Health Ecosystem

The Health Rosetta defines a blueprint for wise healthcare purchasing that is allowing health services to be purchased for 20-55% less than the status quo while improving benefits on a sustained basis. Further, it helps protect employers from the rising spectre of liability due to dereliction of fiduciary duties on managing health benefits (under ERISA regulations in the U.S.).

In the works is a certification that borrows approaches from LEED and Fair Trade to accelerate the growth of the new health ecosystem. This will include certifying benefits professionals as well as components of health plans including the following:

The Health Rosetta is also the call-to-action for the grassroots Health 3.0 movement that is growing and will be catalyzed by the satirical The Big Heist film.

Outlined below are a set of guiding principles for how organizations will succeed in the new health ecosystem. The items listed above are the “what” and the principles below are the “how” of a high performing health ecosystem. As the graphic below depicts, clinical care only drives 20% of health outcomes. One must address the totality of health to overcome the catastrophic misallocation of resources that has led to abysmal health outcomes.

The new health ecosystem will focus on the true drivers of health outcomes

Click on the image to see the detailed industry taxonomy for the new health ecosystem

A New Medical Science

A new social, psychological, biological, and information-driven medical science is emerging that will better understand a person’s environmental context and it’s relationship with disease. It’s precision medicine, but more, using sensors and networks to better predict and prevent as well as treat the root causes of disease. No vision of the future of medicine can be complete or even competent if it doesn’t recognize these new sources of information and the power of patient engagement.

Eric Topol, MDHealth Rosetta Principles essay to be provided by Eric Topol, MD, Professor of Genomics The Scripps Research Institute; Cardiologist, Scripps Health; Chief Academic Officer, Scripps Health; Vice-Chairman West Wireless Health Institute

Open source, open APIs, open data and open knowledge (such as wikis) will become central to defining a common architecture to support this new science. These are modern versions of peer-review.

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To improve care and reduce costs with this new science, we must focus on what drives 80% of of outcomes, the non-clinical factors which include social, economic and psychological determinants of health.

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Cross-disciplinary collaboration and sharing of research data will be a requirement to accelerate new discoveries.

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This new science will arrive at an evidence-based understanding of what works through a great wealth of shared longitudinal health data captured through mobile devices, sensors and health records. It must be mindful of the concept of transforming Data to Information, Knowledge and Wisdom.


Ben Heywood, Co-Founder, President PatientsLikeMe

95 Theses essay by Ben Heywood, Co-Founder, President PatientsLikeMe

If we’re going to talk about evidence-based understanding in the context of a reinvented and redefined health system, we need to first reassess what we mean by evidence and redefine how we understand it.

Benjamin Heywood is president and co-founder of PatientsLikeMe, a patient network that improves lives and a real-time research platform that advances medicine. He is responsible for setting the company vision to improve healthcare and accelerate research, while directing its business growth strategy.

The new medical science will focus on understanding the personome. “The influence of the unique circumstances of the person — the personome — is just as powerful as the impact of that individual’s genome, proteome, pharmacogenome, metabolome, and epigenome.” Roy Ziegelstein, MD, JAMA, April, 2015

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Openness Drives Effective Action

Individuals have the right to make choices and control their health destiny with the best information available.

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Open access to information that will enable individuals to make the best decisions and become well-informed individuals, particularly when curated and contextualized by clinicians.
OpenNotes Team

95 Theses essay to be provided by Hannah Chimowitz, Tom Delbanco and Jan Walker, OpenNotes Team

Openness and privacy are not in conflict with the right kinds of identity, consent and data control mechanisms in place.
Adrian Gropper, MD

95 Theses essay to be provided by Adrian Gropper, MD, CTO Patient Privacy Rights

With this openness will come a required culture change. We must release information in order to ensure high quality information and code. In software, Linus’ Law states, “given enough eyeballs, all bugs are shallow”. Keeping information sealed until it is perfect, we will mean we miss opportunities to improve the data and fix the system.

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Economics and Transparency

Information asymmetries lead to inefficient systems and sub-optimal outcomes. Access to life-saving, taxpayer-supported research must be open.

Health and wealth are tightly linked. Eventually, poor financial health will negatively impact overall health.

Tamara StClaireHealth Rosetta Principles essay to be provided by Tamara St. Claire, PhD, MBA, Chief Innovation Officer, Xerox Commercial Healthcare and Deryk Van Brunt, President at Healthy Communities Institute

 

The cost of care can be a comorbidity. By ignoring costs in clinical decisions, conditions can worsen as financial stress may drive individuals to choose not to follow a plan of care because it is too expensive.

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Individuals have the right to know how much care will cost before receiving care, both out of pocket and covered. When there is unpredictable complexity (not caused by medical error which shouldn’t be charged for at all), individuals should be informed of the most likely ranges.

Jim MillawayHealth Rosetta Principles essay to be provided by Jim Millaway, President and Innovation Lead The Zero Card; Benefits Consultant; Chairman of the Board of WellOk, the Northeast Oklahoma Business Group on Health and a member organization of the National Business Coalition on Health

Individuals have personal responsibility to manage their lives along with their care.

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Relationships and Peer to Peer Networks Will Become Central

The most important “medical instrument” is communication. Communications drive actions, build relationships and create trust.

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Exchange of personal health data will become enabled via decentralized Peer to Peer (P2P) networks and “HIEs of 1”. These P2P exchanges will improve health literacy, healthy action and a functioning health economy.

Lygeia RicciardiHealth Rosetta Principles essay to be provided by Lygeia Ricciardi, Consumer Engagement & Digital Health Expert; President, Clear Voice Consulting

P2P networked conversations will empower new ways of organizing better health, allowing individuals to “organize without organizations” (h/t Clay Shirky) for better care.
Susannah Fox

Health Rosetta Principles essay to be provided by Susannah Fox, Chief Technology Officer of the U.S. Department of Health and Human Services

Verifiable but de-identified, opted-in health data will become part of a unified view of healthcare for research and risk assessment. Individuals will have the choice to contribute.

John WilbanksHealth Rosetta Principles essay to be provided by John Wilbanks is the Chief Commons Officer at Sage Bionetworks and a Senior Fellow at the Ewing Marion Kauffman Foundation and at FasterCures. He runs the Consent to Research Project.


New Intelligence

To “Cognify” (h/t Kevin Kelly) is to instill intelligence into something. Medical knowledge will increasingly be “cognified” into the IoT and much of the world around us is made “smart” and data-aware. This is good, and will free people to care for themselves where they want to receive care.
Sue Siegel

95 Theses essay to be provided by Sue Siegel, GE Ventures, Licensing & Healthymagination, GE

All feedback has utility. Whether the news is good or bad, opinions become known and become a source for improvement and competitiveness.

Mitch Rothschild95 Theses essay to be provided by Mitch Rothschild, Executive Chairman and Founder, Vitals

Community-driven health

True health system leadership comes from not just being stewards of hospitals and clinics but stewarding social and economic factors and the physical environment of a community, which account for half of outcomes.

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Assessing community health needs and adopting strategies to address those needs will provide hospitals with a valuable opportunity to partner with community partners to identify strategies for improving health, quality of life, and the community’s vitality.

Esther Dyson95 Theses essay to be provided by Esther Dyson, Founder, HICCup/Way to Wellville

Healthcare organizations that aggressively promote health literacy will build community capacity in addressing health issues. This may mean enabling and curating others in the community to reach all facets of the community.

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Start by teaching medicine and psychological self-awareness and resilience to kids. Starting in schools, health education needs to include the “medicine” we consume every day. Insurance/benefits literacy should be included in schools’ financial literacy courses.

Dr. Tom Ferguson95 Theses essay to be provided by Dr. Tom Ferguson, Senior Research Fellow for Online Health Pew Internet & American Life Project

School lunches are an access point of great power: they reinforce or remove the unhealthy products we consume.
Kate Adamick

95 Theses essay to be provided by Kate Adamick, co-founder of Cook for America® and author of Lunch Money: Serving Healthy School Food in a Sick Economy.

Hippocrates said, “Let food be thy medicine and medicine be thy food.” Individuals are “poisoning” themselves by the food they eat, largely without knowing it.

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Hippocrates also said, “Walking is man’s best medicine.” Communities and workplaces that make it easy to walk and be active can gain an advantage over the status quo.

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Healthcare waste is like a bandit stealing from our future. Healthcare is breaking U.S. schools. Money once directed to education is getting gobbled up by healthcare’s hyperinflation. This piles onto the problem that kids don’t learn enough about health, nutrition, finance or any of the things that lead to healthy, long lives.

Bill GatesHealth Rosetta Principles essay provided by Bill Gates, Co-Chair of the Bill & Melinda Gates Foundation. 


New Choices for Individuals and Care Teams

Health is not the limited time individuals spend in clinics. What happens in the other 99+% of their life has the greater impact on an individual’s overall well-being.

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We will learn how to rapidly enable better choices through motivation, tools, and access to better choices and lifestyles. Each individual will respond differently, requiring a whole new level of personalization.

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People are complicated with both innate drives and ingrained habits that work against long-term health. The psychology of understanding these motivations and habit change is critical to success in achieving better health.

95 Theses essay to be provided by Swatee Surve, Litesprite Founder & CEO. A leader who has developed and launched disruptive technology-based healthcare businesses for Microsoft, Nike, T-Mobile, Premera Blue Cross and Eastman Kodak. These efforts led to several commercialization efforts and patents, some of which were in biofeedback and Nike’s first wearable technology patents. As a Lead Consultant at Premera Blue Cross she led executive teams to identify new opportunities in wellness and member engagement programs.

Swatee Surve

Still, people will make incredibly smart decisions when they understand the true risks and choices.

Garrison Bliss, MD95 Theses essay to be provided by Garrison Bliss, MD,  Physician and Owner at BlissMD, Founder of the Direct Primary Care movement

Mental health is an equal component of a person’s overall health. Mental health directly impacts our physical health and our ability to recover from disease or medical interventions. Therefore, mental health needs to be deliberately and systematically integrated into the general health care system.
John Grohol, Psy.D.

95 Theses essay to be provided by John M. Grohol, Psy.D. Founder & CEO, Psych Central.com

Open information and research are needed to understand the nutritional and environmental causes of disease.

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Foods that are void of nutrition are the tobacco of this generation.

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We have defined sick care very well; what happens when things go wrong and how to correct them. We have very little understanding of how to keep things going right, how to get people back on track when they go off the rails, nor how to continually optimize health. Innovations in research are changing this; new entrants will figure out how to enable it.

Daniel Kraft, MD95 Theses essay to be provided by Daniel Kraft, MD, Chair for Medicine at Singularity Univ & Founder & Chair, Exponential Medicine

Systems will be designed so individuals can stay healthy and take as few drugs, have as few procedures, and avoid the system as much as possible by engaging in self-care.

Rob Lamberts, MD95 Theses essay to be provided by Rob Lamberts, MD, Owner Dr. Rob Lamberts, LLC

The emergence of a flat world opens up new avenues to innovation about what has worked in other cultures. The US has the opportunity to learn to be open to ways of healthcare that originate outside our borders, particularly those that are more appropriate to the underserved.

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Individuals and Engagement

Individuals and their caregivers are the greatest untapped sources of information, knowledge and motivation. Optimizing care means partnering with individuals and caregivers to empower them.
Daniel Z. Sands, MD, MPH

95 Theses essay to be provided by Danny Sands, MD, MPH, Co-Chairman, Co-Founder, and Past-President Society for Participatory Medicine, Primary Care Physician Beth Israel Deaconess Medical Center, Assistant Clinical Professor of Medicine Harvard Medical School

The effectiveness of engagement is tightly aligned with how convenient it is, how easily it integrates with where we live, work and play, how culturally relevant it is and its cost effectiveness.

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Engagement and empowerment are different. Individuals are often most engaged, but least empowered. A partnership between individuals and clinicians is when health is optimized.
Jan Oldenburg

95 Theses essay to be provided by Jan Oldenburg, Consumer and patient empowerment and engagement specialist, EY; Author/Editor for HIMSS 2014 Book of the Year, “Engage! Transforming Healthcare Through Digital Patient Engagement”

“Patient engagement” is valuable, but backwards. Individuals need the health system to be engaged with them regularly, and not just during visits.

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An engaged individual is very different from “patient engagement” (h/t Gilles Frydman). One is individual-centered, one is health system-centered. Achieving full health is the goal, not engaging with the health system.

Gilles Frydman95 Theses essay to be provided by Gilles Frydman, Co-founder & Chief Strategy Officer at Smart Patients, President & Founder ACOR (Association of Cancer Online Resources)

An individual can be engaged with their own health without entering the health system at all (h/t Hugo Campos). The goal of an individual is often to become/stay free of the healthcare system. Engaging means empowering them to do so.

Hugo Campos95 Theses essay to be provided by Hugo Campos, Stanford Medicine X ePatient Advisor, White House Champion of Change for Precision Medicine


New Economics

Choose wisely. Often times less is more.

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Oftentimes, early is better than late.

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Overtreatment is one of healthcare’s greatest challenges. In many cases no treatment is much better than treatment.
Shannon Brownlee, MSc

95 Theses essay to be provided by Shannon Brownlee, MSc, Senior Vice President, Lown Institute

A system that profits more from people with “problems” than those without, default set at “treat more”, is destined to collapse due to its inherent unsustainability.

Rob Lamberts, MD95 Theses essay to be provided by Rob Lamberts, MD, Owner Dr. Rob Lamberts, LLC

Systems will become better aligned to better prevent overtreatment and undertreatment, driven by individual’s access to information, informed by statistics.
Vikas Saini, MD

95 Theses essay to be provided by Vikas Saini, MD, President of the Lown Institute

Individuals enter the healthcare system to get measurements, to be diagnosed, to seek answers, treatment and learn. Individuals will seek alternatives outside of expensive, inconvenient care centers. This will drive positive overall change in the health system.

Stanley Schwartz, MD95 Theses essay to be provided by Stanley Schwartz, MD, President and CEO WellOK, The Northeastern Oklahoma Business Coalition on Health

New Education

Medical education will be made continuous, engaging, and scalable in the age of increasing clinical demands and limited work hours.

Bryan Vartabedian, MD95 Theses essay to be provided by Bryan Vartabedian, MD, Director of Community Medicine | Gastroenterology, Hepatology & Nutrition Texas Children’s Hospital; Assistant Professor of Pediatrics Baylor College of Medicine

Medical educators will make thoughtful use of technology and learning design. Those that excel will learn how MOOCs, community engagement, social media, simulation and virtual reality might change the face of medical education.

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The flood of new medical information is impossible to keep up on for any one person. Physicians and other care providers will be enabled by better systems for filtering what’s valuable for an individual’s care.
Daniel Schwartz, MD

95 Theses essay to be provided by Daniel Schwartz, MD, 2018 Congress Co-chair International Society of Peritoneal Dialysis; Medical Director QxMD; Nephrologist & Medical Director, Renal Program Fraser Health Authority; Clinical Assistant Professor of Medicine University of British Columbia; Editor, Nephrology Now

Effective medical education must and will evolve rapidly to focus on care delivery and the use of digital tools in care delivery.

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Medical education will recognize that because only 10–20% of health outcomes are driven by clinical care, physicians must also be stewards of community transformation. Physicians are in the best position to be good partners within a multi-disciplinary alliance enabling community transformation.
Clay Johnston, MD, PhD

95 Theses essay to be provided by S. Claiborne “Clay” Johnston, MD, Dean Dell Medical School at The University of Texas at Austin

New Data Ownership Rights

An individual’s access to and management of data about him/herself is a fundamental human and property right. Why is it easier to have your medical data hacked than for you to get access to it? (h/t Eric Topol)

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Monopolies on medical knowledge and information are unethical.

Jonathan Bush95 Theses essay to be provided by Jonathan Bush, Chief Executive Officer, President and Chairman of the Board of Directors, athenahealth

Now that all information can be connected, all the time, there should be only one record of health data that comes from an individual, controlled by the individual. Problems with HIPAA and “information blocking” are symptoms of a broken, pre-internet, paper-driven era.
Leonard Kish, MBA/MSIS, MS

95 Theses essay to be provided by Leonard Kish, MBA/MSIS, MS, Co Founder at UnPatient.org

Platforms will be developed to enable the rights and transactions around health data property. These platforms will be decentralized, yet enabled to focus on the individual in an instant. Be prepared.

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Individuals have a right to any data that comes from a measurement of an internal state of their body, including medical devices.

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Individuals have literally died, waiting for their lab data. An individual’s lab and other data should be made accessible to individuals as soon as it is available.

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Medical regulations exist to protect individuals from medical harm. Data, ideas and information in the hands of individuals causes no medical harm.

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Individual may have access to metrics and analysis about their own body without a doctor’s permission as long as accessing that data poses no significant medical risk.

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Individuals have a right to health data privacy. Rights to sharing must be established with the individual it originates from, or their legal agent, in advance of sharing.
Adrian Gropper, MD

95 Theses essay to be provided by Adrian Gropper, MD, CTO Patient Privacy Rights

Health data collected about an individual cannot be used to determine a person’s access to capital (credit ratings), employment, education, housing or healthcare services. This will be legislated and empowered by new technologies.

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New Roles and Relationships for Providers

Misaligned reimbursement schemes have impaired providers from doing the primary job of healing and have often robbed them of their humanity. Paying for value will help them get the job of healing back.
Rushika Fernandopulle, MD, MPP

95 Theses essay to be provided by Rushika Fernandopulle, MD, MPP CEO, Iora Health Instructor in Medicine, Harvard Medical School

The enlightened clinicians who embrace these guiding principles, combined with empowered individuals guiding their own care will become a powerful competitive advantage.

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The most trusted professions are nurses, doctors and pharmacists. With the trust individuals have in these professions, they activate us to do things we wouldn’t normally do. Respect this trust.
Susan Hull, MSN

95 Theses essay to be provided by Susan Hull, MSN, Chief Nursing Informatics Officer Cincinatti Children’s Hospital Medical Center

World class teams require a holistic view of a person’s complete health, which includes not just their physical health but also their mental health.

Michael Dermer95 Theses essay to be provided by Michael Dermer, Chief Incentive Officer, Welltok

Relationships are fuel for motivation and behavior change (both positive and negative). Motivations, triggers and ease of action are keys to enabling behavior change.

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Relationships are fuel for motivation and behavior change (both positive and negative). Motivations, triggers and ease of action are keys to enabling behavior change.

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The best care is and will be collaborative beyond the walls of any one institution. Just as “the smartest people work for someone else”, the smartest providers practice outside of this clinic and this hospital. The smartest provider may, in fact, be a collective, or the crowd. New ways to open communications will drive better care.

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Many times, the best place for interaction between the clinician and an individual isn’t at the clinic. We can flip the clinic. Much of what has been done at a clinic visit can be done more effectively in the comfort of an individual’s home via email and other digital tools or in social settings like churches or community organizations.

Brad Younggren, MD95 Theses essay to be provided by Dr. Brad Younggren

The most relevant providers will learn and will be conversant in data analytics and tools. They will be experts in care delivery, not just diagnostics and traditional medical science.

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A New Competition in Life Science & MedTech/Device

Tomorrow’s leaders will redesign development and trials to capitalize on the aforementioned New Science dynamics and mobile technologies.

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New and non-obvious partnerships will need to be forged to ensure leadership in the future. Alliances with health tech and consumer health/Internet companies will be as important as alliances with academic medical centers have been in the past.

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Post-trial relationships with individuals will allow co-creation and insights not possible before. That is a largely untapped opportunity. ResearchKit is just the beginning.

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The individual’s relationship to a device or therapeutic may be as profound as their relationship to their doctor, or more so. Be available and open to engagement to make improvements.

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New Health Plans, New Health Benefits

Fee for service is dying. Transition now in every way you can.

95 Theses essay to be provided by Dave Sanders, MD, Co-founder & CEO ZOOM+Dave Sanders

The dirty secret of health plans is that higher care costs have, counterintuitively, led to greater profits for the plans. This is changing. Winning health plans will capitalize on the opportunity to fundamentally rethink plan design to be optimized for the fee-for-value era.

Stanley Schwartz, MD95 Theses essay to be provided by Stanley Schwartz, MD, President and CEO WellOK, The Northeastern Oklahoma Business Coalition on Health

Catalyzing patient engagement will lead to better care and a more competitive offering.

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The next dirty secret of health plans is that they are money managers. The longer they hold on to money, the more they make. Employers and unions are driving the next wave of healthcare innovation, protecting their employees/members.

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Rather than reflexively denying claims and building up a mountain of ill will, insurance companies should invest resources in protecting their member’s financial security.

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Customers will, in effect, “self-deny” their own claims. A new metric for success is the “Negaclaim” — an unnecessary claim avoided. This isn’t about denying care. Just as energy consumers aren’t interested in kilowatt hours, individuals aren’t interested in health claims — they want health restored and diseases prevented.

Garrison Bliss, MD95 Theses essay to be provided by Garrison Bliss Physician and Owner at BlissMD, Founder of the Direct Primary Care movement

When individuals are fully educated on the trade-offs associated with interventions, they generally choose the less invasive approach.

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The ACA defined “essential benefits” but there will be a corollary about rights to “essential access” as part of coverage. Any modern health plan offering will include virtual visits, transparent price info, updated provider directory, same day e-mail response, next day test results, etc. — all imminently doable with today’s modern technology.

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As the second or third biggest expense after payroll, CFOs & CEOs are failing in their fiduciary responsibility by being overly passive in how they procure health benefits. A rethought healthcare purchasing plan drives direct, financial returns but most importantly enables your valued employees to do what they desire — realize their full potential. Elements are defined at healthrosetta.org.

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Genomics and proteomics information and testing will be key components of personalized medications, tailored to provide the best dose/response relationship in each patient. Because of their importance, these tests and genomic information must be covered by health plans and insurance.

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New Health System

Hospitals have provided amazing service for the last 100 years, but location is becoming less important for healthcare. Care can happen almost anywhere at lower cost. What conditions hospitals treat, and how hospitals serve their communities will dramatically change over the coming decades.
Ed Park

95 Theses essay to be provided by Ed Park, Executive Vice President, Chief Operating Officer, athenahealth

Health systems, your technology procurement process must be up to the task. Systems grown and optimized for the waning fee-for-service often have the polar opposite design to what will optimize the fee-for-value era. Virtually every new healthcare delivery organization that is outperforming on Triple Aim objectives, has deployed new technology re-imagined for the fee-for-value era.

Zayna Khayat, PhD

95 Theses essay to be provided by Zayna Khayat, PhD, Health system innovation lead and Director of MaRS EXCITE at MaRS Discovery District

Outside of healthcare, millions of organizations have reformulated how they interact with their ultimate customers with better communications tools. Next generation healthcare leaders understand that tools will focus on communication over billing.

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Health system leaders, learn from the another local oligopoly in your community — the venerable daily newspaper. While they spent the last couple decades worrying about cross-town and traditional media company competition, it was death-by-a-thousand-papercuts that has been their undoing. Newspaper executives dismissed an array of new asymmetric competitors including eBay, craiglist, Monster.com, Cars.com, Facebook, Groupon, ESPN, CBS Marketwatch and more who stole advertising, media consumption or both. Health system executives are doing the same thing today, and the issue is the same: how valuable content will be delivered in the future. The content is different, but the issue of distribution is the same.

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Winning healthcare delivery organizations recognize that the Quadruple Aim will deliver sustainable success. The “forgotten aim” is a better experience for the health professional. Layering more bureaucracy on top of an already-overburdened clinical team ignores that the underlying processes are frequently under-performing and that a bad professional experience negatively impacts patient outcomes.

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Healthcare organizations wanting to reinvent can harness the new opportunities by unshackling their smart, innovative team members and outside thinkers to reinvent their organizations for the next 100 years. Those that enable their customers will emerge as the leaders for the next 100 years.

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