Six Assertions on Knowing the Unknowable Future of Healthcare

Some things never change. Joe Flower is one of those things. Pay attention. Joe was the keynote speaker at Health 2.0 Silicon Valley earlier this month. We’re excited to feature the text of his remarks as a post on the blog today.  If you have questions for Joe, you can leave them the comment section. You’ll find a link to a complimentary copy of his report Healthcare 2027: at the end of this post. You should absolutely download and read it. And take notes.

The future. The Future of healthcare. 
Here are the seven words at the core. If you take nothing else away from this, take these:

Everything changes.
Everything is connected.
Pay attention.

— Jane Hirshfield 

We are gathered here on holy ground, in Silicon Valley, the home of the startup, the temple of everything new, of the Brave New World.

And healthcare? Healthcare is changing — consolidation, new technologies, political chaos, a vast and growing IT overburden, shifting rules, ever-rising costs, new solutions, business model experiments.

So when I say, “The Future of Healthcare,”
what are the pictures in your head? Catastrophic system failure? The dawn of a bright new day of better, stronger, cheaper healthcare for everyone, led by tech? Do we have all the confidence of a little girl screaming down a slide? Do we just say in denial about the future and end up in a kind of chaotic muddling along?

In this century business sectors crash, transform, and re-emerge constantly.

  • Most malls in America will close in the next 24 months. Yet retail is thriving.
  • Big bookstore chains are history. Yet more books than ever are being published, printed, bought and read, and new physical bookstores are popping up every day.
  • Digital cameras went from a rounding error in the market in 1999 to destroying the film camera and bankrupting Kodak in six years. Ten years later digital cameras are a niche market, yet the world is flooded with images and video because everyone carries a camera in their smart phone.
  • The Encyclopedia Britannica was printed from 1768 to 2010. Now it’s a website.
  • Cassettes replaced LPs and eight-track tapes in the 1970s, CDs replaced cassettes in the 1990s, and now CDs are history — yet music is more widely shared than ever, music distribution is a thriving business, and LPs are making a comeback. My entire music library is on my phone, but most younger people don’t have a library at all — it’s all streaming music all the time.
  • Oil has dominated our geopolitics and economics for over a century. That will end within 10 years. Cars and trucks with internal combustion engines and human drivers will become relics and specialty vehicles in the same 10 years. Tesla already has a higher market capitalization than Ford.
  • This is normal.The people and organizations running each of those businesses and sectors did not anticipate these vast and deep changes until they happened to them. They did not anticipate:
    • that these changes would happen
    • the speed of the change
    • the shape and elements of the change
    • the second- and third-order effects on their business.

    Healthcare is not exempt. We are today where the film business was in 1999, where the retail mall and internal combustion engine is today. Within 10 years healthcare will be unrecognizable. From treatment modalities and workflow, to business models to technologies, it will not be the same industry it is today. Few of those who run healthcare can even picture that future, let alone plan for it. Yet they must not only plan for it, they must plan for it for their particular organization in their market with their constituencies —and they must plan how to get from here to there, how to keep the machine running even as the environment, the funding and the tools change.

    That’s the reason for what I am announcing today here for the first time. The American Hospital Association is increasingly shifting toward recognizing the need to help healthcare executives understand the future better. I will be launching, with them, a curriculum on how to think like a futurist, how to bring futurism into your organization as a normal ongoing part of management and strategy.

    So today I will make six assertions on knowing the future of healthcare:

    1)We need to know the future of healthcare.It is of existential importance to each of our careers, organizations, and products to figure out the future of healthcare.

    2)We can’t.That’s why it’s called the future. It hasn’t happened yet. Making a prediction or a forecast and getting it right is the booby prize. It’s the participation trophy — unless you really understand why you got it right. If you get it right without understanding, you don’t learn nothin’. The real goal of futurism is not getting it right, it’s insight, understanding how the future works.

 must anyway.We have to find ways to say something useful, actionable, practical about the possibilities of the future.
For that, your future casting has to be about

    4) You. It must be localized to your situation, your organization, your product. It has to deal with the fact that healthcare is

    5) Complex. It is a complex adaptive system with many interdependent parts.

    Healthcare is complex. Simple solutions are useless. Any simple picture of the future is a lie. Simple techno-optimism or innovationist neophilia gets us nowhere.

    Thinking about the future is a complex business requiring extraordinary clarity, penetration, the broadest possible view, and the insights of complexity science. Simple futurism is entertainment. Futurism based on the insights of complexity is a tool for thinking, planning, strategizing.

    Simple futurism points at each shiny thing—AI, contractual blockchain, virtual worlds, augmented reality, cell transformation, haptic rebuilds—and says, “Wow! Look at this.” It’s a Jetsons way of looking at the future, as real as using the Flintstones as a guide to the past.

    A futurism based on complexity looks at every element, shiny, dull, or invisible, and asks:

    “What is it for?”
“How does it get its energy?”
“How does it affect other elements?”

    Complex futurism can connect the dots and the 3-D networks of dots building out over time to paint the pictures of future scenarios, of ways the future could really turn out, what will take us there, and what strategies we might employ to meet them.
The sixth assertion is that the future of healthcare can be studied in a table of

    6) Elementsas I lay out in the report Healthcare 2027: Elements. A link to a complimentary version of Joe’s report can be found here.

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4 replies »

  1. Okay, Joe. This one is knowable.

    I think.

    Is blockchain the future? Or hype?

    A little bit of both?

  2. This piece touched a few strings in my soul. It is so true that we see the future of healthcare holding onto shiny pieces of innovations, such as AR, VR, blockchain and others. It seems so disconnected from the current needs of hospitals and healthcare organizations, that this gaps scares sometimes.

    In my opinion, one of the ways to peak through the curtain of time is to glance at recent investments. While yes, those far-from-real innovations get their piece of financial cake, a lot of money is put into solving the problems of here and now.

    For example, if you look at Q2 2017 investments, there’s a major cash thrown at something as simple as appointment scheduling. Well, simple compared to glorious cutting-edge technology, of course. At ScienceSoft, we created a full overview of spending in Q2 2017, so you can dive in and forecast the immediate future with it: https://www.scnsoft.com/blog/healthcare-it-investments-how-much-hospitals-spent-on-technology-in-the-first-half-of-2017

  3. pjnelson, What does this mean?
    “I am convinced that the pursuit of healthcare for highly Complex Healthcare Needs is a response to the age old precarious funding processes for Medical Schools.”

  4. Joe,

    You have laid out the character of the Paradigm Paralysis afflicting our nation’s healthcare and its associated DISRUPTIVE EVENTS. This concept seems to fully describe these types of change that afflict economic institutions. They are well described in the book written by Joshua Gans, published in 2016: “the DISRUPTION DILEMMA.” As a result of reading this book, I have come to believe that the cause of causes for our healthcare’s PARADIGM PARALYSIS is the high level of cognitive dissonance between the humanitarian realms of KNOWLEDGE and the SCIENTIFIC realms of knowledge. Promoting this knowledge dilemma for healthcare is the development of large economic institutions. These have primarily occurred within the Federal government and our Universities that have devoted a substantial involvement in the direct healthcare of citizens for Complex Healthcare Needs as a basis to support their institutions.
    Since medieval times, a University was an institution formed by a gathering of individuals committed to maintaining and advancing KNOWLEDGE through collaboration over time. There was and still continues to be a separation of the educational and scientific University institutions from the civil life of society, EXCEPT for healthcare. In addition, the substantial involvement of volunteer faculty with our medical schools virtually disappeared between 1960 and 1980. In effect, the substantial involvement of a University in the direct healthcare of many citizens for Complex Healthcare has changed its priorities for serving a State’s communities. I am reminded that several medical schools still do not sponsor a Family Medicine Residency.
    I am convinced that the pursuit of healthcare for highly Complex Healthcare Needs is a response to the age old precarious funding processes for Medical Schools. This is now made worse by the lack of any increase in the Federal government’s support, through Medicare, of post-graduate medical education, for several years. This has occurred simultaneously as our medical schools have increased their under-graduate enrollment. Also, the Medicare contribution is heavily skewed to support the residencies for specialists necessary to maintain medical research projects. And so, as training processes evolve with an emphasis on the scientific realms of knowledge, we lack the will and capacity to engage the humanitarian realms of knowledge that primarily underlie the Unstable HEALTH of most citizens. There probably exists an implicit recognition of this in every medical school. Unfortunately, all of the economic forces are aligned against it. The institutional co-dependency between the Medical schools and the payer institutions that support them is profound, even if unintended.
    Finally, I am reminded that all of the successful Western nations, except the USA, have evolved out of feudalism that was centralized, coercive and highly autocratic. The heritage of our nation occurred as a desire to escape those “chains” and evolve a better means for a person’s survival. By any account, they did it. Many world-wide citizens continue to value the hope of future citizenship in the USA. Unfortunately, 90% of the world’s population outside the United State do NOT enjoy our enforced First Amendment Rights. Concurrently, many community’s now recognize its medical school as the largest employer in town, whose community leaders are only too happy to offer huge donations to sustain a medical school. This is certainly true for my hometown in Omaha. To balance the commitment to all realms of knowledge within our medical schools, there is a need to connect these Medical Schools with the local communities of their State.
    For healthcare reform, we need to authorize a community by community process *) to assure that equitably available Primary Healthcare is offered to each of their citizens by the sources of healthcare that currently exist; *) to coordinate this process with an intent to augment the Common Good within each citizen’s community; and *) to annually review and update a summary of the community’s MASTER DISASTER MITIGATION STRATEGY for their knowable, recurring disasters. The Cooperative Extension Service for agriculture was authorized by Congress in 1914…really. It is the most relevant model for connecting a University with the front-lines of an entire industry. This will be necessary to unleash the paradigm paralysis no matter how we institutionalize the payment systems for improving the cost and quality problems or our nation’s healthcare.


    P.S.: Have the C-suite folks chose a Primary Physician who has been in practice for at least 10 years and spend at least one full day a year with that physician for at least 5 years. Like many aspects of life, the success of healthcare begins with a high level of Trust, Cooperation and Reciprocity between each citizen and their Primary Physician.