Monthly Archives: January 2014

business, data saving lives, entrepreneurship, healthy habits, meaning, policy, rapid learning health systems

FDA rearguard frame…

It’s all happening anyway. Eventually, the tide will surge and the wall will burst.

Already, an explosion of monitoring, testing, and sensing devices are coming on the market, providing consumers with instant analysis of their fitness, blood chemistry, sleep patterns and food intake. It’s only a matter of time before regulators feel compelled by consumer demand to find a way to accommodate better and cheaper innovations, and for slowly changing industries to dramatically restructure themselves in the face of overwhelming new opportunities. The long-term potential of vast databases of genomic data to improve health outcomes, reduce costs, and reorient the debate on medical priorities is too valuable to be held back for long — and arguably the biggest transformation for the healthcare industry since the discovery of antibiotics in the early 20th century.

http://www.wired.com/opinion/2014/01/the-fda-may-win-the-battle-this-holiday-season-but-23andme-will-win-the-war/

Regulating 23andMe to Death Won’t Stop the New Age of Genetic Testing

  • BY LARRY DOWNES AND PAUL NUNES
  • 01.01.14
  • 6:30 AM

 

Image: ynse/Flickr

 

Market disruptions often occur — or not — as the direct result of unintended collisions between breakthrough technologies and their more incremental regulators. In the latest dust-up, the U.S. Food and Drug Administration (FDA) last month ordered startup 23andMe to stop marketing its $99 genetic analysis kit, just before the Christmas shopping season kicked into high gear.

To date, over half a million customers have taken the swab in return for detailed ancestry data and personalized information on 248 genetic traits and health conditions. The company, which launched in 2007 with substantial backing from Google, has been working closely — albeit more slowly than the FDA would have liked — with the FDA to ensure it complies with federal health and safety regulations. But the agency concluded in its recent warning letter that 23andMe was marketing a “device” that was “intended for use in the diagnosis of diseases or other conditions,” and as such, its marketing materials required pre-approval from the FDA, which includes extensive research studies.

23andMe is an example of what we call a “Big Bang Disruption” — a product or service innovation that undermines existing markets and industries seemingly overnight by being simultaneously better andcheaper than the competition. What’s happening in genomic testing (and healthcare in general) is consistent with our research in over 30 different industry segments, from manufacturing to financial services to consumer products.

When technologies improve exponentially, many industry incumbents — and the regulators who oversee them — are kept constantly off-balance. That’s because incumbents have been indoctrinated by a generation of academic literature and MBA training to ignore disruptive products until they had a chance to mature in the market, assuming they would first appear as cheaper but inferior substitutes that would only appeal to niche market segments.

Doctors — who are also incumbents in this situation — are struggling to respond to disruptive medical technologies that change the power dynamic in the patient relationship. Several 23andMe users have reported taking the FDA’s advice of reviewing their genetic results with their physicians, only to find the doctors unprepared, unwilling, or downright hostile to helping interpret the data.

Often, incumbents’ only competitive response — or the only one they can think of — is to run to the regulators. That’s what’s has been happening to car-sharing services such as Uber, Lyft, and Sidecar; to private drone makers; and casual accommodation services such as Airbnb, to name just a few examples. And now it’s happening to 23andMe, one of hundreds of new startups aimed at giving healthcare consumers more and better information about their own bodies — information that has long been under the exclusive and increasingly expensive control of medical professionals.

Absent any real law on the subject, the agency has strained credulity to categorize 23andMe’s product as a diagnostic “device” — making it subject to its most stringent oversight. The FDA’s letter focuses intently on the potential that consumers will both under- and over-react to the genetic information revealed. The agency fears that users will pressure their doctors for potentially unnecessary surgery or medication to treat conditions for which they are genetically pre-disposed, for example. And it assumes that the costs of such information abuse outweigh any benefits — none of which are mentioned in the agency’s analysis.

The company, of course, has agreed to comply with the FDA’s stern warning, and has ceased providing its customers with anything other than hereditary data. For now. Perhaps it will reach some accommodation with the agency, or perhaps the FDA’s ire will prove untamable, an end to the innovative startup and whatever value its technology might have delivered.

But as with every Big Bang Disruptor in our study, winning the battle and winning the war are two very different things.

The FDA is applying a least common denominator standard to 23andMe, and applying it arbitrarily. Already, an explosion of monitoring, testing, and sensing devices are coming on the market, providing consumers with instant analysis of their fitness, blood chemistry, sleep patterns and food intake. It’s only a matter of time before regulators feel compelled by consumer demand to find a way to accommodate better and cheaper innovations, and for slowly changing industries to dramatically restructure themselves in the face of overwhelming new opportunities. The long-term potential of vast databases of genomic data to improve health outcomes, reduce costs, and reorient the debate on medical priorities is too valuable to be held back for long — and arguably the biggest transformation for the healthcare industry since the discovery of antibiotics in the early 20th century.

The information flood is coming. If not this Christmas season, then one in the near future. Before long, $100 will get you sequencing of not just the million genes 23andMe currently examines, but all of them. Regulators and medical practitioners must focus their attention not on raising temporary obstacles, but on figuring out how they can make the best use of this inevitable tidal wave of information.

Whatever the outcome for 23andMe, this is a losing battle for industry incumbents who believe they can hold back the future forever.

 

Larry Downes & Paul Nunes

Larry Downes and Paul Nunes are co-authors of Big Bang Disruption: Strategy in the Age of Devastating Innovation (Penguin Portfolio 2014). Downes is Research Fellow with the Accenture Institute for High Performance, where Nunes serves as its Global Managing Director of Research. Their book has been selected as a 2014 book of the year by the Consumer Electronics Association.

business, cool, data saving lives, healthy habits, policy

A behavioural vaccine

  • the marshmallow experiment gone wild >> a behavioural vaccine
  • paying tobacconists for cigarettes they refuse to sell to kids
  • paying smoking mothers to quit

 

Listen to the story: 

Good Behavior’ More Than A Game To Health Care Plan

by KRISTIAN FODEN-VENCIL

Danebo Elementary in Eugene, Ore., is one of 50 schools receiving money to teach classes while integrating something called the “Good Behavior Game.” Teacher Cami Railey sits at a small table, surrounded by four kids. She’s about to teach them the “s” sound and the “a” sound. But first, as she does every day, she goes over the rules.

“You’re going to earn your stars today by sitting in the learning position,” she says. “That means your bottom is on your seat, backs on the back of your seat. Excellent job, just like that.”

For good learning behavior, like sitting quietly, keeping their eyes on the teacher and working hard, kids get a star and some stickers.

Railey says the game keeps the kids plugged in and therefore learning more. That in turn makes them better educated teens and adults who’re less likely to pick up a dangerous habit, like smoking.

The Washington, D.C., nonprofit Coalition for Evidence Based Policy says it works. It did a studythat found that by age 13, the game had reduced the number of kids who had started to smoke by 26 percent — and reduced the number of kids who had started to take hard drugs by more than half.

The fact that a teacher is playing the Good Behavior Game isn’t unusual. What is unusual is that Trillium is paying for it. Part of the Affordable Care Act involves the federal government giving money to states to figure out new ways to prevent people from getting sick in the first place.

So Trillium is setting aside nearly $900,000 a year for disease prevention strategies, like this one. Jennifer Webster is the disease prevention coordinator for Trillium Community Health, and she thinks it’s a good investment.

“The Good Behavior Game is more than just a game that you play in the classroom. It’s actually been called a behavioral vaccine,” she says. “This is really what needs to be done. What we really need to focus on is prevention.”

Trillium is paying the poorer schools of Eugene’s Bethel School District to adopt the strategy in 50 classrooms.

Trillium CEO Terry Coplin says changes to Oregon and federal law mean that instead of paying for each Medicaid recipient to get treatment, Trillium gets a fixed amount of money for each of its 56,000 Medicaid recipients. That way Trillium can pay for disease prevention efforts that benefit the whole Medicaid population, not just person by person as they need it.

“I think the return on investment for the Good Behavior Game is going to be somewhere in the neighborhood of 10 to one,” Coplin says.

So, for each dollar spent on playing the game, the health agency expects to save $10 by not having to pay to treat these kids later in life for lung cancer because they took up smoking.

Coplin concedes that some of Trillium’s Medicaid recipients will leave the system each year. But he says prevention still makes medical and financial sense.

“All the incentives are really aligned in the right direction. The healthier that we can make the population, the bigger the financial reward,” he says.

The Oregon Health Authority estimates that each pack of cigarettes smoked costs Oregonians about $13 in medical expenses and productivity losses.

Not all the money Trillium is spending goes for the Good Behavior Game. Some of it is earmarked to pay pregnant smokers cold, hard cash to give up the habit. There’s also a plan to have kids try to buy cigarettes at local stores, then give money to store owners who refuse to sell.

This story is part of a reporting partnership with NPR, Oregon Public Broadcasting and Kaiser Health News.

healthy habits, policy, politics

Multinational businesses harming health

Strong article. Nothing new. Keeping the message out there.

Source: http://www.theage.com.au/comment/unhealthy-big-business-spreading-great-harm-20140105-30bnk.html

Unhealthy big business spreading great harm

January 6, 2014

Rob Moodie

If our negotiators buckle under the pressure applied by third parties, the price of a new trade agreement will be very high.

Illustration: Jim Pavlidis.Illustration: Jim Pavlidis.

Two-thirds of Indonesian men smoke and more than half of Chinese men smoke. Even more disturbing is that 40 per cent of 13-15-year-old Indonesian boys smoke. How have these levels been reached while the world has known for more than 50 years that tobacco is such a deadly habit?

In China, it is now estimated that 114 million people have diabetes. South Africa has one of the highest per capita alcohol consumption rates in the world, with more than 30 per cent of the population struggling with an alcohol problem or on the verge of having one.

Tobacco, alcohol, and diabetes related to overweight and obesity all have one feature in common. They are each largely driven, and in the case of tobacco completely caused, by powerful commercial interests in the form of transnational corporations. It has been said that China’s booming economy has brought with it a medical problem that could bankrupt the health system.

We now face a major dilemma: unrestrained commercial development is pitted against the health and wellbeing of populations. This dilemma is not new – opponents of the abolition of slavery complained it would ruin the economy – but it is manifesting in more obvious ways in the 21st century.

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The tobacco, alcohol and ultra-processed (”junk”) food and drink industries have been rapidly expanding in low and middle-income countries. In the past decade, tobacco retail sales growth in these countries was 20 times that of the developed world. For alcohol consumption it was three times; sugar-sweetened beverages it was twice. But it isn’t only Indonesia, China and South Africa where we find this dilemma; it is alive and well in Australia.

For years we have known that the tobacco industry promotes and funds biased research findings, co-opts policy makers and health professionals, lobbies politicians and officials to oppose public regulation, and influences voters to oppose public health measures through expensive public relations campaigns. This success has been noticed and over the past decade alcohol and ultra-processed food and drink companies have been emulating these very same tactics.

This is of little surprise given the flow of people, funds and activities across the industries. For example Philip Morris owned both Kraft and Miller Brewing; the board of SAB Miller (the second largest alcohol manufacturer) includes at least five past or present tobacco company executives and board members; and the Diageo executive director responsible for public affairs spent 17 years in a similar role at Philip Morris.

Economic development plays an important role in the health and wellbeing of populations. Income, employment and education levels are all major determinants of good health. Businesses create wealth, provide jobs and pay taxes (but as we have seen, not all of them). One of the best ways to protect and promote health is to ensure people have safe, meaningful jobs. The more evenly wealth and opportunity are distributed, the better the overall health and wellbeing of a population.

But clearly not all businesses are good or healthy – yet we see some of them expanding their markets and influence across the globe – seemingly with no capacity to diminish or mitigate the harm they do. It is astonishing that an industry such as tobacco, which is so harmful to human health, can wield so much power. In Indonesia, Philip Morris and its affiliate, Sampoerna, will invest $US174 million to improve production capacities so, as Sampoerna’s president has said, ”Indonesia would be the centre of the Marlboro brand production to cater [for] demands in the Asia-Pacific region”.

Why do they need to expand their activities? Aren’t the existing 700 million smokers in the region enough? Especially when we know that more than half of them will die prematurely, losing about 20 years of life to tobacco.

The major tobacco, food, and alcohol companies have assets that are greater than many countries and can wield this power in parliament, law courts and the media, against the interests of the public’s health.

A new battlefront in this power play is the Trans Pacific Partnership Agreement (TPP). This trade agreement among 12 countries (including Australia, Japan and the US) represents about 40 per cent of the global economy.

The Australian government aims to ”pursue a TPP outcome that eliminates, or at least substantially reduces, barriers to trade and investment” and that will ”also deal with behind-the-border impediments to trade and investment”.

It is highly complex, has 29 chapters, is being negotiated in secret and is provoking considerable criticism on the basis that it could greatly strengthen the hand of some industries to sue national governments for their domestic policies and also greatly weaken the capacity of governments to buy cheaper generic drugs. The Nobel prize-winning humanitarian group Medicins sans Frontieres says the TPP ”could restrict access to generic medicines, making life-saving treatments unaffordable to millions”.

If our trade negotiators buckle under the pressure from other governments, which are, in turn, highly influenced by transnational companies, then Australia will have to confront some major problems. These include delayed availability of cheaper generic drugs and increased cost of medicines; interference with our Pharmaceutical Benefits Scheme; enshrining of rights to foreign corporations, such as tobacco companies, to sue our government; interference with our capacity to introduce health warnings on alcohol packaging, and the limiting of future options for food labelling.

Surely we must find a balance between unrestrained commercialism and maximising health and wellbeing. We need business for our individual and collective wellbeing. However, the benefits unhealthy businesses bring are outweighed by the costs – in terms of premature death, chronic illness, limited healthcare finances, overcrowding of hospitals and loss of productivity from unhealthy employees.

This is why we have governments – to ensure a balance among the rights of individuals, consumers, businesses and society as a whole. If, as Prime Minister Abbott has said, Australia is open for business, then we need to make sure it’s open for good business. If we can’t control the vested interests of unhealthy industries in trade agreements or in our domestic regulations, unhealthy business will come back to bite us all.

Rob Moodie is professor of public health at the University of Melbourne

Read more: http://www.theage.com.au/comment/unhealthy-big-business-spreading-great-harm-20140105-30bnk.html#ixzz2pbgfIvAZ

business, complex adaptive systems, facts & data points, healthcare, policy, politics, quantified self, rapid learning health systems

Dave Chase – How healthcare’s disruption will play out…

 

PDF Report: Volume_to_Value_Revolution

Healthcare’s Trillion-Dollar Disruption

As a healthtech startup, you can’t help but get excited when Bob Kocher (Venrock) or Esther Dyson speak about the opportunities in healthcare given their impressive track records. Both spoke during this past week’s StartUpHealth Summit.

One of Bob’s main points was that the opportunity in healthcare is so big that most startups are thinking too small and his firm is putting their money where his mouth is (e.g. Castlight). Esther has proven time and again to be very prescient — just go back and watch her old interviews on Charlie Rose over the years to see how accurately she predicts the future. She interrupted attending the JP Morgan presentations to visit with the StartUp Health Summit. Paraphrasing, she said companies like those in StartUp Health are the future. Rather than trying to steal share from the companies presenting at JP Morgan, startups should focus on creating the new market space, and the market will move to them…not the other way around.

Transformers vs. Preservatives

While the opportunities are massive, what’s the biggest obstacle to healthcare transformers? It’s the “preservatives” — the incumbent healthcare players. That is, the preservatives are trying to protect the status quo, rather than focusing on how to sincerely address the Triple Aim (improve outcomes, reduce cost, improve patient experience). In every healthcare organization I’ve talked with, whether they are a provider, pharma, or health plan, there are transformers internally who know what to do but are stymied by preservatives.

The same is true politically. There are those who call themselves “progressive” or “conservative.” Unfortunately, it seems that 80 percent of politicos are actually preservatives just doing the bidding of lobbyists trying to protect the status quo. The preservatives are costing thousands of lives and hundreds of billions of unnecessary wasted dollars. The real leaders in healthcare will see through them and get them out of the way of progress.

One of the transformative organizations pushing for change is Oliver Wyman. Oliver Wyman is a leading consultancy that has setup a Health Innovation Center that recently published a paper entitled The Volume-to-Value Revolution (PDF) with the input of an advisory board (PDF) of CEOs ranging from large public companies to emerging companies (disclosure: I’m on the Health Innovation Center Advisory Board). In that paper, authors Tom Main and Adrian Slywotzky make the case that new patient-centered population health models will cause more than $1 trillion of value to rotate from the old models to the new and create more than a dozen new $10 billion high-growth markets (see also Patients Are More Than A Vessel For Billing Codes). Each of these markets creates large opportunities for healthtech startups. Naturally, legacy vendors are optimized for the old models (see Why It’s Good News HealthIT is So Bad) while startups optimize for the new models.

Most industries compete on value. U.S. healthcare does not. But that is about to change.

Healthcare innovators are already redefining healthcare value, putting patients first and inventing with little regard for current constraints. They have ignited a powerful, self-funding upward spiral by focusing first on healthcare’s big opportunities, transforming the value equation, generating large savings, and fueling smart reinvestment in the next wave of innovation. [Introduction, “The Volume-to-Value Revolution”]

In addition, the necessity for change and the accompanying opportunities are causing many healthcare incumbents to establish venture arms. See Strategic Healthcare Investors’ Investment Thesis for more.

Industry Boundaries Rapidly Crumbling

Everyone is getting into each other’s and new businesses. Industry incumbents would be well advised to learn from the mistakes of incumbents in other disrupted sectors. As I observed earlier, providers are making newspaper industry mistakes.

The changes the industry faces will be neither smooth nor linear. A period of intense turbulence will produce more losers and winners than any industry transformation in recent memory. Cross-industry competition (healthcare versus retail versus technology versus others) will erase traditional boundaries and generate exciting new value propositions for patients, payers, and physicians.

For example, just this past week, Walgreen‘s has made it clear they’ll compete with healthcare providers and insurance companies. Competition, as newspapers learned, doesn’t come from obvious places.

Consumerization Of Healthcare

The consumer empowerment taken for granted from everything from buying cars to planning travel is finally arriving in healthcare nearly 15 years later than most industries.

Consumers, long passive, will have a new role. Employer incentives, retail access, and new technology options will encourage them to engage, demand information, and push for value. Baby boomers reaching the age of peak healthcare need will kindle the fire and Millennials focused on nutrition and fitness will keep it burning. The industry’s metamorphosis from a supply-driven market to a more dynamic one driven by demand will happen more quickly and erratically than we expect. Inevitably, mental models will lag behind market reality, and conventional organizations will fight a rearguard battle, hampered by collapsing margins and eroding market share.  [Introduction, “The Volume-to-Value Revolution”]

Walmart recently validated the domestic medical tourism I wrote about awhile back. Their Centers of Excellence program encourages their insured employees to go to the top facilities in the country for free (including travel expenses). The employees have to pay if they choose to go with organizations that haven’t demonstrated a willingness to have a fixed price while producing some of the best outcomes in the world. Love them or hate them, Walmart has a huge ripple effect. Overnight, every facility in America that does cardiac, spinal, or transplant procedures is now competing with Mayo, Cleveland Clinic and other top providers. Sticking to old models and tools endangers the traditional healthcare player.

By 2014, as many as 85 million consumers with $600 billion in purchasing power may be shopping for their own healthcare on public and private exchanges. Many will be making their own decisions about coverage for the first time. Consumers will shop not just for insurance, but also for their preferred population-health manager and standalone services, such as basic procedures and retail clinics. [pg. 18, “The Volume-to-Value Revolution”]

New Models Jeopardize Hospitals

Many are predicting half of hospitals will close by 2020. In Denmark, nearly 70 percent of hospitals closed as they made the shift from a reactive, sick-care model to proactive care model. More clinicians than ever will be needed. They’ll simply have a mainframe-to-smartphone like shift as outlined inhealthcare’s age of agility. Unfortunately, the average hospital is one of the most dangerous places with over 100,000 hospital-acquired infections causing death every year. Hospitals are almost always the most expensive place to deliver care so smart health systems are developing new models with a fresh start — what I call the Xboxification of Healthcare.

One of the reasons providers are choosing cloud-based systems over on-premise software is the resource-intensive deployments required with legacy systems. We’ve seen a small clinic get their cloud-based system fully setup and ready to use in 30 minutes without any onsite people. In contrast,  in that same amount of time, one might be able to order the server that gets shipped to that clinic. They will then require onsite installers, trainers, etc. and have a dramatically higher cost base to run that system.

For entirely rational reasons, those older systems were optimized for internal workflows and maximizing billing since that is what has been rewarded historically. To think that those traditional systems will then work perfectly well in the ascending “No Outcome, No Income” era borders on delusional. The reality is hitting right away. A recent article in a HIMSS publication quoted a leading thinker in healthIT, Shahid Shah, outlining 9 major gaps in existing EHRs. He listed “sophisticated patient relationship management (PRM)” as the first major gap. It’s my opinion that as integral as EHRs have been to fee-for-service, PRM will be to fee-for-value. The old model relegated patient portal functionality to be little more than a marketing checkbox. In the new model, PRM functionality becomes a linchpin. In other words, patient portals have been like pre-Google web search (low value afterthoughts on web portals). As Google demonstrated, with the right circumstances, there was huge value ignored by the established players. Likewise, if PRM is viewed as an afterthought, that will increase the risk to providers during this transformative period. Being flat-footed in a time of great change is extremely risky.

The New York Times reported this past week that the public hospitals are already changing the way they compensate their doctors. The first performance measure they listed was how well patients say their doctors communicate with them. These doctors are used to easy communication in the rest of their life with email, text, Facebook, etc.  Suddenly, the hospital IT departments are going to start hearing from doctors asking why they can’t have tools that are as easy to communicate with their patients in the other areas of their life. It’s a rare occurrence to hear a doctor say how user-friendly and patient-focused their EHR is. Of course, it’s about more than just technology. The technology simply enables new models. Despite many doctors’ fears, often the changes are for the better as was mentioned by Dr. Bob Margolis, founder and CEO of HealthCare Partners, and one of the physician leaders who has demonstrated extraordinary outcomes:

You get to the tipping point, where the physicians go, ‘Wow, life is a whole lot better.’ You know, I only have to see 20 patients a day and I go home at night and I feel like I really helped them’—as opposed to, ‘I saw 45 patients, worked until 10 o’clock because I had to then do all my paperwork, I’m tired and I can barely pay the bills because Medicare and the commercial insurers are cutting back on my reimbursement.’

Oliver Wyman’s report projects that patient-centered care and the shift to value will eliminate $500 billion in low-value-add activities. One has to be in major denial as a healthcare leader to think that we aren’t entering a deflationary era in healthcare. Just watch Bill Gates’ TED Talk on state budgets if you have any doubts. This is exactly the reason the state of New York has moved aggressively to change care and payment models. While doing that, they recognized new models require new technology and didn’t expect they’d get it from legacy providers. This is why the New York Digital Health Accelerator was established. The good news for proactive health systems is that one can thrive in a deflationary period if they shed old assumptions.

A leader at Virginia Mason in Seattle shared how Starbuck’s pushback on costs caused them to look at their entire care proces:

 “90 percent of what the hospital was doing was of no value.” As it turns out, the best way to treat most back pain is with physical therapy. That insight led to new processes, including same-day visits (as opposed to 31-day waits), reduced use of imaging tests and prescription drugs, and the addition of psychological support. Within three months, 94 percent of Starbucks employees with back-pain complaints were back at work within a day.

Even today, many EMR vendors will justify the price tags that reach into the hundreds of millions of dollars on the basis of increased billings. That game is nearly over and those hospitals will be saddled with systems optimized for the old models. This past week there were articles in the New York Times and Washington Post stating that EHRs have “failed”. I’d dispute that. EHRs have done exactly as they were designed — maximize billings. That’s how they are pitched so it should be no surprise that costs haven’t been lowered.

It has been said that “when the rate of change outside exceeds the rate of change inside, the end is in sight.”

Three Waves Of Disruption

Below, I have excerpted and paraphrased some more of Oliver Wyman’s insights from the Volume-to-Value paper illustrating how each of the three anticipated waves of disruption will shift hundreds of billions of revenue from one set of players to another:

Wave 1: Patient-Centered Care (2010-2016). “If we simply mainstreamed today’s best-in-class models of patient-centered, population-health management, the U.S. health system would eliminate nearly $350 billion of low-value-add activity and shift another $600 billion from provider-centered care models to patient-centered care models.” […] ”Five percent of Americans account for 45 percent of healthcare spending—$1.2 trillion. These 15 million unhealthy Americans at the top of the healthcare pyramid are at the heart of the near-term healthcare affordability crisis and the unfortunate victims of our fragmented, illness- focused healthcare system.” [pages 5 and 7, “The Volume-to-Value Revolution”]

 

Cost & population pyramid

Wave 2: Consumer Engagement (2014-2020). In Wave 2, another $150 billion in low-value-add activities is squeezed out, while $400 billion of additional value will rotate to the new retail value chain.

Oliver Wyman transition


Wave 3: The Science Of Prevention (2018-2025). Wave 2 will help Wave 1’s great population managers become even more effective and will devastate provider-centric players who have lagged the market. Wave 3 will make the most highly evolved and adaptive population health managers more powerful and will significantly constrict the Wave 1 players who don’t continue to accelerate innovation.

Big Opportunities Require Big Brains

I once heard someone say, “There’s a lot of big brains working on small problems.” They were commenting on the brainpower working on the 8,000th social media app versus where they should be applying their brains. That is, there are three areas that demand as many big brains as possible — healthcare, education, and energy. As a skier, I often say that healthtech startups are the double black diamond in whiteout conditions of startups: super challenging and exhilarating but not for the faint of heart.

I believe the trick is to understand the idiosyncrasies of healthcare without being shackled by them. If you want to make a difference, there’s no better place than healthcare. Healthcare needs all the engineering talent possible that is often wasted on low-impact areas of the tech industry.

Follow @chasedave on Twitter or request the Care Beyond the Clinic newsletter for ongoing updates on healthcare innovation and disruption.