Healthcare Is Transforming Regardless of What Happens to the ACA


Xconomy Seattle — 

Powerful arguments and emotions continue to challenge the future of the Affordable Care Act (ACA). The Supreme Court, partisan ideology, presidential elections, and deeply held convictions about the role of government will all make their mark.

Most healthcare leaders, however, share a fundamental belief that healthcare transformation is happening now—driven by some of the same forces that have upended other industries. Changes in the ACA will influence the direction of healthcare transformation, but will not alter the driving forces—which have in common the primacy of the individual.

Individual healthcare consumers have unprecedented access to information, are biologically unique, and want to make the best use of their financial resources.

Businesses that do not respond to individuals don’t stay around long. Healthcare leaders and entrepreneurs know that, and see in each of the big forces outlined here an imperative to transform, and an opportunity.

But there is an important difference in healthcare.

Healthcare is personal, complex, and often life or death. The relationship between a clinician and a patient is a sacred trust. This sacred trust—the caring relationship—must be preserved through healthcare’s transformation. Digitization and technology are tools used by the clinicians and patients in the context of a personal, healing relationship. The synergy of “high tech and high touch” is the goal.

Democratization of Information

Many aspects of our lives have been digitized, creating massive amounts of data that can be processed, analyzed, and organized for effective use by individuals and businesses. A mobile, connected device can bring you the world’s information. This “democratization of information” about ourselves and our world is a driving force of transformation.

It changes how we select goods and services. Businesses that were once based on proprietary access to information now find their customers have that information, too. We get what we want, when we want it, on our terms, and healthcare is no exception.

Monitors, sensors, telemedicine, and iPhone apps allow individuals to self-manage and use information on their terms.

Young people who have grown up in the information age wonder what is wrong with healthcare. When they go to the doctor, they; fill out redundant forms, wait for too long, and have no idea beforehand what it will cost. They are the future and, as they increase their use of healthcare, they will demand its transformation. Young physicians are no exception to this. They will lead transformation with or without their older leaders.

Unique, Biological Individuals

Digitization, analytics, and “recombinant innovation” across disciplines, are propelling profound and accelerating innovation in medicine. Genomics, proteomics, and computational biology are creating revolutionary changes in understanding of the nature of disease, and a deepening appreciation of the uniqueness of individuals. Individuals will expect their uniqueness to be reflected in the healthcare they receive.

For example, we now understand that cancer is not necessarily a disease specific to an organ, but can be a disease of the genome. A unique genomic aberration can result in a cancer of the breast, ovary, or pancreas. This deeper understanding of the disease is reflected in treatment. New insights into individuals’ genetically driven response to treatment are leading to personalized prescribing of some medications.

But medications—like almost all aspects of healthcare—are too expensive.

Individual Financial Responsibility

Employers, insurers, and the government are reducing their exposure to the financial risk of healthcare costs.

Regardless of the ACA’s future, responsibility for the financial risk of healthcare will continue to be moved to individuals and providers. High-deductible health plans continue to grow rapidly. Healthcare providers are adjusting to “value-based payments.”The end of fee-for-service is in sight.

This transfer of financial responsibility will continue no matter what happens to the ACA. The only questions are of timing and magnitude.

Healthcare leaders and entrepreneurs, some new to healthcare, are creating new services and systems to meet the needs of unique individuals. New, innovative services have been developed for needs ranging from maintaining a healthy life style to self-managing a chronic illness to creating price lists for healthcare services. The magnitude of investment flowing into healthcare innovation reflects the size of the opportunity to improve healthcare for the unique individual.

The impact of the ACA is important, but healthcare transformation is inevitable. The unique individual, you, enabled by new information driven tools and partnering with healthcare professionals will usher in a new era of healthcare.

John is a healthcare teacher, board member, and author, most recently of n=1, How the Uniqueness of Each Individual is Transforming Healthcare. He was previously CEO of Providence Health & Services, one of the largest health systems in the U.S., with over 67,000 employees and 34 hospitals serving five western states. Follow @

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4 responses to “Healthcare Is Transforming Regardless of What Happens to the ACA”

  1. Fletch says:

    Great article. Unfortunately, the biggest users of healthcare are poor, mentally ill and the elderly. I wonder how transformation and digital technogy will help them use a more sophisticated health system? Seems like social issues will trump technology.

    • John KosterJohn says:

      Population health with changed incentives will promote use of data for “hot spotting”, predictive analytics, new ways of reaching out to people that are out of the system today. Keep wondering how we can do things differently with different tools rather than assuming the social problems trump good healthcare.

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