At the Health Evolution Summit last week, I facilitated a meeting of about 25 corporate venture capital groups. To lighten up the discussion, I asked the group, comprised of payers, providers, health IT and tech companies and a smattering of pharma/medtech companies, to vote on the buzzword that they can’t stand to hear ever again – a word they would like to see disappear from their inbox, general healthcare discourse and, if possible, the English language. There were some runners up, notably population health, precision medicine and innovation. But the hands-down winner was the word DISRUPTION.
You know the word. Clay Christensen brought it back into business parlance when he introduced us all to the concept of disruptive innovation. Almost twenty years ago, he described it as “a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors.”
The word has now become so overused that it sounds like the humming of bees when uttered.It has all but lost Christensen’s intended meaning. Just today I saw an article about Ford Motor Company figuring out a new plan to “disrupt themselves.”, thus making my point about how the term has jumped the shark. Christensen’s whole idea was this: established competitors get taken out by upstarts that don’t have any reason to care about existing customers, customs, or entrenched interests. It is the rare (to the point of actual real live unicorn kind of rare) that companies commit intentional suicide by blowing up their existing world order. Nibbling around the edges is not disruption and working on concepts adjacent to your core business is not disruption. It is R&D.
I own an ancient hard cover Webster’s Dictionary; it appears older than God but was actually printed in 1980. It weighs a ton and has gold leaf on the page edges. And in it the word “disrupt” is defined thusly: “to break or burst asunder; to tear, rend, sever.” It goes on for a while with other words that sound like they belong at the Salem witch trials.None of them suggest anything good. And yet, today, if you go to the Interwebs at Webster’s Dictionary.com here is what you get:
Good gracious, number 4 could have come straight out of Silicon Valley, the HBO TV show, proving once and for all that the tech world infects all with which it comes in contact, even good old Webster’s Dictionary. It’s amazing to see how the word’s meaning has migrated.
Aside from the new school business model concept, every other definition of “disrupt” is negative and implies misery, trouble, and prelude to chaos. It is aggressive and confrontational word, not one that lends itself to collaboration. No one out there would suggest we should destroy healthcare, but that is pretty much what we are all running around saying by relying on the term “disrupt.” If you look at Thesaurus.com, you will find that each of the synonyms offered for “disrupt” are also far from inspiring. A few examples: bollix, mess up, muddy the waters, screw up. There are no words that imply making something better than it was, which is the way in which most people are casually using the word.
For that reason, I find the word “disrupt” problematic when it comes to thinking about the healthcare system. Not just problematic because every genius who comes up with a new color of iPhone case is suddenly a “Disruptor,” but because we don’t need to bollix, mess up or screw up our healthcare system. It’s already screwed up, thank you very much. What we really need to do is take what works and find new financial, clinical and access models to optimize what doesn’t work. We need to combine clinician know-how and the scientific method with aligned incentives, empathy, evidence, and transparency of pricing and outcome. We definitely do not need to start from scratch because some things actually work. As I mentioned back in January, I had some surgery and now I am completely cured. No need to disrupt that experience. Except for maybe the bill, which was over $100K and didn’t even include an overnight stay, much less a snack.
Rather than disrupt the healthcare system, we need to systematize and harmonize what we have, take the good, remove the bad and figure out how to get consistently better care to people in the right amount, in the right time frame, for the right price.
Last week, I had the pleasure of participating in a San Francisco Business Times healthcare event where there were two panels. One was a group of entrepreneurs who are finding new ways to treat mental health and diabetes. The other was a group of C-suite types who lead Bay Area’s largest healthcare organizations: Blue Shield CA, UCSF/SF General Hospital, Sutter, Hill Physicians, etc. The entrepreneurs were introduced as Disruptors. The other guys were introduced as Thought Leaders.
I made a joke that the way you could tell the Disruptors from the Thought Leaders was that the latter had made enough money to afford to show up in a jacket and tie. But honestly, I wasn’t that far off from the truth. The entrepreneurs (aka Disruptors), from Omada, Livongo and Freespira, are not selling revolutionary concepts; rather they are evolutionary, bringing better ways of delivering concepts already known but hard to deliver without technology and thoughtful creativity. And the “thought leaders”? Well, they are definitely evolving, some more and faster than others, but all of them are working on new ways of doing business while still living half time or more in the ways they have been used to operating.
This situation, where healthcare players are half in, half out of the new world order, particularly around the move to value-based reimbursement, makes Christensen’s concept of disruption particularly challenging. It will take many years for the system to make this great migration and, while we can create new models that show real promise (Iora Health, CareMore, ChenMed), and we can introduce transparency and shared risk around pharma pricing, and we can give every man, woman and house cat access to telehealth on their smart phone, we can’t turn every part of the system upside down all at once.
If we look out 10 or 15 years into the future, I suspect we will see great evidence that Clay Christensen was right – that many new models of healthcare will have displaced those that came before. But in the meantime, we need to come up with a better way to talk about what we do so it is meaningful, measurable and provides hope rather than hype. In other words, we need to disrupt disruption!
I like the idea of harmonizing healthcare – my new self-appointed replacement for disruption – as it has a sense of the positive and suggests making all of the parts work well together. Our friends at Websters.com define harmony as a consistent, orderly, or pleasing arrangement of parts; congruity. Isn’t that really what we are after – harmonic convergence? We must evolve to a world where people/patients, payers, providers and policy-makers reach concordance that the healthcare system is doing what it needs to do for all involved. And that will take collaboration and cooperation, not breaking or bursting or tearing asunder. So all you entrepreneurs seeking to make the world a better place: I anoint you as Harmonizers. You are still free to show up without a tie.
Note: this article first appeared in The Timmerman Report