Although few industries are immune to the innovator’s dilemma, US healthcare has been uniquely resistant to disruption, especially in the arena of consumer experience. In fact, most Americans’ concerns about cost, access, and experience in healthcare have only worsened in the last 20 years. Meanwhile, legacy health systems and once-promising health tech giants are facing layoffs and closures alike. Perhaps it’s worth pausing to reflect on exactly what about this industry is holding us back. Specifically, what unique factors of US healthcare have been stifling progress so persistently – for so long, and what lessons there are to be learned to overcome them.
Although problems in US healthcare abound, the most insidious challenges are often tightly coupled with the industry’s most appealing and instilled virtues. Namely, deep-rooted characteristics that have historically elevated the profession of medicine over others, including (a) a highly selective and independent workforce, (b) an extremely low tolerance for risk and (c) a high degree of professional oversight. When it comes to our doctors – from our family physician to our cancer surgeon, these qualities give us great comfort and confidence. However, when applied to burgeoning innovation in the industry, they often directly combat healthcare’s ability to launch, iterate, and scale the new products and services needed to meet even the most ordinary consumer expectations.
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First, in any life-threatening situation, we want our doctors to be elite; we want them to have trained at the most prestigious institutions; we want their clinical decision-making to be independent of any cost, policy, or bureaucratic restraints. Unfortunately, those bold, independent characteristics we proudly breed into the culture of medicine are incredibly problematic for testing and scaling any new initiative. Imagine for a second if every Southwest Airlines pilot could individually decide if their customers would be allowed to book tickets online for the flights they piloted. And yet, despite overwhelming patient demand, the majority of our nation’s physicians (including fully employed doctors) disallow online scheduling for their patients.
Next, “do no harm” has been central to the ethos of medicine for so long that it is the most (sometimes only) memorable part of the Hippocratic Oath by patients and physicians alike. Although we’re far from a perfect record on this mandate, any clinical researcher today can confirm that the Internal Review Board (IRB) responsible for ensuring the safety and ethical conduct of any human research is as arduous and meticulous as you’d hope it would be. Unfortunately, this prevailing guidance is often cited by any clinical stakeholder who opposes any new initiative. Think I’m exaggerating? Consider this: prior to the Covid-19 pandemic, every State Medical Board’s reticence to allow and adopt virtual health overwhelmingly cited concerns over patient safety. The incredible pace of virtual health adoption since has shown that original reticence to have been – at best – dramatically overblown or – at worst – paternalistic and protectionist.
Finally, non-physicians might not be as familiar with the numerous specialty societies (45+ and growing and the profession evolves) that publish guidelines, best practices, and ongoing research to help leverage the collective experience, knowledge, and judgment of the best and brightest doctors in the country. However, this experience with and deference to committee governance is something non-ironically referred to as “death by committee” in the halls of hospitals and health systems. In fact, typical timelines for any health system initiative include 6-18 months each for strategy development and vendor/partner selection, each involving dozens of committees, departments, and individuals, each with veto power to stop the process and question the relevance, alignment, or safety of the initiative at any time.
Although most legacy industries encounter some of these themes, none are as deeply engrained and collectively inhibiting. When a single highly regarded physician is unwilling to adopt a new idea, solution, partnership, or process, it can completely halt that entire effort. And that’s not to lay the blame for the historic failure of US healthcare innovation at the feet of doctors. Rather, it’s a simple statement of fact. When almost any stakeholder, physicians or otherwise, can slow, prevent, or completely inhibit any new initiative, the natural result is an industry with little to impress consumers, despite decades of investment and growth.
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It should come as little surprise that just like the individuals that comprise them, an industry’s best traits can easily lead to its worst qualities if left unchecked. The solution? Balance. And we see it all over the world, especially in Asia. As a medical student, I spent time in medical rotations in Turkey and China, and although the academic bar for medical training was as extremely high in those cultures as it is in the US, they feel far less individualistic and much more like a part of a team.
To see what’s possible, consider Pristyn Care in India – a digital health startup founded in 2018. By 2021 (yes, just three years later), it reached Unicorn status with a $1B+ valuation. And what does Pristyn Care offer to Indian patients? The website states it incredibly concisely: “book free appointments with our expert doctors near you.” Self-scheduled appointments, online consultations, Amazon-style customer reviews and ratings, same-day appointments, end-to-end care models with surgeries and procedures, and digital health records linked through a national integration key… their features read like a manifested vision board for the US consumer.
Accomplishing one of those features, at any meaningful scale in the US, would likely take a decade in today’s environment because it would require overcoming countless committee reviews, stakeholder objections, and patient safety flags. In the post-pandemic world, competing on consumer experience should be the spark that revitalizes a stagnant US healthcare industry that’s failing everyone involved. There is hope, however. Take Sesame Health, which recently announced a large partnership with retail giant Costco. They’ve created a marketplace of providers organized around two key consumer-centric principles: (1) transparent, guaranteed pricing and (2) fixed appointment times with online scheduling.
I hope Sesame is the first of a trend here in the US where the healthcare industry starts to meaningfully compete on consumer experience. Like in most industries, we all do better when there’s real competition. But we first must understand the barriers and find the balance: we can love, respect, and appreciate our healthcare providers, but no longer tolerate the status quo.
Photo: Fokusiert, Getty Images
Dr. Aasim Saeed is the Founder and CEO of Amenities Health -- a leading Digital Front Door and patient loyalty platform for healthcare. Before Amenities, Aasim led the Digital Health Office at Baylor Scott & White Health as the VP of Digital Health. There he oversaw the development of BSW Health’s industry-leading website and app that helps millions of patients find and access care every year. Before joining BSWH, Aasim was a leader in McKinsey's Health System practice, advising multiple top US health systems on strategy, operations, and technology. Aasim received his MD and MPA from Duke and Harvard Universities, respectively. He is a Presidential Leadership Scholar and volunteers with the Texas Boys State program.
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