The Problem Worth Solving

Introduction to my book Inedible

Software is eating the world—yet healthcare remains inedible.

More than a decade ago, Marc Andreessen, a tech disruptor extraordinaire, penned a pivotal essay in The Wall Street Journal. His opening salvo, “Software is eating the world,” has since become a mantra in the tech industry (Andreessen, 2011). Andreessen proceeded to illustrate how companies like Amazon, Netflix, and Google were devouring industry after industry.

Later in the essay, Andreessen posited that “Health care [...], in my view, is next up for fundamental software-based transformation.” This prediction, however, has not materialised as swiftly as anticipated. While software has nibbled at the edges of healthcare, the industry at large continues to resist wholesale digital transformation.

This book delves into the structural impediments that have hindered healthcare from reaping the full benefits of 21st-century technology. It also examines how modern technological tools can disrupt healthcare for the better, outlining a roadmap for creating a tech-enabled healthcare experience fit for the modern era.

The healthcare systems employed in most developed countries were designed decades ago for a different set of circumstances. This book contends that to improve outcomes dramatically, the system must undergo a fundamental transformation. Merely reforming the existing system without acknowledging new realities is likely to prove futile. To surmount the systemic barriers impeding the optimal performance of modern healthcare, we must reimagine how people choose, purchase, and consume healthcare services and coverage. The goal is not incremental improvement, but a paradigm shift.

The assertion that the system requires more than minor tweaks presupposes that this market is performing poorly. Indeed, this is the case, according to many industry observers. Globally, healthcare costs are spiralling, insurance plans are hemorrhaging money, and coverage quality is diminishing. Consumers and their employers are compelled to purchase insurance plans and supplementary services without a clear understanding of their overall health implications. The result is a market where suppliers lose money and customers are dissatisfied—the quintessential definition of inefficiency. Given that this is a $5 trillion global market, there is a moonshot opportunity to significantly improve outcomes for patients, doctors, the economy, and society at large (World Health Organization, 2019).

The central thesis of this book is that the current healthcare system, designed several decades ago and rooted in centuries-old practices, is ill-equipped to handle the realities of 21st-century life. A new approach, leveraging advances in information technology, data processing algorithms, and artificial intelligence, is urgently needed. However, the entrenched structure of the legacy healthcare system is impeding technology from working its transformative magic, as it has in other sectors, such as retail, finance, and information retrieval.

As discussed in the Preface, diseases can be broadly categorised as either acute or chronic. Historically, the healthcare system excelled at managing acute conditions—a broken leg, a bout of flu. However, as life expectancies increase, we are increasingly grappling with chronic diseases.

This is where the trouble begins. Chronic diseases often have no clear onset, multiple causes, ambiguous symptoms, and slow progression. These factors cannot be addressed with a single intervention. Instead, they require multiple, simultaneous solutions applied over extended periods. Coordinating this complex web of care is a Herculean task. The current system, which operates on an oversimplified ‘detect-and-treat’ model (akin to the arcade game Space Invaders), is ill-equipped to handle the intricacies of chronic disease management.

On the surface, the fragmentation in healthcare delivery appears similar to the challenges that digital marketplaces like Amazon have successfully addressed in other sectors. However, healthcare is a unique beast. The buyers are often not the end-users, decision-makers are frequently not the payers, and regulatory hurdles abound. Moreover, the knowledge asymmetry between different stakeholders and the complexity of predictive models required make even the intricate world of finance seem straightforward by comparison.

It is crucial to note that this is not primarily a medical problem, but a cybernetic one. The challenge lies not in discovering new treatments but in effectively coordinating and integrating the complex web of information, decisions, and actions that constitute the healthcare system. While new medical discoveries would undoubtedly be beneficial, the medical knowledge we already possess, if deployed precisely and timely, could potentially prevent 50-66% of current health issues (McGinnis et al., 2002).

The data we need exists, scattered across thousands of unconnected repositories. The task at hand is to collate and analyse this data effectively. Organizations, from the American CDC to the UK’s NHS, estimate that approximately 60-80% of healthcare costs stem from inefficiencies, rather than a lack of medical solutions (Berwick and Hackbarth, 2012). To put this in perspective, the potential savings from productivity improvements in this sector could generate sufficient funds to provide healthcare for all, with resources left over to address other pressing global issues, such as hunger.

The crux of the problem lies in applying an outdated paradigm to a vastly different healthcare landscape. The system was designed to treat mid-20th-century illnesses, primarily acute, infectious diseases. However, the prevalence of chronic diseases in modern society necessitates systemic adaptations. As we will explore in subsequent chapters, this calls for a fundamental shift from an approach designed to handle discrete, quickly resolvable conditions to one capable of managing diseases like diabetes, which require continuous monitoring and treatment over extended periods.

This book proposes a radical reimagining of the healthcare system, one that harnesses cutting-edge technology and data analytics to deliver personalized, proactive care. Mere incremental improvements or the digitization of existing processes are insufficient. What is required is a new type of organization capable of integrating and coordinating various aspects of healthcare in ways that our current system cannot.

The following chapters will examine how technology and data analytics can transform healthcare organizations to serve patients better and enhance overall health outcomes. We will argue for the creation of a comprehensive marketplace. This one-stop shop care offering allows customers to tailor their healthcare solutions, combining different tools and services to create a fully personalized, holistic approach to their care.

This comprehensive, marketplace-like one-stop-shop care system is essential for several key reasons:

1. Customization and Personalization: Healthcare is highly individualized, and patients often require a combination of treatments, therapies, or services tailored to their specific needs. A marketplace allows users to personalize their care by selecting from a wide array of tools and services, creating tailored solutions that address their specific health needs. This ensures that patients receive more relevant and effective care.

2. Integrated Care: Fragmentation in healthcare is a significant issue. Patients often have to navigate multiple providers, platforms, and processes to manage their health, which can lead to inefficiencies, duplication of services, and gaps in care. A marketplace-style system integrates these diverse offerings, streamlining access to various services, improving coordination, and ensuring continuity of care.

3. Efficiency and Convenience: By centralizing multiple healthcare tools and services into a single, accessible platform, the marketplace enhances patient convenience, simplifying the management of various aspects of their health. This leads to better patient compliance and satisfaction, as users can access all their healthcare needs from a single platform, saving time and reducing confusion.

4. Data-Driven Insights: A marketplace can leverage data across multiple services and tools, creating a more holistic view of the patient. By integrating health signals and system data, it can provide personalized recommendations based on real-time analytics, ultimately improving outcomes and enabling proactive care.

5. Cost-Effectiveness: A marketplace approach can drive competition among healthcare providers, potentially lowering consumer costs by offering a variety of pricing options. It also reduces administrative costs by consolidating systems, leading to more efficient care delivery.

A marketplace-like one-stop healthcare platform addresses several challenges in modern healthcare, including fragmentation, inefficiency, and the need for personalization. It combines different tools and services in a unified, user-friendly interface that enhances care delivery, patient experience, and overall outcomes.

Crucially, the solution should not be a mere collection of disparate tools. Instead, it must integrate data from all parts of the healthcare ecosystem—including claims data, patient-level data from wearables, AI-powered diagnostics, and human interventions—into a single, unified database constantly powered by AI and data science.

This integration serves two primary purposes:

1. Holistic Decision-Making: By combining diverse data points—from wearables that monitor real-time health metrics to claims data that track historical healthcare usage—healthcare providers and individuals can make more informed decisions. AI can analyze these datasets collectively, providing insights into the best treatments, lifestyle changes, or preventive actions tailored to the broader population. This ensures that decisions aren’t made in silos but are based on a complete view of the patient’s health.

2. Continuous Monitoring and Adjustment: Healthcare is dynamic, and patient needs or health risks can change over time. With a centralized AI-powered database, the system can continuously monitor health trends at individual and population levels. Deviations from health plans or unexpected risks can be detected early, allowing for real-time interventions. By integrating data streams and leveraging AI, changes in health can be anticipated and addressed promptly, improving outcomes and reducing long-term costs.

Ultimately, this interconnected system provides customized care paths and the ability to adapt in real-time. The goal is to ensure appropriate choices at both the employer and individual levels, while monitoring and addressing health deviations, thereby enhancing efficiency and efficacy in healthcare management. This also empowers population health management through early detection, preventive measures, and personalized interventions, thus elevating both individual and societal health outcomes.

This approach transcends the limitations of fragmented care, leveraging AI and Data Science to create a forward-looking healthcare ecosystem that continuously evolves with the needs of its users.

This platform solution is designed to achieve three key objectives:

1. Provide customers with access to all the right tools they need, vetted and guaranteed by a single provider

2. Enable decision-making based on data rather than marketing claims

3. Offer continuous monitoring, timely interventions, and adjustments as needed, from the outset and throughout the entire care journey

An entity offering this combination could potentially build an ‘Amazon for healthcare’, tailored to the sector’s unique needs and challenges.

This book will present a compelling case for an innovative, disruptive approach to reorganizing, reimagining, and optimizing the healthcare system, offering both an analysis of the current system’s flaws and a detailed description of the necessary changes.

The book’s first part will delve into the “problem worth solving”—the current state of healthcare and why it urgently needs transformation. More than just a problem, this represents an opportunity to dramatically improve people’s lives and health outcomes while saving billions of dollars. We will assess what has gone awry with the system to determine why we have reached this point. In doing so, we will first focus on the perverse or otherwise incentives that tend to favor suboptimal decision-making. Then, we will focus on the intermittent need for care resulting from certain conditions and the difficulties the current system has in addressing this. Finally, we will examine the inefficiencies and fragmentation that plague the system, often because it was designed for an earlier era and different circumstances.

The book’s second part explores why the time is ripe for implementing a solution to the sclerotic state of modern medicine. A primary reason that many of the most perplexing issues hindering the system can now be addressed is the widespread availability of data, which enables integration among plans and services, as well as the development of open, health-oriented solutions. As we will explore, new technologies and innovative solutions allow us to rethink the entire healthcare value proposition. The goal of employing a data-intensive approach is to engage the public proactively and improve lives by empowering them with the necessary tools to understand their options.

The book’s final part describes what the market may look like once the transition to this new model has been achieved. We will explore specific scenarios, new organizations, roles that could emerge, and the cultural shifts accompanying such a transition.

In conclusion, healthcare needs to evolve rapidly. The world has changed, and another decade of finger-pointing and unfulfilled promises of improvement is the last thing we need. It is time for a moonshot approach to rethinking the way healthcare is organized and delivered. Doing so will not only improve lives but also address the systemic challenges that have persisted for far too long.