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Clayton Christensen makes a compelling argument for Job's Theory. If you read the Harvard Business Review with any regularity he is the local hero. Perhaps you are familiar with the term "disruptive innovation," yep, that's him too. In a simplified nutshell, if we ask ourselves, what job needs solving in healthcare--there is really only one answer. Wellness. So if you are following me this far you might be thinking about the definition of "job" in this context. The working definition as outlined in Competing Against Luck: The Story of Innovation and Customer Choice Is the following... "The progress that an individual seeks in a given circumstance"..."jobs are never simply about the functional--they have important social and emotional dimensions, which can be even more powerful than functional ones."  Naturally his work extends beyond healthcare but here is my little secret. If you read HBR consistently--eventually you get the "joke"--meaning you start to unravel how the case study can apply to one of your persistent business needs in an industry agnostic way. After listening to Clayton's remarkable standing-ovation presentation at Qualtrics Insight Summit last week--I couldn't help but apply his Harvard Business insight to the persistent value-framework discussions in healthcare reform.
What is the job we are trying to get done by using value-frameworks? I would argue that it isn't wellness. It is bending the cost curve. Obviously this isn't a bad thing but it certainly isn't the same thing. My argument remains that circumstance and context matters. Do we believe that healthcare is a right for all or do we want the capitalistic forces to decide? These objectives are clearly two different frameworks. In the absence of a consensus we are focused on attributes and features like alternative payment models, incentivized care, and issues of access and affordability. Shouldn't we define the "circumstance" before we identify a solution? Health economists aim to predict how doctors will respond to incentives, but without understanding the complex pressures they face that shape behavior — including high patient loads, incomprehensible insurance rules, increasing time demands for more and more regulatory requirements, duplicative or conflicting regulations, and documentation of often unnecessary clinical data in different and noncommunicating electronic medical records systems.-- Paying Doctors For Outcomes Makes Sense in Theory. So Why Doesn’t it Work in the Real World? If we have learned anything about incentivized pay for performance frameworks we should be acutely aware that we have no idea what either the patient or provider values at the specific point of care. We create assertions of value and build an "innovative" alternative to "fee for service" but where is the progress? How will we measure it and how will the healthcare economy survive if it really works? You have heard the estimates. By 2030 healthcare will be 20% of GDP. What if it isn't? What does the world of efficiency, triple aim, and managed healthcare costs look like at say 15% of GDP? What about the care consolidation launched by MACRA and MIPS? Hospital systems with empty beds, surgical suites, and NICUs...where is the value in our success?  I will be part of a panel, speaking about innovations in data storytelling, Data Talks, People Mumble. Session 6B2: Innovations in Data Presentation.
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