What is the problem we are trying to solve?

The healthcare “ecosystem” in its basic form operates along 3 themes: care consumption, care delivery, and care financing. These domains are interdependent points of interaction along a value chain of healthcare. To impact one point, you impact them all. Make no mistake – healthcare is a business! The problem is that very few people create business models that are considerate of all three points of view – and certainly, no one has come up with a framework to make this easier.

modelH - Healthcare Ecosystem

In addition, across the value chain of healthcare, there are four key stakeholders: patients, providers, payers, and purveyors. To put it in simple terms, the party who consumes the product of healthcare (the “patient”) is usually not the one who pays for it, or at least not most of it. The party that pays for it (the “payer”) is best served when it is not used and is, therefore, motivated to push for less of it. Furthermore, the parties that deliver it (the “provider”), and the parties that support its delivery (the “purveyor”), are not aligned to place realistic boundaries on its cost, thus forcing the system into bankruptcy. Due to its divided nature, the ecosystem is overrun with inefficiencies and creates dis-incentives across themes and between stakeholders so that each maximizes their value, often at the expense of the others.

But the system is not so much broken as made up of working parts not working together. Our diagnosis of the problem is the misalignment of the ecosystem’s building blocks. Our prescription is to reset these building blocks into a better working order. The outcome will be a healthy and aligned ecosystem that is both market-driven and cost conscious.

 

How do we solve the problem?

The imagine.GO  team believes the ecosystem can be fixed! The answer lies in aligning the business model, so all stakeholders share an understanding of “value” across the themes of consumption, delivery, and financing. Our definition of value is based on that of Michael Porter, put forth in his paper entitled “What is Value in Health Care?“. Value in healthcare is measured as the patient health outcome achieved per healthcare dollar spent. A better healthcare business model must then result in:

  • Improved consumer experience yielding an informed decision maker aligned to their risk and reward;
  • Increased access to necessary care through an engaged delivery system; and
  • Reduced aggregate cost of care, with a market-driven, balanced incentive and reward model.

Our goal is lofty but achievable. We believe modelH will result in a practical guide to fixing the healthcare system that all stakeholders can use to create better aligned and market-sustaining business models. But our goal is too big and too important to try and solve alone. So we partnered with healthcare stakeholders from around the world to co-create the solution together, outside of an over-focus on any particular theme or an over-influence from any stakeholder group.

 

modelH Resources

modelH was developed by imagine.Go .  This work is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported License.   To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/. The following resources are available for download and use.

 

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