PART III CONCLUSION

E Pluribus Unum

In his farewell address to his troops in November 1783, General George Washington marveled at how soldiers from different states, backgrounds, and cultures had developed into a unified and cohesive Continental Army:

Who that was not a witness could imagine that the most violent and local prejudices would cease so soon and that men who came from different parts of the continent . . . would instantly become but one patriotic band of brothers.¹

Washington hoped that the Continental Army could become a model for unifying the new nation. That is what happened. For all its glaring flaws, the United States is a single nation that binds together a heterogeneous, multicultural, ethnically diverse “band of peoples.” Healthcare, which touches every American, is the living embodiment of this reality.

The front of the Great Seal of the United States (Figure CIII.1) depicts an eagle with the phrase “E Pluribus Unum,” Latin for “Out of Many, One.” That phrase encapsulates the genius and challenge of America. In healthcare, America needs to create a system that works for the many, not just the few. It must accommodate regional, cultural, and individual differences while guaranteeing access to appropriate and affordable care for all.

FIGURE CIII.1   Great Seal of the United States, front and back

On the back of the Great Seal is a pyramid with the Latin words “Novus Ordo Seclorum”. This translates into “A New Order for the Ages.” These words have relevance for healthcare as well. Out of the System’s ashes, a new American healthcare must rise that serves all Americans with personalized, value-based health and healthcare services.

It’s appropriate that both sides of the Great Seal appear on the back of the US one-dollar bill. Money and medicine go together like America and apple pie. Perverse financial incentives combined with insider wheeling and dealing have created a healthcare monstrosity that is suffocating American productivity and human potential. Aligning financial incentives with desired outcomes, leveling the competitive playing field, turning consumers into customers, and unleashing the American innovation machine on the System will turn it to dust, replacing it with a new, uniquely American healthcare that dazzles rather than disappoints.

Revolutionary Healthcare will encompass the following:

•   New innovators. Large numbers of nimble, innovative, and well-funded new market entrants that will selectively attack imbedded system inefficiency where they can deliver value-creating solutions.

•   More precise markets. Segmentation of the healthcare marketplace addressing varying degrees of care duration and care uncertainty. The resulting four quadrants are commodity, specialty, complex, and chronic care. They have different customers, competitors, supply chains and price points.

•   New business models. Disruptive and transformative business models advance systemwide outcomes. The most promising new business models are enhanced primary care services, focused factories, asset-light care provision, and retail health services.

•   Enhanced understanding of patient needs. More emphasis on solving customer and consumer “jobs-to-be-done” (Jobs) in health and healthcare. Consumers’ three Jobs are (1) fix me when I’m broken, (2) sustain my health, and (3) enhance my health.

•   Repositioning of incumbents. Massive repositioning by established health companies to accommodate market demands for full-risk contracting, outcome accountability, and holistic health and healthcare services.

•   Decentralized service delivery. Transformation of healthcare services to accommodate greater price transparency, decentralized service delivery, new technologies, and greater consumerism.

•   New levels of engagement. More engagement of consumers in health and healthcare delivery and purchasing. Turning more consumers into customers (buyers) is a necessary component of universal access to appropriate and affordable healthcare services.

•   Emphasis on health. Emergence of health and employer companies that choose to “compete on health” with emphasis on prevention, early diagnosis, health promotion, disease management, and behavioral health services.

•   A dynamic marketplace. An unleashed American innovation engine that will revolutionize American healthcare.