It’s not too early to think about what trends and themes made the most headway in 2019, a year of intense change in health care. Through very unscientific analyses, I’d venture that “social determinants of health” (or SDOH) will win the “buzziest” buzzword this year.
But “ecosystems” is gaining steam, and it’s my odds-on favorite for 2020.
"If 'SDOH' is the buzzword to encapsulate the need to recognize players outside the four walls of our organizations that also serve patients and our communities, then 'ecosystem' is how we systematically integrate these stakeholders into how we innovate at scale."
The concept of an ecosystem strategy was popularized as technology and digital platforms came of age, allowing for various actors to exchange, produce and consume data. Similar to a biological ecosystem, a data ecosystem is a living, evolving collection of processes and applications used to capture, integrate, analyze and share data within organizations and also between organizations, individuals and other stakeholders. An ecosystem strategy recognizes that to plan and accurately predict future customer behavior, we need to look beyond our organization’s limited interactions with the end user. Most importantly, we need to understand the relationships between all the interactions that comprise the workflow and/or lifestyle of those we intend to serve.
If “SDOH” is the buzzword to encapsulate the need to recognize players outside the four walls of our organizations that also serve patients and our communities, then “ecosystem” is how we systematically integrate these stakeholders into how we innovate at scale. Health care organizations are starting to adopt this concept as a way of broadening the application of ecosystem strategy beyond data use cases, enabling all manner of innovation.
Ecosystem strategy and health care disruptors
Despite all the attention on potential disruptors this past year, digital health startups fail at a rate worse than those in other fields. Reasons include the difficulties selling directly to a majority of consumers who look unfavorably on out-of-pocket health care spending; an inability to integrate technology into clinical workflow; and longer, more complex sales cycles. Additionally, the Silicon Valley mantra to “move fast and break things” doesn’t necessarily translate to health care, where patient lives are at stake.
Thus, the growing trend in health care startups — exacerbated by the fact that so many are digital platforms — is to account for the broader ecosystem, i.e., that many factors contribute to a particular end point or goal. So in addition to building the most user-friendly app or technologically advanced analytics platform, entrepreneurs are broadening their business models to include the service elements that complement their software solution as an example to better support the provision of care. This includes starting to address the needs of all users, including clinicians and staff.
"The best innovators have figured out that developing the most innovative idea is only as effective as our ability to understand how and if the end user will actually use it."
This approach allows for a technological innovation to integrate more seamlessly into workflow. It better enables consumer behavior change by interweaving an intervention into the ambient technology and existing lifestyle for our patients, clinicians and administrators. In sum, the best innovators have figured out that developing the most innovative idea is only as effective as our ability to understand how and if the end user will actually use it.
Knowing your role
Instead of focusing solely on how a product or intervention could improve health, an ecosystem approach requires understanding each individual’s or organization’s role as part of a larger symphony of stakeholders. Then, an ecosystem leader or leaders must convince all stakeholders to play from the same sheet music.
An ecosystem approach to transformation differs from traditional innovation initiatives mainly because it requires a longitudinal view of lifestyle, workflow and the determinants of health and well-being. Inherent to this approach is the ability to articulate individual and shared values for each stakeholder, most importantly the end user — in this case, the patient.
Similarly, the concept of health care innovation ecosystems goes far beyond the technology or digital startup space. As health systems tackle population health and community well-being, the idea that they can do it alone — even as anchor institutions — has fallen out of favor compared to the approach of collaborating with other stakeholders that influence the overall environment and entire journey toward health.
We’ve seen extraordinary examples in that vein. In Charlotte, N.C., Atrium Health and Novant Health are partnering with local government, commercial insurers and community-based organizations to reduce barriers to health and care in underserved neighborhoods. In Missouri, the “500 in 5” affordable housing project (part of the AHA’s Hospital Community Cooperative program), links Truman Medical Center and multiple local stakeholders — including affordable housing developer Vecino Group and the Kansas City Public Health Department — to create permanent supportive housing solutions for high-need patients, part of a strategy to support better mental and physical health. All of these initiatives rest on the notion that care delivery influences only 20% of a person’s health, whereas the physical environment, socioeconomic factors and lifestyle behaviors affect the lion’s share.
Magic occurs when providers, purchasers and payers, the public sector, communities and entrepreneurs collaborate toward a shared purpose while playing complementary, but independent, roles in improving health. Thus, perhaps a jazz band is a better metaphor than a symphony. In other words, to be successful, a health care ecosystem must facilitate shared purpose, vision and values, while still allowing for individual creativity and innovation to drive transformation.
Andy Shin is chief operating officer for the AHA Center for Health Innovation.