Health Reform Happening

Understanding innovation momentum in an environment of discontinuity, complexity, and high uncertainty



Competent Health Reform is a powerful resource for describing the recent progress in best practice innovations that will transform healthcare from pre-industrial practice to a future industrial vision. There has been a rapid increase in the medical profession of such best practice innovations as Electronic Health Record (EHR), Integrated Practice Unit (IPU), big data analytics, and value-based payment.


The United States is justly proud of “our best in world” science-based health system. We are home to a significant share of major medical discoveries that have enabled remarkable recovery from serious illnesses. This science-based health system is the Silicon Valley of medical science. However, in the midst of awe-inspiring medical discovery, there is the blackness of the badly broken delivery of healthcare. The broken health system experiences low cost-effectiveness and harms the health of millions of patients, even in the well-insured population every year. How could this be?


The American health system is a closed culture. It has its own language, values and customs that are counterproductive. Essentially, the medical system has been an echo chamber of autonomous provider culture in contrast to an organizational team-based culture that is considered best practice in the industry. Princeton Professor Paul Starr, a Pulitzer Prize winner, described this culture as a root cause of the broken health system in, The Social Transformation of American Medicine: The Rise Of A Sovereign Profession And The Making of A Vast Industry (Basic Books, 1982). Profess Starr noted that since 1920 the culture and practice of health care has centered on the individual physician as an autonomous resource in the care of patients. 

"Hospitals, public health, and medical practice were only partially integrated; no powerful coordinating authority was permitted to emerge because it would have threatened professional autonomy and control of the market." 


Now, in the 21st century, exemplary healthcare organizations are making remarkable progress on innovations that reject the historical physician-centered and move toward a patient-centered delivery in the American health system.


As recently as 2018 there has been a major increase in non-governmental initiatives that are changing the way health care is delivered. Progress includes employer alliances with providers and insurance companies, big technology company innovation fusion power, and the move from fee-for-service volume-based payment to value-based alternative payment models calculated by patient outcomes/cost. The new wave of non-traditional alliances, such as direct employer to provider care plans, is an illustration of the changing structure of healthcare and the move away from a physician-centered autonomous practice.


Big changes are happening rapidly creating a new environment of discontinuity in which health stakeholders must adapt and invest. 


For more information on the innovations now transforming the United States health system and my strategies for investing in an era of discontinuity, complexity, and high uncertainty please contact me at or (617) 620-5990.