Yes, I want to get married. But what about the prenup?

We need a new, refreshing, ethical and ultimately empowering "marriage" of healthcare and technology. And we need it now.

You can't go anywhere without hearing about the digital transformation of healthcare. And yes, I believe that in order to move from a sick care to a health assurance model, we need a fundamental reorientation of how we in the healthcare system view ourselves and our colleagues in the technology sector. We need a new, refreshing, ethical and ultimately empowering "marriage" of healthcare and technology. And we need it now.

This marriage is critical. Health assurance means a profound rethinking of how we see people. We have to shift from seeing "people as patients" to a "people as people who want to thrive without healthcare getting in the way." Much like climate change, healthcare's inequities, access and cost have become a worldwide existential crisis. 

But this rethinking will not happen unless there is a true marriage between healthcare providers, technologists, founders and executives dedicated to the concept of health assurance, using data, technologies and talent to provide individuals and populations a path to living their healthiest lives.

Healthcare will not be transformed solely by Silicon Valley entrepreneurs, artificial intelligence and extreme innovation. We've all attended conference showcases where hundreds of talented young minds offer the latest revolutionary solution or app to every imaginable problem. And yet, healthcare delivery in the United States remains confusing, piecemeal, occasionally unsafe and deeply inequitable. 

And yet — the revolution is coming. As Bill Gates and others have said, we overestimate technology in the short run and underestimate it in the long run. Within our health centers, there are insider revolutionaries ready to build transformation. And there are entrepreneurs committed to long-term creative partnerships, not just selling a new thing.

We believe the revolution of connected care is only a few years away. We will indeed see "healthcare at any address," using the tools of AI-driven data analysis to develop highly personalized screening and action plans for each individual. We believe healthcare will be called on to help people thrive in their pursuit of happiness, not wait to intervene when someone is acutely sick. We believe people will demand the ease of access and integration that they see throughout their lives as consumers. 

But this marriage clearly needs a prenuptial agreement.  After all, marriages only work when they are based on trust. For a marriage between those leading the fourth industrial revolution — drones, robotics, personalized medicine, genomics — and the traditional healthcare ecosystem, "trust trumps technology."

We are in a historic industrial cycle. Industry transformation, new business models and the digital economy will require all of us to fundamentally change our strategies, just as a successful marriage requires both partners to shed some of their previous ways of doing things. We are seeing the digital transformation of all industries, of all elements of life, indeed of work itself. Even the arts, so dependent on legacy buildings, are finding new ways to engage audiences online.

It is time to understand what's gone wrong in the relationship between Silicon Valley and traditional healthcare.

  • You do not need to "fail fast" to "learn quickly."
  • Healthcare needs system solutions, not one-off apps.
  • Trust comes first in healthcare. 
  • Equity matters. So far, too much of digital medicine has been focused on making the wealthier healthier, fitter or happier.

Now for the prenup. Each of those problems suggests an answer: 

  • Re-imagine what "integrated health" means. We call it health assurance — the focus on using high-level data analysis and digital tools to support people (not patients) to thrive. 
  • Seek creative partnerships for transformation, not vendors for one-time deals. At Jefferson Health in Philadelphia, we have a representative of Silicon Valley's General Catalyst sitting on the president's cabinet, positioned to see the full picture and offer linked solutions.
  • Ethics must be part of the design of any product — at the beginning of development, not at the end. Too often companies wait until the product is ready, and then ask marketing to make it appear trustworthy. Put people in the middle as "online meets offline."
  • Healthcare has a mission to combat the disparities caused by poverty. Social determinants and health inequities need to move to the mainstream of clinical care, payment models and medical education. The research studies are clear. People who are poor or people of color can too often be offered therapies different from those offered to wealthier individuals. We have an incredible opportunity to use the tools of AI-driven personalized medicine to reverse discrimination. It is our mandate to do that.

Despite the rocky "first dates" of Silicon Valley and traditional healthcare, COVID-19 did in fact call the question. Overwhelmingly across America, patients were supported via telehealth, as if it had been discovered only in the pandemic emergency. Technology allowing people with chronic conditions like diabetes, such as Livongo, went from luxuries to necessities and have resulted in better care at a lower cost.

So, what could go wrong? What scares us about the acceleration of the digital revolution in healthcare is that we won't get this marriage between technology and healthcare delivery right. It is our responsibility to create the restructuring of the next 100 years that will leave the world a better place.  Shame on us if there are congressional committees five years from now asking us why we didn't see the bad and ugly of what we were creating as well as the good. In other words, how do we create a consumer-driven "healthcare at any address model" that relies on responsible innovation. 

Think back to the last transformations that occurred at this scale. The industrial revolution: Suppose we had known the internal combustion engine, and its need for fuel, would imperil the planet through climate change? The agricultural revolution: Suppose we had known that the corn industry that dominates American agriculture would fuel the crisis of obesity?  

And then bring those revolutions up to date. We're already seeing the failure of responsibility. The social media revolution: Suppose we had known that Facebook was not just for seeing my grandkids virtually, but could be used to affect elections and spew hate? The e-commerce revolution: Suppose we had known that e-systems that target zip codes for marketing would create a new "redlining" and make deep poverty worse? 

We now know that technology will be infused throughout the world economy at a level never seen before. The marriage of that technology with the mission of traditional healthcare providers could be a beautiful and long-lasting one that could truly improve lives.

But this is the time, during our engagement to do the right thing, as health transforms with the digital economy. We need to make health assurance the attainable, ethical goal of the next five years of healthcare delivery. In order to do that, issues around privacy, use of genomic data, and racial, economic and gender biases need to be recognized and overcome. 

Marriages require the humans involved to constantly evolve. As online meets offline, we need to ensure that we do not forget the human in the middle. Instead, we must reimagine a new relationship of both providers and consumers, with technology, based on trust, ethics and equity.

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