“Alea iacta est,” said Caesar when he crossed the Rubicon marched on Rome to attempt to seize the mantle of emperor. That is to say, “The die is cast” and there is no way back. On the first day of SXSW Interactive, I heard from several folks working to transform the healthcare industry about how they see the path to success in driving transformative change – a panel called “To build in health, follow the $, not the patient.” The healthcare industry faces a broad array of challenges to any change, including:
- A massive and interconnected network of organizations, all of whom have a stake in decisions
- Heavy regulation
- The need to maintain quality treatment for patients as change is happening. You can’t “move fast and break things” when it’s real people whose healthcare is being broken.
In the face of large obstacles, it’s a common instinct when trying to sell in a new plan, program or institutional transformation to begin with a pilot program. If your client or your senior leadership is reluctant to commit, try a pilot first to demonstrate proof of concept. It’s the startup way – create, iterate and scale.
Yet Matt Klitus, the CFO of MassHealth, Massachusetts’ Medicaid and CHIP program, an enormous institutional health provider in a highly regulated industry, rejected that idea.
“Really innovative systems are hard to pilot,” he said. “Sometimes you have to burn your ships.”
For example, healthcare is trying to move from a fee for service model, where payment is based on what treatments doctors provide, to a data based model where payment depends on what the eventual patient outcomes are – to improve efficiency by focusing on what matters. But healthcare payers like Medicaid or insurance companies can’t just move 10 or 20 percent of their patients into a totally different payment scheme as a pilot. The hospitals have to be on board, the doctors have to be on board for it to work, and asking them to shift their system for just a few patients to test results is doomed to failure.
So to really create transformative change in the system, healthcare payers have to burn their ships. They have to commit to a new payment model and insist that it’s the only model that they’ll use. Otherwise the internal considerations of everyone else in the system will drag it down. Of course, healthcare is also full of lots of creative pilots of new technologies for connecting patients with doctors and enabling treatments in new ways. So pilots aren’t wrong – they’re just sometimes the wrong choice when a transformative change is needed.
Similarly, companies looking to change their cultures – whether as part of a merger, as a result of new leadership, or a new set of goals – must decide if they are going to try working around the edges first or whether the change is so transformative that you have to commit if you’re going to succeed.
In these cases and others, you can’t fail early and fail often – you’re going to succeed or fail as a whole. It’s scarier and riskier, but sometimes it’s the necessary approach.
Where have you seen incremental change get lost in the system where transformative change might last?
Public domain image from https://www.flickr.com/photos/randnotizenorg/32000502742/.