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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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Section I: The American Health Care Crisis and the Emergence of Health 2.0

Health 2.0 (helth tū dŏt ō) n.

1. The defining technology of Web 2.0 (search, wiki/blogs, mash-ups, etc) applied in the health care setting
2. New concept of healthcare wherein constituents focus on healthcare value, compete based on outcomes, and provide new delivery methods that enable universal access to high quality care

I. The American HealthCare Crisis

Healthcare remains the largest, most information complex industry in United States. Despite amazing advances in diagnostic capability, alternative drug therapy, and personalized genomic medicine, the actual delivery of care is often ineffective, unsafe, and of poor quality. Frought with clinical[1], financial[2], and administrative[3] challenges, managing health and wellness has become a primary concern for the government, industry, employers, and individual Americans. The growing urgency of the broken healthcare system has only worsened with the accelerating global, political, and cultural pressures to manage health care costs and improve health care value.

These challenges arise despite the fact that Americans spend more money on healthcare than any other country. Healthcare is the largest industry in the US, consuming nearly 17% of GDP, with major and ongoing investments in technology, science, education, and delivery systems. Despite these investments, US healthcare is characterized by system wide failures, gross inefficiencies, perverse incentives, and lack of accountability for outcomes which create a confused and crippled system that fails to meet basic healthcare needs. Even more confounding, most of the information and delivery challenges found within healthcare have previously been solved, in some cases for decades, in other major industries industries.

A. What is Web 2.0?

The software and computing industry represents a telling contrast to the current challenges found within healthcare industry. This industry can also be characterized by significant technology, science, education, and delivery investments. However, in contrast with healthcare, this increasing investment in the computer industry has been met with dramatic increases in quality with equally dramatic decreases in costs. Each of us has experienced this personally when purchasing personal computers over the years as the computing power and memory has exponentially increased while the cost has exponentially decreased, with a concomitant persistent rise in consumer value.

The internet experience represents a microcosm of the overall technology impact of last 25 years. The pervasive adoption of the internet, including the ability to remove geographic, time, and efficiency constraints on the flow of information, initiated major cultural, social, and political changes in most industries beginning in the mid 1990’s. Internet investment and subsequent innovation led to a well documented technology “hype cycle[4]. The initial phase of the cycle began with the IPO of Netscape in 1996 and continued for an unprecedented 6 year period of irrational exuberance and speculation which ended in 2002 with the IPO of Loudcloud. The subsequent “bursting of the bubble”, led to a technical shakedown and dramatic loss of valuation due to white hot over-speculation.

However, emerging from the internet “crash” was a plethora of companies that not only survived, but were thriving by introducing new combinations of technologies, products, and services while engaging consumers in new and previously unimagined ways. Many of these companies shared several characteristics and these emerging themes began to coalesce around a gravitational core of concepts. Consistent with the Hype Cycle predictive model, these companies found new ways to deliver on the promises of their predecessors in highly innovative ways. Far from a flash-in-the-pan flameout, the internet bubble had served as a refiner’s fire for creating the next generation internet renaissance, appropriately dubbed “Web 2.0”.

The authoritative description of this phenomenon, “What is Web 2.0”, was authored by Tim O’Reilly in December 2005. While a singular definition remains elusive, and may be impractical, the 20-page white paper accurately describes the core principles and representative companies putting these concepts into practice. Importantly, O’Reilly also identifies Web 2.0 as more than technology, but also a social, cultural, and even political phenomena. Thus the movement is described by inclusive phraseology such as “collective intelligence”, “user generated content”, and the “architecture of participation”.

B. Health Care Hype Cycle

Healthcare has experienced a similar hype cycle during nearly the same time period. Beginning in the mid 1990’s, the healthcare industry responded to rising healthcare costs by creating manage care organizations which engendered a culture of denial, cost shifting, perverse incentives, and diminished value for patients. The fallout from HillaryCare and the ongoing unrest created a backlash for health maintenance organization and the return of double digit healthcare inflation. The prosperity of the bubble eased some of this burden, but the crash reawakened an awareness of just how much trouble our healthcare system was actually in. This has been played out with awareness about cost/quality issues, global competitiveness issues, and the political intensity of this topic in the upcoming elections.

The healthcare crisis is no longer something that can be ignored. The current challenges are being met with increased investment, increased participation by influential corporate entities, increased engagement by some of brightest and most capable entrepreneurs, and increased creativity from current players in the healthcare constellation. Multiple regional and national experiments have been successfully conducted, major state-wide reform initiatives have been passed, and new technologies are constantly introduced to tackle the largest healthcare problems facing our country. From this mileu of innovation, several new themes have begun to emerge. In fact, several new (and old) concepts about how to deliver high quality health care have created a gravitational core of ideas around increasing healthcare value.

The purpose and intent of this paper is to discuss the principles of the reform movement in which enabling technologies can redefine the American healthcare experience.

[1] Commonly cited clinical evidence of system failure include: only 50% EBM are adopted, US has poor outcomes despite most expenditure, 100,000 patients annually die from preventable medical errors, etc.

[2] Commonly cited financial evidence for system failure include: spiraling costs, premiums rising, 3rd party payer system leaves 45M uninusured, etc.

[3] Commonly cited administrative evidence of system failure include: Up to 33% of healthcare costs is due to administrative overhead; 50% of persons feel an adversarial relationship with their health plan, bureaucracy, culture of denial)

[4] Hype Cycle was originally defined by Gartner Consulting and includes 5 stages.

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