BLUF – in October, Circulo acquired my little company, Huddle Health. We are now fully integrated into Circulo – and it’s time to describe the rationale for our convergence and some of what comes next.
If you haven’t read my short essay on Primary Health, please go read that first. We’ll wait.
Ok … back? Great. Now, let’s resume the story.
Years ago, I was on the faculty at Albany Medical College. We had a course called Health, Care & Society wherein students were challenged to learn and think about ethical issues, health policy principles and engaged in conversations on the role of medical providers in our communities. It was a “soft” class that many students seemed to feel was peripheral to what they would do as physicians. They didn’t take the course as seriously as biochemistry, pharmacology, or anatomy.
And this is a symptom of our problem.
Physicians are taught medicine – not health. This is why it’s called medical school and not health school. Our training prepares us well to diagnose problems, respond to those in need, order testing and treatments, prescribe medications and other therapeutics. Notice that much of what we are doing is reactive – focused on managing illness rather than optimizing health.
Over the last few decades, we’ve marketed medical services as the center of our communities’ health lives. But medical services are not the center of any community – and with good reason. As Clay Christensen expresses, our people, products, and processes weren’t designed to optimize health. Rather – they were designed to optimize care (and the revenue that care creates).
This is hard for many of us to really understand. “You mean my doctor wants me to be unhealthy?” Well – no – of course not. We hope. Some consider Fee-for-service to be evil. I won’t go that far. Let’s stick with “misaligned incentives.”
Why does this happen? More volume = more revenue. Incentives generally aren’t aligned.
But there is hope, Luke Sykwalker. As more medical service providers have migrated to value-based payment, interest in health (rather than just care) has grown.
This is good! But it’s just one step on a long path.
Over a decade ago, Eric Dishman described the “shift left” as a way to “get more people on the end of the health continuum with lower levels of chronic disease, lower levels of functional impairment, lower costs of health care, and a higher quality of life.”
His focus was the self-evident migration away from the hospital and toward the home as a focal point for health, but allowing for other service locations and other kinds of services along the continuum. Rather than waiting for problems to worsen enough to merit a trip to the medical office or hospital, Eric argued that the shift left would also enable us to prevent problems – reducing both cost and suffering.
And this is the shift we are ready to make. As William Gibson offered, “The Future is here – it’s just not evenly distributed.” Let’s consider a few examples of the future:
- Iora Health started 10 years ago and developed an extraordinary model of person-centered care. Iora’s visionary leader, Rushika Fernandopulle, led the company through a series of saltatory phases of growth and discovery.
- ChenMed was built on the foundation of a small practice in Miami and has grown to serve thousands of members in the southeast and mid-Atlantic markets.
- Oak Street Health launched in Chicago and focused on value-based person-centered primary care for Medicare Members.
- VillageMD empowers primary care practitioners to participate in value-based payment arrangements.
- Aledade has built a broad network of independent and medium-sized primary care practices that share analytics infrastructure, processes, and other resources to optimize care experience, quality, and cost.
Each of these companies is taking a different approach, and while one might view them as competitors, we see them as co-travelers – bushwhacking through the forest of fee-for-service in search of a better model.
Most medical providers haven’t let go of fee-for-service, in part because they don’t have the opportunity. These companies (and a handful of others) have forged a way to the future. Yes – they compete a bit with each other, but as a group, they demonstrate to the majority of others a better way.
Huddle Health was created to learn from our predecessors, question the healthcare industry’s assumptions (who/why/how problems are solved), and work hard to meet the needs of the people we serve. Especially members of underserved communities – Medicaid Members and the uninsured. Learning from time that several of us spent at Alliance for Better Health – we knew that we need to focus on social determinants of health as a key element of our work – not just bolted-on as an adjunct or afterthought – but at the core of our work. What we had was a great team and a great model. There is a better way.
Circulo was created to express two guiding principles: first, information technology in general and automation, in particular, is an essential component of the future we seek to create. Things that weren’t possible in the days of paper are possible now. Yet, much of the technical infrastructure created has remained focused on maximizing efficiency and, therefore, the volume of care rather than optimizing health. Therefore, we have demonstrated that technology and automation could change things, but so far, we’ve aimed them at the wrong targets. Second, the needs of Medicaid members and the uninsured have not been well addressed. We can/must/will do better. We need to reinvent Medicaid. There is a better way.
See a theme? Me too.
Our shared sense of urgency, our impatience to make things better, and rejection of the status quo are the ties that bound Huddle Health to Circulo.
We are now one team – committed to making the world a better place as Circulo Health.
Stay tuned for the next post – how we will do this!