Health Care Is a Terrible Business. The Good News? Great New Startup Ideas Abound

Covid-19 has refocused much of the world’s attention on the critical importance of health care across the globe. We’ve seen great strides forward in the development of vaccines, while also witnessing in horror how fragile the health care system can be when stressed. Yet, all of this is just a glimpse into what may be the inevitable future of health care for a dramatically aging world population if we do not fundamentally change the way in which we manage and deliver health care. 

Consider that by 2060, the U.S. will be spending as much on health care for those over 65 as it is for all of health care today. 

This is also one of the main reasons the percentage of GDP dedicated to health care in the U.S. is roughly equivalent to the last two digits of the year we are in. In 2020, it’s about 20 percent, by 2060 it will be about 60 percent. A third-grader can predict where that trajectory leads. 

And all of this doesn’t factor in the dire need for health care to 4 billion people who still do not have access to essential health services, according to the World Health Organization.  

Simply put, health care as it stands today is an unsustainable system.  

Which is why health care may well represent the single greatest set of opportunities to not only create new businesses and innovations, but more importantly to change the world in a way that has lasting consequences for billions of people.  

If you’re thinking that this doesn’t apply to you because you are not a health care professional, think again. The greatest opportunities are not in the medical side of health care, such as diagnostics, therapies, and pharmaceuticals, but in reengineering the most dysfunctional aspect of the health care system, its administration. Here are just four opportunities to do that, which I talk about in my book, Reimagining Healthcare: How the Smartsourcing Revolution Will Drive the Future of Healthcare and Refocus It on What Matters Most, the Patient (Post Hill Press, 2020). 

While the number of physicians in the U.S. has barely increased since 1970, the number of administrators has grown by more than 2,700 percent. Health care is and will become increasingly more complex. The problem is that much of the administrative burden falls on the clinicians. A typical primary care doctor in the U.S. spends at least 50 percent of their time with administrative activities that relate to billing and patient management. 

Yet, having a primary care physician can lower a patient’s health care costs by 30 percent. That’s a savings of $67 billion in the U.S. yearly if everyone had a primary care physician. Since we can’t graduate enough new physicians to make up for the coming deficit created by an aging population, we need to find ways for physicians to spend more time with the patient.   

Hospitals and clinicians should not be in the business of administration. So, who will take on that burden? Smart startups that are what I call health care services providers or HSPs. HSPs are private companies that use knowledge gleaned across hundreds of health care providers and insurers to run areas such as claims processing, billing, scheduling, and medical coding. All of these fall under the rather obscure area in health care called revenue cycle management, known by its initials RCM. No, it’s not sexy, but it’s a space where dozens of new startups are appearing to take on the task of streamline RCM.  

Prediction: Within the next five to 10 years, every health care provider will be out of the business of administration, and by 2030 a $500 billion industry for HSPs will have emerged. 

An aging global population demands greater access to analytical data and predictive technologies to deal with a more complex set of health care issues. The average U.S. patient over 65 has had interactions with more than 28 separate physicians during their lifetime.  The problem is not the number of doctors but rather the absurdly disconnected nature of their health records. No single entity, including the patient, has immediate access, if any, to all of the records that make up their lifetime health care record. 

This results in what I call the episodic care conundrum. With half of all health care visits in the U.S. to emergency rooms and the increasing number of specialists required to treat an aging population, clinicians are forced to make decisions that have immediate and severe impact without the appropriate context of knowledge about the patient. While that may work for an 18-year-old, it certainly does not work in the case of a 70-year-old with several conditions and a medicine cabinet filled with prescriptions. 

The answer is not a government-owned health record but rather a patient-owned health record that is as accessible and as permanent as a bank account. This is where the largest sea-change may be occurring.  

Here’s the opportunity: Patient records are now being created outside of the purview of the health care provider. There is likely to be more information on your iPhone about your health habits, history, medications, and biometrics, such as heart rate, blood pressure, and sleep patterns, than in your medical record. Within the next five to 10 years, the overwhelming repository of data about your health will be data that are managed by third party apps and devices. 

Prediction/Opportunity: By 2030, the overwhelming majority of data that contribute to your health care will be captured, stored, and, yes, managed by companies that are startups today. 

Patients need advocacy to navigate the health care system. This is one area where technology can have a significant impact in several ways. The integration of a universal health care record along with wearables and sensors that monitor vital signs and adherence to medications and therapies and that constantly provide health metrics to both providers and family can significantly increase the ability to understand risk factors and predict health care needs. But you still need someone to act as the patient’s advocate when they can’t do it for themselves. Many startups are already creating AI-enabled bots that will one day be able to gather all of this information and act as the interface between the patient and the health care provider to maintain continuity of care that takes into account the entirety of a patient’s history and current condition. 

Prediction/Opportunity: The creation of bots that can gather, track, analyze, and deliver health care information about a patient to health care providers when the patient can’t will be standard practice within the next 15 years.  

One of the most profound shifts in health care is the emergence of what I call the hospital in the cloud. Think of this as a personalized set of health care services that are built to suit each patient anywhere, anytime–a sort of portable hospital for one. The hospital in the cloud isn’t just about taking advantage of leading-edge tech, such as virtual health and robotic surgery. It’s more about building personalized health care awareness that can both identify risk factors and quickly deliver therapies to head off disease and illness. It combines public health and personal health in a way that makes world-class diagnostics and delivery of health care as easy in a remote part of the world as it is in downtown Boston.  

Even in the U.S., where you would think access to health care is readily available, 100 hospitals per year merge into larger health care systems. At the same time, 30 hospitals shutter their doors yearly. With only those dynamics at play, it’s hard to see how the notion of a free-standing hospital will survive beyond the next decade.  

Instead of consolidation, imagine a health care system in which the basic building blocks of a hospital are virtualized and available in the cloud. In this future, everything that today causes friction and distraction, for both the patient and the provider, is reduced dramatically or entirely eliminated.  

Prediction/Opportunity: Build personalized services that patients can use regardless of location to reduce the number of and reliance on in-office visits.