Hack:
Healthcare Reform – the Purpose Innovation© Way…..

With that said, the sustainable long term question that needs to be solved within the health care reform context (especially when we add those 32 million uninsured people) is – which solution option? – distributed, integrated or virtually integrated solution options.

As part of this right framing, we have also identified the key pros and cons of these three solutions options, and let the "pros and cons", themselves decide the right solution option.

1. Under the distributed model (by and large the current model in US and most developed countries), hospitals are motivated to keep patients for longer - whereas the insurers are motivated to minimize reimbursement; thus creating conflict of interests – which means, any process improvement solution done on one end (provider side or insurer side) is not sustainable as it lacks a systemic view. In some cases, process optimizations, done in one side of the health care value chain, to save money or improve performance, invariably might have a detrimental impact on another side of the value chain, because the system lacks an end-to-end systemic perspective. The classic example, is privately managed private hospital providers, like hotels are motivated to fill their beds (or increase their room occupancy) whereas independent insurers are motivated to minimize reimbursement charges; thus creating the conflict of interest.
2. Under the Integrated model, (as proposed by Prof. Christensen), providers and insurers will come under one roof (perhaps as one firm) and so, provider’s action to reduce costs will also help the insurer side, as the conflict of interest, no longer exists as they are all part of the same organization. Increased room occupancy, a primary motivation for increasing the revenue in the distributed model, may not be a revenue opportunity under this model, and hence, conflict of interest, is greatly reduced, resulting in a better solution. On the flip side - while it provides a superior strategic/systemic solution, it might also introduce some structural challenges, in terms of making the health care value chain much more complex and bigger, potentially leading up to a monopolistic market model, as opposed to the free market driving the long term solution. In other words, a superior strategic solution, without a solid free market structure, sometimes, may not get the support from the business world!
3. As a middle ground solution, we propose the Purpose Innovation enabled virtual model, wherein, providers, insurers and consumers alike, are motivated to come together under a virtual roof, that is bounded together by a powerful “Purpose score based, virtual PurposeCare© platform”, that inherently motivates the parties to reduce the cost (with incentives to reduce their conflict of interest & malpractices), resulting in a “collaborative health care value chain” providing win: win value proposition for all, as outlined in the picture below. In other words - stronger their purpose causal chain (e.g. H&W consumers with a history of consuming/applying H&W P&S’s, leading a healthy lifestyle in body-soul-spirit dimensions), higher will be their purpose scores (and lesser their risk profile), and hence, resulting in increased number of uninsured being accepted by the insurers with lower premiums, facilitating a quick treatment turnaround time(as healthy consumers, in general, respond to treatments faster, with less expensive medicines & do-it-yourself and commoditized/shop floor type procedures), thus increasing the profit margins of all parties involved. It is also important to highlight yet another point here - that the spiritual dimension of "body-soul-spirit" has been consciously incorporated into the purpose causal chain, as health & wellness, in our opinion, also has a spiritual component, as history has proven again and again, that spiritual minded people (regardless of their religious denomination background), lead a healthy life style and have a better resilient power to recover quickly from health issues. On the down side - although, this solution is a sound systemic solution like option #2, (yet does not have as much of structural challenges like option #2), it still needs, some revamp of the health care value chain, as it needs lot more collaboration mindset among all parties (without much of direct control) - potentially resulting in a model, where we might need regulators policing the governance and purpose scores.

By looking at the "pros and cons" of these three options - options #2 and #3, in our opinion, deserve some additional exploration. Having said that, by no means, we are suggesting that any of these options, will totally replace the current solution(s) in totality – rather, we suggest that our solution, among many of the other experimentation solution options, has a great potential to compliment the current solution options, that are being considered by the experts from Washington. In other words, our solution is an experimentation option – with a potential to become the stepping stone, for the long ranging solution(s) within the 5-10 year health care reform road map.