How Do You Bridge the Now and the New?

Every CIO, whether in healthcare or not, is confronted with the dilemma of how to balance the now with the new. Whether it is EMR deployment, improving cash flow or plugging holes in the HIT system, the problem is the same: finding the right balance between operational improvement and innovation.

The problem is immediate since we are seeing attempts to rapidly change the healthcare business model from fee for service to bundled payment, with the announced goal of Medicare making 50% of its payments to doctors and hospitals on the basis of the quality of care they provide, rather than the quantity, by the end of 2018. Hitting that goal would mark a big change in a program that paid providers $362 billion for their services in 2014.

So how does Sickcare USA Inc. bridge that gap? Most docs in private practice are having a hard enough time keeping their heads above water complying with payment and IT regs. Biomedical and digital health entrepreneurs have one eye on fee for service to keep the profits flowing while at the same time have another eye on bundled payments as the model of the future with the need to drive down costs.

Most Chief Medical Information Officers and CIOs spend 99% of their time working on operational efficiency. At the same time, the CEOs are charged with seeing around corners and creating a strategy to bridge the gaps. Unless they are on the same page with clear marching orders, budgets, and sponsorship, things move slowly into the future.

Many times, operational improvement is confused with innovation. Planning groups, subcommittees and retreats are assembled to produce a "blueprint" for the future. In fact, the C-suite does not walk the talk, the result winds up on the shelf, there is incremental improvement through tinkering and everyone calls it “innovation.” They just declare victory and go home.

Healthcare sorely needs new business models. However, implementing them will be a painful process for all the stakeholders. After all, the now is a whole lot more comfortable than the fear of the new. Machiavelli knew it when he wrote (“The Prince”):

“And let it be noted that there is no more delicate matter to take in hand, nor more dangerous to conduct, nor more doubtful in its success, than to set up as a leader in the introduction of changes. For he who innovates will have for his enemies all those who are well off under the existing order of things, and only the lukewarm supporters in those who might be better off under the new. This lukewarm temper arises partly from the fear of adversaries who have the laws on their side and partly from the incredulity of mankind, who will never admit the merit of anything new, until they have seen it proved by the event.”

You know it too.