Most of the vital healthcare information technology (HCIT) companies that power the $3.5 trillion U.S. healthcare system are not household names: EPIC, Athena, NextGen and even IBM Watson Health. None of these companies, on a revenue basis, amount to even 5% of the size of the big five tech companies or, even when consistently profitable, garner similar valuations.
Rarely do any of the established HCIT companies, the ones that best understand the intricacies of the healthcare system, get acquired by the largest technology companies. This is due in part to growth rates that are slower than those of Silicon Valley leaders. It’s also due to concerns about getting tangled up with sensitive data.
By contrast, early stage companies in healthcare that are small enough to put up impressive growth numbers regularly get gobbled up by both the tech giants and the healthcare incumbents.
The current landscape has very large tech companies who regularly talk about the importance of healthcare but barely play in the industry. The most overused cliché is the concept that the “data” these organizations hold is the most valuable asset in the world. However, high IQs and capital alone do not produce an understanding of the healthcare system.
The “grand” problem of healthcare is this: How can we achieve the greatest healthcare value—for a person or population—by getting the highest health status at the lowest total input cost?
The size of big technology companies like Google, Apple or IBM offers no inherent uniqueness to solve this problem. They may be slightly advantaged because they are large employers and have the perspective of paying large amounts to insure their employees. They face the same impediments and reality barriers that all companies face in terms of data privacy and security issues.
And they encounter the same difficulty everyone has when trying to understand how the healthcare system works today or how to understand the inertial forces that must be disrupted to promote meaningful change. The pace of change in applying information technology to healthcare has long been criticized as exceedingly slow. This perceived slowness is a direct result of just how complicated, intertwined and vast the industry is.
Unimaginable Scale
Not long ago, Amazon, J. P. Morgan, and Berkshire Hathaway announced a new collaborative health venture called Haven that quickly disbanded. The reality is that even when you put the roughly 1.5 million employees and the healthcare spend of these three corporations together, they would represent but a small commercial health plan.
Compare healthcare to self-driving cars. For all the data required to maneuver a car in the dynamic environment of mixed modes of transportation—other vehicles, pedestrians, bicyclists, and so on—not only does the driverless car benefit from traffic that moves in a two-dimensional plane, but there is nowhere near the number of variables when compared with any given healthcare encounter.
To put it simply, solving the problems of healthcare are infinitely more complicated than making a car not run into things.
The Click Problem
Silicon Valley companies have experienced a great deal of success in getting information in front of people through advertising, causing them to click and buy things. Yet there couldn’t be more of a double-edged sword than putting resources in front of people related to their health that are not helpful. Just as those in clinical care can cost the system a lot of money by providing unnecessary procedures or medication, putting resources in front of consumers that are not evidence based and are not appropriate for improving health status can be just as harmful.
The good news is that Silicon Valley is far better positioned to assist with problem solving in the larger vision of optimizing people’s health along the lines of daily living than it is in aiding data use for treating clinical issues.
Why? Because it already possesses far more data about where and how we live than what happens at our pharmacist or doctor’s office. But Silicon Valley has shown scant interest in improving the health of the total population.
In the past Microsoft, Apple, Google, Oracle, and others have focused nearly all their attention on bringing new or applying existing technology toward electronic health records or clinical monitoring and interventions.
Since the information placed in such records by clinical providers or produced by sensors largely fails to connect to the benefit plans or social determinants of consumers, this data is usually irrelevant to consumers. Hence, Silicon Valley’s attempts to help have had very little economic or health benefit for the consumer.
If consumers can’t benefit from integrated data from both clinical providers and daily living to inform their actions, then it’s just binary information stored in electronic files.
Artificial intelligence is limited by human intelligence.
For all the very real brilliance of superbly talented data scientists and software engineers, they don’t possess the background knowledge of how the healthcare system works. Why would they? Learning the intricacies of the healthcare system will take even very smart people many years of focused study and traditional experience.
As I mentioned, Silicon Valley tends not to absorb or integrate with the scaled HCIT companies. As a result, these highly capitalized, highly talented corporations have no real advantage for solving the affordability or access problems in healthcare.
How Can Silicon Valley Help?
Silicon Valley can help by asking data scientists to develop evidence bases for how daily living correlates to health. We need data analysis capable of recognizing what resources are available to individuals based on their benefit plans and social determinants and how best each individual can take actions to improve their total health and well-being. This clearly requires data well beyond what is currently gathered in clinical settings.
Companies with technological expertise will have to form partnerships with those who possess healthcare expertise and then adopt a holistic vision of the healthcare system. That will mean going well beyond employing doctors, which is currently how they tend to initiate massive investments in healthcare IT. Doctors understand how data can be applied for the diagnosis and treatment of patients, and some can extrapolate data for treating a population, but there are many other aspects of the larger healthcare system in which they lack expertise.
I am calling for partnerships between Silicon Valley and the healthcare industry to improve people’s total health. Doing so can extend healthier and more fulfilling lives. And it can be done while still turning a tidy profit.
