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Elephants, Egrets, and Healthcare Partnerships

by Brian Eastwood | October 27, 2016

Having attended my fair share of healthcare IT conferences through the years, I’ve learned to separate the signal from the noise much like scientists searching for signs of intelligent alien life. In doing so, I have learned that healthcare is innovating along two parallel paths – one driven by vendors, the other driven by providers – that rarely seem to come together.

The Connected Health Symposium, organized by the Center for Connected Health at Partners HealthCare, tries to bring these paths together, with startups standing alongside providers from one of the nation’s most prestigious healthcare organizations (HCOs).

At times, it’s an uneasy relationship. At the most recent symposium, meaningful discussions of improving quality of life and encouraging value-based care were interspersed with bland statements such as “Innovation begins by doing something” or a call for freeing patient data made by a speaker whose hospital charges patients up to $400 to obtain their records. True solutions for coordinated care and engagement shared expo hall space with a firm touting laser therapy for weight loss. Even Dr. Joseph Kvedar, Partners’ Vice President of Connected Health, admitted that the IDN’s efforts to bring pilot projects to scale have often “sputtered.”

Much of the challenge, to borrow a phrase, stems from the fact that Partners – and all the other IDNs, AMCs, and IPAs in the United States – are like elephants. Examine their constituent parts in isolation and you see, depending on your perspective, a research hospital, a critical access hospital, a rehabilitation hospital, a suburban outpatient clinic, or a surgery center.

It’s only when you zoom out and see the trunk, tail, floppy ear, thick leg, and giant tusk together that you realize that, somehow, each of those unique constituent parts belongs to the same big animal.

As the saying goes, the best way to eat an elephant is one bite at a time. Companies such as Twine Health (chronic disease care) and Iora Health (direct primary care), both of whom spoke at the Symposium, are starting to take small bites.

Sometimes, they compete, taking actual bites out of the elephants. Iora Health, having reframed care delivery around an ongoing patient-physician relationship as opposed to an individual care visit, has pulled physicians away from Partners. (Not having to use Epic is a good recruiting tool.)

In other cases, they cooperate, biting instead the gnats, grubs, and other creepy crawlies that transmit the diseases that threaten an elephant’s livelihood. These diseases, in a way, symbolize the various alternative payment models that behemoth HCOs, with only a few exceptions, have until recently been able to ignore.

It’s nearly impossible for an elephant to manage all of the proverbial pests – bundled payments, CPC+, APM, low-acuity virtual care, and a hodgepodge of ACO contracts – without some help. And that’s where egrets come in. Twine CEO John Moore (no relation to either of our own John Moores) noted that new, nimble entrants to healthcare can focus all their attention and energy on single pieces of the value-based care pie. In other words, they can take on the gnats and grubs while the elephant worries about its trunk, tail, ears, legs, and tusks – not to mention its brain, heart, and other vital organs.

For all the tension between healthcare’s incumbents and challengers, it’s important to remember that they can work together. Twine has partnered with Penn Health System and Joslin Diabetes Center; Iora works with Humana and various large employer groups. Partners, too, works with companies ranging from Evidation Health (clinical trials of digital health) to American Well (telehealth).

The key is finding an egret willing to put the time and effort into a symbiotic relationship – not one that’s just standing on your back, squawking loudly and calling attention to itself. When both egret and elephant have a shared vision and a common goal, the friendship can blossom.

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