5 Potent Predictions Shaping Healthcare Strategy ft. Chris Bevolo, Parts 1 and 2

Chris Bevolo (00:00):
So here are the five predictions. Number one Copernican Consumer. Consumers will become the center of their own health universe more than ever before, enabled by sensors, AI and other technology, as well as services geared toward empowering them. Number two, constricted consumerism, while consumers will become increasingly responsible for their own health and use of healthcare services, they will actually become less and less empowered in the choices they have for care, especially in higher acuity, higher cost situations.

Speaker 2 (00:28):
Hello Healthcare. You were just hearing from Chris Bevolo, the Chief Brand Officer at Revive, and also the author of Joe Public Doesn’t Care About Your Hospital. Chris was discussing his new book, Joe Public, 2030, where he and leaders from Geisinger, Intermountain Health, CVS, John’s Hopkins Medicine, and many others got together and discussed what the next 10 years of healthcare strategy are going to look like. We sat down with the forum for healthcare strategists to discuss this book and his predictions. Here’s what’s coming up next in that conversation. First, we’re going to focus on his team 2030 and how they generated these predictions and validated them. Then we’re going to go deep into what those predictions actually are. And with that, I hope you enjoy that conversation. And I’m going to hand it over to Chris.

Chris Hemphill (01:17):
Consumer experiences. Major disruptors in AI tech are shaping healthcare for years to come. On Hello Healthcare we dive deep on these issues with leaders who are driving change. I’m Chris Hemphill, VP of Applied AI at Actium Health, and we hope that these stories will help you to create or demand better future in healthcare.

Chris Bevolo (01:40):
Chris, thank you for this setup. We’re going to try to get through this upfront part as quickly as possible. I think as Chris mentioned, it is really important that you get a chance to understand how this was developed, why it was developed, because that aligns validity to, I think the things you’re going to hear and also I think will allow us to have a better, more thorough conversation. So real quickly, where do this come from is the 10 year anniversary. And as we approached 2021, we thought, what are we going to do with the 10 year anniversary of that first book? We’ve had a couple come out in the series since then. And we thought, heck, it’s been 10 years. Why don’t we do a 180 look forward 10 years and see what we can find. We took about three months to develop these predictions. We really started with a blank slate.

Chris Bevolo (02:23):
We did not set out to prove any hypotheses necessarily. And there’s one prediction in particular that I can talk to you that I think proves that point. We picked team, we called them team 2030 from Revive. So this was a intentionally diverse team in terms of age, experience, gender, race, you name it. We tried to create a really nice collective of folks to think as thinkers and futurists. We poured everything we knew and everything we could find onto a table. It was during COVID. So that table happened to be Mural. If you’re familiar with Mural, if you saw a picture of our Mural board it’s kind of nuts, all the different things that were on there. But we just really wanted to get everything out that we could think of related to everything from the marketing of hospitals and health systems, all the way up through the industry, to even societal trends.

Chris Bevolo (03:12):
I’m going to talk about some of the resources that we leverage, but the book ends up having more than 260 citations in it. So you can get a feel for how many different things we brought to bear to really support the thinking here. The other thing that’s important to note and to give credit to is Rohit Bhargava. If you’re not familiar with him, he runs a company that puts out predictions in terms of business and society pretty much every year. In 2020, I think it was his last book, Not Obvious Megatrends. He actually shared the process that his team goes through to look at predictions, to start as widely as possible, and then call those down. He calls it the haystack method. So we adopted that and we used that Team 2030, used that to really figure out how do we sort through the thousand one things that were in front of us to get to the point that you’re going to hear about today?

Chris Bevolo (04:01):
I think one of the coolest things about this is we had a chance not only to leverage the super smart people in our agency, but we talked to 22 industry leaders from across healthcare. So for example, we had the privilege of talking to the CEO of Geisinger, the CEO of Henry Ford Health System. We talked to the head of health investments at Bank Capital. We talked to the head of brand at CVS Health. We talked to some really smart people and their input and their feedback had a lot to do in shaping the predictions you’re going to hear, as well as validating a lot of what you’re going to hear. We also provide different perspectives because not everybody agreed with where we ended up and we don’t expect all of you to agree either. That’s not really the point. The point is to drive conversation and debate.

Chris Bevolo (04:50):
But I think, again, it just lends a lot of credibility to what we’re about to say, as Chris said, this was not me. I get all the credit, because my name’s in the book. I had the privilege of working with this amazing team and talking to these amazing people to pull these ideas together. So I think that’s really important to emphasize. All right, one last thing and then we’ll get to the predictions. So you’re going to hear five, as Chris mentioned, these were the five, again, that emerged from our process. They’re built on 20 foundational trends. So for example, we didn’t set out necessarily to say what’s the future of value-based care, right? But that is a critical trend we have to understand if we want to understand the next 10 years. So we lay out those foundational trends at a very high level in the book.

Chris Bevolo (05:34):
It’s not a place to go if you want to learn everything you need to know about value-based care or AI, but we have enough back ground in there to understand how these trends will impact the predictions that you’re going to hear. It’s important to know these predictions are not meant to be comprehensive. This is not a full picture of 2030. In fact, some of these predictions may feel a little bit contradictory to each other, which makes them interesting as well to think about how they might intersect, but they really are intended to kind of stand on their own. And so again, our point was, how do we pull this forward to really drive the conversation we want to have and need to have as an industry. Some of these predictions are great. They’re going to get you excited, some are going to make you think, oh, bleep is that really what’s going to happen.

Chris Bevolo (06:21):
It’s up to us to make the future we want. And even if some of these may sound negative or problematic, we got to put that on the table. We got to have that conversation and figure out as individuals, as organizations and as an industry, where do we want to go? And the last thing I’ll say is, in each case, all of these predictions are already underway. The question isn’t really will these happen? The question is to what degree will they happen and by when?

Chris Bevolo (06:49):
So here are the five predictions. Number one, Copernican consumer. Consumers will become the center of their own health universe more than ever before. And they will buy sensors, AI and other technology, as well as services geared toward empowering them. Leading to profound implications for both consumers and healthcare organizations. Potential results could include a dramatic reduction in the need for primary care clinicians, an entirely new sector devoted to personal health management, true precision medicine combined with health management and more.

Chris Bevolo (07:18):
All right, so that’s the first one. Number two constricted consumerism. While consumers will become increasingly responsible for their own health and use of healthcare services, they will actually become less and less empowered in the choices they have for care, especially in higher acuity, higher cost situations. While many in the industry will continue to sing the praises of choice. The reality is most consumers will have far fewer choices moving forward often in ways they might never ever consider or see.

Chris Bevolo (07:46):
All right, number three, the funnel wars. Today, we tend to consider hospital and health systems as birds of the same feather in terms of business model with variances based on size, scope of services, for profit or nonprofit. Moving forward, we could see the splitting of the healthcare system model with some systems moving even further to the larger, more comprehensive health organizations, others retracting into solely acute care destinations. What one person called the giant ICU on a hill and others somewhere in the middle. These models may emerge based on core geographic or market differences, such as presence of competitors, plan consolidation, regulation, and dozens of other market forces. Yet the primary area where this transformation will play out is with health wellness and the lower acuity care points. That’s the top of the funnel and that’s why we call it the funnel wars.

Chris Bevolo (08:36):
All right. Number four, the rise of health sects. Challenges to and skepticism of the mainstream medical field and science itself have exploded in the past two years because of the pandemic and political tribalism in the U.S. Anti-vaxers, non maskers and COVID deniers are just the start of an expansion of the distrust of experts, which taken to its potential and could result in multiple health sects, primary schools of medical thought that coalesce around a political or worldview. Imagine main streamers who follow the established healthcare point of view, progressives who follow minimal medical intervention combined with complimentary and alternative medical solutions or contrarians who deny mainstream medical thought and create their own set of alternative facts on everything from vaccines to childbirth to end of life care. These sects will not only follow the medical thinking that best fits their worldview. They may in fact create their own reality through alternative research, diagnosis and treatment approaches and models for the delivery of care itself.

Chris Bevolo (09:33):
And finally disparity dystopia. The COVID 19 pandemic shown an ugly light on the disparities that have plagued the U.S. Healthcare system for decades. Unfortunately, that health gap is more likely than not to expand as the haves gain access to increasingly more expensive medical treatments, health services, and personalized care. While the have nots will face growing shortages of basic health resources from clean water and air to physicians and clinicians, rural healthcare, and more. This shift will be compounded by the mental health crisis, which disproportionately affects systemically disadvantaged populations and groups outside traditional healthcare access channels, such as teens. All while those entities that might address these disparities increasingly struggle financially, such as health systems or state and federal governments. And others lack the incentives to focus on this growing issue.

Chris Bevolo (10:20):
All right, so let’s go with constricted consumerism. Imagine it’s 2030. You are me, a 50 something working at a great gig with an employer who offers a generous health insurance allowance. Like many companies, mine stopped offering health insurance through work a number of years ago, thanks to changes in how health benefits are considered from a tax standpoint. Now I take my allowance and head out to the market to find insurance on my own. My plan will make me pay through the nose if I use any healthcare outside of my network and they insist all urgent primary diagnostic care starts with their own clinicians, using their own urgent care clinics and virtual care offerings. From the there if I need more care, my plan will tell me exactly where to go based on whatever is the least expensive option given certain standards of quality. Of course, there really are only two games in town anyway, like most markets mine is seeing provider consolidation so that there are really only two health systems that provide the full continuum of care.

Chris Bevolo (11:15):
And once I engage with the provider, for any reason, they fight like mad to keep me within their system for any additional care with automatic referrals and appointment scheduling. Both local systems are included in my network, but my plan typically dictates which I use. Of course with my $25,000 deductible, I could spend out of pocket for the low cost care I need from places like Dollar General or Amazon. I can remember not too long ago when I had so many more choices for my care, but today, even though I’m spending far more money out of pocket, it feels like there are only a few ways I get to choose, but that’s okay. Healthcare has become so complex anyway, who has time to figure out what’s best for themselves on their own. Just tell me where to go and I’ll go. Welcome to prediction two the world of constricted consumerism.

Chris Bevolo (12:01):
So this is super interesting because this is the one that I said at the beginning. If we had set out to kind of with a hypothesis and then wanted to prove it and put it in the book, we would’ve had the opposite answer for consumerism. I have been talking about consumerism so long. My joke is that when I first started doing presentations on it, I used to use a picture of my daughter as a toddler. And it was one of those classic pictures where she’s in her high chair, she’s got spaghetti all over her face. She looks kind of like not happy. And I would say that’s what the healthcare consumer feel is like when they have to wait an hour to see the doctor, or when they pick up a copy of golf digest that’s 10 years old or they can’t even find a place to park.

Chris Bevolo (12:41):
Well, the joke about that is that daughter Kelly just graduated from high school this last summer. So that’s how long I’ve been talking about consumerism. And so the point of this is we’ve been waiting for the real impact of consumerism to hit for 20 years and from talking to our experts and the research that we’ve done, what we’re saying is not only do we not expect it to really hit in ways that we would want moving forward. Particularly related to choice in higher acuity settings, we actually think this could get worse. And so here’s some ways to think about this. I’ve already kind of talked about how long that we’ve been waiting and waiting and yes, there’s been some incremental change, but when you really dig into it, consumerism has not hit near to the degree that a lot of people thought it would.

Chris Bevolo (13:27):
One of the great things we heard from the experts we talked to, and this was a new perspective for me was, the reason why consumer hasn’t delivered all the promises that we thought it would have. It’s because we’re talking about the wrong consumer. When we talk about consumers, we talk about individuals, those of us out in the public receiving care. And the idea was that by spending our own money and having access to more choice and having more information on those choices, we would drive the changes in healthcare that we would want to see to our benefit, more access, lower price, transparency, all these great things. Well, the reason that hasn’t come to fruition is because the actual, most powerful consumer in healthcare is not individuals. It’s those who pay the bill and we don’t pay the bill as much as we think we do.

Chris Bevolo (14:12):
The biggest payer of healthcare expense in this country is the federal government through Medicaid. It’s employers, it’s health insurance companies, it’s public payers in terms of the federal government, primarily who are the ones that are the true customers here. And if that’s the case, then it helps us understand why they’re the ones that drive the changes that most influence healthcare rather than the individual consumer. It helps explain why I can’t drive four hours north to get cheaper drugs in Canada. Why I’m not allowed to do that. It helps explain why we have things like PBMs, which are like incredibly complex, weird things that really aren’t here for us. Some of us may benefit in some ways, but they’re not for us. And so that was a really powerful insight that came through in talking to people. We know that payers are going to be payers.

Chris Bevolo (15:03):
We know insurance companies really try to restrict. That’s part of their job, right, is to limit costs. And so you see people going through tiers, they’re steered. Now you have folks… All of them, all of the major health insurers are integrated in some way in terms of providing care now and in different ways. But of course you’ve got the largest health insurer United, also happening to have the largest provider in this country. If you measure health systems, in terms of the number of employed doctors, Optum is the largest health system in this country with over 55,000 doctors. And so these folks are really trying to guide people to their own care before they go to the legacy hospitals and health system. Providers aren’t off the hook here, consolidation certainly limits choices. We all have read about the closing of hospitals in rural areas and the difficulty of having access there.

Chris Bevolo (15:57):
It’s true in some inner cities as well. Health systems don’t always play ball with things like transparency. We see that in people kicking and screaming to have their prices in a transparent way on their websites, many of them still not doing that, holding out that that will change. And so all of that is really oriented to making it more and more difficult for us as consumers to choose where we want to go. It’s going to be chosen for us in most cases.

Chris Bevolo (16:27):
And the final point of this is consumerism was always predicated an idea that as consumers could act in our own best interests. Well, that assumes we have access to all the information we have. We understand how the system works. And I think most of us, if you’ve experienced the healthcare industry in any way as a patient can speak to the fact that it is very difficult to navigate this on your own. Most consumers are nowhere near equipped in terms of understanding what they need to do to advocate for themselves, to pick the best choices, all of those things. So even if we look to ourselves, it’s very similar to how we think about retirement. Most of us are not equipped to invest for ourselves in a smart way, which is why we have financial planners and all of that. So that’s kind of the final nail in this coffin, if you will, about why we see consumerism becoming more constricted.

Speaker 4 (17:19):
First of all, I want to thank you. We got a question from Jake Port, which was like many, I’m concerned about the current nursing shortage and those who are planning to leave soon. How do you see that in relationship to the constricted consumer?

Chris Bevolo (17:33):
Yeah, I mean certainly, the really desperate situation the industry finds itself in right now in terms of workforce issues driven primarily by COVID. But also related to the burnout from COVID clearly. The great resignation in the ways that you might interpret that related to this. That will have at least a short term impact on this. It feels like it’s a little bit incidental. It’s a terrible word to use. It’s nobody’s fault that we’re really going to face more of a constricted option in this regard because nobody wants this situation. Everybody wants to be able to provide whatever care they can to the fullest capacity they can. The trick with the other aspects of constricted consumerism is they’re intentional. So they are insurance companies intentionally restricting our options or providers doing that. That’s the trickier thing to deal with.

Chris Bevolo (18:26):
Let’s all hope that within the next few years we can emerge from the crisis we have and maybe technology will help us in that regard. But I also think it’s fair to say, this is not a short term issue in terms of workforce. It’s not something that once COVID ends, which God help us all is this year, or hopefully we’re coming out of it. Omicron is the last greek letter that we’re going to have to remember. But even if that’s the case, the workforce shortage is not going to be solved in the short term, but hopefully in a couple years it will be, but that won’t change the trajectory overall. That’s how I’m seeing it. Chris. I don’t know if you’ve got thoughts.

Chris Hemphill (19:06):
Hello Health Care is brought to you by Actium Health. Healthcare leaders use Actium CRM intelligence to activate patients and drive meaningful engagement. You can make it simple to identify and predict patient needs by using AI driven next best actions. Learn more at actiumhealth.com. And now back to the show.

Speaker 4 (19:33):
So next subject let’s go into copernican consumerism.

Chris Bevolo (19:37):
All right, imagine it’s 2030, you are me a 50 something. And this disc I’m wearing, which if is probably impossible to see with the sweater I’m wearing. But I have a little disc right here in my arm. It’s doing more than just monitoring my blood sugar. It monitors a hundred health metrics from my white blood cell count to my mental state of mind. Whereas my monitor today is noticeable in my arm. Think two quarters stacked on one another, my 2030 monitor will be invisible to the outside world. It will connect seamlessly and instantly to my personal mobile device, which could be a phone, a watch, glasses, whatever. Thanks to blockchain, inputs from everything from my personal monitor to my EMR, to my health plan records to my refrigerator and even my Peloton are instantly added to a holistic health record available to anyone at any time I allow. Advances in genomics provides truly personalized medicine.

Chris Bevolo (20:27):
So the biologics I use to treat my Crohn’s disease are custom designed for my genetic makeup. And my insulin is engineered from a unique presentation of diabetes. 95% of the care I need is available to me wherever I’m at, whenever I need, at work, online, at the store but mostly right in my home. My health coach makes regular house calls, supported by a digital health platform that leverages AI and software driven digital therapeutics to help manage my health on a real time basis. Like so many others, I stopped seeing a primary care physician a few years ago. My digital twin will serve as a proxy for health issue diagnosis and potential treatment paths. As with other industries today such as flying or checking out at the grocery store, much of my healthcare will be self-service driven by my digital health support. And like so many aspects of my life in 2030, my work, my entertainment, my education, it all revolves around me, is centered on me, both in terms of where I’m physically located, but also who I am as an individual health wise.

Chris Bevolo (21:28):
So now, if you remember who Copernicus was from your astronomy class or wherever the heck we learned about him. He was the guy centuries ago who predicted the sun was the center of the universe. As we now know he was wrong, but we love the idea of the opernican consumer and everything revolving around them. And after all, this is a prediction. So we’re fine with the irony of naming it after somebody who is wrong in their prediction. This is one of the more exciting predictions we have, I think. And maybe one that is not as surprising as the others. I think most people would look at this and go, yeah, this is coming. Is it going to come by 2030? That’s the question. But you can see from Dr. Rude CEO of Geisinger, there are a lot of organizations that have made this really their vision for what they’re going to try to do.

Chris Bevolo (22:12):
Whether that’s health system wise, whether that’s health tech, whether it’s a service company and supporting all of this, you can kind of see all the different elements that might be included there. One thing I think is important to note about this is we have… I’ve spent 20 years really working within the hospital and health system space and the idea of patient centricity and consumer centricity has been around a long time. But really that has always referenced when people come to us, they come to the hospital typically, or maybe they come to the clinic, how do we surround them with an experience that’s personalized to them? This is really a fundamentally different concept where everything that’s related to health is centered on the individual, where he or she is, where he or she sits, where he or she lives. And that’s really a completely different model than what we’ve been trying to attain.

Chris Bevolo (23:03):
And what’s not always the greatest success in terms of patient centricity, right? You hear a lot about dispersion of care. So this goes all the way back to Clayton Christensen, who I referenced to the book time and time again. 10 years ago, he wrote the Innovator’s Prescription, which was his follow up to the Innovator’s Dilemma all about healthcare. And he said, look, if we’re going to succeed in the healthcare industry and not go bankrupt, we’re going to have to see things that happen in the hospital move to outpatient, outpatient to doctor office, doctor office to clinic, clinic to retail, retail to home, home to virtual. And we have seen that happening. And of course COVID 19 accelerated a lot of that, which is super exciting, right? So we’re going to see more and more of that blockchain. I am not a blockchain expert. I know enough to be really dangerous, but I know the promise of it.

Chris Bevolo (23:56):
And we actually have a LinkedIn group that you can go find where we’re talking about all these things and Alan Shoebridge, who some of you may know said, how is all this going to be connected? And I think things like blockchain have the potential to take all of the data that I mentioned that narrative and bring it together. And a great way to think about this again, is to allude to the financial services industry and a personal example of mine. Like many of you guys probably, I had a financial planner for forever to help me kind of particularly manage my retirement investing, but also how I save for my kids colleges, how I save for my own personal savings, all that stuff. But it was something where I would see her twice a year for an hour. She could barely kind of manage all the questions I had.

Chris Bevolo (24:39):
And then I would go away. About a year ago, two years ago, I switched all of my investments to a company called Betterment, plenty of platforms out there. It’s online. Basically it’s just an index driven investing model. It’s not active investing. If you’re like me, I’m not a day trader, just set it to the S&P 500 and go, and there are experts there to help me. I don’t have a financial planner. It’s about a 10th of the cost of the financial planner I was using before. And it pulls in through API and other sources, all of my financial information, whether it’s part of Betterment or not. So my bank accounts, my 401k, which is run through my company, my wife’s 401k, my 529s so it’s all in one place. I can go on there. I can manage it myself. If I need expertise from their people, they have the full picture of everything they need.

Chris Bevolo (25:30):
Think about that and apply it to the primary care doctor and where we could be going with healthcare. A similar experience to my primary care doc, right? See him twice a year. He has about 45 minutes, no way in heck. He can help me with all the things I need help with. So he touches them about five minutes each and then off I go. Imagine that I had a Betterment like solution for my health and the implications of this are pretty significant, right? If that came true, we wouldn’t need as many primary care docs. We might see what we call the barbell effect, which is already happening in the radiology field, where AI as an example has really supplanted a lot of what though, not everything radiologists can do. So radiologists are moving to one end of the spectrum or the other. They’re becoming more focused and specialized or they’re becoming even broader in what they do because there’s a middle ground or technology in AI can do what they do. So same thing with primary care and other areas of care. So that’s the Copernican consumer. Let’s have at it, Chris.

Speaker 4 (26:29):
Sure thing. Let’s dig into it because I think that people are started to dig into the Copernican consumer concepts before the constricted consumer one. Got this question, there’s a couple I wanted to address, but got this one earlier from Zachary Griffin. He agrees with the idea of the Copernican consumer in spirit that we’re amassing more and more data points that paint a deeper picture on who we are and how we should respond to that. But there’s a disagreement there. Disagrees that that would necessarily result in a reduction in demand for primary care. The vision that he laid out is what if the PCP is working alongside the person, helping to parse those additional data points, helping to use those additional points to guide them with their care. How does that jive with the research that you’ve done on the subject?

Chris Bevolo (27:15):
Yeah, I think it’s a great point and we’re making a pretty bold prediction about, well, we’ll need less primary care physicians. I think it could go the other way, but also imagine this. Imagine, I mean, don’t imagine it’s already happening. Amazon is getting into this space. They’ve gone national with their virtual care. They’ve just announced they’re opening 20 kind of prototype stores around the country. Amazon has the scale to do what I suggested in a Betterment type format for healthcare. So Amazon will employ primary care doctors, but imagine how many more people one primary care doctor could serve through a technology driven online platform then could happen now with the in person situation we have with primary care. So primary care’s not going away, but will we need as many, will my relationship be different? Do I need to see the same primary care every time? That’s where scale helps right?

Chris Bevolo (28:11):
So does it really matter to me that if I’ve come back in with an issue that I’m talking to somebody different, if they have a full picture of my health and that’s supported by technology and software. I’m not sure it really does. I mean, that kind of infers in my primary care doc today always has the full picture of me and always remembers it when I walk into his office. That’s normally not happening, he’s looking at his EMR to remember everything. You can’t expect that of a doctor so I can see it both ways. But I do think there’s a real potential for a reduction in need for individual primary care physicians where scale can help provide it even to a broader audience, maybe in a broader way.

Speaker 4 (28:50):
So another question that we’re getting is around the overall impact on access. Basically this one came from David Perry, but it was around having this additional technology and data points available and suggestive of prescriptive technology from other sources, does that allow the PA/nurse relationship to answer more questions and involve more deeply and overall reduce the cost of how that care and how those conversations are delivered?

Chris Bevolo (29:18):
Yeah, a hundred percent think so. I really do think that it enables the nonmedical doctor to step forward in even greater and broader ways than they’re able to now. Because the assumption here is too is there’s more data. So if you think about all the monitors and stuff that provide the data, there will be some kind of technology platform, AI driven or not. Chris, you could probably speak to that better than I could. But certainly that would aid in a nurse practitioner or a physician assistant or somebody else providing a lot more care than they would be able to today potentially. So I definitely think that is part of that future.

Speaker 4 (29:54):
Great. And this question might get reflected back to me, but I’m going to ask it. It was around what AI solutions should be conventionally adopted in healthcare and what’s on the horizon and it goes deeper. Like what goals are meant to be really achieved with AI in healthcare and how can it be executed at a system level?

Chris Bevolo (30:11):
Yeah. So this is where I raise my flag of saying, I am not an AI expert, but somebody else here is, do you want to answer that?

Speaker 4 (30:18):
When it comes to what’s on the horizon and what should we be focused on adopting? Well, right now within digital health, there’s a whole slew of various point solutions. One of them you referenced in your book, robot health, like all kinds of different things that come out using various aspects of AI and things like that. But AI to me is so broad a term rather than focusing on AI, the technology itself. I really think that AI should be embedded in a lot of different processes and tools and things like that. I kind of look at it as I look at my cell phone, it wasn’t advertiser sold to me as an AI device, but it uses AI to do things like enhance the pictures that I’m taking, predict text messages and things like that. So it’s a matter of embedding predictions into my workflow.

Speaker 4 (31:01):
So the things that we should be looking for within a healthcare context, because let’s say that there’s apps designed, for example, to help people manage their mental health or mental health challenges. Well, there’s a couple of ways that that could be delivered. Company A could take an approach of, we have these in these national language processing experts that go in and parse all this text and then like feedback a result, and consumers can use that. And we’re trying to replace the therapist with a cell phone app. There’s one aspect, but then there’s the other type of company that involves clinicians in the types of predictions that they’re making that focuses on having the human in the loop and relying on the domain expertise of medical experts, and also focuses on making sure and working with those same constituents to make sure that the results and suggestions that they’re making, predictions that they’re making are ethical and valid.

Speaker 4 (31:54):
So what choice of technologies, what services to focus on? I would say depends on your overall health system strategy, but working backwards into that, if there’s company A, company B, company C, then what should dictate that decision. Is their focus on working with clinicians or working with end users so that these algorithms and things like that actually get adopted and used? And also their focus on whether or not they’re perpetuating one of the topics you brought was disparity dystopia. Is this vendor, is this partner and their algorithms, are their approaches on the problems that they’re solving actually perpetuating bias and perpetuating unethical uses of data. So the technology and path depends on strategy, but there’s some very distinct, clear criteria that you can start using to be able to say, well, this approach is better than this other one.

Chris Bevolo (32:41):
That’s great. I think you’re making a great argument for your own book here, Chris. So just keep that in mind.

Speaker 4 (32:46):
Okay. Well…

Chris Bevolo (32:47):
That’s not already happening.

Speaker 4 (32:48):
Let’s partner up on that, Chris and Chris together. I like that. Yeah.

Chris Bevolo (32:52):
Yeah. Do we want to try to squeeze one more super quick? It is the one that I think is maybe the most, not the most controversial, but I think one that particularly if you work for a hospital health system, you most need to hear, and that’s the funnel wars.

Speaker 4 (33:05):
I was hoping you’d let me guess, because I knew it was going to be the funnel wars.

Chris Bevolo (33:09):
So again, let me just really quickly kind of explain what we mean by the funnel. It’s not too too difficult of a concept, but it could be confusing. Think of a funnel like a triangle and it’s a acuity funnel. So in general, people enter the healthcare system at the top of the funnel. So think urgent care, emergent care, virtual care, retail care, health even, and also sometimes primary care. That can be right up there. And then they tend to funnel down depending on their condition and their situation. So they might move down to specialty care, surgical care, tertiary care, Quantinary care. Most hospitals and health systems are rightly focusing their business on the middle part of that funnel because that’s where the financial model makes sense. That’s where the surgeries and all of that support what they need to do financially. But what we know and what we’ve learned, and what we know is that the top of the funnel is critical to filling the middle of the funnel because it’s a funnel, right?

Chris Bevolo (34:06):
You don’t fill a funnel by trying to force things through the side, you pour it through the top. And this is really important because all of the entrants and players that we’ve been talking about for a decade, they are all focused at the top of the funnel. We have seen them trip and fall. We have seen them stumble. We have seen them come and go, but they are not going away. And this is really a race for the patient relationship. And this quote, I’m going to come back to it is the Head of Brand at CVS health, I think is just phenomenal in capturing why this is so important for hospitals and health systems in a legacy sense. So just some things to think about. We have said for maybe a decade, Chris, Hey, remember, you’re not just comparing your brand. Consumers don’t just compare your brand to other hospitals and health systems, but they compare them to their favorite brands like Apple and Amazon.

Chris Bevolo (34:55):
Well now they’re not just comparing your brand to theirs. You’re competing with those brands. Top five Fortune 500 companies. Two of them are a hundred percent healthcare United and CVS health. The other three, Walmart, Apple, Amazon have all committed in a significant way to entering the healthcare space. Apples CEO, Tim Cook has said in an interview that when all said and done Apple’s legacy will be known first and foremost for its impact on health. Which is crazy when you think about what Apple’s known for now. You’ve got all kinds of new entrants and companies from Iora to Oak Street and everything in between with venture capital behind it. You now I mentioned before you are now, if you’re a legacy hospital health system competing against most of your payers in some way, Optum is a great example, who definitely is focused at the top of the funnel, but even goes further.

Chris Bevolo (35:46):
And so what we learned from these experts, and one of them said, the risk here is for systems that aren’t strong enough to survive this battle is they will become what he said was downstream vendors of care. So almost B to B brands, no longer consumer facing brands, but utterly dependent on the patient relationship being referred to them from somebody else. Amazon, Apple, Walmart, CVS, you name it. It doesn’t mean hospitals and health systems are going to go away because most of these folks don’t want your surgery. They just want the relationship at the top of the funnel, because it helps them in other ways. They may be financially incented if you’re Oak Street and you’ve got an MA model or you need to own that relationship and you’re incented to do so by United, if you lose that patient relationship as a legacy hospital and health system, you lose control.

Chris Bevolo (36:40):
And that may force a lot of these systems to shrink in terms of scope in size. And so when I asked Russ Meyer and he was the only one who said this, what do you think about this prediction? He said, the question isn’t if this will happen, it’s where and when. This will be market to market, but it’s going to happen it’s inevitable. There’s not enough space at the top of the funnel for everybody, somebody’s going to win. And he said in my experience as a brand expert, who has worked with the best brands in the world, in my whole career, in and outside healthcare, what I have learned is when companies try to transform, it is far easier to gain knowledge in that pursuit of transformation than it is to change culture. And when you think about the two sides of the funnel war, the legacy health systems, where do they bring to the table?

Chris Bevolo (37:24):
Medical knowledge, expertise, physicians. They’ve been doing this for 20 years. All of the data, they own that. What’s the other side bring? A culture that puts the consumer 100% in the center, Amazon, Apple, Walmart, CVS, all of those. That’s just who they are. And his point is, if this is a race for the patient relationship at the top of the funnel, it’s going to be easier for the one side to gain or buy the medical knowledge they need than it is for the other. And that’s the legacy systems to change their culture in a way where they’re consumer oriented. And I think that’s really profound and really scary if you’re in the hospital and health system space, depending on who you are. Some systems will thrive. Some are not going to thrive in the face of this.

Speaker 4 (38:10):
With that, just anybody who’s interested in discussing these predictions further or discussing strategy around where your health system might fit into this and patient engagement strategies. You can reach out to myself or Chris or Chris, Chris Bevelo or Chris Hemphill. I’ll just say LinkedIn is the easiest place to reach me. Same for Chris Bevelo so you can find us there. Just wanted to give a thank you on behalf of Acium Health, on behalf of Revive and on behalf of the forum itself. Thank you very much everybody.

Chris Bevolo (38:40):
Yeah. Thank you Chris. Thanks everybody.

Chris Hemphill (38:42):
I know you’re on the edge of your seat right now, wondering who is poised to thrive and who is poised to fail based on the funnel wars and that battle for those early consumer journeys. Unfortunately, we’ve run out of time. But keep your ears peeled for more in depth breakdown of the remaining predictions, the funnel wars, the rise of healthcare sectarianism, disparity dystopia. We’ll be covering all of those in depth on an upcoming episode.

Chris Hemphill (39:10):
Thanks again for tuning into Hello Healthcare. If you like what you heard, we appreciate a review on Apple, Spotify, or wherever you’re listening. You and your feedback fuel us. This conversation is brought to you by Actium Health. To get the latest on what these healthcare leaders are saying. Subscribe to our newsletter on hellohealthcare.com or join us for our weekly sessions on LinkedIn. Thanks. And when we see you next time, hello.

Chris Bevolo (00:00):
Without some kind of moonshot-like effort, it’s going to be really hard to solve for the health disparities and inequities that we’re facing in a meaningful way in the coming decade.

Chris Hemphill (00:10):
Hello Healthcare. What’s going to have the largest impact on healthcare strategy over the next 10 years? That’s what Chris Bevolo and over 30 healthcare leaders at places like Geisinger and CVS endeavor to answer with their new book Joe Public 2030. There are some startling insights, such as the idea that healthcare consumerism will actually contract.

Chris Hemphill (00:32):
In this episode, we’re going to focus on three other predictions, starting with the funnel wars, which is the idea on how big tech and retail are competing for people earlier in their healthcare journey. Then we’ll go on the rise of healthcare sectarianism, which is how people are politicizing their healthcare decisions today. And finally, disparity dystopia, which is the widening gap between the haves and the have-nots in healthcare.

Chris Hemphill (00:58):
Let’s take it to Chris, starting with the funnel wars.

Chris Hemphill (01:04):
Consumer experiences, major disruptors in AI tech, are shaping healthcare for years to come. On Hello Healthcare, we dive deep on these issues with leaders who are driving change. I’m Chris Hemphill, VP of Applied AI at Actium Health, and we hope that these stories will help you to create or demand better future in healthcare.

Chris Bevolo (01:28):
Imagine it’s 2030 and you’re a 30-something living in Chicago. Your main health relationship is not with the primary care doctor, but with a team of providers at Amazon Health platform, where all of your health is managed. You could have chosen to partner with the similar offerings from Apple, CVS Health or Optum, or even one of the niche providers like One Medical, but you like Amazon’s online experience better and how they cater your shopping choices to your personal health situation. You haven’t been inside a hospital for years. A number of hospitals in your area have actually closed in the last few years, and if you do go, it’s for something critical that can’t be handled by Amazon’s health stores, of which there are three within 10 minutes of you. Most of your friends have never been to a hospital. Though you know your boss at work had to use one downtown for major surgery.

Chris Bevolo (02:11):
Before you lived in Chicago, you lived in Erie, where your health provider was Geisinger. They offered all the same services and experiences as Amazon. You’ve heard there are other organizations out there like that such as Kaiser, Intermountain, or Providence HCA, old school systems with their own hospitals that seem to have figured things out. You can remember when there used to be a lot of hospital advertising here in Chicago, but they always seem to be competing with each other, ignoring the new health players like Walmart or Best Buy. But now, here in Chicago, as well as many big cities across the U.S., hospitals are just the last resort when you need serious care, and you turn to true partners like Optum, Amazon, and Apple to manage your health. They’ll tell you which hospital to go to if you ever need one. Welcome to prediction three, the funnel wars.

Chris Bevolo (02:56):
So really quickly, what I we mean by the funnel? We’re talking about the acuity funnel. So think about the top of the funnel as health and wellness or the initial ways that people enter the healthcare system. Virtual care, emergent care, urgent care, retail care, and then typically they’ll progress down to the mid-funnel. So that might be medical care, specialty care, surgical care, and then on down to tertiary and quaternary care. And what we have learned over the years from working with health systems is that while most folks are rightly focused on those volumes, those patient volumes in the middle of the funnel, because that’s where the revenue and the margins are. The best way to build those is to fill the top of the funnel.

Chris Bevolo (03:34):
It’s a funnel. You don’t stick things through the side. You pour them through the top. And this, the funnel wars, is all about all of these new entrants that are coming in with billions of dollars of investments behind them focusing right at that top of the funnel, and if they’re successful there, they will divert patients away from you if you’re a traditional or legacy hospital and health system and will come to own the patient relationship and the implications of that are actually quite profound.

Chris Bevolo (04:02):
This is a quote and I think it’s phenomenal, and I’m going to come back to this because I think it’s a great way to kind of wrap up what’s at stake here, particularly for legacy providers and health systems. But this is from the head of brand at CVS and it just really, I think, captures… It will capture when I explain it why those of us, if we spend a lot of time in the legacy health system space, are up against it.

Chris Bevolo (04:27):
So just a few things to keep in mind. If you’ve been to a conference, if you’ve heard a keynote, if you’ve read articles for the past five years, you’ve probably gotten sick of hearing “Hey, hospital and health system, patients aren’t just comparing your brands to other hospitals and health systems, they’re comparing them to the best brands in their lives like Apple and Amazon.” Well, now they’re not just comparing you to those brands. You, as a legacy provider, are competing with those brands.

Chris Bevolo (04:53):
The top five companies in the Fortune 500, when you look at that list, two of them are completely healthcare. That’s United and CVS. Three of them, which are Walmart, Apple, and Amazon, are all heavily, heavily invested in coming in that top of the funnel. So you as a legacy health system are up against some of the biggest retail and tech giants in the country who want to own that space at the top of the funnel and who want to own the patient relationship to one degree or another. Then you’ve got all of the startups, all of the VC capital, all of the private equity opportunities, the startups, the One Medicals, the Oak Streets, that are coming in, and they’re primarily focused in primary care. They’re focused in Medicare Advantage care. They’re focused in urgent care, virtual care, Teledec, they’re all up at the top of the funnel.

Chris Bevolo (05:44):
You’ve got payers who are now, we just heard yesterday, I think it was yesterday, United wanting to buy a home health company. They’re not the only ones. All of the major health plans have invested in provider-side vertical integration. And when you talk about Optum as the largest of those, if you want to think about the largest health system in the country, if you use the metric of who has the most owned physicians to define that, that’s Optum. That makes Optum the largest health system in this country, as they have more than 55,000 employed physicians. So you’re not only up against Apple and Amazon, you’re also up against Optum, which is obviously kind of a scary place to be. And when we talked to some of these experts that I mentioned earlier, it was astounding, I have to say, their feedback on this prediction.

Chris Bevolo (06:33):
So for one, they said, “This isn’t a question of whether this is going to happen. It will happen. It’s just a question of where.” They talk about it as kind of like a, if this is the funnel wars, the battles will be fought market to market, and it will depend on the dynamics of a market, how legacy providers might do. But in some markets, you might see health systems kind of shrink to what one of our folks called “downstream vendors of care,” B to B oriented organizations, no longer consumer brands, because they would be so dependent on those patient relationships and referrals coming from the Apple’s and the Walmart’s and the Walgreens and anybody else who might own them.

Chris Bevolo (07:13):
And so that obviously would be a huge deal. Hospitals will still be around. Still a great place to run a business. If you’re a downstream vendor of care, as one CEO put it, “A giant ICU on the hill,” because again, that’s mid-funnel business. But a lot smaller organization than a lot of health systems aspire to, and also the loss of a lot of control there. So that’s a big issue.

Chris Bevolo (07:38):
And then finally, if you think about the funnel wars and the two sides in the war, you’ve got legacy hospitals and health systems, and you’ve got all these new entrants battling for that top of the funnel, this is where it goes back to this quote from Russ Meyer at CVS Health, and he has spent his whole career working with huge, huge organizations, not just in healthcare, but otherwise, to change and transform their brands. So he’s seen them try to transform themselves as organizations, and he says, “From that experience, what I can tell you is when I look at the two sides in this war, I see legacy health systems having the advantage of all of the knowledge. They have the medical knowledge, they have the expertise, they have the physicians, they have all of that. That’s what they’re bringing to the war. The other side, what they have as a culture there’s 1000% focused on the consumer.” Think about Apple. Think about Amazon. Think about Walgreens. That is their super power.

Chris Bevolo (08:32):
He said, “I can tell you from my experience of watching brands for decades try to transform, it’s far easier and quicker to acquire the knowledge you need to transform than it is to change a culture.” And so when you think about who’s going to win the race at the top of the funnel and win these funnel wars, he would say those new entrants have the advantage because they can acquire, just as we heard about United. They can acquire the clinical expertise faster than the legacy systems can become consumer-oriented, and that’s what it’s going to take to win at the top of the funnel and to potentially own that patient relationship.

Chris Hemphill (09:08):
Again, this was a live conversation. So the back and forth and questions and answers we got were from healthcare leaders just like you. And we already got one from Ravi Bala, which was “How will these funnel wars show up in senior care?”

Chris Bevolo (09:23):
Yeah. We see, gosh, I might get this wrong, but I know it’s one of them. I think it’s Cigna. It’s Cigna or one of the other major health plans, and this is covered in the book, investing significantly in long term care as an example. So I think across the continuum, you see health plans as one example investing in this. Certainly Medicare Advantage is a really, really hot area for new entrants in terms of primary care, and there are some significant implications there for legacy providers.

Chris Bevolo (09:55):
So our agency does a lot of work with health systems in terms of their payer negotiations and their relationships with health plans, and one of the things you can look at is United really working with some of these primary care companies that are focused on Medicare Advantage saying, “Hey, we’re going to put you at a hundred percent risk. Here’s a giant bag of money. You manage these relationships, and if you manage them to your benefit, you keep the money.” And if you don’t, obviously, you’re out, but these companies, because they’re focused on primary care, they don’t have to worry about the rest of the much riskier care that comes from a surgery or long term kind of situations. That’s a risk that they can take.

Chris Bevolo (10:37):
That’s not a risk that most legacy health systems can take, because they can’t go a hundred percent at risk. Most health systems struggle with any value based care working out for them. They’re trying to get there, but there’s no way they could go to a hundred percent risk, and so that just means there’s more incentive for these powers to pull folks through, and I think that goes for senior care, which was where Medicare Advantage would obviously come to play, home health, you name it.

Chris Hemphill (11:04):
It leads into another question, too. We got another one from Lori Shawentenberger, just following up on the question about senior care. With the pandemic and internet things and with the changes brought on by that, how do you think that’s changed their engagement at the top of the funnel?

Chris Bevolo (11:20):
That’s a great question. I don’t know if I can speak with authority on seniors specifically. I do think this nods a little bit to the first prediction, which again, we covered in the last one, which is about the Copernican consumer and about more data coming to us consumers, and some of that is almost self-service and managing it ourselves. But I don’t know that… There’s a guy who follow named Galloway. He’s fantastic. He’s a podcaster. He just put out an article today and there’s content on this in the book about, we often think that more choice is better, and there’s a lot of conversation in the book about how actually no. Consumers don’t necessarily want more choice, they just want relevant choice that’s easy to understand. And so I don’t know that the things that are coming forward, like the internet of things, you’re certainly going to have more options at the top of the funnel than you ever did before.

Chris Bevolo (12:10):
We’ve all experienced that with just our COVID. If you’ve taken a COVID vaccine, I got my last one at, at Hy-Vee, which is a grocery store. My first one at my provider. You get them almost anywhere. So there are far more choices for that kind of thing, but I don’t know that necessarily makes it easier for people to manage their health. So I think that, and it’s you get… Now maybe this is stereotypical. I can think of my dad who is 82 and had to shop for a Medicare Advantage plan. Boy, that was a trip trying to help him through that because it’s very complicated to understand “What are my choices out there? What is best for me?” Of the 27 Medicare Advantage plans he could actually opt into in his market here in the Twin Cities, only two were appropriate for him because they had his provider. So it’s tough.

Chris Hemphill (12:55):
How are you seeing family networks influencing plans across the board coming up?

Chris Bevolo (13:00):
Well, the family’s going to be just as important as ever in particular, again, going back to the two things that we didn’t cover today, which were Copernican consumer, which again, if the individual’s at the center of their own health, that relationship with those folks around them is going to be even more important to support that. They’re going to be part of that kind of universe that orbits them. And as well as constricted consumers, in which I just kind of alluded to with my own dad.

Chris Bevolo (13:25):
My dad going out on the market that was not a pretty sight. More choice. You know, “Look at this, you get 27 plans.” If he didn’t have me to help him, he might not have picked the right plan or he might have just given up or missed the deadline, so I think families are going to be even more important in the future, and I think that this goes back again to the funnel wars in what gives maybe those retailers and those tech companies, new entrants, a bit of an advantage, because if your culture is 1000% consumer focused, you almost, by definition, are going to understand the power of family to that consumer and you’re going to try to accommodate that relationship wherever you can.

Chris Bevolo (14:04):
And I don’t know that is necessarily a default on the legacy hospital and health system side. I think you actually see more of it when you get into higher acuity care, though it still could be hit and miss. I’ve been through this a lot in the last few years. It really depends on the circumstance, the situation, the provider, whether or not they’re looping in the family appropriately. But if I had to bet on who’s going to do that better, I’m going to bet on Walmart or CVS or Apple just based on how they think about consumers to start with. So that’s the best I got on that one, Chris. I don’t know if you have anything to add.

Chris Hemphill (14:38):
There’s there’s a glue that’s connecting these questions and the way that you concluded it on Walmart, CVS, the bulks that have the consumer in mind, this really rings with the P.R. Bigalence’s question, which is “With culture not being as easy to purchase as knowledge. It’s not something you can buy and just transform the organization like that. How will this funnel war impact communities where the healthcare seeking culture is challenged by historical engagement issues?”

Chris Bevolo (15:06):
So historical engagement issues, that could mean a few things. That could mean health disparities, which could take all kinds of shapes. So being from Minnesota, we have a lot of conversation about rural healthcare, which might play into this. And in the book, in this chapter, there’s a pretty heated debate about whether the disintegration, I don’t know if that’s the right word, but the separation of care is a good thing for consumers or the country at large. We’ve had this conversation since the ACA came forward, which was, “Hey, continuum of care, integrated care is better. Which is something that the CEO of Geisinger argues in the book. Said “No, no, no, no. We don’t want you getting care from Walmart and Apple and all these other places. That’s really disparate care. That’s going to be more harmful for you. It’s better if it’s all together, like at a Geisinger.”

Chris Bevolo (15:58):
But the other side, the other folks say, “Hey, most health systems can’t even integrate care within their own system. The primary care folks don’t know what the orthopedics are doing. Orthopedics folks don’t know what happens when you come into the ED. And so, there’s a really good argument about this, and I think that impacts the question, because how is this going… Is this better or worse for rural healthcare? The funnel wars?

Chris Bevolo (16:24):
Well, in some ways, if this causes a shrinking of legacy health systems, that might be worse. But in other ways, if I can get my primary care option from CVS or from Walgreens, much more likely I’m going to have access to that in a rural community than I would a larger system with locations there. And then of course, all of the virtual things that have come online and hopefully will stay online will help with that. So I think it can impact it in different ways. It really just depends on where it goes.

Chris Bevolo (16:53):
Imagine it’s 2030, you’re a 40 year old mother of two living in Dallas, and your cousin keeps telling you to check out the new Liberty Land Clinic that just opened in town. It’s focused on providing medical care based on your personal views, not the views of the lame-stream medical establishment. The clinic, one of 200 that has sprouted up across the country, is part of Liberty Land Health, a new entrant into healthcare backed by billionaire medium moguls and venture capitalists that includes 25 acute care hospitals, 100 urgent cares, and more than 5,000 affiliated physicians. Even has its own medical university that produces research supporting such alternative medical approaches as vaccine-free living and ivermectin protocols.

Chris Bevolo (17:32):
Your neighbor’s a primary care doctor in a nearby clinic and he’s told you of patients walking out when he recommends proven medical treatments, they don’t agree with, some of them claiming they’re headed to Liberty Land Health. The largest growing group on Facebook is dedicated to contrarian healthcare and has been the primary driver of hostile demonstrations at city council meetings, school board meetings, and hospital board meetings across the country. The group’s charter says it’s “anti-science, anti-expert, anti-CDC, and pro do your own research.”

Chris Bevolo (18:00):
Here in town, a group called “Boycott Deep River Hospital” has been fairly successful at convincing dozens of formally long-term patients to switch to Liberty Land Health, which better reflects their political views. The organization has been running television ads throughout primetime, featuring spokespeople like Joe Rogan and Jenny McCarthy. Some politicians, such as former Minnesota representative Michelle Bachman, have called for the creation of an entirely separate parallel health system in the U.S., one she says that won’t be “Beholden to the monsters in D.C.” Welcome to prediction four, the rise of health sects.

Chris Bevolo (18:35):
So if this sounds a little out there, know that that last quote is a real quote from Michelle Bachman who’s a real former representative from my home state. You may recall her. She’s kind of a fire brand when she was in Congress. But she gave an interview in December and it was in response to the federal government’s proposed vaccine mandates for companies and healthcare organizations, and she called for exactly what we potentially predict here in the book, which is not only just the rise of health sects, which are groups that are oriented around medical views that fit their worldviews, but also the potential rise of providers to meet that group, to serve that group. So think clinics and hospitals just like the fictional Liberty Land Health that might crop up that are focused on that political worldview and serving those people in the community that believe the same thing.

Chris Hemphill (19:35):
Hello Healthcare is brought to you by Actium Health. Healthcare leaders use Actium CRM intelligence to activate patients and drive meaningful engagement. You can make it simple to identify and predict patient needs by using AI-driven next best actions learn more at actiumhealth.com. And now, back to the show.

Chris Bevolo (20:02):
So this is not a new concept, the idea of politicalization, if you go back and you read news stories from the Spanish flu outbreak in 1918, you’ll see stories about the San Francisco anti-mask league, and politics has shaped healthcare to one degree or another ever since then. But clearly, COVID-19 and the hyper-charged political atmosphere we found ourselves in 2020 due to a very, very contentious election, and then also some of the social justice issues that also happened that same year, like the George Floyd murder in my own community, together has really brought this to a forefront in a way that we’ve never seen before, and from our research and talking to experts, likely we’ll be having to deal with for some time to come. This isn’t necessarily going to get better once COVID fades away. There will be a long lasting impact of it.

Chris Bevolo (20:57):
We learned last year that the number one way to tell if an individual has been vaccinated by COVID is their political affiliation. Not where they live. Not their prior vaccination status. Not their health status. Not their income. Surveys show that the best way to know is to ask whether they voted for a Democrat or Republican, and based on that one question, you’re more likely to guess whether they were vaccinated or not than any other question you could ask. The same was proven true at the end of last year and this year with booster shots.

Chris Bevolo (21:25):
So that politicalization of medical choice is still coming through. The book talks about all of the trends that are fueling this from the drop in trust in healthcare experts like the CDC, which has just gone through the floor since the start of the pandemic. A lot of that is self-induced pain that the CDC caused themselves. The rise in influencers. We joke about Joe Rogan, but he’s very influential, and obviously most of you know about the controversy he’s gotten into around COVID, to social media and the spread of misinformation. We sent the book to press, but right before everything came out about Facebook late in the fall from the whistleblower that talked about how Facebook knew that their algorithm was driving misinformation in terms of COVID, but did nothing to stop it because it was also driving engagement and ad revenue.

Chris Bevolo (22:16):
So that’s not even the book. This stuff keeps climbing out, and so really we asked the question “How long until we are going to see politically oriented or motivated clinics and organizations come forward?” We really, to be honest, if you ask me personally, I’m surprised we haven’t seen them already. And this isn’t meant to be a political debate. This isn’t about what’s right or wrong, left or right, red versus blue. This is really to say, this is the state of play. Now, in moving forward, if you are a provider of care, what do you do with this?

Chris Bevolo (22:50):
We talked to so many folks who said, “We can no longer sit on the fence. When a George Floyd type incident happens, we have to say something.” If I’m a health system, not saying something is now saying something. You have to say things about the importance of vaccines and social distancing and all of the accepted medical advice when it comes to public health issues. Yet, if you have a portion, in some cases, a large portion of the population that disagrees with those things, what happens when they come into your clinic and they argue with you, as we have seen time and time again in the news, about COVID treatments? What happens when they have an alternative and they say, “Screw you, I’m going to go over there. They listen to me over there.”

Chris Bevolo (23:36):
And so that, to us, is the danger. Even if we don’t see these alternatives crop up, for C-suites and boards of healthcare providers in particular, this is going to continue to consume oxygen in the room moving forward. It’s not going to go away with COVID going away.

Chris Hemphill (23:51):
One thing that this sectarian view of healthcare, where there’s political alignment causing different views and then infrastructure rising to support those alternative views of it, you can see where that takes an already existing bubble and then intensifies it. Not only within this bubble are there news sources that support you, but now healthcare organizations and systems that support you as well.

Chris Hemphill (24:19):
So, knowing that how difficult it is to get somebody out of a [inaudible 00:24:25] , through a bubble, especially if there’s just so much misinformation with easy access and access that people can easily do. What is the response to that kind of growing infrastructure and growing misinformation? Have you seen anything that gives hope to “Well, these are some approaches that might be effective?”

Chris Bevolo (24:42):
You know, Chris, it’s really sad, because I don’t know that the solutions related to this are any different than the solutions related to the problem at large. Politicalization in this country has hit everything, not just healthcare. What cars you drive, what music you listen to, how you watch sports, all of this stuff. We talked to that in the book, and so when you have folks that are… It’s one thing to disagree about somebody protesting at a sports venue. It’s another to disagree about the appropriate treatment for a disease. And you would like to think like, “Well, one is just an opinion and we can have opinions and there’s no necessarily right or wrong. Even there might be in some ways. But this is the way to treat this disease. It’s proven in medical science.”

Chris Bevolo (25:30):
You would like to think that facts would do it. But we know, we have learned, that facts are actually sometimes the last thing that you can use to help people see through the bubbles they’re in. Because oftentimes, when people are presented with facts that are the opposite of their worldview, it actually gets them to dig deeper into that worldview. It doesn’t pull them out of it. It just makes them… They’ll dismiss the source. They’ll dismiss the fact itself.

Chris Bevolo (25:56):
So it’s not that. I don’t know what the answer is, to be honest with you, because it’s something we struggle with beyond just healthcare. For doctors, for hospitals and health systems who have to deal with this, they’ve got to figure it out. And at some level, as we’ve seen, you may have to turn people away. If they are arguing with you about your proven treatment that is what you’ve benchmarked to be appropriate and they want something different, you may not be able to deal with them. But we see legislation in states across this country, right now in Wisconsin, Florida, and a couple other places, that would force providers to follow what the patient wants even if it goes against that provider’s own medical expertise. So that’s how far this is going.

Chris Hemphill (26:39):
And David Butman pointed out that outside of COVID, even when we focus on things like Planned Parenthood and politicization around that, then it’s a very clear line in the sand that’s being drawn politically around what kind of care is allowed to be delivered.

Chris Bevolo (26:56):
Yeah. Look at Texas right now. You got the largest pediatric system in the country that had to stop entirely their transgender services because of what’s going on in Texas. It’s impacting providers right now in that way. In my own market in the Twin Cities, we had a story of a hospital that was treating a COVID patient and he had been on an incubator. He was basically coma and he was being kept alive by the machines, and after a month, the hospital says, “We need to basically pull the plug.” It sounds terrible. And the family was arguing, “No, give him these other treatments.” Which the hospital said, “Those aren’t going to work.” They transferred him to a hospital in Texas, gave him the treatments, the patient died. Who is the family suing? Family’s suing the first hospital who refused to give the treatment. So this is impacting folks right now.

Chris Hemphill (27:45):
One thing, there was a couple that I wanted to address here, which Sundeep Aurora pointed out the impact that technology can have on intensifying these health sects, such as Google searches and things like that. Just curious about, in your research did you find anything in terms of how there might be attempts to limit where the algorithms take people down YouTube rabbit holes or search and things like that?

Chris Bevolo (28:11):
Well, it’s a huge issue. It’s still a huge issue with Facebook in terms of misinformation, and obviously we’ve seen alternative platforms arise, social media platforms that are politically oriented. And was it just this weekend, Elon Musk kind of teased the idea that maybe he’ll start a social platform? I’m not even sure where that would land politically, to be honest, but I don’t know that it’s… We can count on tech platforms because there will be, just like we’re predicting in healthcare, there will be platforms that grow to serve a political orientation. They’re already here. So we certainly can’t count on those platforms. And so, I don’t know. I don’t know.

Chris Bevolo (28:52):
When you think about this, we get to the end of this prediction and we thought, “Well, how far can this really go? Could you really have a doctor who’s going to prescribe things that aren’t part of a proven medical, accepted medical procedure?” And you go “Well, who monitors that? Who polices that?” It’s the health boards. County health boards. State health boards. And we talk about this in the book, right at when we submitted the copy for the book at the end of last year, there was a doctor who was having his license reviewed in Minnesota because, he is a pediatrician, he told all of his families “Don’t get your kids vaccinated with anything. Not just COVID, anything.” And so the medical boards were reviewing his license. You think, “Oh, okay. So somebody will make sure this doesn’t go too far.”

Chris Bevolo (29:32):
Then you look at how our medical boards are formed. In almost every case we found, state, county, they are political appointments. And so you see a story in Idaho where the county where Boise is, where the people that are responsible for building a health board put a physician on the health board of that county that doesn’t believe COVID is real. So the health boards may not also be there to save us. You’ve got stories of health boards in California, or counties in California where they’re creating a second health board. Another health board. Politicians in the area are saying, “We don’t like what this health board is doing so we’re going to create a separate health board.” What does that even mean? How does that work? But that is the kind of thing that potentially is coming.

Chris Bevolo (30:14):
For this prediction, rather than try and imagine the future through the eyes of an individual consumer, we think it’s critical to think about this collectively. Throughout the history of the country, a large portion of our population has faced devastating health inequities and disparities. Communities of color, the poor, the elderly, all have been marginalized in numerous ways. Disease symptoms misunderstood, downplayed, or ignored. Sparse access to quality care. Discrimination. Inhumane treatment. Over-indexed health issues. A worse quality of life. Bankruptcies. Shorter lifespans.

Chris Bevolo (30:51):
The events of the last two years stemming from both COVID-19 pandemic and social justice issues have brought these issues under the microscope. In the case of COVID-19, exacerbated them. As we know these issues are systemic and not easily addressed, but worse, as we look forward a decade, we see these issues deepening thanks to other equally significant challenges. For example, the growing healthcare affordability crisis. According to one study, while the middle class spends 19% to 23% of their income on healthcare, the poor spend 34%. The aging of the population. By the year 2030, there will be more grandparents in the United States than grandchildren. The growing digital and technology gap. For example, one study showed that for those below the poverty level, only 24% own a smartphone. And finally, climate change, maybe the biggest threat of them all. Research shows that Medicare and Medicaid patients shoulder a hugely disproportionate share of climate sensitive illness costs.

Chris Bevolo (31:48):
All these issues are worrisome in their own right, but they also have one thing in common. They have an outsized impact on those who already face health inequities and disparities. Without some unforeseen dramatic change of events, the road ahead is not a positive one in terms of the health gap of the United States. Welcome to prediction five, disparity dystopia.

Chris Bevolo (32:09):
So one of the cool things I got to do as part of this book was interview a like sixth cousin of mine, his name’s Marco Bevolo from Italy. He lives in the Netherlands. He’s lead an amazing life. He lead brand at Phillips. He has studied health systems. He’s a lecturer. He’s just an incredible person and he had some amazing insights to share. But this quote, I think, is why maybe we took a little bit of a skeptical view, not a little bit, a deeply skeptical view of where the health gap is going to go in this country, and that is from his perspective in studying health systems across the world in particular Europe and the United States.

Chris Bevolo (32:49):
So the health system you have is basically a reflection of the society you have. And the one thing about the United States is we have a society that’s built on individualism. We have a society that’s built on, “Pull yourself up by the bootstraps.” It’s why we’re one of the major societies that doesn’t have, advanced societies that doesn’t have socialized medicine, because there’s a huge proportion of our population that thinks that’s just a terrible idea. And so the things that make us great as a country, to be honest, also are why we see some of the things we see with our health system. And unless we can address things at a systemic level, that’s where we’re really kind of discouraged about where things could go.

Chris Bevolo (33:32):
Again, this isn’t new. We’re not talking about something that’s a new concept. Clearly, COVID-19 has made things worse and also shown a light on it, as I mentioned. What was really sad and frightening to us was, those other dynamics I mentioned coming forward and really shaping the future of this health gap in a worse way, not a better way. And we talk about it in terms of the haves and the haves-nots, the very first prediction, which we didn’t cover again today, the Copernican consumer, it shows this amazing world. As a consumer you have all of these things kind of at your beck and call with your health, but that’s going to be great for the haves. What if you can’t afford an Apple watch? What if you can’t afford the right internet service? The have-nots are going to have less access to all those amazing things that make the Copernican consumer what is great. And at the same time, so while the haves are going to have it better, the have-nots are going to have it worse. So that gap is widening in both ways.

Chris Bevolo (34:31):
And so, of course there are hundreds if not thousands of entities that are trying to work to solve this, some big, some small, across the spectrum of healthcare and beyond. Federal government, state governments, payers, providers. But from the research we did, from the experts we talked to, without some kind of moonshot-like effort, it’s going to be really hard to solve for the health disparities and inequities that we’re facing in a meaningful way in the coming decade.

Chris Hemphill (35:00):
So Alexis Jetkin came had an interesting question about when we look further than the outreach side and demographic side and look at what the actual what’s going on at the provider level, are providers trusting and believing when people who are minorities or people who are women, when they have certain healthcare conditions, what’s the idea on addressing provider bias all the way down to that provider, physician, clinician level?

Chris Bevolo (35:26):
Okay, huge. It’s a huge issue. We document that in the book. I don’t think it’s probably news to most people. We give enough resources. In case somebody was wondering whether that’s an issue, it’s such a big issue, and that is really difficult to solve for. There’s a few things that come to mind. Women facing heart issues. Acute heart issues have historically been misdiagnosed, have been brushed off and like, “Oh, you just feeling stressed. Take some aspirin and you’ll be fine. Lay down.” Missing really heart attacks, stroke potential, just because as soon as they walk in the room, they’re perceived in a different way just because of their gender.

Chris Bevolo (36:06):
Clearly people of color face this and continue to face this systemically. That is a huge, by itself, if we could just focus on fixing that. Even though it’s just one dimension of this, again, the book goes into depth about how that impacts so many different people and in so many different ways. So all of that is a hundred percent a part of this, but there’s a lot more to it as well. So, yeah. That is a big part of this that has to be solved for, for sure.

Chris Hemphill (36:34):
And yeah, to add on to that is, when we, when providers or when people in the healthcare system make decisions on what types of care people should receive. If someone is believed to have that heart condition and they then go onto proper diagnosis and things like that’s, that reflected in the data. If that person is ignored then that’s something that we don’t have… From a data perspective, you lose the opportunity to address. So it hurts on more angles than just one that by missing out on that one patient, it reduces the likelihood that others be seen as well, because it’s data that’s not being reflected properly. Another question that came in. Sundeep Aurora, this was, I thought, a good one because we were talking about, “Well, hey. It will take some major moonshot to address a lot of these, these healthcare disparity issues that we looking at.” So Sundeep’s question was “Well, what does a moonshot look like?”

Chris Bevolo (37:31):
Honestly, we’re talking about socialized medicine of some kind. We’re talking about, as an example, as maybe the best example, the easiest to understand, something that we see in Western European countries. Because there’s so many people that struggle to access care, to pay for care alone, it’s going to have to be something like that, which is partly why we’re really skeptical of that. Because if you know, you look around today, the odds of something like that coming to pass are… It was the first thing shuttered when the ACA was debated. Like “Well, we’re not going to have a public option.” Not even just a public option, let alone single payer kind of thing. And it’s not necessarily socialized across the board, but even single payer would count as a moonshot.

Chris Bevolo (38:17):
Bringing Medicare to all would be a moonshot because it would clear up so much access, partially. It doesn’t solve for everything, and it’s interesting. In the book we had one of the people weighing in on this, he said, “When you look around the world, the very thing that we do to solve for inequity often drives greater inequity.” So he pointed to the socialized medicine, like the systems in Canada or the Scandinavian countries. And this is also, my cousin Marco spoke to this. He’s like “Here in the Netherlands, we have government-covered care, but we have a second tier like exists in all the other countries.”

Chris Bevolo (38:56):
Who gets access to the second tier? The people who have money. So even though we have now given access to everybody, we have created another inequity. Got money? You’re going to get better care. By definition. You’re going to get faster access, better access. But at least the people that can’t get to it now will have it. So it’s going to have to be something like that. But again, I don’t remember what the polling is, but there’s a significant, it’s not the majority, but it’s somewhere between 35%, 45% of the people don’t believe that healthcare is a right. In this country right now don’t believe you should have a right to healthcare.

Chris Bevolo (39:33):
They just think like, “Hey, you’re on your own. You should build yourself up, get a job, get insurance. You can’t? That’s not my problem.” And so that’s the kind of thing that I saw a comment in the chat like, “Hey, this feels like a reflection of wealth inequity.” Yeah. There’s wealth inequity in our country because of who our country is and that’s why we have inequities to a large degree in healthcare, too.

Chris Hemphill (39:55):
Pierre asked about this growing interest in patients owning and controlling their data. Do you see a relationship there between patients and ownership of data and healthcare disparity dystopia?

Chris Bevolo (40:07):
Yeah, and it’s probably a negative association or relationship. And by that I think there’s a huge opportunity in patient ownership and management of their health data. If that can be made accessible and understandable and private and secure and all the things that need to happen, for those people that are able to leverage that, it’s going to be fantastic. In some ways exacerbates the disparities we already see. Like I mentioned, the digital divide. If you’re going to own and leverage your own data, you got to have great access to it. You got to have high-speed internet. You’ve got to have a mobile, you’ve got to have a smartphone or something. That data has to be leveraged fairly, which systems right now aren’t set up fairly for a lot of communities.

Chris Bevolo (40:55):
So it has the potential to solve some of this, but maybe it’s just because it’s mid afternoon and it’s been a while since I have had coffee and so I have a negative outlook right now, but I would think that the more we see that, the more we might see more of that gap. It goes back to the haves and the have-nots, and so, yeah, I don’t know that will necessarily help this problem. It could be part of this solution, but we shouldn’t look to it on its own as, “Okay. That’s going to move the ball for the have-nots.”
Chris Hemphill (41:25):
Thank you for that and I wanted to highlight a comment from Marilyn Joiner about the expectation that not-for-profit health systems might have to shoulder a disproportionate amount of the cost that for-profit health systems don’t under the current system.

Chris Hemphill (41:40):
I wanted to finalize it with a question from Charles Sanders, which was that if we’re in a situation where the majority of Americans don’t believe that systemic racism is going to be difficult to deal with for healthcare inequities, how does that paint the picture for… One thing you pointed out was that healthcare, that Marco Bevolo said, that it was that healthcare is kind of a societal mindset and things like that. So how does the picture point out with the majority of Americans having a laxed attitude towards racism? How do you see that impacting this healthcare disparity dystopia that you outlined?

Chris Bevolo (42:14):
Well, it definitely has an impact. Chris, you and I haven’t had great conversations on this, but I’m sure we could. There’s racism on an individual level, which may or may not impact it. It’s the systemic racism where this is going to play a role. So systems that have this built in inherently and how that will sometimes overtly, but a lot of times in an invisible way, impact this kind of thing. That’s part of what we need to root out and solve for. We can’t even have those conversations. Literally, in some states you’re not allowed to have these conversations in certain circumstances. And so that’s also frustrating. It feels like we’re going backwards in even being able to discuss this stuff. It took how many years for us to finally be in a place where we could allow the CDC to study the impact of guns on healthcare in this country? That just came about this year or last year? Forever it was prevented. Couldn’t do it.

Chris Bevolo (43:14):
How is that even possible? How can we not have a scientific review of something that causes so much harm to people’s health? Guns rights [inaudible 00:43:23], it’s not even about that. We couldn’t even have the conversation. So I think I’m less concerned about the movement we need to make in society to move people to a better place when it comes to things like racism and other inequities than I am about the systemic side of it and how it influences our institutions.

Chris Hemphill (43:43):
Erica Johansen had the idea on do NFTs potentially provide a way for patients to monetize their healthcare data? Well, there is an argument there on the technical disparity, but curious on your thoughts on NFTs or other ways that patients can monetize their own data?

Chris Bevolo (44:02):
Yeah. We touched this a little bit in the Copernican consumer. It’s less NFTs to me, it’s more blockchain, and they may not come out in the form of a NFT as we know it today, maybe it does. But that’s kind of the spirit of web three, too, is that, “Hey, it’s my data. I should own it. I should benefit from it. I’ll let whoever I want leverage it.”

Chris Bevolo (44:21):
So I think the potential is there, but Chris, I know enough to be dangerous on web three and crypto and NFTs, and so my initial thought on a lot of this is, especially web three. Boy, it sure seems like this is just going to be a different organization. Still platforms dominating this, just like it is in web 2.0 with Facebook and Twitter monetizing our content and our data.

Chris Bevolo (44:47):
I love the utopian vision of web three, but ironically enough, I kind of leaned toward the CEO of Twitter’s take on it, Jack Dempsey, when he said, “You guys, it’s going to be the same. It’s going to be different platforms, but you’re still going to have the same kind of centralized power. You have to.” I’m a little skeptical to see that side of it, but I do think the potential is there. Wouldn’t it be great? Geez, I have so much… I could retire right now, Chris, if I could monetize my health data. I got so much of it. People would love to get their hands on my health data. So I think there’s potential in that whether it’s blockchain or not. NFT or not.

Chris Hemphill (45:24):
With that, I’m excited, Chris, that you have this conversation with us. I’m glad that you’re open to presenting the future as you research it, rather than trying to paint a rosy picture where it’s not necessarily rosy yet. It opens the opportunity for conversations like this, thinkers like the people that were on this call, to figure out well, “Hey, what can my role be in helping to address or solve this issue?”

Chris Hemphill (45:48):
I know that sounded like a bleak way to end it, but the truth is that if we don’t make the right decisions right now, then the future will be bleak. However, to quote one of my favorite data scientists Cathy O’Neil, “To predict the future is to cause the future.” So part of this is in your hands now. What can you do or build or support in order to make Chris’s predictions wrong?

Chris Hemphill (46:12):
So let us know your thoughts and are there any predictions that we missed and until we see you next time, hello.

Chris Hemphill (46:21):
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Chris Hemphill (46:32):
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