In his 1992 book, Future Edge, author Joel Arthur Barker traces the sometimes tortuous, yet generally predictable and duplicable, path of paradigms.
One of the key takeaways is that new paradigms are most often brought to market by "paradigm pioneers." The pioneers aren't invested in the old way of doing things, which frees them to create new paradigms.
Harvard Business School professor and author Clayton Christensen would call them "disruptive innovators." In our weekly podcast, we call them "Shift Shapers." No matter the nomenclature, all of these pioneers seize shifts in the marketplace and alter them to create opportunities.
In health care (writ large) we are witnessing an interesting and unusual phenomenon.
A great portion of the disruption has been externally generated. Yet despite this twist on the normal process, the innovators — the paradigm pioneers — are making their presence known in nearly every facet of the industry.
Hospitals have been purchasing physician practices that have become the de facto networks of Accountable Care Organizations (ACOs). ACOs seek to coordinate care and deliver a better patient experience while lowering costs. If they achieve their goals, they become eligible (under Medicare) for bonuses. It will be interesting to watch ACOs develop and to see whether care actually becomes more efficient and effective, or whether throttles to both access and care are employed to achieve those metrics. Nevertheless, this is a very different paradigm with potentially broad implications.
New paradigms are sprouting up in smaller organizations as well. We recently interviewed Frank Roby, CEO of RevelationMD. Frank and his colleagues had the radical idea that doctors ought to have access to pricing and outcomes information. While their treatments, prescriptions and referrals drive costs, until now they have been largely outside the plan and payer loop. Bringing all stakeholders together and sharing data should help plans reduce or eliminate waste. At present the company works exclusively in the large group, selffunded market, but their model could have profound effects on the entire market.
