Is Healthcare At The End Of Its Middle Age?

There tends to be this general misconception that the historically bleak era of the Dark Ages was immediately followed by the Renaissance. In reality, the two eras were separated by several hundred years between them. These years were known as the Middle Ages and they witnessed significant turmoil and widespread economic uncertainty.

We can draw parallels between this historical context and our experiences in healthcare over the past few years. While not directly between the bubonic plague of the Middle Ages and Covid-19 – that would be too on-the-nose – perhaps more with the era of uncertainty created by crisis after crisis, each making the situation more dire and complex. Not unlike the recent global pandemic’s downstream effects that have caused much upheaval throughout the healthcare industry in the years that followed.

You see, the recovery efforts focused on the problems of the Dark Ages were the precursors for the calamities in the Middle Ages that followed, from famine to the devastating “Black Death” bubonic plague pandemic that decimated entire populations.

As Europe emerged from the shadow of the plague and the preceding crises, new political powers succeeded the former kingdoms and expanded across the continent, emphasizing trade and exploration. This shift gave rise to universities and sparked a renewed interest in arts and sciences. Consequently, the Renaissance gradually spread throughout Europe as a cultural and intellectual movement. Among its notable contributions was the printing press, a groundbreaking invention that revolutionized the distribution of knowledge, thus paving the way for the subsequent Age of Enlightenment.

In essence, the Dark Ages were not the pinnacle of misery; the Middle Ages offered even greater hardships. And the attempts of established kingdoms to recover from the Dark Ages often ended in failure, as they faced further unforeseen crises. These kingdoms had to undergo significant changes that then resulted in unprecedented advancements in the region.

Along the same historical vein, the traditional healthcare provider organizations have been attempting to recover and adapt to the post-pandemic world, but are now encountering additional challenges with intense financial and operational burdens. While costs for everything from supplies to labor have gone up dramatically, payments from payers, both government and private, have not. Similarly, the expectations of the patients and healthcare consumers have shifted greatly, having an equally drastic effect on the predictability of volumes for providers. It is evident, then, that the healthcare sector’s previous operating models are no longer sustainable in the present era.

Perhaps this is where we find ourselves now, at the edge of healthcare’s Middle Age. The question arises then, what radical change in our landscape will push us through to the other side and usher in our renaissance?

It is clear that the provision of care will extend beyond the confines of acute-care inpatient hospitals. Despite the traditional health systems’ varying adoption rates of virtual, remote, and home-based care, the aging population (65+), expected to reach close to 20% of the U.S. population by 2030, will accelerate this transformation due to increased demand regardless. And it is clear that this transformation will be digital in nature, relying heavily on technology to augment the workforce and change the way work gets done. Therefore, if the legacy provider organizations of the pre-pandemic era are no longer suited for what lies ahead, where will evolution take us? Here are a few recent developments worth noting:

• Non-traditional entrants into the healthcare provider space – The likes of Walmart Health and Dollar General are beginning to capitalize on their retail footprint to roll out primary and urgent care centers, along with diagnostics, in certain states. One of the main value propositions here is their existing logistics and supply chains that they can tap into over a wide geography to support these physical centers.
• Targeted expansions by companies that have had ambitions within the provider space in the past – Amazon, CVS Health, and Walgreens have tried out various forms of care provision in the past. However, it is clear from their recent acquisitions of One Medical, Signify/Oak Street Health, and Summit health respectively, that they are betting on that front-line primary care model as their inroad.
• Scaling-up of established healthcare giants – Some notable examples of this would be Kaiser Permanente forming “Risant” jointly with Geisinger to create scale in the value-based community health systems arena (“Kai-singer” model), UnitedHealth Group’s chain of acquisitions under Optum, which is now the largest employer of physicians in the U.S., and the mergers of large health systems like Advocate Aurora and Atrium Health to form an even larger organization that spans six states.

Another item of note is the recent spike in usage and maturation of Artificial Intelligence (AI) tech. If the analogy of this article holds, are we now in the presence of our generation’s version of the printing press?

Together with the recent developments in the industry listed above, perhaps we are now witnessing that final dam-breaking crack in all that has held healthcare back. Perhaps now we will finally see real transformation burst forth, freely flowing across the healthcare landscape… much like kingdoms in the Middle Ages attempting to hold their influence together through crisis after crisis, only to finally give way to dramatic wholesale change, heralding the onset of the Renaissance.