Documentaries Can Change the World. Change Healthcare With Us.

The most common question I'm getting now that I'm back from my post-WebMD vacation is "what's next?" I addressed my early thinking in Arrivederci WebMD but there is one item I am kicking around that I'd love to get your input. I'd like to add to the early thinking that we have around a health-related documentary.

I believe there is a need for a documentary to enrage, inform and then activate a grassroots movement driven by individual citizens, doctors and employers to dramatically accelerate Healthcare's Trillion Dollar Disruption. For example, at a time when we have ever-growing needs for seniors, education and other important areas, it's powerful to think about what the U.S. could buy with the dollars we waste on healthcare. Further, almost all the payroll increases over the last 20 years have gone to fund healthcare's hyperinflation which is why I believe our employer-based healthcare system is both the original sin and potential source of redemption for healthcare. 

We have had some nice documentaries about healthcare that tell interesting stories, however they have fallen short for the following reasons:

• The filmmakers have been great storytellers but haven't come at it from a systems level -- both the problems and the solutions. Anecdotal stories can be fascinating but aren't transformative.
• Most filmmakers don't have the domain knowledge to know how to create a system-level solution nor do they understand how to determine what are scalable solutions. 
• That, in turn, has left the calls to action that don't catalyze a consumer movement. Interestingly, every thought-leading doctor I talk with says that system-level change can't happen without consumers. It's a huge lift to activate consumers but it can be done. In fact, I'd argue that the aforementioned thought leaders (clinicians of all stripes, provider organization leaders, etc.) are essential to giving consumers confidence that it's an achievable goal to develop a higher performing health ecosystem.

Imagine if every other server Amazon procured for their datacenter didn't function. They wouldn't tolerate it for a moment, yet we are doing the equivalent of that with the way we spend on healthcare. The byproduct is we are wasting $1 trillion per year just in the U.S. according to PwC and the Institute of Medicine. For most organizations, health benefit costs are the second largest expense after payroll. The consequences are enormous. For example, most people aren't financially prepared for old age, let alone dealing with today's high deductible plans. I did a back-of-the-envelope calculation of what would be in an average American's retirement account if they'd worked over the last 30 years. The key difference between their current status of their retirement account and the theoretical retirement account is what I think of as the "healthcare hyperinflation tax". If you took the difference between regular inflation and healthcare's inflation and had invested it in an index fund, they'd have roughly $1M in their retirement/pension account. 

Most of us lament how backwards healthcare is when it comes to information technology. It's clear to me that the root cause of that goes back to how poor the healthcare purchasing practices are. For the tech industry, we need to look in the mirror -- Tech Industry, Heal Thyself. Tech companies pride themselves on being forward-looking yet most are buying health benefits essentially the same as a crusty old-line company. 

Documentaries Have Changed the World

I don't underestimate the power of "preservatives" protecting the status quo. One's waste is another's revenue and incumbents have and will use every tool in their toolkit to fight change. As far as I can tell, the only way I can think of fighting the Preservatives is to create a grassroots movement demanding change. For this reason, I believe a documentary can be a critical tool to overcome the ferocity of Preservatives. When documentaries are done well, they can change the world as others have highlighted here, here and here.

The future is already here — it's just not very evenly distributed. William Gibson

The good news against the backdrop of waste is that I'd argue all of the solutions that are needed to fix healthcare have already been created and are proving over and over the tremendous impact they can have. I'll let you in on a little secret to what was behind the success of Avado. People often wondered why I spent the time writing about topics such as Direct Primary Care. In a nutshell, I was on a quest to find as many of the healthcare organizations that were dramatically out-performing the norm and observing where they were frustrated (despite their success). This was the best form of Customer Development that we had.

Through that journey, I became very optimistic that these breakout organizations would show how the Quadruple Aim could drive the next generation of healthcare delivery. That is, when you add another "aim" to the Triple Aim -- satisfaction of the clinical team, you ensure long-term, sustainable success. The contrast is sharp between docs who are increasingly dissatisfied within the current system and the docs who are inventing the next generation of healthcare delivery. The latter group are loving their work and are living the dream they envisioned when entering medicine.

Doc-Entrepreneurs Delivering Salvation to Healthcare

Thus far, I have found that every breakout organization has been led by a doc-entrepreneur -- a velvet medical revolution. These are the individuals who are driving healthcare's age of enlightenment. The following are a couple examples of doc-entrepreneurs that I've written about in the past:

• The Marcus Welby/Steve Jobs Solution to the Medicaid-driven State & County Budget Crisis
• The Hot Spotters Sequel: Population Health Heroes

To activate the groundswell necessary to accelerate the needed change, I believe individuals need to first be enraged and informed. However, the objective of the documentary wouldn't be to throw the industry under the bus. It's my firm belief that the vast, vast majority of people inside the industry are well-meaning, but many operate inside of systems that have responded to an adherence to flawed reimbursement incentives (and tradition). These well-meaning individuals have no interest in stealing the future of seniors and kids as has been taking place.

Given the magnitude of obstacles to change, I believe only a collaboration of clinicians (with doctors playing a particularly critical role) and individuals (aka patients/consumers/people) can create the uprising to expect more from our system. Many find healthcare as difficult to solve as ancient Egyptian hieroglyphics. However, I have found the aforementioned doc-entrepreneurs to have created the components of healthcare's Rosetta Stone to solve the complex healthcare puzzle. 

How You Can Help

At this point, the two biggest items that we need to get this off the ground are funding and additional powerful stories. 

Documentaries rarely earn megamillions at the box office. Thus, they require funding. I would expect that there would be three primary sources of funding -- foundations, corporate underwriters and crowdfunding sites such as Kickstarter. Undoubtedly, many of you know potential sources of funding at corporations or foundations who would be motivated to accelerate healthcare's reinvention. Any introductions are welcome. 

Naturally, any film is about storytelling. Great stories will bring this to life. On the negative side, having individuals willing to be filmed that share where the healthcare system is falling short will set the stage. On the positive side, we can always use more great stories like this one. The following are areas of particular interest:

• The impact of great primary care such as Nuka, Iora, ChenMed, CareMore, Camden Coaltion, Qliance and others.
• Radically transparent pricing for high cost procedures that docs such as Keith Smith, Stan Schwartz and others have come up with that are a win for patients, employers and the docs themselves.
• Stories of where individuals are Choosing Wisely with the help of their docs
• Stories to illustrate how in-depth pharmacy management is about far more than utilizing generics
• Examples of how disease-specific pathways have a big impact on the Triple Aim
• Since 80% of outcomes are driven by non-clinical factors, there are various initiatives such as The Way to Wellville are taking proven approaches and scaling them.

While I've learned a lot recently about the documentary filmmaking process, I have a lot more to learn and likely have some blindspots. I'd appreciate any and all input, words of wisdom and contacts that can help bring this project to life. 

I'll leave you with a quote from one of healthcare's enlightenment thinkers, Dr. Jeffrey Brenner about the opportunity to drive changes to what may seem like an insurmountable obstacle:

There comes a point in a democracy when the public’s had enough and they stand up and they get upset. And, you know, the baby boomers shifted every public system they’ve ever touched. They shifted schools, colleges and universities. They changed the institution of marriage, of child rearing, of employment. I think that they’re probably going to change the institution of aging, medical care and dying, ultimately. It would not take very much change in taste and preference to collapse the system.

Update: Since posting this, there has been great progress. Unbeknownst to me, I was one degree separated from some of the most acclaimed documentary filmmakers. After some discussions, we are now teaming with an Academy Award-nominated producer/director and her film-making partner who has won a Peabody Award as a producer/director with The Daily Show. These world class talents know how to bring a smart, funny, enraging and empowering film to life.

I've also had a great response from individuals experienced in financing films. There is still a long journey ahead but I'm very encouraged. Feel free to reach out if you have experience or connections in financing and distributing films -- we've self-funded so far but will require funding for full-scale production.