If I Describe Your Company as the “Uber of Healthcare”, Don’t Take It as a Compliment. 7 Reasons Why.

I am constantly surprised by the number of companies that intentionally describe themselves as the “Uber of Healthcare”. If you hear me describing your company that way, I don’t mean it as a compliment. What I do mean is some combination of:

  1. Your ethics and values are dubious
  2. Your swashbuckling disregard for regulatory boundaries is backfiring
  3. You underestimated the competition
  4. Your network effects are overstated
  5. Your platform governance model is Medieval
  6. Your business model is unproven
  7. Your valuation is inflated

Let’s take a more detailed look at each of these seven criticisms. Drawing on my background of 30 years in healthcare, I’ve included examples specifically directed at companies describing themselves as the “Uber for Healthcare”.  However, I hope you’ll find the analysis applicable to a much wider range of companies that have described themselves as “Uber for X”.

MIT Platform Strategy Summit, Boston, July 10


Healthcare has been a laggard in adopting platforms…

…but that’s rapidly changing. In fact, I’ll suggest that healthcare will become the PINNACLE platform industry.


  • Many value propositions are very strong — literally “life-or-death”.
  • Acute and episodic care has focused on relatively discrete, time-limited events; the emerging model of chronic care and population health requires ongoing collaboration among care providers and patients.
  • Many of the value propositions of digital health are dependent upon development of interoperable platforms. For example, non-interoperable platforms would NOT work for:
    • The patient who shows up unconscious in an emergency room away from home
    • Patients with chronic conditions who are treated by multiple providers, multiple lab and imaging centers, and over a long period of time
    • Referrals to specialists using non-standardized, proprietary health IT
  • The healthcare data explosion. Think “omics”.

Healthcare has much to learn from platform development in other industries…and you can take a deep dive into platform strategies at the upcoming MIT Platform  Strategy Summit, July 10 in Boston.

I’ll be chairing a panel on “Healthcare’s Digital Revolution: Emerging Platform Leaders”. The distinguished panelists are:

Michael Salerno – EVP Cohealo
Julie Yoo – Co-Founder & Chief Product Officer, Kyruus
Mark Dudman – Senior VP, NaviNet
Michael Jackson – GM, Intel Corporation

Other speakers at the event include:

Paul Daugherty – CTO, Accenture
Geoff Parker – Director, Tulane Energy Institute / MIT
Chet Kapoor – CEO, Apigee
Sangeet Choudary – Founder, Platform Labs
Luis von Ahn – Founder, DuoLingo & MacArthur Fellow
Malcolm Frank – CSO, Cognizant
Jerry Wolfe – CEO, Vivanda
Chris Dellarocas – Chair Digital Learning Initiative / BU
Eddie Hartman – Founder, LegalZoom
Youngcho Chi, EVP Corporate Strategy, Samsung Electronics
Marshall Van Alstyne – Professor, Boston University / MIT
JP Rangaswami – CDO, Deutsche Bank

Hope to see you there!


ONC Report on Health Information Blocking: A Solid Double, But NOT a Home Run

A Stand Up Double

By Vince Kuraitis JD, MBA and David C. Kibbe MD, MBA

Last Friday ONC (the Office of the National Coordinator for Health IT) released a long-awaited Report On Health Information Blocking. The ONC blog capsulizes the report:

Health information blocking occurs when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information. Our report examines the known extent of information blocking, provides criteria for identifying and distinguishing it from other barriers to interoperability, and describes steps the federal government and the private sector can take to deter this conduct.

We were struck with two major reactions to the ONC Info Blocking Report:

  • It’s a solid double: it does a credible job of recognizing that the major problems of interoperability and blocking are not technical or due to a lack of standards, but rather due to business practices and business models. The report also proposes a baseline of potential solutions.
  • It’s not a home run: the report misses the opportunity to describe a comprehensive approach to combat information blocking.

In turn, we offer seven recommendations to strengthen the report:

  1. Place Greater Weight on Patient Safety and Public Policy Concerns
  2. Lower the Burden of Proof For Information Blocking
  3. Put Criminal Penalties On the Table
  4. Broaden the Scope of Tactics for Addressing Information Blocking
  5. Emphasize Federal Purchasing Power — Not Regulatory Power — to Address Information Blocking
  6. Place Less Weight on the Interests of EHR vendors
  7. Name Names, Shine the Light

Where’s the Evidence that Hoarding Data is a Good Business Strategy?

Dear Hospital CIO/CEO,

So you think that hoarding patient data is a good business strategy? …that it discourages patients from going to another hospital?


So why is the marketing department buying billboards encouraging patients to switch for convenience? to save a few minutes?


Permalink: http://bit.ly/1yclLAV

Hospitals’ Soft Underbelly: The Capital Conundrum

Tax-exempt hospital systems without fortress balance sheets and top quartile operating performance will be capital constrained in the future healthcare economy, even if tax-exempt debt continues be cheap and accessible. Stating the obvious: operating a hospital is a capital intensive activity. Historically, hospitals have required about $1 of invested capital to generate $1 of hospital revenue. As hospital systems contemplate changing their facility-based fee-for-service models into health enterprise models responsible for managing populations of patients and being at risk, capital will need to be deployed into new areas….

For less than top tier rated hospital systems, these capital demands create a capital conundrum: building both balance sheet strength in the form of increased days cash on hand and reduced leverage, while also spending capital that is not financeable with tax-exempt debt and very difficult without extraordinary operating margins.

Carsten Beith, Cain Brothers Industry Insights; March 30, 2015

Post permalink: http://e-caremanagement.com/snippets/hospitals-soft-underbelly-the-capital-conundrum/


Apple ResearchKit is Open Source, But is it “Open”?


For now, the answer is “we don’t know”.

But… the question is very important and worth tracking over the coming months. Let’s not assume that open source will equate to “open”.

7 Questions Are Shaping the Patient Digital Health Platform Ecosystem — HIN Article


My article “Seven Questions Shaping the Patient Digital Health Platform Ecosystem” is published in the February 2015 issue of Healthcare Innovation News.

You can download a copy of the article by clicking here.

Accompanying PowerPoint slides are available here.

Table of contents for the series--The Patient Digital Health Platform (PDHP) Ecosystem

  1. Patient Digital Health Platforms…A First Take
  2. Will Apple’s Strategic Beachhead Be Doctors, Not Patients?
  3. PowerPoint — 7 Questions Shaping the Patient Digital Health Platform (PDHP) Ecosystem
  4. 7 Questions Are Shaping the Patient Digital Health Platform Ecosystem — HIN Article
  5. Apple ResearchKit is Open Source, But is it “Open”?

The “Shake the Winter Blahs” Edition of Health Wonk Review


It’s the middle of winter. Feeling blah? Need some stimulation? You’ve come to the right place!

Welcome to The “Shake the Winter Blahs” Edition of the Health Wonk review. For the second time, it’s my honor to host HWR — providing you summaries and links to the best recent writing in the health blogosphere. Let’s go!

Federal Health Policy

At the Health Affairs Blog, Princeton professor Uwe Reinhardt jumps off from the recent controversy about Jonathan Gruber’s remarks describing the American public as “stupid”. He writes that Gruber’s apologies were appropriate. The post is descriptively titled Rethinking The Gruber Controversy: Americans Aren’t Stupid, But They’re Often Ignorant — And Why.

As an American, (I think) I’m relieved to know that I’m not stupid, just ignorant.

PowerPoint — 7 Questions Shaping the Patient Digital Health Platform (PDHP) Ecosystem

PDHPs HU 11, San Diego

I hope you’ll enjoy reviewing my slides from my December 3 presentation at the 11th Annual Healthcare Unbound Conference.

The presentation is formally entitled: “Patient Digital Health Platforms (PDHPs): Epicenter of Healthcare Transformation?”…

…but more informally, I pose and address 7 key questions — the answers to which will shape the future of the PDHP ecosystem.  The answers aren’t all that clear yet because it’s very early and because most of the companies involved haven’t yet shared a lot of details about their plans.

The 7 questions about the emerging PDHP ecosystem are:

1) What’s the “Healthcare Platform Void”

2) How will the emerging PDHP ecosystem reshape the planet?

3) What’s the central issue? It’s about DATA!

4) Will PDHPs converge with mainstream healthcare?

5) How many platforms?

6) What are some “secondary” issues?

7) Why are PDHPs about much more than just healthcare?

You can download a copy of the PowerPoint slides here.

For additional perspectives on PDHPs, take a look at my previous blog post: Patient Digital Health Platforms…A First Take.


Table of contents for the series--The Patient Digital Health Platform (PDHP) Ecosystem

  1. Patient Digital Health Platforms…A First Take
  2. Will Apple’s Strategic Beachhead Be Doctors, Not Patients?
  3. PowerPoint — 7 Questions Shaping the Patient Digital Health Platform (PDHP) Ecosystem
  4. 7 Questions Are Shaping the Patient Digital Health Platform Ecosystem — HIN Article
  5. Apple ResearchKit is Open Source, But is it “Open”?

ACO Lessons Learned: Revisiting the Timing of Downside Risk


The editor and publisher of Accountable Care News have been generous in allowing me to republish my article from the November 2014 issue.

Click here to download a .pdf copy of the article. It’s in-depth — about 2,000 words.

Here’s the article in a nutshell:

One of the most critical aspects of the Medicare Shared Savings Program (MSSP) ACO has been around the timing and certainty of requiring mandatory downside financial risk for physician and hospital participants. Provider protests cajoled CMS to backing off an initial stance of “firm and unwavering” for ACO mandatory risk requirements in 2011.

The issue is being revisited in major 2014 MSSP reg revisions which are in process. A central lesson we are learning about ACOs is that clinical transformation is a long and difficult process, and thus CMS (and all payers) should continue to be “firm but flexible” in the timing of requiring downside risk. There are many advantages of a stance of “firm but flexible”, and while the shift in wording might seem subtle, the implications are profound.