The Impact of Social Determinants of Health on Population growth

By Maria Chaves, MBA, MPH

There’s an uptick in discussions about the global drop in birth and fertility rates. Nations, including the United States, are increasingly concerned given the significant risks to economic stability, workforce sustainability, and societal systems that rely on growing populations to support its citizens.

Regardless of the measurement source used, there is a common theme of declining population growth.

• Birth rate measures the number of live births per 1,000 people in the total population in a given year regardless of age and gender.

• General fertility rate measures the number of live births per 1,000 women of reproductive age (typically ages 15-44).

• Total fertility rate projects fertility over a woman's entire reproductive lifespan rather than measuring it for a single year. The fertility rate cited for a population to replace itself is 2.1.

Efforts to identify and address social drivers of health (SDOH) factors to improve health are emerging as important elements in the tapestry of solutions that ease the worries that hinder family planning decisions.

1. Financial Security: A Key to Family Stability

For many, the decision to have children hinges on financial security. Concerns about job stability, student loans, and the rising cost of living are significant deterrents. “Baby bonuses” have not shown to impact fertility rates in Italy, Singapore, nor Japan. Comprehensive family benefit packages and broad societal support, as seen in France and Sweden, have proven to be more effective in sustaining or boosting birthrates.

Organizations focused on improving financial security through debt reduction, wage increases, and affordable childcare are playing a pivotal role in making family life more accessible. Their work enables more individuals and couples to feel confident in their financial ability to start a family.

2. Affordable Housing: The Foundation of Family Life

The high cost of housing has become a significant obstacle to family formation. Austria and Germany have stabilized fertility rates by providing housing subsidies, affordable rentals, and homeownership incentives, which have eased financial pressures on families, particularly in regions where housing affordability has improved.

By ensuring that safe and stable housing is within reach, these efforts are helping to lay the foundation for families to thrive. The importance of this work cannot be overstated as it directly influences the decision to start a family.

3. Work-Life Balance: Making Parenthood Possible

Balancing work and family life is increasingly challenging, with many jobs demanding long hours and offering limited flexibility. The generous parental leave systems and work-life balance measures in Sweden, Norway, and Denmark have fostered higher fertility rates by supporting shared parental responsibilities and family stability.

Organizations that prioritize work-life balance through improved parental leave, flexible work hours, and enhanced childcare support are making a substantial impact. Their work plays a key role in making family life more feasible and reducing the tension between career aspirations and parenthood.

4. Quality Childcare and Education: Supporting the Next Generation

The availability of affordable, high-quality childcare and early education is vital for reducing the stress associated with raising a family. State-subsidized childcare in France and Denmark has facilitated parents’ return to work and contributed to higher fertility rates by reducing childcare burdens.

Organizations working to expand these services are providing essential support for today’s parents and laying the groundwork for a stronger future. The significance of this work is clear: by making childcare and education more accessible, they are removing one of the most significant barriers to family growth.

5. Healthcare and Support Services: Building a Healthier Future

Access to comprehensive healthcare is a cornerstone of family planning. Israel has one of the highest fertility rates in the developed world (around 3 children per woman) due in part to comprehensive healthcare services, including subsidized fertility treatments and strong support for family planning. The cultural value placed on family also plays a significant role.

Organizations that are expanding affordable and inclusive healthcare services—from reproductive health to pediatric care—are making a substantial contribution to the well-being of families. Additionally, support services like parenting classes and mental health resources are providing critical assistance to parents. The importance of these efforts in creating a healthier environment for families cannot be understated.

6. Environmental Health: Safeguarding Future Generations

Environmental factors play a significant role in reproductive health.

• Endocrine disruptors, heavy metals, microplastics and pesticides disrupt reproductive hormones and damage tissues, leading to fertility challenges and pregnancy complications.

• Air pollution has been linked to reduced sperm quality, lower fertility rates and increased risks of pregnancy complications including low birth weight and preterm births.

• Elevated temperatures from climate change and occupational heat exposure can impair fertility by reducing sperm quality and disrupting ovulation and menstrual cycles. Additionally, climate-related stress can further disrupt hormonal balance, increasing the risk of pregnancy complications.

Organizations working to reduce pollution, minimize exposure to harmful chemicals and address elevated temperatures from climate change are addressing a crucial aspect of SDOH that are often overlooked. Their work plays a key role in boosting reproductive health outcomes and ensuring a safer world for future generations. Addressing environmental health is not just beneficial; it is crucial for fostering the confidence needed to bring children into the world.

Conclusion: The Vital Role of SDOH in Addressing Declining Birthrates

The decline in birth and fertility rates is a multifaceted issue. The essential work being done by organizations to address SDOH offers one of the critical paths forward. Efforts to enhance financial security, provide affordable housing, support work-life balance, ensure and expand access to quality healthcare, and address environmental health are laying the groundwork for a future where families can thrive. The importance of these initiatives cannot be overstated—they are foundational to reversing the trend of declining birthrates and building a society where families are supported and valued.

Scenarios Preparing for the 2024 Election

Scenario planning has been an essential component of our strategic work at Spring Street Exchange. In June, we prepared this document which offers an approach to exploring issues that could impact healthcare organizations leading up to the 2024 election. Developments since then have continued to alter the landscape in ways that were difficult to predict. With about 100 days left until voters head to the polls, there are likely to be even more changes.

We hope that this framework helps your organization to support your patients, members, partners, and other constituents as we navigate the next several months and beyond.

Let us know how you are using this resource, and, of course, reach out if we can support you along the way!

Click here to access the Scenario Pack

AI and Primary Care: A Personal Story

By Katie Poole

This past weekend, my 9-year-old son came running into the house with his arm and neck covered in a stinging, bright red rash. He said he had tried to retrieve a ball that had landed in some weeds and, right after, the reaction started. I will admit, I’m not super familiar with native plant species and I typically would have immediately taken him to his PCP or an urgent care out of caution.  

I’m a single mom with three school-aged kids living in a rural part of NY and an urgent trip to a doctor’s office would have been time-consuming, stressful, and expensive. It also would have prolonged my son’s discomfort (and surely my own when my other two children complained about the inconvenience of having to tag along). So, I decided to try something different. 

I asked my kids to show me the plants where the ball had landed. I opened ChatGPT, snapped a quick photo of the weeds in question, and asked if anything in the photo could have caused my son's reaction. Within seconds, ChatGPT identified the culprit as a stinging nettle plant (cute name, rude plant) and advised me on how to treat the reaction and ease his pain, all of which was manageable from home. In a few minutes, my son was feeling much better and back outside playing. Crisis averted. 

The whole incident got me thinking about AI’s potential to change primary care. Instead of an inconvenient trip to a doctor’s office, I got a quick and accurate answer and was able to treat him from the comfort of my home. As demonstrated by this incident, AI tools like ChatGPT, are currently able to make healthcare more accessible and convenient. The promise of convenience and a lightened load feels like a myth we keep being promised but always remains on the horizon. And yet…. 

Imagine a world where AI-driven diagnostic tools are as common as household thermometers, enabling instant insights into health needs and issues. AI’s ability to support immediate diagnostics and treatment recommendations could significantly reduce the burden on the healthcare system, as well as for consumers, especially in underserved rural areas like my own. The technology exists already, so is this really that far out of vision?  

As AI continues to advance, traditional primary care services could become increasingly self-managed. This makes me wonder what primary care will look like 10 years from now. What will be the role for primary care providers? What will member engagement and care management look like in the years ahead?  

The future is unknown, but it is hard to imagine that the healthcare industry is not altered in significant ways by AI. My experience this weekend showed me just how valuable access to AI can be and, at the same time, how essential it will be to thoughtfully integrate AI into the broader healthcare system. The future could be incredibly bright with AI, but we must navigate the challenges carefully to ensure it solves, not exasperates, care fragmentation. 

Where Did My Doctor Go?

Where Did My Doctor Go?

When I was a little girl, I was fortunate – what I have now come to understand as privileged – to have access to doctors of different kinds for whatever I needed. It was easy to get in to my primary physician, whether for an annual physical or when something came up, like a throat infection or a mystery allergic reaction. Maybe because my maternal grandfather was a pharmacist, I inherited a high level of trust and respect for medical practitioners of all types. This regard continued throughout my adult years; however, as life unfolded and I entered the world of software consulting, changing providers became routine due to frequent job transitions.

When selecting a set of new in-network providers, it became my habit to conduct an interview process. Taking charge of my health, I developed a habit of conversing with potential providers, ensuring they were comfortable with alternative treatments like acupuncture and chiropractic care (early on, those treatments were rarely covered by insurance). My self-advocacy and collaboration with doctors proved effective for most of my life, but over the last 10-20 years I began to notice that I did not always see the same provider each time I went to the doctor’s office, which thwarted the ongoing partnership that I wanted. In addition, it began to feel less and less like the doctor managed the practice; on more than one occasion I had the appointment scheduler try to tell me what my provider did and did not treat, typically giving me different information than was later shared by my physician.

More recently, it is often difficult to get an appointment with my provider when I am ill. In some cases, we can do a teleconference call, but most of the time a physical exam is needed for diagnosis and treatment – and, depending on staffing, it might be challenging to get in the same day. So instead, if I have acute symptoms, I am likely to opt for urgent care or, in more severe cases, the emergency room. There, I must count on the on-duty provider I see to listen to me and review any notes in whatever electronic medical record is accessible. Add to all this that I have seen more providers retiring, changing the type of practice they do, or having turnover for one reason or another. This means that I have lost the ongoing relationship with a regular provider. My success at self-advocacy depends on the goodwill/energy/focus of whoever I’m seeing at the moment.

With the gradual changes in the healthcare industry, it seems like a gargantuan issue to solve. The focus of the US healthcare industry has often revolved around diagnoses, treatments, and outcomes on a case-by-case basis. It is tempting to want to return to a time when healthcare operated more in a way that suited me. However, I know that’s not the answer; we need to be looking forward. As the system is increasingly embracing whole-person care, value-based care, and with more focus on consumer-centricity, I am encouraged to believe that we are on the march to addressing these issues. However, many in the system with a better personal solution may not realize the gaps being faced by many of us who are still trying to coordinate our own care. My hope is that as we embrace new technology and new business models, the type of relationship-based, accessible, and equitable coordinated care that most of us crave becomes a reality for all.

Book Review: The Worlds I See

"The Worlds I See" by Dr. Fei-Fei Li: A book about AI, humanity, and a deeply personal journey 

In the book "The Worlds I See," Dr. Fei-Fei Li offers a narrative that is as much about artificial intelligence as it is about her own personal and professional journey. As a woman in tech, an immigrant, a scientist, a scholar, a teacher, and a foundational developer of AI, the book offers a richly layered perspective on the past several decades of technological development. 

The book starts with Dr. Li’s early life and her move from China to the United States as a high school student. We learn about her challenges and intellectual passions and of the mentors who helped her through tremendous adversity. Dr. Li earned a full scholarship to Princeton as an undergraduate and then received her Ph.D. from the California Institute for Technology (CalTech). She achieved all this while taking care of her parents and helping to run a dry-cleaning business in New Jersey – even from California! She became a professor at Princeton and then at Stanford, where she served as the Director of the Stanford Artificial Intelligence Lab (SAIL). She is currently Co-Director of the Stanford Institute for Human-Centered Artificial Intelligence and the Stanford Vision and Learning Lab. In 2017, she co-founded AI4ALL, a nonprofit organization working to increase diversity and inclusion in the field of artificial intelligence. Dr. Li is the real deal.  

Dr. Li's unique position in the tech world allows her to provide an insider’s account of AI's evolution. She is renowned for her pivotal work in creating the "ImageNet" dataset. ImageNet is a large visual database designed for use in visual object recognition software research. It significantly advanced the field of computer vision and artificial intelligence by providing a large, structured dataset for training machine learning algorithms, particularly in the development and improvement of deep learning systems. Reading the story of ImageNet offers an overview of the underpinnings of AI and, therefore, what the technology is and how it works.  

But this book isn’t just about technology and AI. Characterized by an uncommon mix of humility, curiosity, and compassion, Dr. Li’s enthusiasm for learning is deeply intertwined with her humanistic values. She advocates for a balance between technological advancement and ethical considerations, a theme that resonates throughout the book. 

As Dr. Li’s career developed, she became focused on leveraging AI to help improve peoples’ lives leading her to apply this technology in healthcare. I found it painful to hear her reaction to some of the dehumanizing statistics that those of us healthcare insiders have become so accustomed to, such as the number of lives lost each year due to medical error. Her discussion on this topic not only informs but also inspires, showcasing the positive impacts AI can have on our lives. 

Despite her optimism about AI's potential to better our lives, Dr. Li remains sober about its potential to do harm without direct intervention to drive the technology toward positive purpose. She highlights the need for responsible and ethical AI development, and one that focuses on equity and inclusion. 

After reading "The Worlds I See" I have developed a profound respect for Dr. Li due to her brilliance, her creative spark, her strong commitment to a north star, and her humility. The book is a rare gem that intertwines personal story, a history of AI, and thoughts on the future, all in a compelling read that kept me captivated. I am left feeling a deep sense of gratitude for Dr. Li for being vulnerable and brave in sharing her own story and in daring to be bold, ground-breaking, and visionary in leading forward.  

If you’ve read “The Worlds I See”, I’d love to hear your thoughts! 

The Path to Equity Starts at the Top - Part 2

By Janice Sparks, PhD

Recently, I wrote a blog in relation to the headline, Hamstrung by ‘golden handcuffs’: Diversity roles disappear 3 years after George Floyd’s murder inspired them. The NBC News article highlights the loss, in major corporations, of diversity, equity and inclusion (DEI) officers who were hired in early 2020, due to many organizations that are reducing or eliminating these positions. 

This article made me think about these roles in healthcare. Specifically, does this trend exist in healthcare? How does the presence or absence of these roles impact the development and implementation of health equity interventions, and does the trend reflect a healthcare organization’s commitment to advancing health equity? This is of particular importance in light of the growth in health equity policy development and increasing state contractual requirements mandating compliance to Medicaid and other publicly funded programs. 

The industry with the largest number of chief diversity officers is education, at 26%, and healthcare comes in at 8%. The figure for healthcare is concerning because findings show that healthcare leadership and governance teams that reflect the communities they serve are more committed to including community voice in their decision-making. This commitment is conducive to best care practices, leading to better health outcomes. Collecting data on hiring trends for these roles is important and tells a story about the status of the roles and waning interest. While there is a trend to monitor activity around chief DEI positions, the same level of data tracking does not appear to exist for chief health equity officers (CHEO). 

To be fair, CHEO roles are new for most organizations, so monitoring trends pertaining to them may not be on the radar. Spring Street is encouraged by the fact that so many of our community-based health plan colleagues and other healthcare entities are committed to advancing health equity and have hired CHEOs. These advances have the potential to move the needle on health equity and disparity reduction. But now that these roles have been secured, what does an organization do to monitor and retain the CHEO role?  

DEI in general is under attack, and related roles face the same challenge. Failure to monitor CHEO hiring and retention practices puts hard-won appointee wins at risk for diminution or elimination due to political dynamics, fading interest, limited resources, and loss of appetite for continued attention to the issues that initiated their implementation. 

As an industry, we should be monitoring these positions and ensuring that the roles continue. The federal government could also track hiring and retention patterns of CHEOs among federally funded healthcare organizations. This could shed light on the link between an organization’s ability to lead in the area of health equity and health equity advancements. 

The questions posed at the beginning of this post will remain as CHEO roles evolve, and it will be interesting to watch what happens over time. The hope is that the growth of these roles remains to advance disparity reeducation and achieve health equity.  

Coming Back 5 Years Later

Five years ago, I was just coming back to work after the death of my husband after endured 17 months of treatment and suffering from pancreatic cancer. The journey as his wife, caregiver, and number-one fan was the most life-altering and humbling experience I have been through. It was an existence where everything mattered (life, love, connection) and yet nothing mattered (mail, social media, formalities) at the same time.

I wrote this article attached here to highlight some of the takeaways I had from the experience. As I read it now, I’m transported back to the time when I was writing it. I had been searching for a way to create meaning from everything my husband had endured and to honor all of the generosity, grace, and goodwill that we benefitted from.

I still stand by everything in the article. The deep connections we made with providers, family, and friends around this higher purpose are a marvel of the universe that I feel privileged to have been a part of. And I remain deeply gratefuly to the incredible providers who cared for my husband. But the article doesn’t include the most profound and difficult misfires of treatment.

Despite my education, privilege, empowerment, and informed status as a healthcare insider seeking care at elite cancer treatment facilities, I was unable to protect my husband from avoidable suffering. We experienced it both personally and in witnessing the experiences of those around us. A few examples include:

Failed care: The ways in which hospice utterly failed us when their protocols for escalation didn’t precisely match my husband’s symptoms, leading them to ignore pleas for help until he was hours from death.

Medical error: The day when my husband experienced a cascade of five medical errors within 24 hours, none of which were likely reported, and which resulted in a dramatic late night surgery.

Avoidable suffering: The failure to address extreme pain, and then later to ignore all symptoms that weren’t precisely pain.

Administrative labyrinths: Learning to bypass weekend ‘don’t call us’ phone trees by randomly calling in-house phone numbers until we found someone at their desk who could transfer a call to an admin on the GI floor.

And so on.

During our many trips to the ER and hospital, I primarily donned my wife and caregiver hat, but I could never entirely take off my healthcare system hat. I kept thinking – if only someone were shadowing us through this day, and documenting each step of the journey, there is no way this madness could continue. The mass acceptance of the inanity is a collective venture, not born out of bad intentions, but endured by everyone along the way.

Guiding other family members through the healthcare system during the past five years has been discouraging; little seems to have improved. I can imagine that the friction these experiences create for patients is also wounding to the clinical and administrative professionals witnessing them. There are few bad actors, but a mostly broken system is enough to create harm. And it is a system that I am a part of.

As we sit on the precipice of dramatic change in healthcare, enabled by emerg ing technology and new business models, we must use this moment to ensure that we get it right. We need to make sure that healthcare is accessible and equitable, kind, and personalized. We need to honor the incredible compassion and skill offered by humans in the system, and also take an honest look at the pain the system itself can cause. We can do better.

Nancy Wise's Top Reads of 2023

Choosing this year’s top three books was harder than ever – and so I landed on four. It is rare for me to find books that shake my thinking in a foundational way. Each of these four books made me see the world in a new light, and so I couldn’t take any off the list.  

At a time when sound bites rule and we are all seeking information and insight in shorter and shorter bursts, I still relish the opportunity for the deep perspective and understanding that comes from reading a book. It feels like a precious chance to spend time with the thoughts of an expert who has so generously given their time to share their intelligence and perspective with the world.  

I would love your thoughts on any of these and recommendations for more!  (In alpha order by author last name – not in any order of preference) 

The AI Revolution in Medicine: ChatGPT-4 and Beyond 

By Peter Lee, PhD, Carey Goldberg, M.A. and Isaac Kohane, MD, PhD  

The AI Revolution in Medicine highlights how ChatGPT-4, already trained on both clinical and administrative aspects of healthcare, could transform the practice of medicine. The use cases are grounded in the present-day healthcare system, highlighting that AI substitutions for troublesome aspects of our healthcare system are already available. When seeing the specific use cases in action it is an easy leap to see how broad adoption of these capabilities could have a transformative impact on the practice of medicine and of healthcare at large. As the title suggests, making current healthcare more efficient isn’t the revolution that is badly needed in healthcare. The examples of what AI can do are so rich that the reader can instantly start envisioning how the same tech could be used to drive toward better solutions and business models. The book was written by several authors, with each chapter touching on a different theme. Much of the content is delivered through case examples, making it a quick and impactful read.   

If you are looking for a single source to advance your thinking into real-world use cases for AI in healthcare, read this book! 

The Worlds I See: Curiosity, Exploration, and Discovery at the Dawn of AI 

By Fei-Fei Li, PhD 

The Worlds I See is a rare intersection of the personal, professional, and scientific worlds in one coherent narrative. Dr. Li shares her personal story as an immigrant from China, her tenacious quest for purpose and achievement, and her commitment to making a positive impact. We hear her thinking for each step of her professional journey, including her periods of doubt and her incredible breakthroughs. In telling her own story, we also hear about the history of AI and how contributions from various scientists and academics built upon each other to develop what we see of AI today.  

Dr. Li’s journey taking care of her mother’s health leads her on a quest to apply AI to solve problems in healthcare, long before the current applications of AI were understood or even contemplated.  

The story is told with an uncommon and heartwarming sense of gratitude and humility. I am left with profound respect for Dr. Li as well as a deeper understanding of just what AI actually is. The former propelled me through the book, and the latter is a gift that grounds my thinking for where the future could lead.  

If you are looking for an inspiring story and a more profound sense of what AI actually is and how it could be used to solve previously insolvable tasks, especially in healthcare, read this book!  

The Coming Wave: Technology, Power, and the Twenty-First Century’s Greatest Dilemma 

By Mustafa Suleyman 

The Coming Wave is a head’s up by one of the world’s leading experts in AI. Suleyman founded DeepMind, led AI Products and Policy at Google, and more recently founded InflectionAI. Few people have as deep an understanding of the power of new tech and how it could both help and harm our world. He describes the outcomes of this new wave of tech that will bring to us in the near term capabilities that would have seemed ‘Jetsons’ to us only a years ago. Examples include: bring about a world characterized by DNA printers, quantum computers, engineered pathogens, autonomous weapons, robot assistants, and abundant energy. This book raises vital concerns about unmanaged tech without being overly reactionary or alarmist. It also offers practical solutions that could be taken to try to keep humanity, equity, and fairness at the forefront of regulation and policy. And The Coming Wave does all of this in an accessible and compelling way.  

If you’re trying to understand why those closest to AI are saying this new wave of tech-driven change is different than anything we’ve faced before, read this book! Trust me – you won’t ever look at the world in the same way after.  

Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present  

By Harriet Washington, M.A. 

Medical Apartheid is a jolting history of racism against Black Americans in healthcare that brings home, in a visceral way, how dehumanizing people leads to cruel and dehumanizing acts. The book reveals how, throughout time, supposed healing professionals have been able to wrap a narrative of good intention around abusive, discriminating, and inhumane atrocities. The text is meticulously researched and artfully written -- appreciating the author’s skill helped to drive reading through difficult parts. Medical Apartheid highlights lingering consequences and vestiges of this legacy and serves as a call to action for greater awareness, inquiry, and reform throughout the healthcare system. 

If you’re interested in learning a broader view of our country’s history and more context to the inequities that persist in healthcare today, read this book! 

Book Review: AI 2041: Ten Visions for Our Future

AI 2041: Ten Visions for Our Future, by Kai-Fu Lee and Chen Qiufan

Robin’s head was spinning. Hacking their account would require four thousand qubits of computing power. “How is this possible? There’s no such machine on Earth…” 

All the screens in their hideaway dimmed at the same time. There was only the buzz of electrical current as no one spoke.  

“It’s over.” Lee signed, his expression wooden.  

The lines above set the scene of a catastrophic heist in 2041 that uses quantum computing to steal bitcoins sealed in a historic vulnerable key from back in the early 2020s. The book, titled, AI 2041: Ten Visions for Our Future, by Kai-Fu Lee and Chen Qiufan is an engaging and thought-provoking read that uses both story and analysis to sketch out ten stories that illustrate ways that artificial intelligence (AI) could sculpt our world over the next two decades.  

Each story is set in a different corner of the globe and addresses a few aspects of how AI could impact our lives. Rather than the doomsday scenario often associated with future-thinking related to AI, these tales reveal both risks and also ways that human interaction with AI can overcome the challenges. Concepts explored include custom education and even friends for children; new forms of currency and attribution of value; risks related to personal data, history, and bias; self-driving vehicles; a transformed robotic and human workforce; potential ways that single bad actors could wreak havoc, and more. After each tale authored by Chen Quifan, Kai-Fu Lee unpacks the technical capabilities of AI and how they could develop over the next few decades.  

Published in 2021, amidst the pandemic and before AI's surge into public and business spheres, this book is bold and insightful. And yet, just two years later, many of the future possibilities anticipated for 2041 are already available today. The capabilities of AI and computing capacity have developed more rapidly, even since 2021, than the authors envisioned.  

For instance, the book contemplates a world in 2041 where a young adult seeking to work in finance is devastated and surprised to discover that AI could prepare a company profile as well as an analyst could – something that would hardly make my current 17-year-old blink today. It’s a sobering realization that some of the world’s deepest thinkers about AI had dramatically underestimated how quickly its capabilities would advance.  

As I stand at this metaphorical base camp of a new age, our calling in the healthcare industry has never been more profound. At Spring Street Exchange, we work with clients in driving change in healthcare, that keep values around equity, fairness, quality, and consumer-centricity at the core. Because healthcare has been slower to evolve than other sectors of the economy, the industry is likely to face an especially transformative period in the years to come. We have an opportunity and responsibility to ensure that the capabilities of new tech reach and enhance the lives of those who are too often left behind. Our goal can be not just to create greater efficiency of our current model, but to sculpt a better and more equitable future that this tech enables.  

At Spring Street, where we delve deep into scenario planning and future visioning, our aim is never to predict but to explore. I loved how Kai-Fu Lee and Chen Qiufan chose to envision the future with a focus on us all as authors and creators rather than just passive observers. Although the authors highlight risks, the book is also infused with visions of how AI and new technology can be used to address inequities and drive toward a greater good for all.  

If much of what these authors expected to occur in 2041 is already just around the corner, we have a lot of work to do. A first step could include our visioning workshops that can be experienced by executive teams and boards to explore some of the near and long-term new tech and changes on the horizon. ‘Trying on the future’ as these authors do, creates a profound sense of interest and urgency in addressing the opportunities before us.  

Till we talk next,  

Nancy 

Women's Healthcare = Big Questions

Women’s Healthcare = Big Questions

By Rachel Sandoval

My personal journey with my own reproductive health began about 3 years ago when I approached my OB/GYN with concerns about the long-term effects of hormonal birth control. I told my doctor, whom I had been seeing for the previous 5+ years, that I was considering stopping the use of birth control for a variety of reasons including the concerns I had about the effects of being on hormonal birth control for over 13 years. My doctor’s response was “there are no concerns with taking hormonal birth control for an extended period of time” and “you can stop at any time with no repercussions.”  

Hard stop. That can’t possibly be right, can it? 

I’m no doctor, but I couldn’t possibly wrap my head around that being true. So, my journey began to understand what the heck was going on inside my own body. 

I began reading (and watching) anything I came across on the topic of women’s reproductive health. One book in particular, “Everything Below the Waist: Why Healthcare Needs a Feminist Revolution” by Jennifer Block showcased to me how complex the history of female health has been. I learned how birth control has somewhat become the catch all remedy for any gynecologically-related dysfunction (cramps, heavy flow, acne, etc.). This fact is true, even though studies and anecdotal reports show that there is a higher rate of diagnosis and treatment of depression among those taking hormonal contraception. But the fact that really got me, was “that one’s hormonal profile on the Pill looks more like menopause than pregnancy.”  

Say what now? 

It's not just gynecological medicine either; Block also explores how overdiagnosis and overtreatment of women is particularly acute. She quickly points out, “We’re more likely to be prescribed antidepressants and antipsychotics and recommended for electroconvulsive therapy. We’re also more likely to be prescribed opioids, and 40 percent more likely to become dependent on them. We are prescribed more drugs and more surgery in general.” Block goes on to explain how US doctors’ offices have remained stagnant when it comes to women’s health, particularly women’s reproductive and sexual health. 

Through this journey to just understand what was going on in my body, I felt I kept coming back to one persistent thought: “I wish I had known about this sooner.” And why didn’t I? Why wasn’t I taught about the hormones in my body and how they would forever affect my health? My middle school health education didn’t prepare me for what I needed to know about my own body. 

I thought I was being a responsible woman and empowering my own health by relying on the “expertise” of my health professionals. But the reality was, I was not receiving the information I needed to make informed decisions. 

Don’t get me wrong, I am not blaming doctors. I am simply putting forth the idea that, as women, we have not been receiving all the information. We also haven’t been seeking it out, for a variety of social reasons including the fact that many of us have been brought up to believe that our reproductive health is something to feel shame about. We should be empowered to learn more about our health, and that includes our reproductive and sexual health. I know that all seems a bit grim, but there are ways to improve this – here are a few:  

• Comprehensive Sex Education – Advocating for age-appropriate education in schools and community settings 

• Patient-Centered Care – Shifting toward care that includes active listening of questions and concerns and creating a safe, non-judgmental environment 

• Research – Promoting research that is inclusive or female centered 

• Policy – Advocating for policy that supports and improves health outcomes and healthcare access for women 

• Eliminating Stigma – Working to eliminate the social stigma around reproductive health, menstruation, contraception, and the female body 

For more on closing the female health education gap, check out this article by Dana Alloy. 

Book Review: The People's Hospital by Ricardo Nuila

By Kenzie Bahr

While browsing my local bookstore recently for some engaging summer reading, I stumbled upon "The People's Hospital" by Ricardo Nuila, a captivating narrative that uniquely illuminates the challenges and opportunities that lie ahead in the realm of healthcare. 

Nuila's book delves into the heart of a public hospital, intertwining personal stories with the many systemic complexities that lie not only within our healthcare system, but society in general. As I combed through the pages, the key themes outlined below truly resonated with me. 

1. Equity: A Mandate, Not a Suggestion 

   Nuila's accounts underscore the pressing need for health equity. The book poignantly highlights how patients from different backgrounds have different experiences in the healthcare system. For healthcare leaders, this reality creates urgency of bridging these gaps. Recognizing that a one-size-fits-all approach is no longer justifiable, we must channel resources into fostering equitable access and care. 

2. Agility in the Face of Challenges 

   "The People's Hospital" doesn't shy away from showcasing the hurdles that many healthcare organizations face daily. Resilience and adaptability emerge as essential qualities. In shaping future strategies, we should anticipate disruptions and build agility into our plans. 

3. Human-Centric Care: The True North 

   Nuila's narratives spotlight the power of human connection in healthcare. He coins the term “Medicine Inc.” to describe how disjointed and impersonal healthcare has become. This term highlights that while the business aspects of healthcare are essential for sustainability, it's crucial to maintain a relentless focus on patient-centric care. As leaders and change agents, we must continuously evaluate our work to ensure that financial objectives do not compromise the quality, accessibility, and equity of healthcare services. 

4. Technology as an Enabler of Care 

   Amidst the tales of compassion and resilience, "The People's Hospital" subtly addresses the role of technology. By embracing innovative tools, healthcare organizations can optimize processes, enhance patient experiences, and streamline workflows. The insights from the book prompt us to explore cutting-edge solutions, from telehealth initiatives to data-driven decision-making, ultimately improving outcomes and operational efficiency. 

In the world of strategic consulting, our goal is to support innovation that transforms the trajectory of organizations. "The People's Hospital" gifts us with a tapestry of narratives that give insight into the complexities of healthcare. It's not just a book of patient stories; it's a treasure trove of insights that can help the reader to think differently about what we’ve become used to. Let us embrace these lessons and chart a course toward a more equitable, technologically enriched, and patient-centric future. 

As Ricardo Nuila wrote, “Healthcare today is as much a part of identity politics as any other issue, and yet, at its core, when it comes to the kind of care people like to receive from their doctors and hospitals, there is agreement.” 

The Path to Equity Starts at the Top - Part 1

By Janice Sparks, PhD

News travels so fast and things evolve so quickly that sometimes we may miss taking the time to think about change, transformation, and the movement associated with swift evolution.  

A few months ago NBC News published a story with a headline that reads, Hamstrung by ‘golden handcuffs’: Diversity roles disappear 3 years after George Floyd’s murder inspired them. To summarize, the article highlights the loss in major corporations of diversity, equity and inclusion (DEI) leaders who were hired in early 2020 after George Floyd’s murder; however, now many organizations are reducing or eliminating these positions. In over 600 companies, Revelio Labs found that since late 2020, DEI role attrition outpaced non-DEI roles by 40% and 24% respectively.  

So why is this happening?  

There may be a couple of reasons: First, although organizations had good intentions in creating these roles, they did not count the costs of what it would take to sustain them and did not understand the deep-rooted complexities of things like institutional racism and what it would take to overcome the challenges. Second, organizations are, understandably, unsure of how to address DEI in the “right” way. This may be why some are shifting from a single role to using Environmental, Social and Business Governance, or ESG, models to address DEI. While integrating this work organizationally has potential staying power, a DEI lead should remain in place to oversee, shepherd the process, and hold the organization accountable to DEI commitments established through ESG efforts. 

The reduction in DEI roles reflects progress, and no business has a magic wand that will instantaneously craft the right organizational configuration. These statistics, while alarming, should help us think about not only the why, but also the what: What can be done to sustainably create organizational cultures that reflect dedication to the cause? Hopefully, over time, we will see commitment reflected in visible change and measurable outcomes. 

In future posts, I’d like to explore whether this trend also appears on the healthcare landscape, what it means internally for an organization, and possible external implications related to service delivery and addressing health equity for the community at large. Spring Street is evolving too, and we hope to continue working with organizations that are committed to making real, impactful, sustainable change. 

Innovation vs. New-to-You

We have grown accustomed to dealing with regulatory change, competitive dynamics, evolving trends, and advances in consumer expectations. At times it can feel like there is too much change on deck in healthcare when there are still so many primary operational issues demanding day-to-day attention.  

All this is true, yet over the past several decades, healthcare has been relatively stable when compared to the upheaval in other sectors of society. The pandemic accelerated a pathway to accessing care via various channels, but we are still early on the trajectory of seeing how these dynamics could reshape how we deliver and pay for healthcare.  

Healthcare organizations themselves vary in the pace and scale of their adoption of change. Sometimes what feels like transformational within an organization is actually working toward capabilities that are already broadly adopted throughout the industry. The Innovations vs New-to-You framework offers a means to understand how initiatives on a strategic portfolio position an organization for the future.  

Innovation vs. New-to-You graphic created by Spring Street Exchange print version here

As healthcare companies face increasing competition and recognize even more change on the horizon, many are taking a bolder and more purposeful approach to strategy. As they do, it is important to recognize that sometimes dramatic change within an organization can still be catching up to evolving industry standards.  

For those aiming to bring true innovation and change to an industry very much in need of it, they need to think longer-term and be willing to break existing conventions. A fresh five- or ten-year strategy can reframe how an organization goes about its near-term change. It can also infuse an organization with purpose that is both aligning and motivating.  

At Spring Street this dynamic is infused throughout virtually all of our engagements. When an organization has an aligned view of its aims for the future, its vision can help to clarify decision-making in the here and now. And aligned vision supports not just the strategic portfolio but can also provide guidance on how to approach operational and administrative goals. With this mindset, every healthcare organization has the means to carve out its own unique space in the landscape of the future. Within our strategic planning practice Spring Street supports clients practical tools to develop and execute a differentiating strategic position in the market.  

We all want to be working toward how healthcare should be rather than helping the healthcare industry get better and better at how it has always been.  

Spring Street Exchange is a Preferred Vendor!

Spring Street Exchange is thrilled to announce that we have been accepted as a Preferred Vendor with the Association of Community-Affiliated Plans (ACAP), a national trade association which represents up to 80 not-for-profit Safety Net Health Plans. With a mission to strengthen these plans in their work to equitably improve the health and well-being of people with limited resources and/or significant health needs, ACAP plans serve more than 25 million enrollees through Medicaid, Medicare, Marketplace and other public health coverage programs. 

As a mission-driven healthcare services organization, Spring Street has long been an ally of ACAP plans through our work in driving toward more equitable and socially informed healthcare. These engagements have included enterprise-level strategy, market analysis, new product development, innovation management, and a range of services in helping plans to address health-related social needs (HRSN) and social drivers of health (SDOH).  

We also have a history of partnership in working with ACAP directly to support its plans’ goals: 

• SDOH Benchmark Assessment: In 2020, through ACAP, we worked with a cohort of plans to assess their progress in addressing SDOH through the SSX SDOH Benchmark Assessment and are currently in the process of updating this analysis in 2023.  

• SDOH Learning Collaborative: In 2021 we launched a four-part series of Learning Collaborative ‘Sprints’ to support participating ACAP plans in advancing select SDOH projects. We launched the fourth of these sprints on measuring impact and outcomes on May 23, 2023.  

• ACAP Center for SDOH Innovation: In 2022 we helped ACAP to design and launch its Center for SDOH Innovation, a collaboration center for helping plans to both accelerate and increase the impact of their work in addressing socially informed care and health equity.  

We have deep respect for ACAP as an organization and for the personal commitment and incredible knowledge and skill of the full ACAP staff. Advancing our working partnership by also becoming a Preferred Vendor is an honor that we take with earnest determination. Spring Street Exchange is committed to working with others for positive change toward equitable, kind, high-quality, and accessible healthcare -- it’s a joy to advance this work with ACAP! 

Book Review: Evicted by Matthew Desmond

I am a voracious reader, so I don’t say this lightly—Evicted: Poverty and Profit in the American City by Matthew Desmond is one of the best books I've read. It’s well-written, well-researched, experiential, important, and engaging…winning the 2017 Pulitzer Prize in general non-fiction. https://www.pulitzer.org/winners/matthew-desmond 

This book explores the root and cycles of housing insecurity, which is one of the most prominent social drivers of health (SDOH). Through individual stories and personal witness, Desmond explores income inequality, poverty, racism, and discrimination, and how these issues drive and perpetuate housing insecurity in the United States. 

To provide an honest and insightful account of these topics, Desmond spent time living in several low-income communities in Milwaukee. First, he inhabited a trailer park on the outskirts of town predominantly inhabited by white Americans.  He then moved into a section of town that's predominantly populated by African Americans with extremely low income. In each of these two sections of the city, Desmond gets to know the residents by living within the community.  

By following the personal stories of several families and individuals he provides details on how the economics work in these people’s lives and how the constructs keep people from moving out of poverty. The personal narratives bring the struggles to life as we read of the painstaking perseverance required to try and find housing by submitting more than eighty applications with no results, of how having children can be a barrier to securing and sustaining housing, and of how victims of domestic abuse are further punished through losing their homes. Desmond includes perspective from the landlords and the financial dynamics that lead to the cycle of housing insecurity.  

Throughout the narrative, Desmond is a master at connecting the story of these people’s lives to something bigger. He describes how society’s laws, regulation, and rules around taxation allow the cycle of poverty and profit to continue. 

Reading this book made me feel humbled, inspired, and committed to continuing the important work that we do in addressing health-related social needs generally, and housing in particular. It’s a big feat to make a book about the devastating impacts of systemic poverty into a narrative that is both page-turning compelling and also lands with hope.  

I can’t wait to read Desmond’s upcoming book on poverty in America! For those who have read Evicted, I would love to swap thoughts! 

Organizational Kumbaya

During a recent weekly team meeting, I was reminded of how different the work world is for the ones who entered it even 5-10 years ago, much less those of us who started decades ago. Coming from a family of journalists who published a weekly newspaper using an offset press and linotype machine, it has been quite the journey for me to see publishing progress through word processing and computerized printing to online-only subscription versions. No more the smell of printer’s ink and semi-permanent stains on fingertips! 

It's easy to list off numerous changes in technology, society, and culture during the lifetime of someone like me, who has retirement on the horizon. As far as work goes, though, I remember more recent times when working from home or otherwise remotely was unheard of in industries not typically associated with data-related tasks. Aside from service industries (e.g., auto repair, food service, barbering), direct care for patients and clients, and other fields requiring physical presence, the workplace was, as one manager put it long ago, “butts in seats.”  Even as a contractor on software implementation projects across the country (in a road warrior, travel on Sundays and Fridays between home and client locations, type of existence) it was not the norm. Most organizations required me to complete my tasks in a cubicle, even if I didn’t need to engage in any face-to-face meetings or discussions.  

Then came COVID, and it was amazing how quickly employers learned about how productive remote workers can be! Now “telecommuting” is more the norm than I could have imagined, and videoconferencing is used on a daily basis in many work environments – and telehealth for many visits with medical providers, including therapy sessions. 

In the last few years, I have had the good fortune to experience what it is like to work in a company that has always been virtual: designed and nurtured to operate under a fully remote business model. For us, the workplace roles during the pandemic barely shifted. While we do make sure to get together once or twice a year from all parts of the country for “face time,” and some of us travel together to hold company events, attend conferences, or deliver client presentations, it’s the week-in and week-out remote work that keeps us going. It’s not always easy or intuitive to stay connected in this way. We use online chat solutions, task management systems, and Zoom meetings to collaborate and keep moving forward on our services and products – or even to celebrate someone’s birthday. 

What’s missing, then? It’s what is often referred to these days as “water cooler” time: the ongoing opportunity to bond, encourage each other, and get to know one another in a personal way that often eludes teams without access to a place to go for a walk together, go out to lunch, stop to visit and catch up. I’m happy to say that we have found a pretty good solution for this. 

Once a week, we have a full team video call where we reserve a block for that personal touch. Here’s what we have done to stay connected: 

1. Meeting planning: Although we use a standing agenda, it is flexible and is developed by a designated owner who asks for input each time to cover topics any member of the team would like to address. 

2. Agenda management: We typically have the same individual each week who handles the agenda and ensures that all the topics are covered and that we don’t run out of time (unless it’s by agreement because of a priority issue). 

3. Personal opening: An icebreaker question opens every one of our regular sessions. The web is full of lists of possible questions to use, although one of our leaders typically offers whatever comes to mind. This time both allows for more personal sharing and humor (e.g., “What did you name your first car, and why?”) and enables the meeting to start on time even if others are running a minute or two late joining from other calls or tasks. 

4. Celebrate first: Before getting into the details of challenges and ongoing work, we celebrate successes and wins from the last work week – and each other! Of course, we enjoy acknowledging completed projects and anticipating upcoming new work, but we don’t stop there. This time is open for anyone who wishes to spontaneously express appreciation for someone who is picking up extra work tasks, improving a process to a new level, offering additional insight, always brings an optimistic perspective, etc. We call this filling up each other’s bucket. It doesn’t take long, but the resulting encouragement is immeasurable. 

5. Calling on the team: While the team is together, we make sure to plan for needed coverage when someone has upcoming time off, or to ask for support with meeting a deadline. This allows us to problem-solve and prioritize as a group to help with work allocation and leverage each person’s talents. 

6. Share the wealth: We make time to share tips and tricks in working with the technology everyone on the call uses. On our team, every one of us has come across something that was not common knowledge – like how to add favorite commands (checkboxes, object alignment) to the title bar in a Microsoft application, or how to quickly format a table, instead of having to follow a ribbon selection path every time. 

7. End with something inspirational: We call this agenda item Kumbaya, and it’s typically led by one of our leaders. The topic can be anything from promising news about upcoming growth for the company to reflecting on how everyone pulled together to get through a recent difficult period, or sharing an uplifting message, book, article, quote, conversation – anything, really – to close out the meeting. This week, one leader shared the story she had read about how otters hold hands when sleeping so no one drifts away, and how it applies to us. It reminded her of how we support each other and handle each other with care – the work we do is hard; it requires having people around you and holding on so we don’t get lost. We “hold hands” to keep us grounded and help us not go down too many “rabbit holes”. For us, like the otters, it’s also “home” – comfort, support, and giving each other grace. Kumbaya leaves us on an “up” note and energizes us as we move forward into the rest of our work week. 

Resilience is a term often used around our workplace to describe nature, and we use nature as our inspiration. So much has changed in our world, both at home and at work, but resilience keeps us together, finding ways to change along with it, stay positive, and create our own solutions to challenges. What works to keep your team connected during changing times? 

Book Review of Medical Apartheid, by Harriet A. Washington

Every once in a while, I read a book that does more than provide insight but offers a radical update to how I understand the world. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present is one such book. While I expected to read a history of inequities and discrimination, the degree of intentional experimentation and abuse in the name of research or even care was alarming to me. As someone who has committed to learning about differing experiences and racial injustice, I realized, yet again, how much I have to learn.  

Washington provides a history of how Black Americans have experienced the healthcare system in the United States. The chronical starts from the early days of slavery, through reconstruction, the pre-civil rights era, and continues up through the modern era. The book covers a range of topics, including the forced sterilization of Black women, unethical medical experiments on Black prisoners and mental health patients, and the exploitation of Black bodies for medical research. She reveals how, throughout time, supposed healing professionals have been able to wrap a narrative of good intention around abusive, discriminating, and inhumane atrocities. The book provides detailed examples, describing how the often-cited Tuskegee Syphilis Study was not an egregious anomaly, but rather a single example among a broader landscape of abuses.  

The book also highlights some more failures of our modern-day systems designed to prevent such abuses. Some examples are direct, such as with failures of Independent Review Boards (IRBs) to preserve research ethics. Others are more systemic, such as how research using subjects that are poor, incarcerated, or otherwise disempowered, disproportionately burdens people of color. Medical Apartheid was published in 2006, and I would be interested to learn how some of these dynamics may have shifted, or not, since then.  

There were sections of this book that were extremely painful to read. I admire the thoroughness of the research and found myself marveling at how difficult it must have been for the author to read through all of the personal accounts referenced in order to write this book. But, as I made my way through, I was both riveted and committed. If others could live through the stories shared in this book, the very least I could do was learn of their experiences.  

For those interested in health equity, I highly recommend Medical Apartheid. It’s meticulously researched, brilliantly written, and provides essential context to many of the lingering inequities today. And when you do, or if you already have, I’d love to hear your thoughts! 

https://www.penguinrandomhouse.com/books/185986/medical-apartheid-by-harriet-a-washington/ 

Strategic Partnership Announcement

Spring Street Exchange (SSX) and PascoAdvisers are pleased to announce a strategic alliance that complements the services each firm brings to the healthcare industry. Spring Street Exchange has driven strategic and operational change in healthcare since 2016. Since 2019, PascoAdvisers has provided risk-related and revenue accelerating advisory services to health plans and startup healthcare companies.

Having informally collaborated on successful client projects throughout 2022, today the two firms are publicly announcing their formal strategic partnership. Working together they will leverage their deep healthcare expertise to better serve their clients. They also share a mission to advance the strategic, operational, and actuarial underpinnings of the healthcare system by helping their clients sustainably evolve toward the future healthcare landscape. “Our partnership has developed organically,” said Nancy Wise, president of Spring Street Exchange. “We continue to discover how the expertise that we each bring to clients is delivering greater combined value to the industry.”

“Healthcare companies deserve the best thinking available to overcome the challenges they face in serving the needs of individuals and families. This strategic partnership presents an opportunity to provide a unique, integrated offering that hasn’t been available.” said Keith Passwater, Managing Director of PascoAdvisers.

Spring Street Exchange (www.springstreet.exchange) has a mission to ensure a sustainable role for values-driven leadership in the healthcare landscape of the future. SSX works with boards and leadership teams around innovation, long-term visioning, strategic planning, and market analysis. The firm has developed expertise and specialized tools in addressing social drivers of health and health equity.  

PascoAdvisers (www.pascoadvisers.com) helps healthcare companies increase revenue growth and improve risk performance through executive advisory services, analysis, and its proprietary Risk Performance Assessment. Pasco also works with healthcare startups on ensuring value-add and sustainable revenue models.  

ChatGPT and the Future of Healthcare

ChatGPT, Dr. Seuss, Soup, and Internal Innovation Studios 

Like most curious futurists, I’ve been enjoying exploring what ChatGPT can do. For those who haven’t tried it yet, ChatGPT is a Chatbot prototype that was launched by Open AI in November 2022. It is a ‘generative pre-trained transformer (GPT)’ which has been programmed / trained to mimic human conversation. Its many capabilities include writing and debugging computer programs, writing student essays, answering test questions, and even writing poetry and songs. I have used ChatGPT for a soup recipe I can make with the ingredients in my fridge, and it suggested a plan to take my son on college tours. ChatGPT has even described social determinants of health (SDOH) in the style of Dr.Suess (you can view at my LinkedIn post here).  

At Spring Street Exchange, we have working with future-thinking healthcare organizations to prepare for what’s next. When we look at planning in short-term cycles, we tend to assume that the future will be similar to the past. This makes it easy to dismiss the very real breadcrumbs of change on the horizon. When we suggest that the next ten years will include more change than the past thirty, I have sometimes felt like the woman crying wolf. However, with the disruption spurred by the pandemic and more immediate competitive threats, many healthcare organizations are now embracing longer-term strategic planning.  

Looking at longterm change can be a daunting task. After all, the fastest adoption of any innovation in the history of humanity, ChatGPT, was something that, until recently, most of us didn’t even know could be possible. Robert Pearl’s vision for how ChatGPT could transform healthcare suggests how this functionality could be used to emulate the way clinicians make decisions and to provide ongoing care outside of the medical office. As technology improves, and as our thinking catches up with its capabilities, it seems certain that the greatest impact that an AIChatbot could have in healthcare has not yet been envisioned. After all, it’s only been a few months.    

So, I thought I’d ask ChatGPT about the future of healthcare; ‘it’ answered me with some meta thoughts that you can see it in the response below. ChatGPT has an “I” identity, even though ‘it’ doesn’t have a name like the helpful ‘Siri’ and ‘Alexa.’ ChatGPT included Artificial Intelligence in its list of anticipated changes in the industry, but didn’t have the self-awareness to identify itself in this category.

——-

Me: What will healthcare be like in 2033? 

ChatGPT: Answer pulled on February 22, 2023, from https://chat.openai.com/chat 

As an AI language model, I cannot predict the future with certainty, but I can provide some insights based on current trends and technological advancements.  Can

Here are some potential ways healthcare could change by 2033: 

1. Personalized medicine: By 2033, healthcare may become more personalized, with doctors using advanced genetic testing and analysis to tailor treatments to individual patients based on their genetic makeup. 

2. Virtual healthcare: With the advancements in telemedicine and remote healthcare, healthcare in 2033 could become more accessible and convenient for patients. People may be able to access medical consultations, diagnoses, and treatments from the comfort of their own homes. 

3. Artificial intelligence and machine learning: The use of artificial intelligence and machine learning algorithms will likely become more prevalent in healthcare in 2033. These technologies may be used to analyze patient data and provide more accurate diagnoses, develop personalized treatment plans, and even help with medical research. 

4. Nanotechnology: Nanotechnology has the potential to revolutionize medicine by allowing doctors to deliver medications and treatments more precisely to targeted areas of the body. By 2033, nanotechnology could be used to develop advanced drug delivery systems that are more effective and have fewer side effects. 

5. Genomic medicine: By 2033, genomic medicine could become more widespread, with doctors using genomic data to make more accurate diagnoses and develop personalized treatment plans. 

6. 3D printing: 3D printing has already been used in the medical field to create customized prosthetics and implants, and by 2033, it could become more common in other areas of healthcare, such as tissue engineering and drug development. 

7. Wearable technology: Wearable technology, such as smartwatches and fitness trackers, has already been used to monitor physical activity and health indicators. By 2033, wearable technology could become even more advanced, allowing for continuous monitoring of vital signs and providing real-time feedback to doctors. 

   Overall, healthcare in 2033 is likely to be more personalized, accessible, and technology-driven. However, it's important to note that many factors, including economic, political, and social factors, can impact the future of healthcare. 

———-

Much of our current understanding of computing capabilities is informed by the pace of development to date, often driven by our own understanding of Moore’s Law. However, in the 2010s, AI developers began working with a network model more similar to the many connection points of neurons in the human brain. The new structure of networks enabled computing capacity to accelerate further, leading to advanced AI chips and quantum computing.  

A quantum computer tested by Google in 2019 was more than 1 billion times faster than a traditional computer. It was able to perform a computing test in 200 seconds that would have taken a computer at that time hundreds of thousands of years to perform. We cannot yet comprehend what this type of analytic, computing, and intelligence capability could bring to our world. (Note that my understanding of developments in quantum computing are informed by The Exponential Age by Azeem Azhar).  

Like any change, these developments have the potential to create new advantages for economic leaders in healthcare. But they could also spark an opportunity for a more level playing field, or even strategic advantage for nimble and focused healthcare organizations. Indeed, rather than ‘deep pockets’, perhaps the path to ensuring that an organization’s mission is fulfilled in the healthcare landscape of the future is to develop an ongoing channel to monitor and explore the evolving landscape. 

Many healthcare organizations have had protected markets and revenue streams for so long that they have enjoyed the luxury of foregoing an innovation function. In fact, many of the ‘innovations’ on a strategic portfolio may be new to the organization but are really catching up with an evolving industry standard. With virtually every sector in our economy exploring the role it can play in healthcare, we cannot assume that our market protection will continue into the future.  

Most of us didn’t see ChatGPT coming, but with an internal innovation function there could be a channel and organizational muscle memory for recognizing and exploring the implications. Such an ‘Innovation Studio’ would include monitoring the landscape, organizing innovations in a way that they can be prioritized, and exploring how they could be an opportunity, risk, or adjacent insight. At Spring Street Exchange, we provide this service to enable a healthcare organization to stay current without becoming overwhelmed.  

No one is too busy to think about the future. The future is here every day. Let’s welcome the opportunity as a means to drive healthcare to what it could be.  

2022 Top 4 Professional Book Reads

For the past few years I have shared the three books that have done the most to influence my professional work. Because I read/listen to a lot of books, it can be hard to narrow down. This year I couldn’t leave any of these four out, so the 2022 highlights includes the Top 4! 

If you have read any of these books and want to connect to discuss, I’d love to chat.  

The Exponential Age, by Azeem Azhar: This book has done more to provide context to our moment in history than almost any other book I have read (perhaps rivaling Sapiens, by Yuval Noah Harari, but that was in a different way). The Exponential Age refers to the accelerating pace of technological change. Azhar makes the case that four General Purpose Technologies (GPTs) – computing, energy, biological sciences, and additive manufacturing - have been developing at an exponential pace. Because exponential growth seems slow in the early stages, it can be easy to miss. However, when these GPTs work together and build upon past developments, we are likely to see an era of tremendous change, potentially in the near future. There is so much more to this book, and I find myself referencing it frequently – highly recommend! 

Reimagining Capitalism in a World on Fire, by Rebecca Henderson: After working in community-based non-profits early in my career, I became convinced that a more equitable world required humane and thoughtful behavior was needed throughout the economy as a whole, and not just in the non-profit sector. Reimagining Capitalism provides the best framework and narrative I have come across for how this could be possible. By using concrete examples and a vision informed by business and economic acumen, Henderson makes the case that urgent change is needed and that a hopeful and sustainable pathway is available to us. She does all of this in a compelling read that feels energizing and not maudlin. Would love to hear your thoughts. (And thank you to Carladenise Edwards, PhD for the recommendation!)  

Jugaad Innovation, by Navi Radou, Jaideep Prabhu, and Simone Ahuja: Jugaad is a Hindi word meaning an improvised solution born from ingenuity and cleverness. The authors argue that rich investments in highly structured research and development can lead to disappointing results. They offer as an alternative inspiring examples of practical solutions to hard problems that have arisen from people with great minds and limited means. These embody the notion that forced constraints rather than deep pockets can lead to truly groundbreaking ideas. This book made me feel more optimistic about the potential role that community-based organizations (CBOs) and other community-affiliated healthcare organizations could play in healthcare of the future.  

The Book of Joy by his Holiness the Dalai Lama and Archbishop Desmond Tutu: Honestly, this book was originally part of my personal rather than professional reading list. Yet, I was so moved by the clarity, peace, and joy exuded by these incredible leaders that I wanted to recognize the impacts that these principles have had in my own work in healthcare. The book documents the dialogue of these two friends coming together for a week to discuss their thoughts on some of the most important human experiences, challenges, and joys. The dialogue format is engaging, and their insights are novel and familiar at the same time.  

What are you reading? I love recommendations.