Dinosaurs Ruled
For over 150 million years, dinosaurs ruled the Earth. Massive sauropods migrated in herds across vast floodplains, their long necks sweeping treetops and their footprints left imprints big enough for us to sit in. In the skies above, pterosaurs soared; creatures like the Pteranodon, glided on wingspans as wide as a small plane. And on the ground, smaller, quicker dinosaurs darted through the underbrush. As nimble predators and opportunists, they were built for speed and adaptability. For an unimaginable stretch of time, these creatures survived throughout several eras of ecological change through evolution and adaption.
Compared to the dinosaurs’ reign, humans have barely arrived -- we are at just 300,000 years and counting. When I think about the breadth and scale of the Mesozoic Era, it’s hard to imagine how it all came to an end...but it did, and not because dinosaurs were flawed, but because the world changed faster than they could adapt. The impact of a sudden asteroid hitting the earth turned their greatest strength - size, specialization, and dependence on a stable environment -- into vulnerabilities. In a relatively short time, the dominance of dinosaurs roaming the earth collapsed.
Nowadays, we call something a “dinosaur” when it’s outdated or too big to survive, but this association misses the point. The biology of dinosaurs were optimized for an environment that changed around them.
Applying the analogy to healthcare
I sometimes worry that we could be facing a similar moment in healthcare. Many of the most historically successful and mission-driven providers and health plans, the backbones of our healthcare system, could be at risk not because they’ve done something wrong, but because they’ve been optimized for a version of healthcare that could be rapidly changing around them.
Healthcare organizations are already feeling the strain. Recent years have been difficult for many and there is even greater uncertainty in the years ahead. Healthcare has evolved incrementally in recent decades. During this period most of us have watched predictions of change come and go while the healthcare system remained mostly steady. This history has made many healthcare leaders understandably skeptical about change.
But we all know that change doesn’t arrive because someone predicted it. Instead, it comes when the cost of staying the same becomes higher than the cost of doing something new. We are likely at this tipping point now… but even if we are not, there could still be a reason to take a fresh, bold look at the healthcare business model.
It’s largely believed that the Chicxulub asteroid, which hit the earth approximately 66 million years ago, caused a dramatic "impact winter,” stirring massive amounts of dust and sulfur into the atmosphere. This led to a significant shift in global temperatures which contributed to the mass extinction of the dinosaurs.
But, not ALL dinosaurs went extinct. The large, land-dwelling non-avian dinosaurs like the Tyrannosaurus rex and Triceratops disappeared, but a group of small, feathered dinosaurs, the ancestors of modern birds survived. This was likely because they were smaller, more adaptable, had varied diets, and could exploit ecological niches that vanished for larger species. The asteroid and its aftermaths served more like a massive evolutionary filter. The species best able to adapt in a new environment survived.
The great convergence
We are currently in a period in healthcare not just when the environment is changing, but during which many dimensions are changing at once:
Artificial Intelligence (AI) Adoption: The promise of AI is no longer theoretical, as its capabilities are being rapidly deployed to address an increasing number of gaps. In 2024, the AI in healthcare market grew by 33% and is expected to grow by another 26% in 2025. The compounding impact of such development over years is difficult to imagine. It’s driven not just in the power of the technology but, even more by the applications developed and adopted to change the nature of our daily lives. Even if we are not personally using AI, the industries around us will continue to, which changes the world for AI skeptics as well.
Financial Pressures: Operating performance in the U.S. health insurance industry has been unsteady in recent years. Health insurers faced significantly losses at the end of 2024 and continued high cost of care is expected in 2025. Hospitals and health systems are facing similar pressures with rising costs and declining patient populations.
Policy Shifts: With the new Trump administration taking shape, we can expect a sharper shift toward market-driven policies that favor scale, flexibility, and privatization. This could lead to increased competition and further strain traditional industry players. Regional payers and safety net providers that serve the most complex populations could be required to do more with less capital and political influence than their national and for profit competitors.
Competitive dynamics: Competitive pressure is also more intense than ever. National insurers, retail giants, tech-backed startups, and care delivery disruptors are seeking to expand. Many are redefining expectations around access, experience, and speed. In such an environment getting better at current models isn’t necessarily advancement; it could still be falling behind in an era of shifting requirements of survival.
Taking flight
In such a time of uncertainty, we can have an instinct to wait until we know more, or until the dust settles, or until several large projects are completed, before acting differently. It turns out that waiting for the literal dust to settle was too late for the dinosaurs. Not to over-extend the analogy, but, running the same playbook but with smaller budgets until things calm down is a risky approach, especially while competitors are escalating their own evolution and preparing for a rapidly advancing future state.
Over millions of years, the surviving dinosaurs evolved into modern birds. Their bones grew lighter. Their feathers became more specialized. Flight, agility, and flexibility became their keys to thriving in a radically different environment. The lesson isn’t that all giants fall, but rather that the chances of survival are greatest to those who can shift, adapt, and evolve when the environment demands it.
In healthcare, the organizations that endure are likely to be the ones that recognize the climate has changed and start moving, in a new direction, even as they address near term challenges. This doesn't mean starting big new innovations when in crisis, but I would suggest it means preserving a future-looking mindset as a sacrosanct steam of perspective informing strategy and planning.
And on the chance that the current expectations of change are just another failed prediction, what is truly the harm in developing a more dynamic, diversified, and compelling approach to healthcare?
I don't know anyone who thinks the current state of healthcare in the US adequately supports consumers, providers, or communities. Could it be that this moment of shifting assumptions, in what is a very difficult time for many in healthcare, to shake assumptions and think differently?
Can we shake our wings, and maybe hesitantly at first, take flight?
Would love to hear your thoughts!
In peace, with feathers,
Nancy