The Coming Healthcare Revolution

Expert review of how the antiquated United States healthcare system is transforming

The Coming Healthcare Revolution: The 10 Forces that Will Cure America's Health Crisis identifies and describes five top-down macro forces and five bottom-up market forces that have sufficient strength to transform the U.S. healthcare industry from the outside-in. The powerful macro forces are demographic determinants, funding fatigue, chronic pandemics, technological imperatives, and pro-consumer/market reforms. The equally powerful market forces are whole health, care redesign, care migration, aggregators' advantage, and empowered caregivers. Written by David Johnson and Paul Kusserow, professional healthcare advisors operating at the intersection of healthcare economics, policy, strategy, and capital formation, this book provides expert insight on how the U.S. healthcare system is becoming cheaper, better, more balanced between prevention and treatment, easier to access, and more empowering for both frontline caregivers and consumers.

In this book, readers will learn about:

• Factors leading to rising healthcare costs, including an aging population, perverse economic incentives, armies of middlemen, and expensive breakthrough therapies
• U.S. healthcare in comparison to other high-income countries—twice as expensive per-capita, and inferior in terms of health status metrics
• Similarities between the U.S. automobile industry crisis in the 1980s and today's adapt-or-die situation for healthcare providers and suppliers
• How the healthcare industry is reorganizing to decentralize delivery of whole-person health in ways that will improve health outcomes and overall societal health

The Coming Healthcare Revolution is a must-read for professionals and organizations seeking to understand and react to the paradigm-shifting forces revolutionizing the healthcare ecosystem.

Foreword xi

Introduction: Healthcare’s Roaring 2020s 1

Part I Macro Forces 19

Introduction: Look Out Below 21

Force 1 Demographic Determinants 25

Force 2 Funding Fatigue 43

Force 3 Chronic Pandemics 69

Force 4 Technological Imperatives 91

Force 5 Pro-Consumer/Market Reforms 115

Part II Market Forces 137

Introduction: It’s Complicated 139

Force 6 Whole Health 145

Force 7 Care Redesign 167

Force 8 Care Migration 197

Force 9 Aggregators’ Advantage 227

Force 10 Empowered Caregivers 259

Conclusion: Guns and Butter 287

Notes 293

Glossary of Acronyms 311

Acknowledgments 315

About the Authors 321

Index 325

DAVID W. JOHNSON is the CEO and Founder of 4sight Health, a healthcare media and advisory company. A former investment banker to many of the nation’s largest health systems, Johnson is now a leading thought leader, strategist, advisor, lecturer, and policy analyst.

PAUL KUSSEROW is Chairman and former Chief Executive Officer of Amedisys (AMED), a publicly traded, leading provider of home health, hospice, palliative, personal care, and high-acuity care services with over 22,000 employees in 39 states, and the District of Columbia, making over 12.3 million patient visits per year.

The Centers for Medicare and Medicaid (CMS) estimate 2024 healthcare expenditure levels to be $4.9 trillion, representing 17.8% of the entire U.S. economy. Despite its gargantuan size, or perhaps because of it, the U.S. healthcare system (Healthcare Inc.) has resisted transformation. It still operates largely as it has for the last century as a very fragmented, high-cost, revenue-driven, centralized, hospital- and physician-centric system for treating acute illness and injury. As currently configured, Healthcare Inc. emphasizes volume-based care delivery, engages in profiteering, tolerates unacceptable levels of medical error, exploits perverse economic incentives, under-invests in preventive care, and mightily resists change. As a society, the U.S. pays far more for healthcare services than other high-income countries but achieves far worse health outcomes. This can not continue.

The Coming Healthcare Revolution: 10 Forces That Will Cure America’s Health Crisis is your guide to understanding how the nation’s largest industry is disrupting and rewiring itself in real time. Written by David W. Johnson and Paul Kusserow, professional healthcare advisors operating at the intersection of healthcare economics, policy, strategy, and capital formation, this book identifies and describes how five top-down macro forces and five bottom-up market forces are transforming the healthcare industry from the outside in.

The macro forces are demographic determinants, funding fatigue, chronic pandemics, technological imperatives, and pro-consumer/market reforms. The five market forces are whole health, care redesign, care migration, aggregators’ advantage, and empowered caregivers.

The authors detail how new technologies and superior business practices foster human-machine collaboration in ways that ease caregiver burden, delight consumers, enable preemptive diagnostics, offer 24/7 service provision, and promote well-being.

The Coming Healthcare Revolution is a must-read resource for professionals and organizations seeking to understand and react to the paradigm-shifting forces revolutionizing the U.S. healthcare industry.

“Essential reading for anyone who wants to understand healthcare today, the necessity of transforming the world’s largest industry, and the ideas, companies, and people that will lead us back to the top.”
—WILLIAM FRIST, MD, former U.S. Senate Majority Leader

A BETTER PATH FORWARD FOR THE FRAGMENTED, BLOATED, AND EXPENSIVE U.S. HEALTHCARE SYSTEM

The Coming Healthcare Revolution chronicles how the fragmentedand dysfunctional U.S. healthcare system (Healthcare Inc.) is bankrupting the country and contributing to Americans’ declining health status. Powerfully, it reveals how the healthcare ecosystem is reorganizing to overcome Healthcare Inc.’s pernicious influence. And, here’s the punchline: healthcare will change more in the next ten years than it has in the last one hundred.

Written by two leading healthcare strategists, this book details a constellation of ten irresistible forces making U.S. healthcare better, cheaper, safer, and less burdensome for both consumersand caregivers. Readers will learn about the strategic bets that enlightened healthcare companies are making to create a future where all Americans get healthier together through democratized and decentralized delivery of whole-person health (3D-WPH). Drawing on lessons from the U.S. automobile crisis and the Great Migration, this book clearly explains how payers, providers, and suppliers must either adapt or get left behind.

The Coming Healthcare Revolution is a timely, essential read for executives inside and outside healthcare seeking to understand the industry’s dynamics and the emerging solutionsthat will advance our collective health.