When you think about one of your past medical issues, like that pneumonia you had, you’ve probably told many people the story. How you woke up feeling kind of run down, and you had this cold that just didn’t go away, and then you developed this fever, and you went to see this doctor who told you it was a virus and it’d go away soon, but then it didn’t go away, and then you went to another doctor and she diagnosed you with pneumonia and gave you some antibiotics and after a day or so you started feeling better. It’s a classic story and one that unfolds over time. It’s got the typical phases of a story— an introduction, character development, a climax, and a resolution. But it unfolds in real time and things are at times unclear, murky, and confusing. But those are the kinds of details that contribute to the bigger story. Sometimes these stories last a few hours and they’re great short stories. But other stories are more like Game of Thrones-length series of novels that last a lifetime.

Imagine if the only option you had to tell your story was in 10 minute chunks that had to be scheduled 4 weeks in advance in an office by someone who was more interested in firing questions at you than listening to your story in your own words?

That is how healthcare is delivered in America.

And that’s why I think the fundamentally broken thing in healthcare is communication. It’s nonsense that your story must fit within the confines of a 10 minute in-person visit. In fact, the video visit, which seems to be all the rage these days (it’s not btw), is the same tired “your story must fit within this box” solution. When you actually think about what the video visit is, you quickly see that the only innovation here is not requiring patients to travel to see doctors. It’s not fundamentally changing how your health story is allowed to be told. It’s simply replacing an annoying 10 minute office visit with a technologically wonky 10 minute video visit with a professional stranger you met on the Internet this one time who you’ll never see again. Is that an innovation? Or is that replacing one broken, tired thing with another?

I recently returned from Medellin, Colombia where @I spoke at the Salud 2.0 conference organized by the Universidad EAFIT, one of the finest educational institutions in Colombia. I was asked to speak for a very simple reason— my entire career has been about reimagining healthcare delivery and what it could be if we designed it today with today’s capabilities for today’s savvy consumers. There are very few people in the world who are not only reimagining healthcare, but actually doing it. There are plenty of researchers trying to study healthcare delivery, but they’re theoretically tackling the issue in academic settings. There really is nobody else in the world who questioned why healthcare delivery is so broken and then designed an entirely new and fundamentally better process of delivering and receiving healthcare. 

I’ve spoken about redesigning healthcare delivery on 6 continents… the second Antarctica invites me, I’m there. Healthcare delivery looks the same everywhere, even in countries where the government pays for healthcare for its people. Norway. Australia. Colombia. Britain. Spain. People are still waiting weeks to see a primary care doctor and forced to communicate with their doctors within the confines of a 10- or 15-minute exam room visit. Nobody in any of these countries stepped back and asked why. If they had, they’d discover that 70% of all of these exam room visits do not require a face-to-face visit. They can be handled best by asynchronous, online, secure communication with a physician at the time a patient thinks they need to access healthcare. Imagine if 70% of the world’s doctor office visits didn’t actually happen! What if those doctor visits could be replaced by more appropriate visits? What if patients didn’t need to take off work for 70% of America’s 1.5 billion office visits a year? That would eliminate just over 1 billion office visits and add 5 billion hours of productivity in America alone! 

 In order to truly change things, you’ve got to get your hands dirty and put your hypotheses into action, gather data, and use it to chase even more efficiency. That’s why I get to speak all over the world. Sherpaa was founded on asking one simple question— why? And we followed it up with another question— why not? Fortunately, here in America we have two distinct advantages that other countries don’t really have: 

  • The economic and political freedom to create new healthcare services and markets relatively independent of government approval 
  • Access to mature venture capital who can fund the creation of a new market 

For example, in Britain, since the government is the sole payor for healthcare, anything new has to be approved by a very conservative government-funded healthcare agency. Getting approval takes years and years of academic rigor and pilot projects. Here in America, we can just do it if we find the market willing to pay. And once we’ve created it, if it’s successful, the market will grow and the service will improve in response to competition. American healthcare sure does have its faults. But the private infrastructure to innovate is what makes American healthcare so great. 

 One of the other speakers, Alejandro Jadad, a Colombian-Canadian physician academic who I’ve respected as an influential thought leader in healthcare for many years, pulled me aside at the beginning of the conference and said he wanted to thank me. He said, “you said something to me years ago that forever changed how I view my career.” I met Alex roughly 7 or 8 years ago at another conference and we had a conversation. I said “a technological solution to a political problem will fail 99% of the time.” He said he stopped looking at healthcare as an IT problem, and started thinking about how we can politically make the best tech happen in healthcare. 

 Alex lives in Canada where healthcare is even more of a political problem than America. It’s so political, asking why and then creating something better because, why not, doesn’t happen that easily. And that’s why I’m thankful to be in America. Because we can make things like Sherpaa. Things that are fundamentally different and fundamentally better. I love traveling and speaking in other countries about Sherpaa’s radically different healthcare delivery model. It truly blows their minds to see how healthcare can be reinvented. But towards the end of the talk, after I’ve shown them the vision and the data, I can see the audience go from excitement to a sad frustration when they start thinking to themselves that “we could never do that here.” And that’s when I have to leave. My job is to show them the future. It’s now their job to politically get their country to the future that Sherpaa has created.

I’m in Medellin, Colombia. Speaking at a conference tomorrow. The annual homicide rate in Medellín 20 years ago was 381 per 100,000. In New York City, this would come to more than 30,000 murders a year. This coincided with Pablo Escobar’s reign of terror where he was pulling in $60 million per day from the global cocaine trade that originated here in Medellin. But the city has made such a huge transformation. One of the founding principles for this change was investing in the poor so they can either choose opportunity or violence. This “Metrocable” is one of those investments. Medellin is located in a valley with mountains all around. The hillsides are full of favelas, poor neighborhoods. So they built a series of cable cars to connect those neighborhoods to the main public transportation routes. They are packed and they’ve completely transformed the neighborhoods and gave people hope and opportunity rather than drugs and violence. It’s quite an inspiration.