A 30-Year Framework for Platforming Healthcare

Healthcare has a reputation as being one of the most complex and fragmented industries. I’ll bet you’ve spent time pondering how we get ourselves out of this mess. This post is first in a series that takes a long-view perspective on platform adoption and evolution in healthcare. I’ll start by sharing Version 1.0 of “A 30-Year Framework for Platforming Healthcare” — see the graphic above.

A few weeks ago I was interviewed by Ruta Gabalina and Aiym Sarmanova of PPMI, a leading European research and policy analysis center. They are working on a study exploring the evolution of platforms in healthcare.

I shared my framework with them verbally, and now I say “thanks” for their creating a v1.0 graphic. It’s rough…gotta start somewhere 😐. I’ll greatly appreciate your reactions and suggestions for v2 and beyond.

Let’s take a look at the time frames listed in the graphic. The phases are not discrete — think of them as overlapping

Before 2008: (Mostly) Paper

In 2008, less than 10% of hospitals and less than 20% of physicians had an EHR.

Why “mostly”? Prior to 2008, the use of computers in healthcare was limited and predominantly focused on administrative tasks rather than clinical care. Early computer systems lacked standardization; the term “API” had not yet entered the vocabulary of healthcare.

2008 — 2014: Point Solutions

Fueled by factors such as $35 Billion of HITECH funds to subsidize EHR adoption, starry eyed VCs who “discovered” digital health, and low interest rates — point solutions proliferated over the course of a decade.

Too many point solutions creates fatigue for many healthcare stakeholders:

• Patients. They would prefer to manage their health in as few apps as possible, especially patients with multiple chronic conditions.
• Care Providers. They are frustrated having to juggle multiple UIs and UXs.
• Employers and Health Plans. They have to vet, implement, monitor, and pay for multiple solutions.
• IT Departments: They have to evaluate, implement, manage, and monitor multiple solutions.

In 2023, sympler surveyed health system clinicians and IT/CIOs. They found that the majority (55%) of respondents still use between 50 and 500+ software solutions to run their organization’s healthcare operations. 80% agreed that working with disparate IT systems complicates their job.

The era of point solutions isn’t over — but customers are fatigued and want more integrated offerings.

Don’t get me wrong — I’m not against point solutions. They’re useful in many circumstance. As I’ve written previously, point solutions are a necessary first step in the evolution of general-purpose technologies, such as AI.

2015 — 2022: Early Digital Health Platforms

We’re seeing an explosion of early digital health platforms. They focus on uniting various disparate aspects of healthcare, e.g., workflow within organizations, patient journeys, care coordination, chronic disease management, and many, many others. A few examples — Notable, a platform to improve patient experience and health system workflow integration; AIDoc, a radiology integration platform; and Transcarent, a healthcare navigation and personalization platform.

2022 — 2030: The beginnings of Unified Digital Health Platforms (UDHPs)

Gartner wrote about this new category in a December 2022 report.

“The DHP shift will emerge as the most cost-effective and technically efficient way to scale new digital capabilities within and across health ecosystems and will, over time, replace the dominant era of the monolithic electronic health record (EHR).”

You can download a copy of Gartner’s report on “Digital Health Platforms” from the AWS website.

While Gartner uses the terminology of DHPs (Digital Health Platforms), I’m using the terminology of UDHPs (Unified Digital Health Platforms) to distinguish broad-based UDHPs from the thousands of narrower digital health platforms on the market.

As an example, SAP wrote an excellent article describing their vision for a UDHP — “Digital Platforms Will Re-Define Healthcare“. The diagram below is a conceptual model of SAP’s UDHP — open the graphic in a new tab to view a larger image.

2030…: Mega-platforms and (maybe) super-apps

The best early example of this today is Ping An Health in China, part of the broader Ping An group of companies that provide integrated financial, health, and senior care services. In the U.S., UnitedHealth Group has described its two businesses — UnitedHealthcare and Optum — as platforms.

For long-run examples, recall a recent article written by a16z Bio + Health VCs Daisy Wolf and Vijay Pande, PhD – “The Biggest Company in the World”. They make the argument that “the biggest company in the world will be a consumer health tech company.” They share 2 possible scenarios, each of which fit the label of “mega-platforms”.

(1) a vertically integrated path of building a “payvidor” (a combined payor and provider) that eventually owns most care — e.g. UnitedHealth Group x Apple, and

(2) a horizontal path of building a consumer marketplace or infrastructure layer that enables all other care delivery companies — the healthcare Amazon or Visa

What’s Next in this Series?

Future posts in this series will explore topics such as:

• A deep dive into the magnitude of point solution fatigue. How did we get to where we are today?
• A closer look at the emerging category of UDHPs — what are value propositions, who are players, etc.
• An evaluation of whether EHRs (especially Epic) have the potential to become UDHPs — we’ll look at arguments both ways.
• What if you’re a healthcare point solution company? What are strategies/tactics to consider in a new environment where customers prefer integrated offerings?
• Version 2 of “A 30-Year Framework for Platforming Healthcare”

I’ll greatly appreciate feedback/suggestions on v1.0 of “A 30 Year Framework for Platforming Healthcare”.

• Does the high-level framework make sense?
• What’s missing?

Please continue to the ongoing discussion of this topic on LinkedIn, where you’ll see how many others have reacted to this framework. Or you can email me — Vince Kuraitis — at vincek@bhtinfo.com.