The Age of Discontinuity

By Cathy Eddy, Health Plan Alliance, December 8, 2014

Newt Gingrich and David Nash

On December 2, I was invited to be on a panel at a Health Care Executive Forum in Washington DC that was sponsored by the Academy of Managed Care Pharmacy. David Nash, MD, MBA, dean of the Jefferson School of Population Health facilitated discussions about:

• Population Health and the Insurance Marketplace (my panel) 
• Narrow Network vs Value Network: Where’s the Greater Value? 
• Specialty Pharmacy & Biosimilars: Improving Population Health?  

One of the most interesting aspects of the day-long discussion was the morning keynote by the Honorable Newt Gingrich, the author of the Contract for America and Speaker of the House when the Republicans took both the House and the Senate in 1994 – a political point in time that parallels the recent 2014 election.

He referred to one of his mentors Peter Drucker and a book he wrote in 1968 called “The Age of Discontinuity.”  I’ve read some of Drucker’s work and always found it to be very insightful, but I hadn’t heard about this book, so I looked it up and found this summary:

Drucker begins by examining four major areas of obvious discontinuity:

1. The explosion of new technology and its resultant new technology 
2. The development of knowledge as a result of mass education and its impact on work, life, leisure and leadership
3. The social and political realities of the new industries
4. The change from an inter-nation economy to a world economy. 

He was writing this in a time before cable TV, the internet, cell phones or the fall of the Berlin Wall. But I do remember 1968 as a year of political unrest in this country.

However, Drucker's framework for discontinuity is very relevant today and especially to the challenges that are facing the health care industry. Here are some of my take-away perspectives from the discussion we had in DC:

• We are trying to leverage and integrate multiple forms of technology as part of our approach to care. The smart phone, which is with people now 24/7, will become the monitoring and informational tool of choice in the future.
• As healthcare pushes the “consumer” to become more self-governing, the value of information as a driver of behavior continues to grow, while at the same time the expectation is for more services, but at a lessor cost.
• ACA – what happens next? The direction and degree to which the new Congress can change the current health care law is uncertain. The impact of a Supreme Court decision on subsidies can impact millions on the exchanges run by healthcare.gov. 
• How will the instability of the rest of the world impact the US economy and spending demands, while an increasingly large portion of the federal budget is going toward healthcare expenditures?

Although it is clear that healthcare has the attention of leaders in business, state government, Congress and the Supreme Court, it is as yet unclear how that attention will change our industry in the future.

The health insurance industry by definition manages risk, but in this “Age of Discontinuity,” it is hard to plan for some of the risks that are coming our way. Hold on - 2015 looks to be an interesting year.