What's Next Health: Designing an Elegant Health Care Process

Mar 20, 2014, 8:00 AM, Posted by Pioneer Blog Team

Jay Parkinson, founder of Sherpaa Jay Parkinson, founder of Sherpaa

Each month, What’s Next Health talks with leading thinkers with big ideas about the future of health and health care. Recently, we talked with Jay Parkinson, founder of Sherpaa, who challenged us to consider what a more "beautifully designed" health care system might look like. As you'll read in his post below, Jay’s trying to do just that through his work at Sherpaa. (Jay’s opinions are not necessarily those of the Robert Wood Johnson Foundation.)

By Jay Parkinson

Everything great comes from an elegantly designed process. Just think of all of the experiences we love and use on a daily basis. Consider the iPhone. Apple re-imagined what a phone, or rather, a tiny computer in your pocket, could be and created a revolutionary device. Steve Jobs designed not only the interface that changed computing forever, but Tim Cook designed the manufacturing and material sourcing processes that enabled them to produce a remarkably complicated device at a relatively inexpensive price. They understood that, in order to deliver an exceptional user experience, they had to design the entire process, from the interface to the factory.

Health care was never designed. It just happened, revolving mostly around doctors’ needs and wants, in a culture that strongly believed “doctor knows best.” But our culture changed with the democratization of health information and other industries quickly evolved, raising consumers’ expectations of what health care could and should be.

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Comparing the Apple Genius Bar with today’s average health care experience is laughable.

So how can health care catch up? Design an elegant health care process that enables intelligent health care delivery. Don't only design that process, but implement it. Essentially, combine the elegance and creativity of Steve Jobs with the process-driven business savvy of Tim Cook. That’s what we do every day here in my company, Sherpaa. Here’s how it works:

  • Our salaried, full-time doctors have one mission: communicate via phone or web and creatively solve our patients’ health problems, all day, every day.
  • When patients have health problems, they log in and tell us their story.
  • Our doctors then, online, ask the right questions and get a careful history, prompting them to either order lab or imaging tests, treat with a medication, watch and wait, or refer for an in-person evaluation to a doctor in the patient’s neighborhood.
  • 70% of the time, our doctors treat or solve the issue without having to refer to an in-person doctor. When we do refer, it’s always to the exact specialist the patient needs.

Does that really mean that 70% of primary care, specialist, and ER visits don’t need to happen? Does that really mean that 70% of those insurance claims should never happen? Yes, exactly. If you give patients accessible doctors at the right time to skillfully decide how best to use health care, health care is used intelligently with very little waste. In this system, everything that’s done actually needs to happen.

All of this is the result of an elegantly designed health care delivery process. But elegant processes aren’t free. So, in conjunction with this process, you must have an equally innovative business model to pay for this new process. There’s a hard fact floating around companies saddled with health care costs—health insurance premiums double every seven and a half years. Employers have a vested interest in taming those costs. And with roughly 70% of health care costs in America fronted by employers, they are the perfect innovation partner. Employers pay us to innovate their way out of rising costs through intelligent health care delivery.

This is all very interesting for the early adopters—the innovative and creative companies looking to make health care awesome for their employees. But what about the rest? What about the unions, those folks on Medicaid, and companies with minimum wage workers? Well, it’s called trickle-down technology. When the iPhone came out, few people could afford it. Over time, we now have cheaper versions of iPhones and, most importantly, Google’s Android smartphones. There’s even a $25 Android smartphone soon to be released. Now, almost everyone can afford this fancy “new” technology. This will also happen with health care. Start with the innovators who can’t stand frustrating experiences and who are dying to pay for something better. Work with those folks to refine your process and make it even more elegant, build an even bigger business, and watch competitors arise. And in the not too distant future, we’ll all wake up one day to see health care transformed by a little combination of dreamers, designers, and businesspeople who couldn’t stand seeing something broken without doing something about it.

To learn more, visit What’s Next Health to watch a conversation with Jay and RWJF's Wendy Yallowitz and view an infographic inspired by Jay's ideas for reimagining what primary care should look like.