After working in healthcare technology for 30 years, including nearly two decades building Zocdoc, I’ve developed a habit.
Every time a company announces it’s going to “disrupt healthcare,” I start a mental clock. How long until they discover healthcare does not yield to disruption playbooks? By this, I mean: building a system outside of the existing one, scaling it quickly, and forcing incumbents to adapt or disappear.
Don’t mistake me. Healthcare desperately needs fixing and people who are willing to take ambitious swings at improving it. I commend all fellow travelers working to improve healthcare. But nowhere is it more true that ideas are easy and execution is hard than in healthcare.
Just look at the track record. Wave after wave of companies — from big tech to digital health, retail to pharma — has tried to reinvent healthcare.
Haven — the joint venture launched by Amazon, Berkshire Hathaway, and JPMorgan Chase in 2018 to simplify health benefits and lower costs for their combined 1.2 million employees — disbanded in February 2021, after not quite three years, following a string of executive departures including CEO Atul Gawande.
Walmart Health launched clinics in 2019 offering primary and dental care at low, transparent prices; in April 2024, Walmart announced it would close all 51 clinics across five states, along with its virtual-care service, saying the business “is not a sustainable model.”
IBM Watson Health launched in 2015 with a pledge to use AI to improve cancer treatment recommendations; seven years later, in 2022, IBM sold the bulk of the unit — including Watson for Oncology — to private equity firm Francisco Partners in a deal reportedly worth about $1 billion, a fraction of the roughly $4 billion IBM had invested.
Babylon Health, the UK-founded startup that promised AI-powered primary care through an app, went public via SPAC in 2021 at a valuation north of $4 billion; two years later, in August 2023, its US operations filed for bankruptcy and its UK business was sold off in a fire-sale deal.
With AI ushering in the next technology cycle, healthcare is once again about to be disrupted. Revolutionized. Fixed. And yes, AI is a genuine technological breakthrough. It has the capacity to improve many things; it also has the capacity to accelerate healthcare’s broken incentives. Either way, I have seen this movie before. Technological breakthroughs do not magically generate a working healthcare system.
Disruption playbooks don’t work in healthcare
That is because healthcare is not a technology problem. It is a complex systems and incentives problem: trillions of capital deployed across hospitals, physician groups, insurers, pharmacies, electronic health records, regulations, clinical workflows and more.
Disruption playbooks assume you can reinvent one part of a system and the rest will conform. But healthcare does not work that way. Everything is connected: providers, hospitals, insurers, EHRs, regulations, workflows and incentives built up over decades. You can build the world’s fastest train. But if its wheels do not fit the existing tracks, it will not travel far.
Healthcare is not a greenfield; it is the brownest of fields. If you want to solve its biggest problems at scale, your innovation has to work with the system that already exists. That is where disruptors collide with reality.
Many attempt to build around the system. They might create niche products and even valuable businesses. But because they’ve built outside the core of healthcare, they will remain on its fringes — lacking the scale needed to solve its largest problems.
Others assume the existing system will bend to the will of their brilliance. That trillions of dollars of infrastructure, tens of thousands of institutions, decades of incentives will somehow reorganize around them. That the tracks will magically rebuild to fit their trains’ wheels. History suggests that’s wishful, fatal thinking.
Healthcare can only be fixed from the inside out, not disrupted from the outside in
After watching decades of disruptors’ moonshots fail, I am convinced that healthcare is simply not disrupt-able from the outside in. It is only fixable from the inside out.
I learned this lesson building Zocdoc. Making it easier for tens of millions of patients to find and book care would not have worked if we tried to either ignore or “disrupt” health systems, physician practices, insurers and electronic health records. We did not expect them to adapt to us. We did the unglamorous work of connecting to all of them — across more than 200,000 providers who practice in 200 specialties, matching more than 10,000 insurance plans, building more than 175 different calendar integrations, and accounting for innumerable bespoke scheduling rules and workflows, regulations, and more.
This approach requires building fewer walled gardens and more bridges. It requires connecting what exists instead of trying to replace it. It is slower. It is harder. But it is not anti-innovation; it is anti-delusion.
It is also pro-progress. Healthcare’s status quo is unsustainable, and without change it will break the bank, our health, or both. But healthcare innovation must be matched with pragmatism and approached in a way that will actually drive meaningful change at scale.
Fewer moonshots, more progress
For too long, we have mistaken disruption for progress. Patients still struggle to find a doctor who takes their insurance. They wait an average of 31 days for the privilege of a visit. They run into dead ends across fragmented systems and repeat the same paperwork. And while patients wait, 20 – 30% of providers’ appointment openings go to waste; they remain saddled in administrative work and besieged with burnout. Premiums and costs continue to rise, while outcomes have not improved nearly enough.
Patients do not want disruption in and of itself. They want what disruption promises: a healthcare system that works for them, not the other way around. And delivering on that is much harder than shooting at the moon.
Thirty years in health tech didn’t make me less ambitious, but it has changed what I consider ambitious. So before we attempt to build yet another colony in space, let’s make things better for the patients down here on planet Earth.
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