Scramble the Healthcare Red Team!

France's Defence Innovation Agency (DIA) -- its equivalent of our DARPA -- wants to set up a team of science fiction writers and futurologists to help them plan for the future.  This so-called "red team" is intended to "propose scenarios of disruption" that the traditional military strategists might not envision, in order to not be caught off-guard. 

As Futurism put it:

Basically, it seems France wants the creatives to imagine how the future could go really wrong so that the nation can stay one step ahead of any trouble — and really, who better to envision dystopia than a team of science-fiction scribes?

It made me wonder: do CMS, United Healthcare, CVS, Kaiser Permanente, HCA, or Pfizer have their red teams of science fiction writers?  If not, why not?

Now, I have to admit that I am a science fiction fan (I am currently in the middle of reading Neal Stephenson's latest opus, Fall; or, Dodge in Hell), so this idea appeals to me.  Science fiction writers have been making some pretty good predictions for a while now, from Jules Verne sending rockets to the moon, H.G. Wells blowing up things with atomic bombs, Arthur Clarke using satellite communication, or William Gibson's cyberspace. 

Of course, they've been wrong much more than they've been right, which is why we're not all using jet cars, teleporting, or taking fast-than-light trips to the stars.  The point is that they imagine a future that is different than what we're used to, and the great science fiction writers imagine the technologies mostly to draw out the implications for what they might mean for society.

The DIA said: "The work of this cell will be to construct valid strategic hypotheses, ie likely to upset the capability plans, " and added that the team would also be "reflecting on the strategic consequences of the arrival of disruptive technologies.”

Bruno Tertrais, deputy director of France's Foundation for Strategic Research, told The Telegraph that the red team was supposed to challenge "any certainties that we may have and hypotheses about the future outside the usual bureaucratic procedures.”  However, he clarified:

It is certainly not the Red Team that will decide France’s military strategy and still less its defence policy. Its role will be to help the Defence Innovation Agency think about future technologies and their impact on strategies.

I can understand not delegating a country's military strategy to a bunch of science fiction writers, although some critics might argue that France could scarcely do worse.  😉

Healthcare organizations aren't about to turn their strategy over to a team of science fiction writers either, nor should they.  But the DIA's notion that science fiction writers might picture possibilities that an organization's leaders and usual consultants might never think of seems very valid, and this is where healthcare should be paying attention. 

We talk a lot of looking for solutions that are out-of-the-box," but we typically have a hard enough time realizing the boundaries of those boxes, much less picturing topologies that don't even include boxes.  That's the kind of thing that science fiction writers try to do. 

Healthcare is already getting into territories that, not that long ago, would have been considered science fiction.  We've got robotic surgery, nanobots, 3D printing for tissues and prescriptions, and an increasing number of applications for artificial intelligence, to name a few.  But we're still trying to graft them onto our existing delivery and financing systems, and, at some point, that is going to fail. 

My favorite example is with artificial intelligence.  We've had telemedicine, with human doctors, for some 20 years now, and we're still trying to make state licensing and reimbursement work.  So when we get A.I. that can fill many roles of those human doctors, and which make decisions in ways that we don't and probably can't understand, how are we going to solve those same state licensing and reimbursement issues?   

That's the kind of thing that science fiction writers may be better at than most healthcare executives. 

It's easy enough for a science fiction writer to just assume really smart healthcare AIs or nanobots that can deliver pinpoint fixes within our bodies.  But I'm not sure that's where we need their kind of imagination the most.  Where we may need it most are in some of the nuts-and-bolts of the healthcare system, where things work, just not very well.

For example, here are some of the grubbier aspects of healthcare that need reimagination:

• Eligibility: how does everyone in healthcare agree that Person A is Person A?  Right now, we have NPIs that change seemingly willy-nilly, health insurance IDs that change with every change of health plan, and often multiple IDs for the same person.  It's amazing we ever get it right.
• Billing: we spend way too much time and effort trying to get billing "right," the definition of which healthcare professionals and health plans would not agree on.  With ICD-10, we're taking an already incomprehensible coding system and ramping it up still further.  We mix billing with diagnosis/treatment in ways that don't serve either purpose well.  Billing isn't supposed to be the point, but, in many ways, it is.
• Claims payment: Few of us understand our health plan benefits.  Few of us ever really know how a specific medical encounter is going to get paid.  Payments are often less than we expected, and many denials get reversed upon appeal.  Despite health plans' best efforts to automate, many claims end up needing a human to adjuticate.  It is to health plans as billing is to healthcare organizations -- vital to get right, hard to explain, and hugely expensive.
• Financing:  Despite just about every variation experts can think of, no country that I know of is happy with how health care is financed, nor how health care services are paid.  People grumble about taxes, complain about health insurance premiums, and worry that we're incenting the wrong kinds of health behaviors and treatments.  As we spend ever more on health care, this will all get worse.  

Imagine healthcare systems that solves those, and I'll be impressed.

A lot of very earnest, knowledgeable people are working on these and other healthcare problems.  More power to them, but it's not clear to me that they can see over their own biases.  This is where we need fundamental rethinking.  This is where we need daring speculations.  This is where we need wild imaginations to describe a very different future.

This is where healthcare could use science fiction writers.