Sam Glick’s Reflections On The Industry
Sam Glick does not settle for the easy answers. Anyone who has been to the Oliver Wyman Health Innovation Summit knows that. He constantly challenges leaders to ask hard questions and find solutions for fixing healthcare’s most daunting problems. Whether its rebuilding trust with consumers, rethinking staffing models, embracing new technologies, or exploring new financing mechanisms, Glick is passionate about the mission of Oliver Wyman’s Health and Life Sciences practice: transforming healthcare through the relentless pursuit of a better way.
In June, Glick will bring that enthusiasm to Kaiser Permanente as he steps into the role of Executive Vice President, Enterprise Strategy and Business Development. A critical part of his remit will be looking for ways to expand Kaiser Permanente’s value-based care model to more communities across the country.
Oliver Wyman Managing Editor Matthew Weinstock caught up with Glick ahead of his transition to talk about where the industry is heading and what’s needed to truly transform healthcare. Below is a Top 10 list from that conversation, in no particular order.
The Affordable Care Act and healthcare consumerism: When I think about big transformative moments, the Affordable Care Act is obviously one of them. Everybody’s mind goes to expansion of coverage and the ACA exchanges. But with passage of the ACA, we suddenly had a lot more attention on value-based care. We had a push for accountable care organizations. There was new attention to healthcare consumerism. The ACA brought into the spotlight a number of topics that Oliver Wyman, as a firm, wanted to push forward to make the industry better. It was a big step in terms of how we thought about improving healthcare as a national imperative and all the different elements of that.
Impact of COVID-19: The pandemic was a very different kind of transformative moment. On one hand, it revealed many of the fractures and fissures we have in the healthcare system. Before March 2020, there were a lot of pundits saying, “We have too many hospital beds.” That sounded pretty glib when we had people stacked up in hospital hallways because there weren’t enough ICU beds. We’ve talked for a long time about the labor shortage that was coming and then it became very real, very fast. Sadly, the pandemic also accelerated the erosion of trust in institutions, and particularly in healthcare institutions. We’re still seeing the effects of mistrust among consumers. It’s going to take years of hard work and new ways of engaging with consumers to rebuild.
On the other hand, COVID revealed a tremendous ability to innovate. We saw a vaccine developed in record time. We saw rapid growth in telehealth. Now, telehealth volume has come back down, but it’s still higher that it was in 2019. That’s partly because reimbursement finally caught up, and partly because millions of consumers came to see it as a better option. And telehealth is just one aspect of digital health. Despite the recent slowdown in funding, I think we will continue to see growth in digital health and COVID likely accelerated that by about five years.
Emerging technologies: We are in the early stages of another wave of incredible innovation. When I think about what’s going on with artificial intelligence, this feels like the early days of the internet when health systems were beaming microwave dishes between their facilities, or the early days of smartphones when I held the first iPhone in my hand that had 2G internet and no App Store. But we all could look forward and imagine what would happen when the technology got better and everybody had access to it. You can see the future coming with AI.
A similar effect is happening with cell and gene therapy. In early May, we had the first person treated with a commercially-available genetic therapy to cure his sickle cell anemia. He's a 12-year-old who's been in agony and in the hospital for most of his life. We're going to see a million-plus people eligible for those kinds of therapies, not just for sickle cell, but for many diseases over the next several years. That’s a huge moment. We are going to move from managing diseases to curing them. It's going to fundamentally change everything about treating people. There’s a lot of attention, rightfully so, on how we pay for these therapies, but the idea that that we could really cure diseases we never thought of curing is a transformative moment.
Generative AI's potential: We are at an inflection point on generative AI. It is great with language. It's great with writing software code. It's great at being creative. Absent AI, there are many tasks that we do sparingly in healthcare because they are expensive to do en masse. Think about individual-level personalization. If I can communicate with somebody at their reading level, in their language, in the type of media they prefer, with references that resonate with them, I can have an amazing impact. The challenge today is I need somebody who has pretty good emotional intelligence — and the time to do it — sitting in front of a patient to communicate with them that way. So, instead, I write one-size-fits-all materials, and then translate them into the languages that the majority of my patients speak. My hope is that kind of approach will look antiquated five years from now.
Similarly, I predict that software development cycles will get shortened dramatically. Today developing software is an 18-month capital project for most organizations. In the future, asking for an app to be developed will be as simple as asking for a spreadsheet or a PowerPoint presentation.
Designing for the future: One of the things leaders must do is design today assuming tomorrow. We may not know exactly when certain types of AI are going to be able to do certain types of activities, but I know I need more automation and I need somebody who runs a hospital, or a call center, or a manufacturing line thinking about how to design processes to make it easy for automation in the future. Some of the Silicon Valley innovators, while not perfect analogs, can be instructive. Reed Hastings, co-founder of Netflix, always envisioned a world where we would be streaming movies. The technology wasn't there when they launched, so they started with mail-order DVDs, but he designed for the idea that people would go online. Similarly, from the day they were founded, Uber was talking about self-driving cars. What they needed to do was to create an interface that allowed people to interact with cars, and then wait for the technology to catch up.
As healthcare leaders, are we thinking about designing for tomorrow? Instead of designing assuming that a chronic care or rare disease patient is going to get treatment in my facility for life, am I thinking about what happens if they get a curative therapy? Am I designing for a workforce that wants to at least do part-time work into their 70s and 80s? Do I have jobs that allow for that? If I'm a health plan, am I thinking differently about the risk pools to pay for these very expensive therapies? At some point, maybe 10 years out, most of my business is going to be sold to consumers as ACA, Medicare, and Medicaid coverage. That’s different than a business that was built around selling to groups. If I'm a pharmaceutical company, in the future I won’t just have a one-way supply chain where I spend a lot of money to do research and development, finally get approval, produce a drug, and push it out my loading docks. I will have an ongoing obligation for patient support, provider support, two-way supply chains, and digital solutions.
Engaging the workforce: The way you design for automation and AI best is by talking to people on the front lines and asking them some simple questions: What things are we doing inefficiently? What are the things you do today that are joyless and that you would want to see replaced with technology so that you can focus on the aspects of your job that really add value for the people we serve? You’ll still have natural attrition and people will retire, but then you'll hire as many people as you need based on new efficiencies.
Most people want to change and grow. They just don’t want to be changed. Too often we engage in a kind of lazy leadership, vastly underestimating the wisdom and willingness to engage of the people who actually do the hard work of serving consumers every day. We have to stop that.
Advancing clinical education: Clinical education is starting to evolve. Bit-by-bit we continue to move away from memorization-based approaches to more augmented approaches that help clinicians learn to be productive and effective in modern care settings.
But I think we need to move faster to revamp the educational system. Part of that is redefining medical professions. For example, we need more professionals who can spend time in communities and who have some social work skills and some clinical skills to help people interpret and feel empowered to manage their own health, wearing t-shirts not white coats.
To use another example, today, in most cases, the same doctor diagnoses a condition, plans treatment, and delivers that treatment. But those are very different skills. In a world where high-speed internet is nearly ubiquitous and telehealth is commonplace, the person who diagnoses my cancer or other complex disease can be at a center of excellence somewhere across the country, and the person who does my treatment planning can be sitting in my living room taking into account my social context, knowing me, my family, and my community. And then my treatment might be delivered in a local pharmacy, at times that work for me. It’s a powerful vision — but one that will require new workflows and new approaches to education to make real.
Shift to value-oriented care: The commitment to being evidence-based, having aligned incentives, ensuring equity, and creating an integrated consumer experience — those things can work across the country. You can do it in multi-payer and multi-provider environments. The technology landscape has evolved to make that possible.
The economics don’t always line up right away and the transition is the hardest part; that’s often why organizations get stuck. One of the strengths of the American healthcare system, however, is that managed competition can provide for a natural learning lab. You see this in elements of the Medicare Advantage program. We have to create more such environments where the best approach — not just the biggest player — wins.
Personal leadership: I got into healthcare to make people's lives better. Health and education are the ultimate leverage points. Healthy, educated humans have the foundation they need to thrive. This is why I find our Oliver Wyman HLS mission so compelling. By being relentless about transforming an industry, we are transforming people's lives.
It's also why I've chosen to join Kaiser Permanente. I wasn't looking for a job. My role at Oliver Wyman is a delight and a privilege. But, sometimes, you don't get to choose your own timing. I simply couldn't pass up the platform KP provides to continue to transform healthcare. And my new colleagues there truly are mission-driven, just like my Oliver Wyman colleagues are. Moving to KP feels like a big challenge and like coming home simultaneously somehow. I'm excited.
The industry’s essential question: The healthcare industry has many odd dynamics. We’re probably the only industry that gets together and regularly talks about how to make ourselves smaller. We have this mix of public and private funding, and not-for-profit and for-profit entities. We have a large amount of venture capital flowing in — often without the returns we’d like. And we serve literally everyone, delivering some of the most complex services in the world.
Our industry probably does need to be smaller on an absolute basis. Value-based care only works if we actually spend less in total, and don’t just spread the dollars around differently. But the choice we have to make is whether we will be smaller because we took out elements of the system that were inefficient and unnecessary for everyone, or because those organizations that served the most vulnerable among us couldn’t survive anymore. That’s our essential question: Do we want to have a better system for everyone, or a two-tier system where your income still determines your lifespan? I choose the former. Money is going to come out somewhere. It has to for healthcare to be affordable. But we want it to come out of activities that are unnecessary, that are bad for people. That's my great hope. That's why I go to work every day.