BIF Kicks Off Project With The National Association of Community Health Centers

On November 15, BIF launched a new project with the National Association of Community Health Centers (NACHC) which serves as the national health care advocacy organization for America’s medically underserved and uninsured and the community health centers that serve as their health care home.

Community health centers provide critical health services to vulnerable populations across the United States. One in fifteen Americans use the services of a community health center in both urban and rural areas. Today, community health centers serve 27 million Americans in over 10,000 communities.

As each community center is independent, NACHC provides critical services across the network –  including research, training, and technical infrastructure. Increasingly, NACHC is recognizing the power of community health centers to drive innovation on many different fronts – from how they serve patients to how they influence national policy.

BIF is excited to partner with NACHC to explore the innovation opportunities. At a meeting of primary care and community health networks in New Orleans, BIF’s Chief Market Maker, Eli MacLaren facilitated a day-long design studio to define the first phase of work:

How might we shift our lens to uncover innovation opportunities that will transform how we serve patients? How might we collaboratively innovate, going farther together than we can go alone?

Following this meeting, BIF will launch an innovation exploration, using human-centered research to define the job that stakeholders need to be done, i.e. what do they value? What will enhance their work, while driving opportunities for innovation?

This work will be packaged into a set of customer insights and opportunity spaces for driving innovation at the local and national level. NACHC works in conjunction with state and regional primary care associations, health center controlled networks and other public and private sector organizations to expand health care access to all in need.


Amazon: The Elephant in the Room

As an innovation junkie, Amazon is the elephant in a whole lot of rooms I find myself in these days. The number and variety of the rooms in which the elephant seems to be hiding in plain sight are remarkable.

Amazon either already impacts or is poised to disrupt many traditional retail industry segments ranging from books to food to consumer tech to prescription drugs. No retail segment is immune. And now Amazon has announced it will aggressively extend its platform more broadly into healthcare sending shudders through the entire industry. Amazon also weighs heavily in public sector economic development discussions with the announcement of two new locations in the DC beltway and NYC for its burgeoning headquarters functions and the devastating local impact of so many lost entry-level jobs as many bricks and mortar retailers either go out of business or downsize due to the growth of online commerce.

It’s beyond me how so many public and private sector leaders have ignored the elephant in the room for so long but one thing is clear, no one can ignore Amazon any longer. The question of what to do about it looms large for every leader. One thing for sure, it’s a good time to be an innovation junkie.

It’s been a retailers dream start to the holiday season this year according to Internet Retailer with total retail sales estimates between Thanksgiving and Cyber Monday of $143.8 billion. On-line sales commanded 15% of total retail sales or $21.6 billion. Amazon is estimated to have sold 29% of the online total for a whopping $6.25 billion. Not bad for five days of work!

Both the online percentage of retail sales and Amazon’s share continue to grow showing no signs of slowing down. Just because in-store retail sales also grew over the Thanksgiving holiday don’t be fooled into thinking traditional retailers are safe. We’re at the top of a long cycle of economic growth and when the next inevitable downturn starts retail is always one of the first industries to take a hit and it always gets hit hard. The transformation of the retail industry to online and mobile is still in its early days and the impact on communities and the retail workforce will accelerate over the next five years.

Amazon isn’t just the elephant in a lot of work-related rooms, the pachyderm has also found its way into my home, literally. Never mind the growing number of packages I trip over on the porch when I get home after work but the other night on the local news I watched a segment of a weekly series called Tuesday’s Child featuring a heartwarming story about a local child available for adoption named Alexa. Every time Alexa’s name was mentioned throughout the segment another less human Alexa in the room piped up making her presence known and reminding me that Amazon really is in the room!

Perhaps the best evidence that the elephant is on the move and can’t be ignored is today’s Amazon healthcare announcement. The healthcare industry has been on emergency Amazon watch for the last several years. Every Amazon announcement has been parsed to handicap the odds that Amazon would try to work its disruptive magic on the heavily regulated healthcare industry. Every comment from Jeff Bezos about Amazon’s healthcare intentions sends industry stocks reeling. To say healthcare institution leaders are nervous is an understatement.

There was no ambiguity in today’s announcement from Amazon about their healthcare industry intentions. Amazon announced the launch of a new healthcare service platform called Comprehend Medical. It’s a predictable platform play by Amazon to stampede aggressively into healthcare.

Comprehend Medical is touted as a healthcare service platform which will aggregate patient EMR data, apply machine learning and artificial intelligence, and then provide institutional health care players and professionals with the information and tools necessary to make better more economic healthcare decisions. And oh yeah, it will also integrate the world’s largest product commerce engine. Incumbent healthcare institutions and companies have good reason to shudder at the sound of the elephant’s footsteps approaching.

Disrupting healthcare won’t be as easy as disrupting bookstores or big-box retailers for Amazon. There are many institutional interests and regulatory moats making it more challenging. As Amazon sees it, our current healthcare system is vulnerable and ripe for disruption. It leaves too many individuals and families behind and delivers a fragmented, confusing, overspecialized, unaffordable, and painful experience for far too many consumers. Healthcare institutions and professionals are too slow to disrupt themselves and to take advantage of new emerging technologies to transform customer experience. Our healthcare system as currently comprised is also unsustainable financially. The elephant likes what it sees with lots of room to forage for value creating opportunities that leverage Amazon’s superpowers.

I am curious to watch how Amazon architects its Comprehend Medical platform and service offerings. I’m concerned about privacy issues, control and use of individual healthcare data and believe that the long-term winning play is more like Apple (focus on consumers) than Microsoft (focus on the institutional market). It will also be interesting to see how Amazon handles the growing public backlash to its market size and influence including the risk of increased regulation or antitrust actions to slow the behemoth down.

It’s always best to recognize the elephant in any room. Ignoring elephants is an unwise strategy in an era where cycles of disruption are shorter placing a premium on reinvention, new business models, experimenting with emerging technologies and transforming customer experience. Everyone loves innovation until it affects them. Today, innovation affects all of us. If we try to ignore it, wait it out, or lean against it we leave ourselves increasingly vulnerable to disruption. The only winning strategy to avoid disruption is to innovate from a position of strength while we still can and not from a position of weakness when it is too late.

We also have to be clear-eyed about the impact of innovation on real people and communities. That doesn’t mean we should block innovation and the promise of leveraging exciting emerging technologies for good, it means that we need to recognize the impact on real people, institutions and communities and enable them to leverage emerging technologies to get better faster and to reinvent themselves in order to stay relevant in a rapidly changing world.

Personalized Medicine by Design

Business Innovation Factory (BIF), in collaboration with The School of the Possible founded by Dave Gray, Hatch founded by Yarrow Kraner, and Overlap founded by Michael Dila, is launching a project to explore the opportunity for a transformational personalized medicine business model.

Leveraging a network of networks we will start with a four-month exploratory phase of work to establish a deep customer experience foundation upon which we plan to design, prototype and commercialize a new model that empowers individuals and families to improve their own health and wellbeing. Our intention is to start-out-loud and to work iteratively and collaboratively to inform the development of a repeatable and scalable model. Our intention is to catalyze a personalized medicine movement.

Our U.S. healthcare system is leaving too many individuals and families behind. It delivers a fragmented, confusing, over-specialized, unaffordable and painful experience for far too many of us. Healthcare institutions are slow to disrupt themselves by leveraging new emerging technologies to transform the customer experience, and the healthcare system as currently comprised is unsustainable financially.

Healthcare is ripe for disruption. It is up to all of us to make sure that we disrupt it on behalf of those being left behind by today’s system. It is up to us to imagine a new healthcare system that puts individuals and families first. We need a new system in which families have access to the information, tools, and resources necessary to improve their own health and wellbeing. We need a new healthcare system that puts us at its core.

In the exploratory phase of our Personalized Medicine By Design project, we will establish a strong foundation of understanding of today’s healthcare customer experience. Any transformational personalized medicine business model must start with an understanding of the job-to-be-done from the customer’s point of view, not primarily from the perspective of today’s healthcare institutions and system. We will not be admiring the problems of today’s healthcare system, they are well known. We are seeking to understand how individuals and families experience the current healthcare system and their pain points as a jumping off point for imagining how we might transform, not tweak, it. A rigorous human-centered exploration phase will inform the design and prototyping of a transformational personalized medicine business model with healthcare consumers and families at the core.

We won’t start with the question, “how can we improve today’s healthcare system.” Building on a deep understanding of healthcare customer experience as an actionable foundation for design we will start with the question, “Can we imagine a new healthcare system that is in service of helping families better manage their own health and wellbeing?” We won’t get bogged down worrying about scalability and how to change the current system until we have demonstrated at a small scale that there is a better way that is financially viable. Let’s figure out what we want to change to before we obsess over how to change the way it works today. It’s time to create the conditions to imagine, design, prototype, and commercialize a transformative new patient and family-centered business model unconstrained by how healthcare works today.

I have been waiting for the stars to align for personalized medicine and to lead this BIF project for a long time. Over my career, I have engaged in and have every black and blue mark imaginable from working in and trying to change every aspect of how today’s healthcare system and business models work. Our passion at BIF is making transformation safer and easier to manage. As a leader in the healthcare industry, a strategy consultant, a government bureaucrat, and as the founder and Chief Catalyst of BIF I have led teams working on the mindsets, muscles, and tools to enable business model transformation and healthcare has always been my home industry.

I worked at Eli Lilly and Company in the 1980’s and will never forget the opportunity to witness first-hand how genomics might transform healthcare when I got to attend the opening of the world’s first commercial-scale recombinant DNA manufacturing facility. I was wowed by Lilly’s fete of tricking e-coli into producing human insulin at scale. Fast forward to today when the cost of mapping our own personal genome is rapidly approaching $100 and companies are already being launched that will offer us the opportunity to map and store our genome for free if we allow them to monetize our most valuable data set, our double helix. What if we made sure that we controlled our own healthcare information and who and how others can access it?

As a road-warrior strategy consultant, I worked with the visionary Mark Levin, founder of Millennium, who was early with a personalized medicine vision to transform the pharmaceutical and biotechnology industry in the 1990’s. Mark’s idea was brilliant but the technology hadn’t advanced enough for a transformational business model to take hold. I never forgot the boldness of his vision and have always believed that it would ultimately come to pass. I believe that personalized medicine is now a viable business model with the potential to transform healthcare. We can already see its transformational potential in the diagnosis and treatment of many forms of cancer. The changes we can now see in personalizing cancer care and treatment will expand to other diseases and care paths. The promise of personalized medicine is within reach and hugely disruptive to every aspect of today’s healthcare system. What if we made sure that personalized medicine business models were designed with individuals and families at their core?

As a geek wannabe, I’ve always lived in the space between emerging technologies and new business models. Emerging technologies including genomics, big data, artificial intelligence, Internet of things, blockchain and all things digital are at a stage where they can actually be deployed in service of new human-centered business models. They are all capabilities in our sandbox ready to be combined and recombined to enable a personalized medicine vision. I was troubled when in 2011 the National Research Council declared that personalized medicine was an antiquated term and should be replaced by the more technology friendly label of precision medicine. I’m certain new technologies will continue to fill our business model sandbox enabling us to more precisely diagnose and treat disease. Today, these new technologies are out ahead of the business models to deliver their value at scale, and their development is predominantly shaped through the lens of today’s healthcare institutions and not customer experience. We need to transform from a sick care to a wellness model. To transform healthcare we will have to put the personalized back into precision medicine.

Our collaborative exploration of personalized medicine opportunities will put individuals and families at the center of our design process. It will bridge the exciting space between enabling agency at the consumer level and leveraging emerging technologies to transform customer experience and outcomes. Join us. We’ve created a Personalized Medicine by Design Facebook group to welcome other purposeful networks like School of the Possible, Overlap and Hatch, companies and institutions that want to play and any individuals interested in project updates or engaging in our exploration process. Let’s transform healthcare together.

Personalized Medicine by Design Facebook Group

10 Steps to Transform the Patient Experience

The healthcare industry is disrupting, and many organizations are struggling to keep up with the times. Often times, business model transformation feels harder than it has to be. Business model innovation isn’t about practices, it’s about next practices. Here are 10 small next practices to help you start:


1) Access

Patients and families must have easy access to unlimited and trusted information and must know that the most convenient care is also the most personal care. Even with telemedicine, it is much more valuable to the patient or family member knowing that the patient has a relationship with the doctor.


2) Meaningful return beyond clinical assessment

Care can’t just have tangible returns like shots and prescriptions anymore. Because so many families have to take time out of work and find transportation to the doctor’s office, there must also be meaningful, tangible and relevant returns on health and wellness and in order to make the benefits outweigh the costs.


3)  Motivation to engage in self-wellness

Patients and families must be encouraged to continue their journey outside the doctor’s office by providing both information and motivation to be independent agents of their own health. Patients will become better agents of their own health if they are encouraged to learn from all experiences, including mistakes and failures. Wellness should be led by the patient, in partnership with the knowledge and resources of the doctor.

4) Patient/Doctor relationships must exist outside of the paradigm of care

The patient-doctor relationship is framed by visits to the doctor’s office; the doctor usually only sees the patient when they are sick. In order to break down this silo, it is important to see patients as people with hopes and dreams, thus building rapport, trust, and engagement.


5) Bridge the gap between physical wellness and the development of personal goals

Current doctor-patient interactions are framed by the scope of preventative care. These interactions have the potential to unlock further value if the discussions centered around both their physical and personal development.


6) Patients need actionable goals

In order to provide actionable goals, it is crucial that physicians focus on healthy habits of the entire family, not just the single patient. These actionable goals must address both existing conditions as well as elements of wellness. Furthermore, it is evident that there may be more pressing matters than simply educating patients and families on wellness such as socioeconomic or social determinants to health.  


7) Overall positive customer experience and perspective on clinical visits

A positive patient experience is one in which the end user trusts that the information and service received has their best interest at heart. Additionally, patients and families must have an experience that leaves them feeling comfortable, engaged and validated through meaningful connections, cultural competencies, and a family-centered environment.


8) Patient/family centered interactions and environment

It is crucial for medical centers to recognize that the patient exists in a family. In order to value the patient as a member of a family, the physical space and staff interactions must be designed around the fact that the family is the unit.

Patient Experience Lab at BIF

9) The clinic must reflect and understand the cultural values of the community

It is necessary for a practice to understand the cultural values of the community. These values need to be reflected in both the facility and in interactions between patients, families, and staff to make patients and families feel comfortable and welcome.


10) Ease of navigating the clinic – language/ welcoming environment

It is evident that families want to be able to navigate the healthcare system in the language that they are comfortable with. In order to accomplish this, patients and families must receive medical services in their own language and have assistance in following medical resources so that they have the proper knowledge to make informed decisions about payment options, medical treatment, and wellness plans. This should be reflected in a welcoming environment.


Are you ready to transform Healthcare? Learn more about Business Innovation Factory here, or email us at

The Equity Opportunity in Healthcare

In 2015, BIF was working in Dallas, TX – a racially segregated city – with Children’s Health System of Texas. As part of that work, we were building Children’s design thinking capability – and nothing was getting designed without customer feedback.

At the end of a particularly grueling design sprint, we brought in a group of teenagers – for whom the staff had been designing and asked them to critique the concepts. We could see the staff sweating – getting critiqued by customers is hard; getting critiqued by teenagers is harder. And, not for nothing, race was on our minds:

How open and honest a conversation would we have, with a primarily black teenager customer group and a primarily white staff group?

Privilege and power were the two elephants in the room.

But something amazing happened. After a fabulous critique, the teenagers were invited to ask questions of the staff. One of the teenage boys turned to the staff and said:

“Was that hard for you? Because it was incredibly uncomfortable for us.”

That question began a courageous conversation that openly and honestly explored and addressed our two elephants.

It is a well-established that racial inequity in the United States generates poor health outcomes. Countless studies, programs, and initiatives have been launched to attempt to close this racial gap in health outcomes, yet disparities persist. Why?

Part of it has to do with implicit (and sometimes explicit) biases. White doctors will often dominate the conversation when seeing a black patient and spend less time listening to the personal experiences of the patient. They will often discredit their patient’s abilities to comply with medical instruction and undervalue perceptions of pain. Often, all done without conscious intent.

These biases affect how healthcare is delivered and also how it is received. When a patient feels belittled by their physician or if their experiences and feelings are discredited, trust in the medical community erodes. As it is, distrust exists writ large, stemming from deep historical roots of unethical and racially motivated practices, from slavery and sterilization to Tuskegee and syphilis in the 1970’s.

This distrust that is not easily abdicated by a well-intentioned institution. Trust is even harder to establish when diversity, equity, and inclusion is treated as a bolt-on, which it so often is. For example, while designing a community health center in a primarily Latino community, we heard first hand how families often screened for Spanish speaking physicians only to discover that Spanish speaking meant the ability to say, and only say: “Hola, como estas?”

The institution is trying of course, but the result is often insulting.

The challenge is that bolt-on’s like this is what we know how to do.

Begging the question:

How might we design healthcare business models that generate better outcomes by recognizing the importance of diversity, equity, and inclusion?

First, we must understand the job that people want done. We hear often from patients that this is as simple as being treated as a human being. This requires that we practice inquiry – instead of creating a story about someone based on the color of their skin or the language they speak, we invite them to tell their stories. In this sense, storytelling is a critical organizational capability  – and the reason why BIF has worked with innovating organizations, such as Mass General Hospital and the Robert Wood Johnson Foundation, to build storytelling muscle within the medical industry.

Second, we must begin to recognize what white privilege means and the implications of that from a customer’s point of view. Our privilege means that we can buy band-aids in “flesh” color and they will likely match the color of our skin. Our privilege means that we recognize and know how to use the food that is sold in our supermarkets. Our privilege means that we can comfortably avoid, ignore, and minimize the impact that racism has on our lives.

This just isn’t true for Americans of color, and it’s incumbent on the healthcare industry to acknowledge that the lived experiences of inequity play a pivotal role in the health and well-being of marginalized communities.  Gaps in income, housing, and education are all significant factors when addressing the underlying disparities in both physical and mental health outcomes. To the extent that upwards of 70 percent of health outcomes are from social determinants, not medical determines. And while we know this, our approaches have been insufficient bolt-ons. We have created and funded collective impact efforts around housing or asthma; we have created care management programs. But rarely have we considered if we needed to fundamentally reimagine the business that we’re in. This is why the business model BIF designed for Children’s Health System of Texas moved it out of the business of delivering health programming and into the business of brokering relationships with social service agencies. This is why we authored the blueprint for creating sustainable new business models for moving Health Care Upstream.

Thirdly, we have to recognize that some aspects and assumptions of white culture in healthcare make it unattractive and irrelevant to many. Our white culture assumes a future orientation with delayed gratification. When we invert this, we’re able to recognize that people just want to feel well now, and that inspired a model for family well-being. Our white culture emphasizes creating divides between the personal and professional, which prevents the empathy, trust, and context that is essential between patient and caregiver.  Our white culture emphasizes rugged individualism which is not aligned with how many people live and thrive. This is why, when addressing preterm births in Cincinnati, we considered “what if we changed our care delivery model and approached medical appointments more like community gatherings” where patients share experiences that affect their overall health and well-being with a community of people who live and look like them?

When care becomes personalized, instead of medicalized, health outcomes improve.

As part of BIF’s early design work in Dallas, we created a small prototype called Your Best You to determine if improving well-being was actually possible. Our hypothesis was that if we activated kids’ sense of personal power, we could improve their sense of well-being. Your Best You was a 2-week curriculum that married aspects of Hip-Hop culture with design thinking, heightening kids’ sense of agency, creativity, and personal impact. One of our participants, an 11-year-old girl, spoke specifically about how awesome and important it was to be in an environment that let her be herself versus asking her to conform to a different set of norms. As it turns out, the ability to be yourself does wonders for your well-being and health.

Our healthcare system, however, still prioritizes quantity over quality. It also remains true that our healthcare workforce is not taught to address societal inequities or community norms. Addressing the social differences of patients would require a different set of skills that is not currently imparted in our medical education. Which leads us to address the question: how might we begin to re-imagine medical education so that group facilitation, bias recognition, and empathetic listening are core skills taught in line with clinical practice?

This is hard work and it all requires new capabilities, like storytelling. This is why efforts to address diversity, equity, and inclusion have been treated as bolt-ons. And herein lies the opportunity:

When healthcare business models are created with equity at their core, they have the ability to move beyond the bolt-ons that have sustained the structural norms of bias and discrimination, both known and unknown and seize the opportunity to fight against insidious structural racism, the implicit biases of practitioners and patients, and even overt external discrimination.

They also have the ability to finally include and pull people into a system which otherwise feels intimidating and hostile.

At the Business Innovation Factory, we know that when our social systems treat diversity, equity, and inclusion as mere bolt-ons to the current models, our systems become fragile and unsustainable. As new business models emerge, we believe that those that put and maintain DEI at their core are best positioned to transform and improve the experiences and lives of their consumers.

Join the conversation and explore how putting DEI at the core of your business model could identify opportunities for transformation.

Part 1: The Diversity, Equity, Inclusion Imperative

Part 2: Finding Our Equity Why

Why DEI? Join The Conversation