BIF Editor

Written by BIF Editor @thebif

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Traditional models of reform have focused on the three conventional pillars of health care: cost, access, and efficiency. Though these pillars functioned as the foundation of the ACA, we still have yet to resolve the underlying pain points that continue to resonant across the country, seven years’ post-ACA implementation.

A study commissioned by the Robert Wood Johnson Foundation, National Public Radio, and the Harvard T.H. Chan School of Public Health tells us:

  • 61% of adults would rate the nation’s healthcare system fair or poor
  • 45% of adults have seen the cost of their health insurance premium rise over the last two years

Just over two weeks ago, a resounding thumb down from Senior Arizona Senator John McCain spelled the latest failed attempt at the repeal and replacement of Obamacare (The Affordable Care Act, or ACA).

Much like our health system, our political system acts more stubborn than transformational, clinging to the comfort of the familiar, rather than forging toward the true change of disruptive innovation and there is no telling what leaders of either system are going to do next.

As uncertainty around current market stabilization continues, political leaders in Washington are moving on and healthcare leaders across the country are hedging their bets and limiting their risk — all to the detriments of the individuals and families that rely on the American health system.

When marooned in a sea of uncertainty, our health and political leaders struggle to explore, prototype, and test new models that yield significant and lasting change and resign themselves to conventional, albeit broken models.

Today, we have a health system that is not valuable to individuals and families. Their needs are not prioritized or solved for, often leaving many unable to access, obtain, or afford needed medical care. This oversight sustains the current model, overlooking the necessary addition of a fourth pillar to transform our health system; the experience and needs of individuals and families.

We need a new way of delivering a valuable health experience in this country.


This new way requires that we design a health system (inclusive of wellness and care models in addition to insurance and payment models) that delivers on two different value propositions: one that offers equity, access, and affordability to consumers, and one that offers efficiency, cost-reductions, and predictability to payers and providers.

What do we do when our healthcare system is overshadowed by our health insurance system? We design for the one thing they have in common: the patient. This requires leaders to step away from the conventional mindset, and get out of the mental valley that accepts the present system as gospel and attempts only to make tweaks around the edges.

Here in the Patient Experience Lab (PXL) at Business Innovation Factory (BIF), we believe that by placing individuals and families at the center of their own experience, we transform the health system in a more inclusive way. We use a human-centered design-driven methodology, making it easier and safer for institutions and organizations across the health system to transform the ways that they create, capture, and deliver value to the individuals, families, and communities they serve.

We start by shifting the focus of institutional leaders away from the traditional three pillars of healthcare (cost, access, and efficiency) to design a system informed by the experience and needs of individuals and families: the fourth pillar of our health system. With this fourth pillar, a new set of questions and challenges emerge loud and clear; questions that we have been asking throughout our work here at BIF.


How might we shift the current experience of health and wellness to be one that is understood and claimed by families and children, rather than simply available to them?

How might we better understand what contributes to poor health outcomes and lack of engagement in a personal health and wellness journey?

How might we promote effective cross-sector partnerships and models between clinical and nonclinical entities in service of whole person health?

When we co-design the care and cost models that make up our health system using insights from institutional leaders, politicians, clinicians, insurance companies and patients, we create a holistic system that adds value and improves the health and wellness experience for individuals and families. Using a human-centered design approach ensures that the fourth pillar of care is first understood and then built-in as a central component. By designing with the consumer and not for them, we can create a more stable system that delivers new and sustainable value.

To do this, institutions and leaders across the health ecosystem must be willing to prototype and test new models and next practices that incorporate this fourth pillar of care. When the voice of individuals and families is incorporated from the start, meaningful models and strategies for health will be formed to create, capture and deliver new value across all pillars at scale.

At the core, BIF’s methodology serves as a roadmap for leaders who are ready to integrate the fourth pillar to transform our health system; challenging not only themselves but the entire health ecosystem to co-design a better way to deliver health across this country by leveraging the experiences of those it serves.