The Family Well-Being Business Model

How BIF is Moving from Tweaks to Transformation in Healthcare

At BIF, we like to play DISRUPTUS. It’s a tool we use regularly in diverse settings — from giving talks to hosting design studios.

When we play, we focus on two challenges — tweaks and transformation. Groups are given a series of images/concepts, e.g.:

Two of my favorite images to use in DISRUPTUS.

We instruct half the group to tweak (or incrementally improve) the situation. We instruct the other half to transform it. We discuss and reflect on each other’s ideas. In doing so, a key learning always emerges:

Sometimes the line between tweaks and transformation can be blurry.

This is something we’re vigilant about at BIF. We should be — we’re in the business of helping leaders explore and test NEW business models. But business models — like the human systems that run them — like to stay in a state of homeostasis. One great risk is that transformative concepts and models get diluted until they look something like a tweak to the existing business model.

So there was a great moment in BIF’s work with Children’s Health System of Texas (CHST), when I realized we had clearly moved from tweaks to transformation in designing and testing a new healthcare model.

BIF’s work with CHST began 4 years ago. CHST, like many hospital systems, was seeing a tremendous uptake in emergency department use for non-emergent situations (e.g. fevers, sore throats). A good number of these cases were either Medicaid or no-pay, which means they posed a threat to the sustainability of the existing business model. Simultaneously, the CEO realized that the health of the community wasn’t good and was getting worse. He began to wonder:

How might we move up stream to design a business model that focuses on keeping people healthy?

BIF started with ethnographic research to understand the job that that families needed done. From them, we learned that the existing system didn’t work for them because they had no agency to act in service of their own health. We learned that the focus on individuals ignored the system — i.e. families — in which health habits are formed, learned, and spread. We learned that physical health is less important than the notion of family well-being.

The job became clear:

Could we design and test a business model that focused on family well-being?

We invited families to co-create concepts. We started small with a bias towards action — prototyping point solutions to determine if (1) we could create (and capture) the conditions for family well-being to emerge, and if (2) we could measure well-being.

With successes under out belt, we focused on designing and testing the entire business model.

The design is simple. It moves the center of gravity away from clinical care (it’s still there, but its a supporting capability, and not a lynchpin capability). At the center, we crafted an experience that is (1) focused on the family, and (2) focused on helping families improve their lives — however that may look. For some, it means taking small steps to become more financially secure; for others, it means getting better housing. The delivery model is comprised of a handful of lynchpin capabilities — personal coaches, motivational interviewing, SMART goal setting, and seamless integration with social services. The latter is key, as over 70% of health outcomes are generated by the non-medical determinants of health (also called the social determinants). It all rests on a new financial system that benefits from keeping people healthy.

Earlier this year, we launched a real world prototype — inviting real families to participate in this new model.

But before we could do so, we had to get through compliance.

After a month of review by the CHST legal team, they concluded that this model was (1) not delivering healthcare and therefore (2) not subject to the regulations governing healthcare delivery.

In effect, they determined that the new model was so far a field, or upstream from healthcare, it didn’t fit in with their healthcare legal frameworks or mental models.

That’s when I knew:

We had successfully moved from tweaks to transformation.

(Note to reader: this doesn’t mean we were playing in an unregulated space. It meant that we had to look elsewhere for the legal constraints of the prototype).

At BIF, we don’t believe in transformation for transformation sake. Health systems have been exploring wellness as an alternative to sick care for eons. But consistently, it has been treated as a “bolt on” to the traditional model, making delivering on the promise and sustaining it difficult.

The beauty of the family well-being business model is that it shows early promise of being able to deliver on the promise of well-being in a sustainable engaging way. The learnings and the data are still emerging, but we have good evidence that the changes in well-being will also improve traditional health indicators.

This is the power and potential of business model innovation.

Ultimately, transformation is a life skill — for individuals, organizations, and systems. And there is a parallel is how prototype is enabling transformation on all three levels.

The new experience meaningfully engages individuals and families in pursuit of their own well-being, by making it safer and easier to do. People set goals. A mom wants to have a better relationship with her son, or wants to learn english and establish citizenship. They are given seamless support to achieve these goals, and when they do, we’re seeing their personal power increase, along with their sense of agency, their resourcefulness, and their critical thinking. When these factors improve, so does their willingness and ability to engage in their overall health. When we improve well-being, we improve health.

The new business model is also transforming CHST and how it does business. The nature of business model innovation encourages us to reimagine how we create value for someone, the capabilities required to deliver this value, and the opportunities for us to sustain value delivery. Business model innovation enables us to move into adjacent spaces — horizontally or, as in the CHST case, upstream from our current markets.

Finally, as more market makers like CHST emerge, the more the center of gravity in the system shifts — enabling whole value chains to emerge and form. System transformation as a whole becomes possible.

Individual, organizational, and system transformation. Perhaps this should be the new triple aim of health care?

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