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scenario planning

Strategy: What If Health Care Costs Go Down?

The telegraph will generate millions of jobs.

In the early 1990s, call centers were popping up around the United States like mushrooms on a dewy morning. Companies invested millions of dollars to improve customer service via well-trained, professional operators in automated centers. Several prognosticators suggested that the segment was growing so quickly that every man, woman, and child in the United States would be working in a call center by, oh say, 2010.

Of course, it didn’t happen. The Internet arrived and millions of customers chose to serve themselves. Telecommunication costs plummeted and many companies moved their call centers offshore. Call centers are still important but not nearly as pervasive in the United States as they were projected to be.

Now we’re faced with similar projections for health care costs. If current trends continue, prognosticators say, health care will consume an ever increasing portion of the American budget until everything simply falls apart. Given our experience with other “obvious trends”, I think it behooves us to ask the opposite question, what if health care costs go down?

Why would health care costs go down?  Simply put — we may just cure a few diseases.

Why am I optimistic about potential cures? Because we’re making progress on many different fronts. For instance, what if obesity isn’t a social/cultural issue but a bacteriological issue? That’s the upshot of a recent article published in The ISME Journal. To quote: “Gram-negative opportunistic pathogens in the gut may be pivotal in obesity…” (For the original article, click here. For a summary in layman’s terms, click here). In other words, having the wrong bacteria in your gut could make you fat. Neutralizing those bacteria could slim down the whole country and reduce our health care costs dramatically.

And what about cancer? Apparently, we’re learning how to “persuade” cancer cells to kill themselves. I’ve spotted several articles on this — click here, herehere, here, and here for samples. Researchers hope that training cancer cells to commit suicide could cure many cancers in one fell swoop rather than trying to knock them off one at a time.

Of course, I’m not a medical doctor and it’s exceedingly hard to predict whether or when these findings might be transformed into real solutions. But I am old enough to know that “obvious predictions” often turn out to be dead wrong. In the late 1980s, experts predicted that our crime rate would spike to new highs in the 1990s. Instead, it did exactly the opposite. Similarly, we expected Japan to dominate the world economy. That didn’t happen either. We expected call centers to dominate the labor market. Instead, demand shifted to the Internet.

In the case of health care, it’s hard to make specific predictions. But a good strategist will always ask the “opposite” question. If the whole world is predicting that X will grow in significance, the strategist will always ask, “what if the reverse is true?” You may not be able to predict the future but you can certainly prepare for it.

 

The Art of the Wrong View

In one of my classes at the University of Denver, I try to teach my students how to manage technologies that constantly morph and change. They’re unpredictable, they’re slippery, and managing them effectively can make the difference between success and failure.

The students, of course, want to predict the future so they can prepare for it.  I try to convince them that predicting the future is impossible. But they’re young. They can explain the past, so why can’t they predict the future?

To help them prepare for the future — though not predict it — I often teach the techniques of scenario planning. You tell structured stories about the future and then work through them logically to understand which way the world might tilt. The technique has common building blocks, often referred to as PESTLE.  Your stories need to incorporate political, economic, societal, technical, legal, and environmental frameworks. This helps ensure that you don’t overlook anything.

I’ve used scenario planning a number of times and it has always helped me think through situations in creative ways – so it seems reasonable to teach it. To prepare for a recent class, I re-read The Art of the Long View by Peter Schwartz. I found it on one of my dustier bookshelves and discovered it was the 1991 edition.  While I remembered many of the main points, I was surprised to find a long chapter titled, “The World in 2005: Three Scenarios”. Here was a chance to see how well the inventor of scenario planning could prepare us for the future.

In sum, I was quite disappointed. The main error was that each scenario vastly overestimated the importance of Japan on the world stage in 2005. In a way, it all makes sense. The author was writing in 1991, when we all believed that Japan might just surpass every other economy on earth. Of course, he would assume that Japan would still dominate in 2005. Of course, he was wrong.

So what can we learn from this?  Two things, I think:

  1. Always remember to ask the reverse question. If it’s “obvious” that a trend will continue (e.g. Japan will dominate) always remember to ask the non-obvious question: what if it doesn’t? Today, it seems obvious that health care costs will continue to rise for the foreseeable future. But what if we make a medical breakthrough and costs plummet?
  2. Remember that resilience is better than prediction. We’ll never be able to predict the future — partially because we can’t really explain the past. But we can be prepared by building flexible systems that can respond to unexpected jolts. The human immune is probably a good model. This means building systems and organizations where information flows easily, creativity is valued, and leaders can emerge from anywhere.

I’ll continue to teach scenario planning in the future. After all, it’s a good template for thinking and planning. I’ll also be able to provide a very good example of how it can all go wrong.

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