Source: Fortune
Summary
The article, written by a Zocdoc founder with 30 years in healthcare tech, argues that disruption playbooks fail in healthcare. He cites examples like Haven, Walmart Health, IBM Watson Health, and Babylon Health, which all struggled or failed. The author claims healthcare is a complex system of incentives, not a technology problem. He emphasizes that innovation must work with existing structures, not replace them. He calls for pragmatic progress over grand, unrealistic goals.
Our Reading
The numbers tell one story.
Healthcare disruption attempts have failed repeatedly.
Big companies like Amazon, Walmart, IBM, and Babylon tried and failed.
Existing systems are too complex to be replaced quickly.
True progress requires working within the system, not against it.
Author: Evan Null
Disruption playbooks don’t work in healthcare
Healthcare is not a technology problem but a complex systems and incentives problem. Trillions of capital are invested in hospitals, insurers, EHRs, and regulations. Disruption playbooks assume one part of the system can be reinvented and the rest will conform. But healthcare is interconnected, and change is not linear.
Many companies try to build around the system, creating niche products that lack scale. Others assume the system will bend to their will, but history shows this is wishful thinking. Healthcare is not a greenfield; it is the brownest of fields.
Building outside the core of healthcare means remaining on the fringes. True innovation must work with the existing system. That is where disruptors collide with reality.
The author argues that healthcare can only be fixed from the inside out. He shares his experience building Zocdoc, which connected to existing systems rather than replacing them. This approach required building bridges, not walled gardens.
This method is slower and harder, but it is not anti-innovation. It is anti-delusion. It is also pro-progress, as the current system is unsustainable and needs change.
Healthcare can only be fixed from the inside out, not disrupted from the outside in
The author believes healthcare is not disrupt-able from the outside in. He learned this while building Zocdoc, which connected to health systems, insurers, and EHRs rather than ignoring or disrupting them. This required extensive integration with 200,000 providers, 10,000 insurance plans, and 175 calendar integrations.
This approach is not about ignoring the system but working with it. It is slower and harder, but it avoids the delusion of expecting the system to adapt to new entrants. The author argues that true progress requires pragmatism and scale.
Healthcare’s status quo is unsustainable, but innovation must be matched with practical approaches. The author calls for fewer moonshots and more progress that actually improves patient care.
He emphasizes that patients do not want disruption for its own sake. They want a system that works for them, not one that disrupts for the sake of disruption.
Thirty years in health tech has made the author less ambitious in terms of grand visions but more focused on meaningful, scalable change.
Fewer moonshots, more progress
The author criticizes the tendency to mistake disruption for progress. Patients still face long wait times, insurance barriers, and fragmented systems. Many providers also face burnout and administrative burdens.
Healthcare costs continue to rise, but outcomes have not improved significantly. The author argues that delivering on the promise of disruption is harder than the initial vision.
He calls for a shift from ambitious, unrealistic goals to practical, incremental progress. The focus should be on improving the current system rather than building new ones from scratch.
Patients want a system that works for them, not one that disrupts for the sake of disruption. The author believes that real progress comes from working within the system, not outside of it.
He ends by urging a focus on making healthcare better for patients on Earth, rather than chasing unrealistic space colonies.
