How Moneyball applies to healthcare

The storyline is familiar. An organization is challenged to achieve better results without spending more money.  An executive is committed to obtaining these better outcomes and recognizes that more financial resources aren’t forthcoming .  Faced with the option of near-certain failure if he continues to work within the historic operating framework, he decides that a different approach is necessary.  With the help of a young and visionary analyst, they decide to challenge the way “things have always been done.”  Introducing data and analytics, the two men decide that they can bend the cost curve and still achieve successful outcomes.  This approach is met with derision and resistance by others within the organization and the industry.  Given a thoughtful array of tools and resources to achieve the desired outcomes, end users don’t adopt these tools as they are intended.  The results are predictably poor, which further threatens acceptance of the vision.

You see, this is an industry that is rich in tradition and rife with seasoned, confident individuals who believe fervently in their ability to succeed by leveraging their experience and intuition.  The data-driven approach threatens their autonomy, their wisdom and indeed their professional identity.  Some of the conclusions reached by the analytics approach are in direct conflict with what their professional judgement would have them believe.  Their  individual artistry is challenged by the promise of a data-driven, team-based approach.  Some  senior professionals decide that this transformation is more than they can stand, and abandon the enterprise while publicly decrying the new paradigm.  Others remain with the organization but passively resist the movement.

By now, healthcare executives and physician leaders recognize this story.  Healthcare reform.  Quality.  Patient safety.  EMR implementation.   Right?

Actually,  no.  The industry is professional baseball.  The organization is the Oakland Athletics.  The visionary executives are GMs Billy Beane and Peter Brand.  The story is Moneyball , a 2011 biographical sports drama based on Michael Lewis‘ 2003 book of the same name.

If you’ve not read Moneyball or seen the film, I don’t want to spoil it for you.  But here’s the punchline:  the transformation envisioned by Beane and Brand ultimately resulted in an American League record 20 game winning streak and a 103-win season for the A’s in 2002.  Applying the approach that Beane and Brand pioneered the Boston Red Sox won a World Series soon after in 2004.  The data-driven approach to evaluating and deploying players (Sabermetrics) has become a part of the fabric of baseball, that most traditional of American games.   It’s  evidence-based baseball, if you will.   And it supplements and enhances, rather than replacing, the wisdom and experience of seasoned baseball executives, scouts, managers and players.  The Legacy of Moneyball has also penetrated other sports and businesses as well.

Actor  Brad Pitt plays Billy Beane in the film.  Here’s how he summarizes the plight of his character and team:  “It’s a tough wall to get over, but they had to by necessity in order to survive. They knew if they fought the other guys’ fight, they were just not going to compete, and I think that takes incredible realism and incredible smarts to figure your way out of the box. It changes the way we look at things, and I think that’s one of the big points of the story.”

So the story is a familiar one.   But it’s about baseball, not healthcare.  Right?

Gregory R. Weidner is an internal medicine physician and Medical Director, Canopy Electronic Medical Records, Carolinas Healthcare System.

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  • http://twitter.com/bfabbio Bob Fabbio

    Moneyball depicts a path that is not dissimilar to the path that we have been on since 2006 at WhiteGlove Health.  Those in healthcare said what we were trying to do was not going to work and all along the way, the naysayers have resisted.  It’s about Thinking Differently About Healthcare.   In the end, the innovation has to be focused on ”re-engineering” the broken healthcare delivery system and not on “gaming” or “optimizing” the broken one that we have.  Far too many VCs have been investing in the latter.   We knew there were things that were imparative to lowering the cost, improving the consumer experience, and delivering better clinical outcomes.  We have built a delivery system that changes how and where you access care (home or work). We have changed how you pay for care (direct pay, membership) — no claims. We have changed how a provider acquires customers (sell directly to employers). And we have changed how you use technology to drive down cost and improve the healthcare experience — order of magnitude of cost and waste removed. This is not incremental change. As Clayton Christensen and others have noted, we are a true disruptive innovator.  #WhiteGlove #Healthcare #in

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Very good parallel. Once upon a time baseball was the national pastime, when anybody could go to the ball game and enjoy an afternoon of sports, family and friends. It was a game.
    Now baseball is an industry, and little boys in the city surrounding the field can only dream about getting in, because it is indeed a money ball, and all activities are geared to making even more money. Those who can still buy tickets to games are nothing more than shopping and advertising targets, i.e. consumers.
    There is no small child today that would be naive enough to utter the words “Say it ain’t so, Joe”. There is no small child today that even cares if it is or it is not so. Wonderful.

    • http://twitter.com/DrWeidner Dr Greg Weidner

      Margalit,

      Your lament is real.  At its core, healthcare is intensely personal, relationship-based and individualized.  These attributes can never be sacrificed at the altar of “industrializing” medicine.  They are the magic of medical care, just as the Willie Mays basket catch is to baseball.   The obvious hope is that evidence-based, reliable, quality, data-driven care can coexist with this magic and give us all more Willie Mays moments.

      Regards,
      Greg

  • http://www.ipatient.com Dan Munro

    It’s a popular analogy to make right now because of the success of the movie (and the premise of accomplishing a lot – with very little is a classic Hollywood theme), but that’s really where the analogy ends.  Baseball is a passionate pastime/sport for many – and a luxury/hobby for owners.  Healthcare is a heavily entrenched industry with *many* mis-aligned incentives.  The first one (and perhaps biggest) is this:  Our current system is based on the practice of expensive, specialized (and event/fee based) sick care.  It is fundamentally NOT based on primary/preventative health care.  In that sense – Moneyball had perfect alignment (owner/GM) absent one variable – a bigger budget.  Healthcare has near perfect mis-alignment AND a huge budget – $3 trillion in 2012.  This is one where as much as we’d LIKE to apply the Hollywood fantasy of Moneyball – I’m afraid it really is comparing apples and oranges.   

    • http://twitter.com/DrWeidner Dr Greg Weidner

      Dan,

      Your points about the current healthcare system and its cost are well-taken. But maybe that’s the promise of the Moneyball analogy – that we can change some fundamental assumptions of healthcare delivery and create a model that achieves the same (or hopefully better) outcomes on an Oakland A’s budget as we currently achieve on a New York Yankees budget.  Can’t do that with our current approach.

      Regards,

      Greg

      • http://blogs.forbes.com/danmunro/ Dan Munro

        Maybe, but we don’t need analytics to highlight the obvious and it’s that exact transition to a dramatically smaller budget that has me concerned.  Fewer baseball fans, industry ridicule and cuts to payroll makes for an interesting 2 hour movie.  We have much larger moral and ethical consequences in healthcare to those same payroll cuts – so I want us to be aligned around who, what and where those cuts come from.  The way the system is today – the patient (all of us) are typically the first to feel the pain of those cuts (higher premiums, fewer primary care docs, expensive Rx – that list is endless).  Cut away – by all means – but the devil is in the details of where, why and by how much.  Fantasizing about how a movie can help guide us with that is popular but (IMHO) a complete waste of time.  

  • Eric Page

    I like Moneyball because everyone seems to have a different reaction to it. My epiphany, watching the movie, was that you could proselytize like Bill James for 24 years or you could step up to the plate, like Billy Beane, and actually implement. Too many people are proselytizing that others should use data; not enough are stepping up to actually do it. We evolved our business model at Amplify Health from an analytics business to a primary care service provider because of this movie (http://techcrunch.com/2012/01/17/money-ball-for-medicine-business-models-for-healthcare/)

    • http://twitter.com/DrWeidner Dr Greg Weidner

      Thanks Eric.  Would agree that the challenge to turn vision into action is upon us all as leaders in healthcare.  Maybe healthcare needs “Billy Beane Awards” for those who quickly and successfully apply theory and vision to practice.  It is encouraging to see and feel the tangible momentum around making it happen.
      Regards,
      Greg

  • http://www.facebook.com/markanten Mark Anten

    Very interesting and I like that it makes one think outside the box.  I have been thinking of my medical practice outside how it is traditionally run and the one issue I run into is all these Stark laws that make normal business practice impossible and illegal!  The primary doctor generates hundreds of thousands in business for a specialist and only gets a bottle of wine at Christmas!  What other business is run like that?

  • http://twitter.com/RUAccountable Linda Galindo

    Anyone seen Escape Fire documentary shown at Sundance?

  • http://twitter.com/CardVasc St Luke’s CVA

    The Moneyball analogy makes me think of the way many hospital systems new approach to purchasing physician practices and employing physicians. You might speculate that in the future these hospitals would look to replace retiring physicians with 2-3 mid-level providers due to their lower cost to employ and potential to perform.  Physicians whose statistics remain high would continue to be irreplaceable, but it would be hard for health systems to argue against bringing in mid-levels that at 1/3 of the cost yet could provide 2/3 of the production.

  • http://twitter.com/CardVasc St Luke’s CVA

    The Moneyball analogy makes me think of the way many hospital systems new approach to purchasing physician practices and employing physicians.

  • Scott Burnett

    You might speculate that in the future health systems that employ physicians would look to replace retiring physicians with 2-3 mid-level providers due to their lower cost to employ and potential to perform.  Physicians whose statistics remain high would continue to be irreplaceable, but it would be hard for health systems to argue against bringing in mid-levels that, at 1/3 of the cost yet might perform well enough to provide 2/3 of the production.