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In his 1992 book, Future Edge, author Joel Arthur Barker traces the sometimes tortuous, yet generally predictable and duplicable, path of paradigms.

One of the key takeaways is that new paradigms are most often brought to market by “paradigm pioneers.” The pioneers aren’t invested in the old way of doing things, which frees them to create new paradigms.

Harvard Business School professor and author Clayton Christensen would call them “disruptive innovators.” In our weekly podcast, we call them “Shift Shapers.” No matter the nomenclature, all of these pioneers seize shifts in the marketplace and alter them to create opportunities.

In health care (writ large) we are witnessing an interesting and unusual phenomenon.

A great portion of the disruption has been externally generated. Yet despite this twist on the normal process, the innovators — the paradigm pioneers — are making their presence known in nearly every facet of the industry.

Hospitals have been purchasing physician practices that have become the de facto networks of Accountable Care Organizations (ACOs). ACOs seek to coordinate care and deliver a better patient experience while lowering costs. If they achieve their goals, they become eligible (under Medicare) for bonuses. It will be interesting to watch ACOs develop and to see whether care actually becomes more efficient and effective, or whether throttles to both access and care are employed to achieve those metrics. Nevertheless, this is a very different paradigm with potentially broad implications.

New paradigms are sprouting up in smaller organizations as well. We recently interviewed Frank Roby, CEO of RevelationMD. Frank and his colleagues had the radical idea that doctors ought to have access to pricing and outcomes information. While their treatments, prescriptions and referrals drive costs, until now they have been largely outside the plan and payer loop. Bringing all stakeholders together and sharing data should help plans reduce or eliminate waste. At present the company works exclusively in the large group, selffunded market, but their model could have profound effects on the entire market.

Their efforts are complementary to value-based health design. In one of our earliest episodes we chatted with Alan Katz of SeeChange Health.

SeeChange is a small company (currently operating in just two states) but they have built insurance plans based on a set of metrics that focuses on cost (of course) but also on quality of care and outcomes. Traditional methodology watches those metrics in the rearview mirror. Value-based plan designs focus their attention out the windshield — trying to bring those metrics in before, rather than after, claims.

In the coming weeks we will introduce you to an old-line brokerage general agent who is using large-scale data to help brokers take a different approach with employers. They suggest that employers treat their employee benefit plans in exactly the same manner that they treat their other corporate assets. Among other benefits, this approach helps to reposition the broker relationship as a longer-term proposition. We found an agency that is experiencing exponential growth with an unusual seven-point strategy that (among other innovations) seamlessly includes individual disability sales in an employee benefit-centered practice.

The good news is that our list of innovators has far exceeded the number we imagined.

In the coming weeks we will introduce you to a broker who has embraced the chaos in the health care insurance marketplace as a lever to market a coverage he would not have approached just a few years ago.

Even the venerable American College is creating new ways of delivering education and designations that have changed dynamically to reflect the needs of clients in today’s economic and regulatory climate.

Change either energizes or paralyzes. Paradigm pioneers are always energized. And as long as they are energized, opportunities for all of us will abound.

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