Health Care Landscape

October 15, 2021

Sg20 Then and Now: Sg2 Thought Leaders Reflect on Past Projections (Part 2)

Editor’s note: Answers have been edited for clarity.

Sg2 was formed in 2001, and, today, our cutting-edge expertise, analytics and tailored consulting offerings help health industry leaders anticipate health care trends and provide them with unparalleled insight into local market dynamics. We are just one of the companies that founder Michael Sachs started—and grew—with his vision, passion and leadership. Michael passed in 2019, and we are committed to honoring his legacy by doing what we were trained and inspired by him to do best—make bold predictions, create industry-leading tools and challenge the status quo in our quest to transform health care.


In 2008, Sg2 presented a talk called Health Care 2020: Tomorrow’s Clinical Enterprise where our experts predicted how the clinical enterprise would be recast over the next 12 years, as the health care industry redefined care delivery in response to the payment landscape, demographic realities and advances in technology.

In honor of Sg2’s 20-year anniversary, we asked our experts and leaders to revisit the presentation’s top ten takeaways and answer the question, “How did we do?” Read on below to explore their responses to the second set of five takeaways, then, if you missed it, go back to our previous blog post to check out the first set!

Learn how some of our experts found their way to Sg2.

Midlevel Providers Will Offer a Broader Level of Care

Justin Cassidy, PhD, Senior Director

More Granular Diagnostics Will Underlie Care Standardization


This kind of did happen. The reason that it's not more widespread is traditional health care has been taking labs and outsourcing. It's much more cost effective to simply just collect the samples, send them off to [a] centralized, consolidated factory of a lab that will do the test. That makes a lot of sense if you're doing things like HB1C screens—why do that on site? You could do it much cheaper with a consolidated staff. Kind of fast forward: we think about the aspect of increased sensitivity—that's kind of the COVID rapid testing, but we're going to see this more and more.

Madeleine McDowell, MD, FAAP, Principal and Medical Director of Quality and Strategy

Midlevel providers have come so far in the last 10 years, in terms of the types of work they're doing, because there's a whole training program specialty, so you see midlevels across all specialties, and they're taking on more and more responsibility. Health systems have developed training programs with certification, that more standardized approach—it's not everywhere, but where it is happening, it's really helping midlevels practice at the top of their license. If we look back 10 years ago, [with] midlevels, the physician had to sign off on everything they did. They've gained a lot of independence, and there's been a lot of learnings about how important it is to train and standardize the care and to have midlevel leadership at a system to really strengthen both the recruiting and the training and the retention of them.

Performance Value Will Drive Technology Adoption

Justin Cassidy, PhD

We mentioned n-of-1 therapies: that has happened, and we definitely do have n-of-1. I have a great case study from Brigham and Women’s Hospital [where] they essentially diagnosed a new, rare genetic disease. They were able to actually create a new drug tailored to one individual sick girl, and it was successfully administered to prevent further degeneration. That literally is an n-of-1 disease, diagnosis and individualized therapeutic that, everything we know about medicine, kind of throws it all out. I think that as we move forward, it will be super interesting to see those approaches scale to wider cohorts. One of the things I would be very excited to see, and I think one of the things that is actually preventing that from happening, is our medical codes, the way we get paid—this goes right back to payment. I think that payment is where the innovation is going to happen in the next decade. And I think that we actually will get there--if anything changes, it will be payment. There are all these awesome technologies and awesome therapies. But how do you pay for them? That's always the question. There's not even a question of is this going work or not? They definitely do work, and they're really helpful and valuable.

Bill Woodson, Senior Principal

Unlike today, where there's such easy access to all kinds of information, [early on] we were still somewhat kind of aggregators for our members of what was going on clinically in the industry, and even on the business side. So it was easier to be a step ahead in terms of thinking and environmental scanning, and we had a big focus on technology which [Sg2 doesn’t] have today. There was a period where there [was] a lot of kind of technological breakthroughs going on in health care that was part of our niche, at least to start with. I think these things happen in cycles, so I think there were certain types of breakthroughs going on in cardiology and imaging and in certain degrees about lab science and a little bit in orthopedics in terms of the types of things available for joint replacement. There was just a wave of it that we were matched up against. Those things just aren't the explosion right now [that] it was then. It's more incremental now, and we’ve moved on to things more related to the IT side of health care. I think that's definitely more where the action is going to be, and also I think our members really wanted more from us. That was kind of a really niche place to be, and it only had a certain amount of growth potential. So we had to expand the things we were doing.

Managing Relationships Will Be Key to Success

Madeleine McDowell, MD, FAAP

I would tie that back to the System of CARE. We were originally just in the four walls, hospitals in their four walls. They've looked beyond that across the System of CARE. To do that effectively, they have developed relationships, partnerships in various settings—some traditional, some nontraditional — that really helped connect the dots across the System of CARE. And one of the ways we've seen it the most is where, instead of a one hospital, it's become a 3- to 10-hospital system with many more assets, including imaging centers, ASCs, physician subspecialty practices; there are chief partnership officers and community relations officers—there's a whole new set of competencies and FTEs that are centered around that as well. So yes, for sure that happened, and we forget that 10 years ago it looked a lot different. If everybody looked at what their hospital or their small health system owned and managed and were responsible for, it's been a sea change in the last 10 years.

Jeff Moser, Principal

Hands-on Leadership Won’t Work in Dispersed Health Network

That was nice, but I don't think that really play played out the way we thought it would. I think that what we've learned now is that connection to the customer is still critical, so I would disagree now that we had that right. Walking the floors is still very important—even though it's time consuming, it's still critical for a senior leader to engage with their patients, to hear what they're wanting and then to build something that works for them. To listen to them is still really, really important. We can use the analytics and real-time information to help us to identify challenges in the system, but I still think that intimacy is needed in health care, so we got that one partially right.

Adaptable Care Systems Will Serve Varied Patient Types


Justin Cassidy, PhD

The patient types: I still really like those breakouts. I think they're really good, they're clever. I think that there's another type of patient though, the “hyper well,” almost a concierge type of individual [who] wants to not only maintain health but even to optimize. And in the future, there will be more of that type of activity. It may not be within the health care sector, because if there's not a disease diagnosis, it's not necessarily the practice of medicine. I think the PCP of the future is going to be Peloton—it's that sort of thing, anything that's really engaging, anything that you interact with every single day. We're [also] going to start to see more specialized diet types of offerings. Medical meal replacement for obesity is a very lucrative offering that the outpatient obesity management programs are all starting to incorporate because it's such a potential revenue generator. But as you think about all the different kind of specialized diets that are available, there's a big opportunity for more of that kind of niche activity. We already see it with all the meal boxes, but I would imagine that to continue and get a little bit more medicalized in some cases.

Steve Jenkins, Senior Advisor

On the positive column that made me happy is, we spent a lot of time on targeting segments and meeting needs of different consumers, which was kind of a radical idea 13 years ago. People didn't like the term consumer—that's what Walmart did. What we did was took care of patients. We stood by it and said, no, consumers are going to pay more of the bill, payment [is] changing; [consumers are] more assertive, they're more informed—you gotta pay attention to how you meet the needs of consumers and think of them as consumers. And that's really been borne out. And that four-character narrative—the Bob and Mary and and Calvin and Juan—they were great narrative devices, they helped it come alive. Imagine this guy, he's this age, he's got this set of needs, and this is what he expects from the health care system. And it's totally different from this woman, who's in a different demographic cohort, has different clinical needs. That kind of narrative construct to the four patients, I've used, I still use it, and I think it's powerful to bring it to life.

Madeleine McDowell, MD, FAAP

It was such a great idea. Clients loved it, and they still love it—they still want to be able to look at their patients by specific segments. I don't know if we need to address the patient types specifically, but I will say that consumer segmentation is more important than ever. And that the lines have been blurred because [of] chronic diseases on the rise with 40% obesity—and just staggering numbers of other chronic diseases in terms of diabetes, hypertension—that you no longer have an “elective patient” necessarily. That elective patient that comes in for a joint replacement will likely have a chronic disease. So thinking that's going to be a separate patient population, I think, is challenging because there is crossover with the complex critical and the perpetual [patients].

One thing we have seen since this time: the whole movement of consumerism. I was not familiar with that term I don't think in 2010, but I understand that the consumer will be able to shop around and look around and evaluate care, and the millennials will have different expectations of what that care looks like than what we traditionally saw. That has been transformative in terms of where patients seek care and how health systems are strategizing and addressing what they think are the consumer expectations. [It] has really taken up a lot of time, focus and money. The other thing that's probably not mentioned here that we did not necessarily anticipate was the impact of external vendors. And that was pretty remarkable to see people outside of the health care industry coming in and disrupting health care in terms of virtual, digital apps. There is so much going on right now with acquisition of providers by nontraditional employers like insurance companies and vendors.

Jeff Moser

It wasn't that it was wrong, it was can people really get to that granular level of patient care? And the answer is they should—but are they? No. And we’re finally starting to see a break into that area in 2021, with moving from the monolithic vision or infrastructure of primary care to something much more atomized, and that's in line with what we were thinking about in terms of the patient types: to say that Juan needs this type of care, so let's have a model that's available to him to access his care effectively. I think, again, it was right—we just didn't have a way to pivot from the really hard-to-break existing model for primary care, and, for that matter, any little bit higher-acuity care. So maybe that's why it kind of fell off, as we weren't seeing the health systems actively start to do this, and because they didn't have the capability to do it, the systems weren't in place.

Continue the Sg20 celebration…