Category: Disruption

The Employee “Shrug” is the Moment When Your Extraordinary Startup is no More: On Reversion to the Mean

I have family in Canada, and so often find myself flying from Boston to Toronto. There are two ways to fly:  you can take Air Canada from Logan to Toronto’s International Airport a couple of times a day.  Or, for the past 10 years, you can fly on a small turboprop operated by Porter Airlines from Logan to a small municipal airport located on an island in Toronto’s harbor.

Since it started flying in 2010, I’ve always preferred Porter because it’s a scrappy little airline that successfully disrupted the big guys by offering great service, friendly staff and easy airports.  To me, the airline was always a textbook example of how small entrepreneurial companies that have a relentless focus on the customer can win.

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Witness the Rise of the Matchmaker

My family and I just got back from a relaxing vacation put together by a travel agency that we found through Zicasso.  If you haven’t come across the site, Zicasso is a “matchmaking” website where consumers  describe a complex trip they’d like to take.

9496054340_8b68a80c80_zThe website has a roster of vetted travel specialists who focus on specific areas of the globe.  Three of these companies will respond to your request with a general travel itinerary and proposal.

For our trip to Asia, Zicasso matched us with three out-of-state “boutique” travel agencies who specialized in the region and who were incredibly knowledgeable.  We picked one of the proposals and ended up with an well put-together trip.  Every step along the way was expertly considered.

I’ve been giving some thought to this type of matchmaking site.  The genius of the site is that it makes travel agencies relevant again, because it makes narrow and deep knowledge available to a diffuse consumer population.

  1. Zicasso allows “experts” with narrow but deep knowledge to stay narrow.  The platform allows them to be connected to a large number of buyers looking for something very specific and complex.  As an agent, you could, for example, run a viable travel agency specializing in trips to Thailand from your home.
  2. The site empowers consumers.  Back in the day, if you decided to use a travel agency, you’d end up having to rely on the professed expertise of a generalist.  On a matchmaking site you compare offers, and also see reviews left by other travelers.

It’s an interesting trend, because in this era of wholesale “cutting out the middleman” and self-service on sites like Expedia, boutique travel agencies are in demand and seem to be doing a lot better than the generalist corner travel agency.

We’ve seen matchmaker sites before, or course. I’m reminded of the famous “when banks compete” ads from Lending Tree:

Dr. Jack Guttentag, a Wharton professor of finance (and curator of the excellent “The Mortgage Professor” website) has criticized Lending Tree as a lead generation site, with inaccurate and incomplete information.  Mortgages, Dr. Guttentag argues, are too complex and individualized for website offers to be accurate. He argues that the site is effectively a lead generator for banks that are willing to pay the largest finder’s fee.

It strikes me, though, that the key distinction between Lending Tree and Zicasso is that mortgages aren’t distinct enough.   Zicasso woks because it is matching consumers who have a very narrow need with agents who have narrow expertise.

The implications for healthcare are obvious, of course.

I first wrote about “skinny” or unbundled medical networks in 2014. My sense, at the time, was that transparency, innovation and specialization were leading consumers to “skinny platforms” in education and healthcare where narrow “star” performers competed against more expensive generalists.  This was particularly that case when patients needed something quite specific. I wrote:

We are seeing the emergence of “skinny platforms” which support a handful of superstars: it is a profound “distillation” of the product consumers are seeking…

… there will continue to be ample business for the top group of clinicians.  But not for everyone: “stars” will be leveraged to the extent that a “star physician” with charisma, a set of expert protocols and a focused team of advanced practitioners will unseat a cadre of lower-quality doctors.

Validating the premise of that early post, I recently learned about Best Doctors, a Boston based company that, among other services, connects patients with specific and complex medical problems to physicians who specialize in that area. The company provides referrals and second-opinions for 34 million members, most who are employees of companies that contract with Best Doctors.   The firm now has a database of 53,000 physicians.

For 25 years, we have asked physicians to identify the doctors they consider the leaders in their field. Today, our peer-selected network has more than 53,000 medical experts in over 450 specialties and subspecialties.

Witness the rise of interfaces between buyers and narrow+deep knowledge.  Witness the rise of the matchmaker…


Photo: Nick Kenrick via Flikr, cc search


Segmenting Healthcare: What’s Your Customer’s Currency?

Over the past few years, I’ve spent a lot of time speculating about the emergence of consumer segmentation in the US healthcare market.

As background, here are the three main conclusions drawn from previous posts: Continue reading

SimpliSafe’s Disruption of the Home Alarm Business and Some Thoughts for Healthcare

You may have seen the ads for Simplisafe on TV: it’s a do-it-yourself home security system that you can buy for a couple hundred bucks and install in an hour.   Instead of having a home security company come to your house and wire your windows and doors to a central monitoring box, Simplisafe is a wireless system that connects to the cellular network. You buy various sensors that connect wirelessly to the base station and for under 20 bucks a month you can connect to central monitoring services.   They don’t require a monitoring contract – you pay month-to-month. And, you can take the system with you when you move.

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Physician Disrupt Thyself

(Stepping away from health policy and business this week, a quick post on alternative careers in medicine).

Wrapping up a great week spent with emergency medicine friends attending this year’s American College of Emergency Physicians national meeting in Boston.  Over the course of a few receptions and dinners, more than one old friend has stopped to ask me about how I made the decision to step away from caring for patients in the emergency department and into a nonclinical role at a progressive startup healthcare company.  A few friends confessed that they love the idea of getting their hands dirty fixing a broken healthcare system– but don’t know where to begin.

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The Trajectory of Disliked Companies in Disrupted Businesses: A Visual Guide

I was recently impressed by the full page ad placed by Time Warner Cable in the Sunday New York Times. They write:

We get it.  We know how you feel about cable companies…. We hear you loud and clear…. So we’ve made some changes for the better.  Changes that we hope add up to more respect for your time, better value for your money and the kind of experience you expect from a leading entertainment and technology company…

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More Thoughts on Segmenting Healthcare: Who’ll Serve the “High End” of the Market?

In a few previous blog posts I’ve written about market segmentation in US healthcare.  I’ve made the observation that healthcare delivery companies which once targeted geographies (we are a nation of “XYZ Regional Hospitals” after all) now target demographies.  Witness, for example, Walmart’s bold move into $40 primary care visits ( with a goal of being America’s largest provider of primary care“) and companies like One Medical that offer concierge service to members only. Continue reading