A blog covering the health/care ecosystem and people.

As Weight Watchers prepares to initiate bankruptcy proceedings, I file the news event under “thinking the unthinkable.”

“Thinking about the unthinkable” is what Herman Kahn, a father of scenario planning, asked us to do when he pioneered the process. In this book, for Kahn, “the unthinkable” was thermonuclear war, and the year was 1962.

The book was tag-lined as “must reading for an informed public” and in it, Kahn

I’ve been drawn back to this book lately because of a more intense workflow using my scenario planning tools for organizations operating in several segments in and adjacent to health care: looking at the future of health plans and insurance, food (as medicine and as basic human need/social determinant of health), and technologies supporting hospital-to-home and a next-generation of home care armed with wearable tech, remote health monitoring and other consumer-facing electronics in the fast-evolving digital health portfolio.

I was lucky to collaborate with several of the smartest Yoda-practitioners in scenario planning. Most notably, I call out Ian Morrison who led Institute for the Future (and the health care practice at IFTF) for many years, ten of which I was affiliated with the Institute. It was through Ian that I really honed my scenario planning skills and Spidey-senses.

In this moment teeming with uncertainties shaping the health/care ecosystem, a world without WW (or its “Weight Watchers” predecessor) is hard to imagine. For me, growing up and witnessing the start of the company and ads for the weight-loss innovator starring founder Jean Nidetch, made the company synonymous with the weight-loss industry. [An historic sidebar: read this origin story of Jean Nidetch here in a 2017 New York Times essay – it’s a great yarn that still rings all too true in the swipe-left-online-dating era].

A press release published last week described Teladoc’s implementing a cardiometabolic telehealth program, in association with BetterSleep and connected clinical care partners, is a next-gen weight-loss concept, which among many other newfangled programs and the bullish consumer-driven market for GLP-1 medicines have collectively nudged WW out of the marketspace.

Momentum is growing for consumers growing into self-made CEOs of their health care, among those people who seek greater engagement and empowerment in their own care. Deloitte has been quantifying consumer-centricity in health care globally, and developed these three cycles of consumer evolution toward that CEO-of-my-own-health role. To the far right we see the longer-term cycle where consumers take over for the intermediaries who were the middle-actors between patients-as-consumers and health care industry stakeholders– whether pharmas and PBMs, physicians and hospital systems, health plans, and other sources of care, supplies, and financing.

What can underpin and support the third cycle of health consumer evolution and “CEO/DIY-ness” are,

• Shifting decision ownership and growing shop-ability of services,
• Generative AI, to “reassemble” care around the patient-as-consumer, and,
• Data access and possession, with growing calls and technology enabling democratization of health data (eg,, through API standards that help personal health information into data liquidity coupled with wearable tech and consumer-generated data on-the-body and at-home).

“Cycle 3 isn’t just a change in health care,” Deloitte explains in the report. “It’s a change in how we live.”

And one of those changes is GenAI in a consumer’s hands for changing “how we live,” including health care in a consumer-patient-caregiver’s hands.

Health Populi’s Hot Points:  Exactly one year ago, I constructed the scenarios illustrated in the last graphic in advance of a panel I led at the annual AHIP conference — focused on consumers and the future of health care in the U.S.

I focused on two key uncertainties underpinning these four alternative futures — which I would still select today, one year later; they were,

• Public vs. private health care payment and financing, and,
• The social ethos in the U.S.: collective, community-driven versus individualistic.

Arraying these two uncertainties on the X-Y, high-low axes, I generated four futures asking what the person – as consumer, patient, plan member, caregiver, and health citizen — would be facing in American health care toward 2030.

One big uncertainty/driving force that accelerated over the past twelve months has been more consumers adopting AI in various forms for daily tasks — for streamlining work at home and at a job, for travel advice and recommendations, and indeed for health care questions and self-care management. We’ve tracked this growing trend here in Health Populi, and we know it is already making a difference for a cadre of early adopters which plays into one being a CEO of their care, along with the retail health care scenario for those health consumers taking a shopping, perhaps Amazon-ified experience when possible.

It feels like 2030 is more like “now” than health care life was for people in the U.S. twelve months ago: uncertainties about private/commercial insurance and employment-based health benefits, as well as uncertainties about Medicaid erosion, Medicare benefit access and enrollment, the status of NIH-funded and tracked clinical trials, and many other aspects of health care security play into these landscapes. Health security, broadly put, is not universal across U.S. patients and health citizens, and this is where DIY-care falls short — as well as in situations of trauma and accidents (at least in the early phase of an acute incident), and in the underlying drivers of health where one’s ZIP or postal code significantly influences one’s health assets from our earliest days of life.

As for being the CEO of My Healthcare, which we see in the lower right of the matrix: the financial risk-shift moves to the individual (and individual family) in a society where the social fabric has holes and is unraveling.

In this moment turning the pages of Kahn’s Thinking About the Unthinkable, I return to this quote he places at the start of the book as well as at the conclusion:

“The outcome of decisions that are well-meaning, informed, and intelligent can be disastrous. However few would argue that this is a good reason to be malevolent, ignorant or stupid. We have to do the best we can with the tools and abilities we have.”

I’d further argue that with this hard-headed approach that I endorse, we add in our softer hearts and empathy as health care and related public policies are put to various tests in the coming weeks and months.