Managed Care: It’s not working & here’s why

For 30-years we have worked hard to make healthcare more accessible, affordable, and better quality. Pockets of data show improvement, but if you look from the perspective of the whole, it isn’t working.

  • Our efforts to control cost create more cost.

  • Our efforts to achieve efficiency in one part create inefficiency in others

  • Our efforts to improve quality makes uniform quality harder to achieve.

  • Our efforts to ensure all people have access to care creates new resource limits

  • Our efforts to reduce errors with standardization creates new errors.

  • Our efforts to integrate clinically has produced technical and business silos.

The results are disheartening and financially unsustainable. Why has our hard work not realized lasting value? 

We cannot manage an adaptive, living system with an industrial model.

In the 1980s, healthcare adopted an industrial model. Industrialization perfects parts and process to create efficiency. For many products and services, this can produce high efficiency in very complicated circumstances. The only requirement is that environment must be ordered and predictable. Unfortunately, healthcare is neither. Healthcare runs is an environment of both biologic and social Complexity. The fixed structures of industrialization stifle our capability to adapt. All living systems must adapt to thrive. 

Adaptation must replace control as healthcare delivery’s fundamental capability.

We need a new model. 

The Curandi Model™— A new framework for success

The Curandi Model uses four success concepts and offers a transitional path to improvement.

The Curandi Model™

Systems Thinking

Our mental model shapes how we think a system works. The difference between that, and how it really works is what makes healthcare so difficult to fix and why the discipline of Systems Thinking is so important

Healthcare is huge and made up of many overlapping systems. Improvement will be incremental and opportunistic. Success will depend on understanding both where we are and where we are trying to go. 

Systems Thinking will help us chart the transition, to understand what success is and how to prove that effectively. 


Systems exist to achieve a purpose. Healthcare is no different. Purpose is the one stable point of reference as new circumstances and events emerge from healthcare’s complex environments. Curandi Model uses tangible and measurable purpose to guide system structure to meet the needs of each patient within the resource limits of society. 


The health care environment is inherently complex and needs a self-organizing system that keeps pace with emergent events and circumstances. In the Curandi Model, self-organizing healthcare networks, guided by purpose, can use the complex environment in the same way sailing uses the emergence of wind to move. The internet is an example of a self-organizing network that adapts to meet the needs of every individual. The same concept, adapted to healthcare, can perfect every point of care to serve each patient. 

Distributed Innovation

The Curandi Model supports a new set of tools and methods for local Healthcare Developers to design and implement local clinical interventions that are portable and comparable with other communities. This allows every community to take part in building a better system, that is optimized for their community and more supportive of patients and practitioners. Curandi’ s innovation network provides a platform for Developers to learn and build. 

The path to a better future

Applying Curandi concepts produces products and services that add value to existing healthcare organizations as they are transformed for a better, more sustainable future. Members of Curandi will have a say in innovation projects, free access to internal knowledge bases, and preferred access to the new healthcare development tools that will keep them ahead of the pack.