Healthcare Reinvention, Impact Networks, and the Two Loops Model

Sofia

So, I want to start by thanking someone who left a really thoughtful comment on LinkedIn. They encouraged us to look into the Two Loops Model of paradigm shift, the Impact Networks Playbook, and also the healthcare reinvention initiative. And honestly, all three are fascinating, so we're gonna... we'll touch on those today.

David

Wait, the Two Loops Model? That kind of sounds like some overly complicated physics concept. Am I gonna need a diagram for this one?

Sofia

Well, maybe. It's actually pretty elegant once you get into it, so hang tight. But before we do that, I thought we'd share a couple of points from some really intriguing videos Dr. Swanson came across this week.

David

OK. Let's hear it!

Sofia

One was from Dr. Eric Bricker. He made this really compelling argument about why medical schools aren't exactly incentivized to embrace value-based care themselves. It’s not that they don’t *teach* about it—it’s just not really, uh, built into the system yet. And when you’re stuck in fee-for-service reimbursement models, there’s not a lot driving that change.

David

Huh, that’s kind of depressing when you put it like that.

Sofia

It is. But then I listened to another video by Dr. Vinay Prasad—it’s on his YouTube channel—and he tackled something similar but from a completely different angle. He suggested that one of the most impactful reforms a new administration, like RFK Jr., could implement would be to restructure payments based on CPT codes.

David

Alright, pause. CPT codes... remind me again what those are?

Sofia

Right—think of them as the billing codes you use to pay physicians for specific procedures and services. And, well, here's the eye-opener: dermatologists, for instance, tend to get paid way more than, say, primary care doctors. Not because they’re, you know, "better," but because the system was set up that way. Dr. Prasad argues we should pay based on value to society instead.

David

Oh, that's... spicy. I can already feel some heated emails coming our way.

Sofia

Probably, yeah. And just a quick disclaimer for anyone tuning in: This podcast is generated by AI, hosted by AI clones—

David

Clones of us. Which, by the way, is weird.

Sofia

Exactly. All of this content is guided and edited by Dr. Chad Swanson, who’s a full-time ER doctor and health systems enthusiast. He makes sure everything here is rooted in credible sources, but as always, treat this as part of the conversation—not the final word.

David

Alright, so we’ve got models, codes, and paradigm shifts on deck today. Let’s go!

Sofia

So, picking up where we left off—paradigms, systems, and all that—let’s dive right into the Two Loops Model. This was developed by the Berkana Institute, and it offers a fascinating lens to understand how big systems evolve. Picture two overlapping curves. The first one represents the current system—we’ll call it the “old system.” It rises, peaks, and then... it starts to decline.

David

Okay, so like a roller coaster. Fun at first, then kind of terrifying when you realize you’re heading downhill.

Sofia

Exactly. That downhill part—well, it’s like the system starts to lose relevance or stops being effective. And when that happens, people begin to notice. That’s where the second curve comes in.

David

The second loop, right?

Sofia

Right. This is the emerging system. It starts small, with people—usually innovators—experimenting with new ideas or approaches. At first, it’s operating kind of outside the old system, but over time, as more people get frustrated or disillusioned with the old way of doing things, they begin to gravitate toward these alternatives. And that’s when the new paradigm really begins to gain momentum.

David

So you’re saying the future of healthcare—or any system, really—is born out of people just getting fed up?

Sofia

Well, kind of. But it’s not just frustration; it’s also about hope, right? The idea that there’s something better out there, something worth working toward. And the model gets even more interesting when you consider the roles people play in this transition.

David

Wait, wait—roles, like characters in a play?

Sofia

Sort of, yeah. So, you’ve got what they call "hospice workers," who help the old system decline gracefully. Then there are "pioneers," who are out there trying new things, building the seeds of the new system. You’ve also got "networkers," who connect these ideas and people, and "stabilizers," who help the new system take root and grow.

David

Okay, so are these actual job titles, or...?

Sofia

Not exactly. It’s more about the roles people naturally take on. For example, in healthcare, you might see hospice workers as those advocating to fix parts of the existing system to make the decline less painful. Meanwhile, pioneers might be the ones testing out value-based care models. Networkers are the people bringing all these experiments together, and stabilizers could be... I mean, policymakers or organizations scaling those ideas.

David

Got it. So the system dies, but in a good way?

Sofia

I wouldn’t say dies—it evolves. This is how large-scale transformation happens—gradually, and from the ground up. It’s not usually a top-down directive; it’s more like all these interconnected efforts slowly building into something new.

David

Huh. I like it. It’s... hopeful in a way. You don’t have to blow everything up—well, not all at once, anyway.

Sofia

That’s exactly it. And when you think about healthcare or any other complex system, this model shows us that change isn’t just possible—it’s inevitable. It just depends on how we approach it.

David

Speaking of networkers and interconnected efforts, Sofia, this reminds me—have you heard of David Ehrlichman’s book *Impact Networks*?

Sofia

Of course. It’s basically the blueprint for how to get a bunch of people and organizations to work together without, you know, everything falling apart.

David

Okay, sold. Tell me more.

Sofia

So, the idea behind impact networks is that to solve really big problems—the kind that no single organization or person can tackle alone—you need to build these loosely connected, yet purpose-driven groups. Unlike traditional hierarchies, impact networks rely on something called distributed leadership and emergent strategy.

David

Wait, distributed leadership? That already sounds like it’s going to go sideways. Who calls the shots then?

Sofia

That’s the beauty of it. No one person is in charge, at least not in the traditional sense. Instead, a facilitator or core leadership team helps coordinate efforts, ensures that everyone stays aligned, but also allows for flexibility. Think of them as more of a guide than a boss.

David

So it’s not chaos, but it’s also not, like, a CEO barking orders?

Sofia

Exactly. One of the key principles is trust. Relationships between network members have to be built through shared purpose, transparency, and consistent interaction. Without trust, the whole thing falls apart.

David

Okay, yeah, that makes sense. But isn’t it frustrating for people to figure out who’s really... responsible?

Sofia

It can be. That’s why a lot of focus goes into enabling decentralized decision-making within the network. Instead of waiting for someone at the "top" to approve every move, local actors take responsibility based on their expertise, all while staying aligned with the bigger goals.

David

Alright, but like... how do you even manage something like that? Without, you know, everything just spiraling into a million little projects.

Sofia

That’s where adaptive structures come in. Networks have to stay fluid and responsive. They evolve based on feedback instead of sticking to rigid plans. And that’s what makes them uniquely suited for tackling systemic challenges where solutions aren’t obvious or static.

David

So, in other words, you’re saying flexibility is the secret sauce here. That and trust.

Sofia

Absolutely. It’s about creating the conditions for collaboration, not controlling every detail. And Ehrlichman’s playbook is essentially a step-by-step guide for doing just that. He gives real-world examples, tools, and strategies for putting these ideas into action.

David

Sounds good on paper, but I imagine trying to implement this in something like healthcare would be a nightmare. How does this all connect back to, you know, fixing the system?

Sofia

Well, that’s the exciting part. A lot of the same principles apply. Healthcare is such a fractured system that traditional, top-down approaches often hit a wall. But if you can build the right kind of networks, where stakeholders—from hospitals to policymakers to patients—are aligned on a shared vision, you can actually start making some real progress.

David

Huh. I like the sound of that. Now, let’s see if we can find someone who’s actually pulled it off, right?

Sofia

Oh, we’re getting there. First, we should dig into an initiative tackling this very idea: the Healthcare Reinvention project.

David

Alright, Sofia, you brought up the Healthcare Reinvention project earlier. What’s the story there? It definitely sounds ambitious.

Sofia

It definitely is. The whole idea behind Healthcare Reinvention is to revamp how we deliver healthcare in the U.S. We're talking about new care models, payment structures, and policies that are actually, you know, patient-centered. The focus is on creating something that’s not just efficient but effective and compassionate too.

David

Okay, so like... reinvent the wheel? Or just tweak it a little?

Sofia

More like a complete overhaul. Their mission is to identify and connect changemakers across the field—people who are already trying to shake things up—and then support them while shining a spotlight on their work. The goal is to push for collective action rather than isolated efforts.

David

Oh, I like that—so less "lone wolf," more "teamwork makes the dream work."

Sofia

Exactly. Their vision is even bigger—they want a world where healthcare reform is driven by collaboration, not top-down mandates. Where the system actually prioritizes individual and community health over profit or red tape.

David

Ah, the dream. So how do they ground that vision—like, what do they stand for? Any buzzwords I should prepare for?

Sofia

Oh, for sure. They’ve outlined some core values that drive everything they do. First is "purpose-driven innovation through diversity." The idea here is that real breakthroughs happen when different perspectives come together, whether that’s across professions, backgrounds, or lived experiences.

David

Okay, makes sense. What else?

Sofia

"Compassionate integrity"—which is basically a fancy way of saying they want any reforms to be both ethical and empathetic. Then there’s "radical collaboration." I love that phrasing, because it underscores how essential it is for everyone—patients, doctors, policymakers—to work together fearlessly.

David

Alright, I’m on board with that. Anything else on the list?

Sofia

Yep. "Systems thinking," which is all about viewing healthcare as a complex, interdependent system instead of just a bunch of disconnected parts. And finally, "courageous action," which is pretty self-explanatory—they’re looking for bold, transformative steps. Not bandaid fixes.

David

Wow, no pressure, right? It feels like they’re asking for a lot.

Sofia

They are. But honestly, that’s the kind of mindset we need if we’re ever going to see meaningful change. Incremental improvement hasn’t exactly been working for us so far.

David

True. So, real talk—do you think something like that can actually work? Or is it one of those things that sounds better on paper?

Sofia

I think it can work. But only if the people driving this can stick to the values they’re promoting. Radical collaboration and systems thinking are tough because they force everyone to step outside their silos and work through a lot of discomfort. But if they pull it off, it could be huge.

David

No kidding. Alright, I’m curious—how does that whole systems-thinking angle tie into this?

David

So, Sofia, coming back to what you were saying before about systems thinking—how does that specific approach really push the Healthcare Reinvention project forward? It feels like such a massive concept to try to operationalize.

Sofia

Well, the initiative is solid—it focuses on improving the delivery of healthcare, making it more efficient and patient-centered. But here’s the problem: it’s... it’s still healthcare-centric. It doesn’t truly expand into health as a whole.

David

Wait, are you saying they’re trying to fix healthcare, but not fix health? Isn’t that the same thing?

Sofia

Not exactly. You see, healthcare is just one piece of the puzzle. True health comes from a mix of factors—social, economic, environmental. Stuff like housing, education, clean air and water. Healthcare deals with the aftermath when those things go wrong. But if we really want transformation, we need to move upstream and invest in those root causes.

David

Ah, so like, instead of just treating someone’s asthma, you figure out why they’re breathing polluted air in the first place?

Sofia

Exactly. That’s what I mean by shifting upstream. And models like the Two Loops give us a framework for that kind of shift. It's about letting ineffective systems decline while supporting new, healthier paradigms to emerge. But reinvention needs—but it needs cross-sector collaboration to pull that off.

David

Right, and that’s where the Impact Networks thing comes in? Getting all these different players, like public health, education, policymakers—everyone—to work together?

Sofia

Exactly. I mean, think about it—how often do we see truly collaborative innovation in the health system? Usually, it’s hospitals doing their thing, public health doing theirs, disconnected from one another. Impact Networks encourage decentralized problem-solving. It's... it's messy, but that’s where the magic happens.

David

Messy magic, I like that. So here’s my next question: if these ideas are so great, why aren’t more people doing them already?

Sofia

Honestly? Because it’s hard. Systems thinking and radical collaboration—they sound great, but in practice, they force everyone to step outside their silos and work through discomfort. Breaking away from the status quo is... is messy, time-consuming work.

David

Yeah, people don’t exactly love stepping out of their comfort zones, huh?

Sofia

No, they don’t. But you know what’s exciting? There are already changemakers out there proving it can be done. These emerging ideas—like reinventing healthcare through systems-level investments and collaboration—they’re gaining traction. It’s slow progress, but it’s happening.

David

Alright, so let’s say this thing works. What does that future look like? Paint me a picture.

Sofia

Okay, imagine this: communities where housing, education, food security—they’re all considered part of the health system. Where preventing illness is prioritized as much as treating it. Where the system adapts to the needs of patients and communities, instead of trying to fit everyone into outdated models. That’s the kind of transformation we’re talking about.

David

Sounds pretty bold. And also, just, like... better. Why wait, right?

Sofia

Exactly. It’s bold, but we’ve already seen that incremental improvements don’t cut it anymore. The time for transformative change? It’s now.

David

Alright, on that note, I think we’ve given people enough to chew on for today. And maybe, just maybe, we’ll see some of these ideas actually put into action soon.

Sofia

Let’s hope so. Thanks for such a great conversation today—and to everyone listening, we’ll catch you next time.