ESPN calls itself the worldwide leader in sports, and there is ample evidence to back up that claim. However, the disruptive force of the Internet economy is undermining ESPN’s leadership position, and the right strategic response is far from clear, even for this iconic brand.

ESPN has 89.5 million subscribers and is in 77 percent of U.S. households.[1] The network is critical to the financial success of parent company Disney, making up about half of the $23 billion annual revenue of Disney’s largest division.[2] About 64 percent of ESPN’s revenue comes from per-subscriber fees paid by cable TV operators and passed along to cable subscribers. ESPN’s other major revenue source is advertising.[3]

The foundation of ESPN’s business model is the network’s perceived essentiality. Traditionally, ESPN has been included in virtually all cable bundles, resulting in high revenue from both fees and advertising. That strong revenue stream has supported the high-cost programming and talent that help make ESPN a necessity for sports fans.

Challenges to the Business Model

This business model has been good for ESPN, but not so good for consumers. In recent years, cable customers have complained at increasing volume about the high price of cable TV subscriptions, asking why they have to pay for large bundles of networks, many of which they don’t watch. Fueling these complaints is the rise of streaming video services such as Netflix, Hulu, and Sling TV—services that, in industry jargon, go “over the top” of cable TV with more tailored offerings at a lower price.

Threatened with the loss of subscribers to more consumer-friendly options, cable TV operators have begun to look for ways to offer lower prices and more flexibility. The result is the so-called skinny bundle—a smaller group of networks at a more affordable price.

Not surprisingly, the first networks to be excluded from skinny bundles were the most expensive. Priced four times higher than most other networks,[4] ESPN had a gigantic target on its back.

Between consumers who have opted for skinny bundles and those who have cut the cable altogether, ESPN’s revenue stream has suffered. Since 2013, ESPN has lost 10 million subscribers—an estimated $2.5 billion in revenue. The pace of subscriber loss is accelerating: Between February and May of 2016, ESPN lost 10,400 subscribers per day.[5]

ESPN’s Options

With its revenue base eroding, ESPN has moved to reduce expenses, cutting about 300 staff in October 2015.[6] Several expensive, high-profile on-air personalities have left, including Curt Schilling, Colin Cowherd, and Bill Simmons. ESPN also shut down its highly respected Grantland website.[7] Reducing program fees is a more challenging proposition, with significant expenses tied up in long-term contracts, such as a $15.2 billion investment in rights to National Football League games.[8] ESPN walks a tightrope with these expense cuts, risking loss of the talent and content that constitute its core value.

A much tougher question is what ESPN’s role should be in the new world of Internet-based entertainment. ESPN is dabbling with streaming video through a deal to include programming on Sling TV, and could form partnerships with other streaming services.[9] Disney recently bought a stake in BAMTech to create an ESPN streaming service.[10]

There are at least three serious problems with any ESPN streaming-video strategy: First, it could further erode the remaining subscriber base. Second, the volume and revenue from these options are unlikely ever to replace the revenue stream from the heyday of cable. Third, ESPN’s cost structure would require that a direct-to-consumer offering be priced far higher than most streaming services. Yet, moving into streaming video will be essential for ESPN’s continuing relevance. The problem is that there is no obvious way to make that move without cannibalizing the existing, still sizable revenue base.

Healthcare’s Path of Disruption

The disruption of ESPN is strikingly similar to the disruption faced by legacy healthcare organizations.

Like ESPN, many legacy health systems have strong brands, market presence, and quality, but high fixed costs and prices. Like ESPN, legacy healthcare organizations have been highly successful under a long-standing business model that institutionalized high price, cost, and utilization—in the case of healthcare, through volume-based payment and first-dollar insurance coverage.

As with cable TV, this business model is proving unsustainable in the long term. Government, commercial insurers, and employers are pushing back on healthcare costs. As a higher portion of those costs are being passed along to consumers, they too are pushing back.

Where streaming video fueled customer revolt in cable TV, options like retail clinics, urgent care chains, virtual visits, and freestanding diagnostic centers have the potential to gain the loyalty of healthcare consumers with services that better fit their growing expectations for low prices and high convenience.

Cable TV operators have provided lower price options through skinny bundles; insurers and employers are developing narrow networks, sometimes excluding highly reputable organizations that are unable to meet stringent demands for lower costs. In the largest cities in each state, narrow networks make up 62 percent of health exchange networks. In the U.S. as a whole, 45 percent of exchange networks are narrow.[11]

Like ESPN, healthcare organizations face an immediate need to reduce costs. Historically, healthcare organizations’ expenses have increased and decreased roughly in line with the rise and fall of revenue. Now, however, revenue is likely headed for a more substantial decline, driven by the pressure of value-based payment and consumer demand. As a result, hospitals will need to significantly change their cost structures without harming core services.

As streaming video has disrupted cable, new technology-based options are disrupting healthcare. Video visits, hospitals at home, mobile diagnostics, and precision medicine all represent potential breakthroughs in care that challenge the central influence of inpatient-based organizations.

Like ESPN, legacy healthcare organizations have no obvious strategic response. Partnering with innovative companies is one option, with hospitals potentially able to align their scale and broad high-intensity services with innovators’ more focused, usually low-intensity services. Examples include Advocate Health Care operating retail clinics in Walgreens stores in the Chicago area and Dignity Health acquiring national occupational medicine and urgent care chain U.S. HealthWorks.

Hospitals also could attempt to go head-to-head with healthcare’s nontraditional innovators, developing their own low-price, high-access services. However, the talent, technology, and other infrastructure needs are unfamiliar and expensive. And like ESPN, hospitals’ high fixed costs make it very difficult to compete on price with more focused companies.

Hard Problems with No Clear Answers

The business model changes being experienced by cable TV and healthcare are not unique. This is the established path of disruption in the Internet economy, cutting through industries from newspapers to taxis. Unlike many business cycles of the past, these changes are not temporary. The percentage of households with cable TV has dropped from more than 88 to 80 since 2010.[12] In contrast, revenue from U.S. streaming video is projected to increase from $3.1 billion in 2013 to $6.7 billion in 2016.[13] In healthcare, revenue from telehealth—just one of many innovations in care delivery—is projected to grow from $585 million in 2014 to $3.1 billion in 2020.[14]

For both ESPN and legacy health systems, quality of service/care, market presence, and reputation are important strengths that will continue to be differentiating factors. However, both ESPN and legacy healthcare organizations face very real erosion in revenue and relevance, and neither has obvious operational or strategic options to change that trajectory.

ESPN’s situation shows that even an iconic brand is vulnerable to attack and deterioration from Internet forces. And even with the enormous resources and human capital of Disney, ESPN hasn’t to date been able to figure out the right operating and strategic response.

A problem that ESPN and Disney cannot figure out is a very hard problem, indeed. It is a problem that will require all the energy, creativity, and insight that legacy healthcare organizations can bring to bear.

Your comments are welcome. I can be reached at:

Ken Kaufman’s book Fast and Furious: Observations on Healthcare’s Transformation is available at:

Modified and reprinted by permission from H&HN Daily (as “If It Can Happen to ESPN, It Can Happen in Health Care”) lth Care”), Aug. 22, 2016. Copyright 2016, by Health Forum, Inc.

[1] Sports TV Ratings: “How many more homes is ESPN in than FS1 and NBC Sports Network?” May 28, 2016.

[2] Levy, A.: “ESPN can’t stop bleeding subscribers.” The Motley Fool, June 5, 2016.; The Walt Disney Company: Fiscal Year 2015 Annual Financial Report and Shareholder Letter.

[3] Gaines, C.: “More than 60% of ESPN’s revenue comes from their dwindling subscriber base.” Business Insider, Nov. 30, 2015.

[4] Molla, R.: "How much cable subscribers pay per channel." The Wall Street Journal, Aug. 5, 2014.

[5] Travis, C.: “ESPN loses another 1.5 million subscribers as cord cutting accelerates.” Outkick the Coverage, May 26, 2016.

[6] Battaglio, S.: "ESPN cuts 300 jobs as subscriber fee growth slows." Los Angeles Times, Oct. 21, 2015.

[7] Chew, J.: "Here are all the people who’ve left ESPN recently." Fortune, April 25, 2016.

[8] Sandomir, R.: "ESPN, already battling rising costs, faces a talent drain." The New York Times, July 21, 2015.

[9] Levy, A. (June 5, 2016)

[10] Brown, M. “Disney Buys $1B Stake In MLB’s BAMTech, To Launch ESPN Streaming Service.” Forbes, Aug. 9, 2016.

[11] Bauman, N., Bello, J., et al.: “Hospital networks: Evolution of the configurations on the 2015 exchanges.” McKinsey Center for U.S. Health System Reform, April 2015.

[12] Udland, M.: “This is the scariest chart in the history of cable TV.” Business Insider, Aug. 18, 2015.

[13] McAlone, N.: “Services like Netflix and Hulu are growing much faster than cable.” Business Insider, April 11, 2016.

[14] Winfrey, G.: “The 5 fastest-growing industries in the U.S.” Inc.., March 18, 2015.


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