What 3 Firms Already Reinvented Healthcare? Why Hasn’t Yours?

Some things are difficult; like folding a fitted sheet. Some things, like long division are less difficult, unless you forget to carry the 1.

The degree of difficulty of healthcare consumerism is somewhere between the two, unless you don’t even try. And not even trying is the point at which most healthcare companies find themselves today. Healthcare consumerism will give up its secrets much easier than say driving to Atlanta and trying to get Coca-Cola to give up their recipe.

At some firms there is more executive involvement in choosing the menu for the executive dining room than there is in planning to make consumerism a strategic imperative. To be good at anything requires planning.

What if one of those executives learned its dog had arthritis? The vet prescribed a quarter of a tablet of aspirin every day—for the dog, not the executive. What would the executive do—make a plan.

  1. Buy aspirin; a 90 tablet bottle
  2. Calculate the number of doses; enough for fifty-one weeks and three days. (It still works out to the same number of days even it’s a leap year.)
  3. Give the dog one dose each day
  4. Buy another bottle of aspirin

See, that wasn’t so difficult.

So let’s skip ahead one full year to see what is going on in the boardrooms of many of the healthcare firms. Several of the executives are worried because four days ago they forgot to buy another bottle of aspirin for their dog.

The boardroom has all of the necessary accouterments for their consumerism tête-à-tête. Eight thousand year-old bottled water melted from a Himalayan glacier that was transported down the glacier by yaks. Croissants flown in that morning from France—if you hold one of the croissants to your ear you can hear Maurice Chevalier singing “Thank Heaven for Little Girls.”

The CEO addresses the Chief Marketing Officer. It could just as easily be the CIO, the COO, or the Chief Patient Officer. We know for certain that the Chief Customer Officer is not being addressed, because there are no Chief Customer Officers in healthcare.

“When I hired you I gave you three envelopes, and I instructed you about when to open each one. You were to open the first envelope after your first major misstep. And the message in that envelope told you to blame your predecessor.   You were to open the second envelope after your second misstep. And the message in the second envelope told you to blame the budget.

I hold in my hand the third and final envelope.” The CEO opened the last envelope and read this message to the executive who had been responsible for consumerism. “Prepare three envelopes.”

There are always firings when a strategic business imperative fails. In fact, it is statistically difficult for an executive to get fired any other way.

The term ‘patient’ in the minds of consumers are those people in ED, in the hospitals and clinics, and people filing claims. The part of consumerism that providers, payers, and retail pharma seems to overlook are the consumers. People who are not quite patients.

They are shoppers, and walk-ins, maybe even impulse buyers. Most certainly they are early adopters and adapters. People who without calling for an appointment want to know the answer to “Am I sick, and can you make me better?” “My son needs a physical.” “I need a prescription.”

And it will only get worse. Millennials, the most frequent users of retail clinics, believe that any industry whose products and services can’t be purchased on a smart phone and be delivered to their doorstep the next day is archaic. Not because they are lazy, but because that is how today’s businesses are supposed to function. And they are right. The model in one phrase—person-to-person service without the person.

My favorite children’s book was Dr. Seuss’s, “If I Ran The Circus.” What follows is the sequel I would write, “If I ran Healthcare Consumerism.”

February 13, 2019.

A man walks into two different buildings—not at the same time. One building’s lobby resembles that of a Hyatt. The man walks to the receptionist and says, “I think I have the flu, and I sprained my ankle.” He shows his swollen, purple ankle to the receptionist. The receptionist hands him a slip of paper on which an address is written. “Four blocks, turn left,” she says, ignoring his ankle.

He pushed the door open and stepped onto the sidewalk. The air was cool. He starts walking; sort of. The sidewalk was concrete, cast in four by eight squares. The squares butted together in black, wide rubberized expansion joints. He could feel the textured concrete through the soles of his shoes. It had been brushed before it dried with a yard broom.

Four blocks later the man entered the second building. Limped past the deodorant and the hair sprays. Ogled at a bag of black licorice in the candy aisle, in the next aisle he grabbed a copy of the February issue of Men’s Health, found a worn vinyl chair, and sat. He clicked the clinic’s app on his phone, and two seconds after clicking the patient icon on the app he received a SMS indicating his registration was complete, there was one patient ahead of him, and his prescription for Toprol was awaiting pickup.

He was examined for the flu; his ankle was x-rayed, he received a pair of crutches, and a script for the pain. The app notified him that he had earned 150 clinic points, and sent him a link to two videos on the clinic’s site, one for dealing with the flu, and one for how to treat his ankle.

In less then three years the model for healthcare consumerism will look like this.

Instead of simply visiting walk-in clinics, consumers will use Telemedicine—services for which Medicare and Medicaid are already covering— for a face-to-face visit with those clinics using a smart device from the comfort of their homes and offices. (Consumers can already do this in many states—and it is a whole lot less expensive than building a clinic.) Those using health apps and wearables will already have much of their health data stored in an interactive and integrated personal health app that resides on the servers of firms like Walgreens.

They will be using a personal health app because people, unlike health systems and their EMR, consumers want to track how they are now, not how they were then.

Clinics will have partnered with major health systems, which may be as close to consumerism as health systems will ever get. Consumers will say they are going to their retail health clinic instead of going to the pharmacy. Screening, diagnostic services, and treatment. In three years, instead of consumers starting their care journey with their PCPs or a health system, the services they purchase from health systems will only be those services not offered by the clinics. And for those drawing journey maps that include an in-path stop at a PCP, that link will be bypassed my many.

There are almost 2,000 retail health clinics. Ten million annual patient visits.   Defining value-based care. Lower cost. And nimble. Presently, these clinics have the luxury of defining the business model. If the model takes an unexpected turn to the left or the right, they do not have to build a new wing to accommodate it, all they may have to do is to remove the aisles that sell deodorants and hair sprays.

In three years firms like Walgreens will likely lead in the provision of basic chronic care services. Why? Look at the statistics. Not only is it a growing market, it is a market with built-in repeat business.

If I ran the retail health clinic circus, I would develop a strategy to own the enrollment business. Like Radio Shack did selling cell phones and enrolling people in their mobile provider of choice. “Would you like Aetna or Anthem?”

(Sidebar. The biggest failure of the Radio Shack enrollment model was their enrollment model. I know that because I met with the Shack’s CEO and told him he should be selling subscriptions, not just phones. The real opportunity was not enrolling consumers in another company’s cellular service; it was enrolling them in their own cellular service. Will Walgreens or Walmart make that same mistake? Of course not. They will design a payer strategy that will work, probably not across states but within states.)

Walmart will be the other Big Dog in healthcare. Go big or go home. And why is that? It is because Walmart won’t have to augment, or amend, or retool what they already do. They will start from scratch, and they will design their healthcare services to be exactly what consumers want. And how will they know what consumers want? They will ask them.

They will be the Big Dog because their entire mindset is tied to being excellent at anything that can be sold, especially those things that most people buy, and those that people buy time and time again. And what else does Walmart know better than anyone else on the planet? Through the use of analytics they know exactly what people are willing to buy and pay for things.

Their strategy is not based on purchasing items and hoping they will sell. Nothing gets within a hundred feet of their loading docks without Walmart not only knowing that it will sell; they already know how many of them they will sell. You can bet your valet parking that when Walmart commits to selling primary care they will go all out.

Walmart doesn’t sell Gucci or Porches. They won’t sell hip replacements, nor will they be certified to treat the occasional case of Ebola. Why? Not enough demand, not enough throughput.

In less than a day the receptionist at Walmart’s headquarters in Bentonville could search Google and create a list of the most common healthcare needs, by age group, of everyone in the U.S. He or she will document what healthcare services are purchased the most, and how often those services are purchased nationally and on a per-person basis. Calculate by time and by service the average length of each health visit. Using analytics, Walmart will calculate, based on estimated patient flow, how many square feet of space they will need, within a margin of error of one to two feet, to allocate the space needed for their in-store healthcare services.

They will set aside hundreds of square feet of space for walk-in consumer health. Their clinics will have with several exam rooms. And down the hall I would expect to see an urgent care capability. A little further down will be a complete onsite lab, and of course they will have the pharmacy. Non-stop healthcare shopping, open seven days a week from 7 A.M. until 10 P.M. Bypassing the need for a PCP.

If I led Walmart’s healthcare strategy, I would ensure chronic care services were also available to treat the most common illnesses. And I would let the consumers pay for everything using their Walmart health plan. The one thing I would bet my house on is that the design of their health plan won’t look like any health plan we’ve ever seen before. It won’t look like any of today’s plans because it would be pointless to come to market with another payer model that mimics the models so many consumers already dislike. After all, nobody wears a T-shirt that reads I love my health insurer.

Walmart’s and Walgreens health plans will put today’s health plans to shame. It will be designed to encourage and reward wellness. It will allow consumers an interactive and digital way of using it, and that way will have a user interface that will provide a user experience that will make using an Apple device seem cumbersome by comparison.

Those same consumers will be accumulating HealthPoints for every dollar they spend at Walmart or Walgreens (already available), and they would receive discounts for purchasing healthy foods and products from those firms.

People say healthcare is in the throes of massive change. It isn’t. The traditional players are not in the throes of change. They are on the sidelines. Maybe those firms should rename themselves to something that starts with a ‘W’.

Anyway, that is how I see it. And since this is my blog I can imagine the future through my own rose colored glasses. Those glasses are half-full when it comes to consumerism.


Why Should You Care About These 5 Healthcare Consumers?

Audibility decays according to the inverse square law. Twice the distance, the sound gets four times as quiet. Four times the distance, sixteen times as quiet. More about this at the end.

I encourage you to meet these five people who live within 15 miles of your health system. Their health insurance is with Cigna, Anthem, or Aetna, and they fill their prescriptions at CVS, Walgreens, or Rite Aid.

Sally. She is a forty-seven year old single mom. Her twins went away to college five months ago, an event that has left Sally with a major case of the blues. During that period, she’s lost twenty-six pounds, and has developed a constant tingling sensation in her toes. She noticed what she thought was a dark mole on her back, and she thinks it has grown larger and it occasionally bleeds.

Bill. He is seventy-two and married. He and his wife Mary just moved to a retirement community several hundred miles away from their former home. They enjoy daily walks and arm-wrestling. He’s noticed that his vision seems to be getting worse. Bill tracks his exercise and diet with two different apps on his smart-phone. Mary’s mom and older sister both died from breast cancer, and Mary has not had a mammogram in the last two years. After losing to Mary arm wrestling yesterday, Bill felt short of breath and broke into a cold sweat.

Jose. He is married and has three children. His wife broke her hip three months ago and has not recovered enough to return to work or to care for her children. As a result, in addition to his fulltime job as a factory floor supervisor, he had to take a second job working nights until eleven, and all day Saturday. He still is not earning enough to pay all of their financial obligations. He is completely stressed, tired, overweight, and drinking heavily.

Monica. She smokes two packs a day, does not exercise, and is fond of fast food. All of her family members have high cholesterol, and her father died from heart disease before his fortieth birthday. She had her gall bladder removed three years ago, and suffers from IBS. Using her hands causes her pain to the point where she has difficulty opening a jar.

Paul. Paul runs six miles a day, six days a week. Other than his thinning hair, he considers himself to be the spitting image of a Greek god—just kidding. He watches what he eats and tracks his diet and exercise daily. He had a heart attack thirteen years ago.

So, what else do we—providers, payers, and pharmacies—know about these people? They each have a primary care physician. Three of them have current prescriptions of two or more medications, although only two of them take their meds.

We also know that half of them will have a chronic disease, and twenty-five percent of them will have two or more diseases. A third will be considered obese, and seven in ten of them will die from a chronic illness. Half of them do not exercise, and three of every four do no strength training.

What don’t we know about them?

We know nothing about how they are today. We know nothing about how they were yesterday, or the day before. Providers, payers, and pharmacies do not know anything about them; we just know generalities and probabilities about the population as a whole.

And who are these people? They are what I call consumers. Your consumers. Only they are not consuming anything. They are potential patients. Prospects. They all live in cities that have multiple providers. They have a choice of where to buy care.

And they all have current healthcare needs. Only as far as the provider community is concerned, they do not exist. They are not on anyone’s radar. Monica’s gall bladder removal is in your EMR, but that is the most current data about her health that is available, and as we both know, her gall bladder is no longer a concern.

Several of them track data about their health. But nobody knows anything about that data because neither the provider nor the payer nor the pharmacy is able to collect that data and use it to manage their health.

That is too bad. Imagine for example, that of the multiple health systems in their area, one of the health systems, perhaps yours created a way for those consumers to bank their data in your system. Take Philadelphia for example. There are several notable health systems; Penn, Einstein, Thomas Jefferson, Christiana Care, Main Line Health.

What would happen if Thomas Jefferson had a way to capture, monitor, and assess the current health data of these people? I think what would happen is that those people would begin to consider TJU as their provider, and once TJU began to proactively reach out to these consumers based on what they learned from their data, the health of those individuals would improve.

Audibility decays exponentially with distance.  For most healthcare institutions consumers are too far away to be heard.

What do you think?

What Is The Most Important Missing Healthcare App?

Depending on what term you Google, there are dozens of health-related apps listed as the best ones for patients and consumers. Things like Tummy Trends, iCookbook, MyFitness Pal, and so on. The list of health-related wearable devices is equally lengthy.

Millions of dollars are being spent to develop these apps and devices. And billions have been spent and will be spent by individuals—consumers—who are interested in either getting better or in staying healthy.

So I thought maybe the time had come for someone to add a voice of reason to this discussion. I kept waiting for someone to do that, and when nobody did I thought perhaps I should take a stab at it.

There are enough apps and devices available to pretty much record data about every body part and every conceivable health condition. I can purchase an iWatch, a Samsung smart belt, an Under Armour shirt, and smart shoes. Sensors can be strapped to every part of me.

So that must be a good thing. Right? Not so fast Charlie.

If you bought and wore every device, and used every app, would you be healthier? Or, would you just have a lot of data?

  1. Each of the apps and wearables are stand-alone recording devices. Data from one app or device knows nothing about the data from any of the other apps or devices.
  2. Data from some apps lacks information. Eating 2,000 calories of Twizzlers records the same number of calories as eating 2,000 calories of salmon.
  3. The fitness trackers look nice, but they are not designed to tell you, “Stop running NOW! Dial 911.”
  4. The user of the apps and the wearer of the devices must be qualified to play doctor. They must be able to understand the data and draw correct conclusions from each app. And they must be able to correlate their data from one app or device and interpret its meaning in light of the data collected from all of the other apps and devices.

Reams of data, very little information. Nothing seems to be able to answer the question, “So what?” So in my small mind, I do not see how an individual is supposed to manage their health using any of there data because they are missing one important piece of information—what is all of this data telling me I should do?

The missing app, the missing device, and the piece of the puzzle that is not available to a consumer is the one that collects all of my data, analyzes all of it, and tells me what I should do tomorrow. Everyone’s current wellness plan for tomorrow and the next day is to collect more data.

One solution would be to allow consumers to download a physician or strap one to their wrist. Any why is that important? Because without being able to do that the consumer is forced to play doctor. They guess, and guessing is not the healthiest choice for maintaining your health.

But what if there were a way for consumers to collect data and allow the doctors to pay doctor? There is. It’s just not being done.

Let’s come up with a solution by simply looking at one person’s app and device data; yours or mine. Suppose the Hospital of the University of Pennsylvania (HUP)—my provider, or Anthem, or CVS decided, “We want to know as much as we can as often as we can about our patients’ and customers’ health. And—this part is a big deal if you happen to be a healthcare executive—what if we wanted to know the same information about people who are not our patients and customers?

(Sidebar. This is a big deal because non-patients and non-customers are the exact group of people your marketing departments are targeting. Suppose that every day for the last two years Sally, who is not a patient at HUP, has been allowing HUP to collect, manage, and assess all of her health app and wearable data.

If Sally gets sick, she is going to go to HUP because they know everything about her. Perhaps HUP, having analyzed Sally’s health data, recognizes Sally, notifies Sally, and treats her? Sally went from being a consumer with no provider to being HUP’s patient.

And Sally will be no more interested in changing providers than she would be to change the bank with which she has stored all of her financial information. Payers—Anthem and retail pharmacies—CVS can develop the same consumer friendly way to proactively manage the health and wellness of their stakeholders.)

This health data aggregator, this Super-App has to be interactive. It can reside on a PC. It ought to reside on a mobile device. And ideally, it should reside in the cloud. And instead of having clinicians reviewing all of this data, it should be cognitive.


Why Is Your Most Complex Business System Disabling Healthcare?

Today’s post is pretty lengthy, so you may want to grab a snack.

If you are male, this piece will make perfect sense. If you are female, it will make even more sense.

I did a project in one of my prior homes. It involved the simple task of rearranging bedroom furniture, a 15 minute project, total cost—nothing. After all, how difficult can that be? The actual moving of furniture involved nothing more than I’d planned. Only when I thought I was done did I notice that the television set was now located a good 20 feet away from the cable television outlet.

The obvious solution would have been to simply move the furniture back to its original position. Can’t do that. To move the furniture back is either admitting defeat, or that I wasn’t bright enough to realize that the cable outlet and the television would be on opposite ends of the planet by the time I finished. Besides, my wife had already seen the new arrangement and if I moved it back to its original position I would have to explain why.

So when she enters the room and asks why—she will ask, that’s her job—there is a 25 foot piece of black coaxial cable snaking its way diagonally across her bedroom carpeting I had better be prepared to answer.

If you’re quick, really quick, you can try and bluff your way around the problem with a technical answer. You can try and explain that all of the static electricity that was created by sliding furniture across the carpet has caused the sonic membrane surrounding the fiber optical transponders in the coax to be 6 ohms off the medium allowable temperature variation for the building codes in your neighborhood. What you’re really doing is stalling, allowing for a brief period of self-correction.

That truth, having failed me, the only other option left was to try something close to the truth. I’m forced to say that I knew the cable would be at opposite ends of the room before I moved the furniture. My plan all along was to call the cable company and ask them to come to the house to install another outlet on the correct wall.

It’s my wife’s job to inquire how much that will cost. This is a clear case of me answering her question without bothering to think. It’s important to have a clear understanding of the underlying issues before trying to solve the problem. I replied that it should cost $40, and that we will only need to leave the cable strewn across the floor for a few days.

It’s then her job to say that if we put the furniture back where it was we could solve both problems in 20 minutes. Besides, the cable technician left a mess the last time they did some work, and she wasn’t going to spend more money for poor service. Stay with me here, this is how it becomes her fault, and how it relates to healthcare.

Once her issues were out in the open was a simple matter to devise a solution to address them. The solution needed to be implemented quickly and it needed to be free. My answer came quickly—too quickly. Eighty percent of the problem could be handled by simply running the cable along the floorboard, and then under the bed. That only left 5 feet of cable between a happy marriage and me. Unfortunately, the 5 feet in question is from the foot of the bed to the television and ran across the major walkway of the room.

Undaunted, I asked her to help me move the bed. This accomplished, I headed for the garage to find exactly the proper tools for the proper job. I returned five minutes later, tools in hand. I was surprised to see the look of dismay on her face. Her look of dismay may have resulted because of the razor blade knife I was holding. After 20 minutes of the best Boolean logic I could muster, I convinced her, or at least myself, that it would be a simple matter to cut a small hole in the carpet and force the cable underneath. After all, the bed would hide the hole.

The only other tool I thought I required was a roll of duct tape and a 4’11” broom handle. Women know we are confused about how to proceed the moment they see the duct tape. Most men, when cornered believe that enough duct tape, properly applied, can serve as a panacea for anything up to and including world hunger.

You’ll note that I specified the exact length of the broom handle. It’s only after having attempted the project that I’m able to relate the relevance of the length of the broom handle. Men on most projects, especially those being watched by their wife, wouldn’t bother to measure a length any more than they would ask directions while driving across Borneo with half a tank of gas.

Hindsight dictates that I should have measured both the distance the cable had to travel under the carpet and the length of the broom handle prior to taping the cable to the handle and shoving a 4’11” broom handle under a 5 foot expanse of wall-to-wall carpet.

The fact that the carpeting was wall-to-wall is key to understanding what lay ahead. Let’s make certain that the situation is spelled out clearly; the new carpet in our new home had a hole in it, a broom handle was now stuck under the carpet. And my wife, my east and my west, God love her, was perched on top of the bed’s footboard, with her talons firmly grasping the solid walnut. She stared at me with a look that would give carrion eaters a bad name.

Walking to the wall and grasping an edge of the carpet firmly, I pulled up a good 10 feet of it from the tacking, acting all the while like I would have to have done that even had the handle not been an inch too short. Leaning with my one arm on the newly exposed carpet tacks, I asked her to help me remove the handle from beneath the rug. Once that was accomplished, and while bleeding profusely, I looked for another proper tool to complete the task. Walking through the kitchen I wondered if the tool I needed was there. Naturally, it was; one half of a pair of chopsticks; also known by its new technical name, a broom handle extender.

Five minutes later, the broom handle extender and cable was firmly duct taped to the broom handle and once again shoved under the carpet. They both went in, but no cable came out the other side. So, I retrieved the handle and surveyed the situation. The situation, as it turns out, was that in my hand were a perfectly good broom handle, a piece of coaxial cable, and no broom handle extender. The extender was now smack dab in the middle of the five foot expanse that I was trying to cross. The problem was that it was now on the wrong side of the carpet—the underneath side. It was positioned perfectly. It was too far under to be reached from either end. In other words, the chop stick had just become a permanent fixture in the bedroom.

Certainly, one small chopstick hidden beneath 400 square feet of carpeting was not a big problem to me. It was not a problem unless you happened to be walking barefoot across the carpet and you happened not to be the one who put it there. In that case, it became not unlike the fable, The Princess and the Pea.

My princess found it immediately.  In that fable, it was the princess could not sleep. In my case, I knew that the non-sleeper in the story would be me for as long as the chopstick remained under the carpet. Keeping my eyes focused firmly on the task at hand, I foolishly believed that if I could resolve the problem of the cable, the matter of the chopstick would resolve itself.

One final trip to the garage led me to return with a second broom handle. The carrion-eater looked on in disbelief at my inability to finish what I had started without us having to sell the house at a loss before I was through.

My project had become a quest. A mile of duct tape later, both broom handles were taped together end-to-end. Even if I destroyed every square foot of carpeting in the house, I would not lose this broom handle under the carpet. A minute later the cable emerged exactly where it should have, on the other side of the room. I pulled the out broom handle, attached the cable, and turned on the television. Everything worked, just as I had known it would.

I took a bow.

Standing in front of the television, admiring my work, I noticed that I was now a good foot taller than when I began the project. Was this an illusion brought about by my success? As was quickly pointed out by the ice princess, my new stature was more attributable to the fact that all of the carpet padding that used to lie between the end of the bed and the wall was now compacted into a large lumpy ball. The ball of padding was located in the same twilight zone the chopstick found, right in the middle of the walkway. Trying to correct the problem only made it worse. Each time I prodded the ball of padding with the broom handle it grew larger underfoot. Within minutes it looked as though I had managed to suck up every inch of padding from every room in the house, and I had placed it between my wife and my getting a good night’s sleep. Resorting to logic once again, I quickly pointed out that she should walk on it because she would no longer be able to feel the chopstick.

The next day I was on the phone scheduling an appointment with the carpet installation service. The carpet installer had to pull up most of the carpeting in the bedroom to be able to reach what she had affectionately labeled Chopstick Hill.

I watched him work and I learned all about carpet padding and the installation of hardwood floors. He explained that it was lucky for me that he came over because our padding was not good quality padding and we would not have known that had he not pulled up the carpet. I asked him why I would want to spend $300 for new padding. Without responding, he just kept slamming his knee into the carpet installer, charging $100 for his efforts and my education.

I was so impressed with his discussion of hardwood floors that I almost bought one on the spot to surprise my wife. By now, you and I know she wouldn’t have appreciated the surprise. Anybody who did not want to spend $40 on the cable repairman would probably have a little more trouble accepting spending $5,000 for a floor she didn’t need. However, I was able to walk around with a silent smirk on my face for days knowing that had we done it my way from the start, called the cable man, we could’ve saved the $100 and never put a hole in the carpet.

Now that I think about it, I should have waited until she was out shopping.

Did I mention healthcare?

This is what happens when you try to fix a problem with which you have no experience.

The largest business system in your organization, whether you work for a provider or a payer, is the system that interacts with your patients and your potential patients. It must interface well and easily with all of your other business and clinical systems.

Those people—patients, caregivers, family members, and referring physicians—need to talk to doctors and nurses. They need to solve problems and resolve disputes. They need to schedule appointments, set up payments plans, file claims, make a payment, order refills, ask questions about their health data, order their health records, and dozens of other things.

A non-trivial exercise. Like moving cable.

Sometimes it pays to get help.  Or, you may be able to wait until everybody is out shopping.

What Are Retail Pharma’s 4 Consumerism Failures

Pascals’s Wager posits that humans all bet with their lives either that God exists, or that he does not. Based on the assumption that the stakes are infinite if God exists and that there is at least a small probability that God in fact exists. He argues that a rational person should live as though God exists and seek to believe in God. If God does not actually exist, such a person will have only finite losses whereas they stand to receive infinite gains or infinite peril if God exists.

Paul’s Wager posits that members of the healthcare triumvirate—providers, payers, and retail pharma—are betting the future of their firms either that consumerism will be the most dramatic change in healthcare in fifty years, or that it will not. Based on the assumption that the stakes are infinite if consumerism exists and that there is at least a small probability that consumerism in fact exists. I argue that a rational healthcare executive should live as though consumerism will create a dramatic change, and seek to act upon it. If consumerism does not prove to create a dramatic change, those leaders will have only finite losses whereas they stand to receive infinite gains or infinite peril if consumerism proves to be what I think it will be.

Anyway, the argument made sense to the voices in my head. There is a football adage that says when you throw a pass three things can happen, and two of them are bad.

So how does consumerism apply to retail pharmacies? When you write a prescription, five things can happen and four of them are bad.

  • People fail to fill their prescription (20%)
  • People fail to pick up their prescriptions (abandonment 14%)
  • People fail to take their medication as prescribed (50%)
  • People fail to renew their prescription (+25%)

Of those who take their medications, fifty percent do not take them as prescribed. In addition, over time, many people stop taking their medication.

These failures are so prevalent that we even have a term to describe them—nonadherence. What we don’t have is a term or a plan to correct the failures.

Clearly, some percentage of these failures cannot be fixed. Nonadherence is made up of several factors; cost, co-pays, convenience, side effects. However, user and consumerism friendly tools could make a world of difference.

Technology exists to let physicians know that what they prescribed was not filled. They could be notified that the medication was filled but not picked up, and the pharmacy already knows the medication was not picked up. And physicians and pharmacies can determine whether a medication was refilled.

Physicians and payers and pharmacies could create incentives for adherence. They could provide digital follow up reminders and track the response. They could automatically refill the prescriptions.

All of those things would work to improve the failure rate. But what if there was a personal health concierge available in patients’ homes. It could reside on a PC. It could operate from a smart app, or be tied to a wearable. Heck, it could even function with Siri-like functionality on an Amazon Echo-like device. And if you can deliver the functionality on Echo, you can deliver it through a smart watch, a smart phone, and a tablet.

  • “Did you take your Toprol today?”
  • “Today is the final dosage of your antibiotic.”
  • “Your Niaspan runs out next week. Do you want me to refill it now?”
  • “If you refill your Niaspan now, we will reduce your co-pay by fifty percent.”
  • “Are you having any side effects from your statin? Please reply, ‘yes’ or ‘no.’ If yes, would you like to speak with a pharmacist?”

All of these things can be done.

They simply aren’t being done.

Every day patients are betting with their lives that they do or do not need to take their medications.  And yes, they are responsible for their choices.  But anyone who does not believe that an Easy Button would improve the process is just being naive.

Consumerism for retail pharmacies.

What If Oysters Ran Healthcare?

New College, in Oxford, England, was founded in 1379, hundreds of years prior to the invention of the I-Beam. Enormous oak beams support the roof of the college’s main dining hall. Each beam is two feet square and forty-five feet long.

Wood has a number of characteristics.  The characteristic most relevant to this discussion is that it rots.

About 100 years ago, entomologists were studying the beams that supported the dining hall’s roof and they noted that the beams were infested with beetles. Apparently the students were not the only diners in the room. The beams could not be repaired, and the integrity of the five hundred year-old roof was in jeopardy.

Unfortunately for the college, it was widely assumed that all of the large trees from the old-growth forests had long since been felled. It appeared that the only way to preserve the dining hall was to use modern materials.

New College owned a great deal of land and actually employed its own forester—someone who could see the forest and the trees. When the college asked their forester about whether he knew of any large trees, the Forester replied, “I was wondering when you’d come asking.” The administrators discovered that when the college was built, a grove of oaks had been planted for just such an emergency.

The information about the grove of oaks was passed down from forester to forester for more than 500 years.

Long term planning: Planning that provided the perfect solution, not a series of ad-hoc fixes year-in and year-out.

When I built my home I did some long term planning as well.  I had telephone jacks and Ethernet wired to every room in the home so I could make a call from any room in the home and have an Internet connection in every room.  About a week after we moved in to the house I learned about something called a wireless router.  So much for my astute planning.

So, how does planning come in to play with healthcare providers?  Or does it?  Has anyone in your organization ever used the terms long-term planning and consumerism in the same sentence? In the U.S., and among U.S. healthcare institutions, long-term usually refers to those events that happen just beyond the threshold of the current year’s budget. Has anyone ever said, “I want to ensure that when I retire, that this is in place for the next CEO?”

When a single grain of sand enters an oyster’s home, the oyster gets irritated—if oysters had children, they would learn to get along with many grains of sand in their homes and cars—at least those oysters who drove. So, we have an irritated oyster. And when irritated, oysters get busy. And when oysters get busy, they build things. Pearls.

Let’s see if we can compare that to healthcare. When someone calls a health system, the health system gets irritated. And when irritated, health systems get busy. And when health systems get busy, they build things. Call centers.

Most health system call centers are nothing more than a big room with a lot of phones in them.  And that is exactly how they function.  There is no ability to both support care coordination and back office functions. There is no ability to support both patients and consumers. There is no first contact resolution.  There are, however plenty of opportunities to call and call and call.

And now the callers are irritated. The callers wish they new how to make pearls.

So, how would things differ if instead of the call center being just a big room with a lot of phones, someone had actually planned for and designed it to support both patients and consumers?

Your call center is probably the largest and the most complex business process in your organization. It is the only business process that will be used by everyone; patients, prospective patients, care givers, family members, and clinicians. It is the only business process whose effectiveness will sooner or later will disappoint every single user.

Yet it is never treated as a strategic asset. Here is a hint. Do not develop a plan to create the most remarkable call center in the country.

Design a plan that allows the big room with phones in it to deliver the most remarkable consumer experience in the country.

But until someone actually creates that plan and designs it to provide a remarkable experience by using the most complex business system in your organization, your call center will continue to be just a big room with a lot of phones.

Here’s one last hint. By the time you have build that call center that delivers the most remarkable customer experience in the country, you should already have started planning for a business model that does not need a call center in order to be great at consumerism.

Now, call Amazon or Netflix.

You can’t. Great consumerism; their big rooms with phones in them were turned into oyster bars. That is where you need to set your sites.


Healthcare Consumerism: $871,”And Hold Your Breath”

To be transparent, when I enter a hospital as a patient I should probably hang a sign around my neck, “You may be in my next blog.”

Did you know that if you shuffle a pack of cards properly, chances are that the exact order of the cards after shuffling has probably never been seen before in the history of the universe? Another fun fact is that 10! (factorial) seconds is exactly six weeks–twice as long as the average time required to schedule an appointment.

Patient access blog fodder. Sometimes the simplicity of what is dysfunctional is so obvious as to make me wonder why we cannot just set aside five minutes a fix it.

“Be here at 8 A.M.,” I was told.  8 A.M. had come and gone several minutes ago.  I was thinking about stepping out for a haircut and a massage when my number was called.  The entire process about waiting to be served reminded me of being at the Department of Motor Vehicles.

The admissions clerk at the hospital told me the charge for my ultrasound would be $871. 871 is not a prime number, but since the admissions process had run beyond fifteen minutes, I thought I would add a little something to the discussion just to entertain myself during the doldrums. “Take the number 871,” I told her, “And reverse the digits to create a new number; 178. Subtract 178 from 871. Add the resulting number, 693, to the result of its inverse, 396, and you get 1089.” This actually works with any three-digit number whose digits are decreasing, but I did not tell her that.

Eight hundred and seventy one dollars. Not $870; not $900. It struck me as a bit odd to be able to pinpoint the cost to a specific dollar, especially since health systems do not know what any procedure costs. I asked a supervisor about the price.  “We do not know what something costs, we only know what we charge.”

“Does anyone know what it costs?” I asked. She told me I was wasting her time and mine with my silly questions.

Anyway, the outpatient admissions process, at a hospital where I was already in their computer, took seventeen minutes. I gave her my phone number 4 times, my address twice, and the name of my first girlfriend once.

I asked if I could have pre-admitted myself online. She said she did not know, but she told me that the pre-admit process should have been done on the phone to save me all of this time. I asked if the process would have been shorter had I done it on the phone and she said it would not have been. “How then would that have saved me any time?” I asked.

By then, her eyes looked like she was in a death spiral. My eyes looked the same.

She escorted me to the waiting area. The television show, “What’s My Price” was playing loudly through the television speakers. A collection of Vietnam-era magazines was scattered among the waiting room’s Formica side tables. I turned on the ceramic, avocado-colored lamp and waited.  I started to calculate each of the periods of waiting just to see how much of my time I was investing in doing nothing.

The rest of the ultrasound went smoothly, more or less. “Hold your breath….” A new radiology technician was undergoing training. Apparently the person doing her training had glossed over the part of the training relating to the bit where she was supposed to reply, “Okay, breath.”

Note to health system executives: Try and schedule an appointment—mine required three phone calls and several minutes on hold. After that, go through the admissions process and see what that teaches you about the issues of consumerism facing your patients.

The scheduling and admissions processes haven’t changed since Betty White was a baby.

They should.

A remarkable experience for every person at any time on any device.

Or not.

None of this is rocket surgery.