I try to learn something every day, and yesterday was no different. I had been a long day. Multiple train rides, miles of walking, and I was tired. I reclined the seat, put on my headphones, closed my eyes and drifted off into a half-lucid state as I listened to Les Misérables.  Apparently, I was doing more than listening.

I had somehow forgotten I was on a train; on a train surrounded by other weary travelers.  One of my favorite Les Mis songs is Bring Him Home.  I like to sing along with it, and I like to sing loudly.  And so I did. I had also forgotten that just because you cannot hear others when you are wearing headphones does not mean that they cannot hear you.

The applause is what caused me to open my eyes. I glanced around to learn what had caused the commotion, and to my embarrassment discovered I needed to look no further than my seat.

So that was my day.

According to CMS the average American spent almost $10,000 on healthcare in 2014.  People, you and I, are having to pay a higher percentage of that amount from our own wallets.

That means we are more selective about where we choose to spend our healthcare dollars.

I spoke recently with a health system executive about what the provider business model will look like in two to three years.  During our meeting I shared the following information about my family’s consumption of healthcare over the last twelve months:

• 17 visits to the Minute Clinic
• 3 visits to an urgent care facility
• 5 visits to specialists
• 0 visits to a primary care provider
• 0 visits to a hospital

We were selective, and we selected to purchase our healthcare services to the exclusion of providers.

The U.S. healthcare system is unbelievably good.  This week Children’s Hospital of Philadelphia announced that it had completed the very first double hand transplant.  Amazing!  One of the things I took away from their announcement was that it was the very first.  I am not knowledgeable enough to know whether it being the first had to do with the lack of demand for this type of procedure.

Healthcare providers are very good at delivering services that are firsts, at figuring out how to successfully do things others did not think could be done.  Things 99.9% of people will never need.

Healthcare providers are proving themselves to be very poor at delivering services that are lasts, services that 99.9% of people need.  Services that people need this year and that they will need next year.

She replied rather emphatically, “We are not in that business.”  Her comment was our biggest point of agreement.  If that is where people are spending their healthcare dollars, wouldn’t it make sense to figure out how be in that business?

People—patients—want access and convenience.

Wayne Gretzky (think very good ice hockey player), when asked why he was so good replied he learned to skate to where the puck was going to be, not where it has been.

While most providers are debating whether ice hockey is even a sport, their patients and prospective patients a lacing up their skates.

Yesterday another provider executive asked me what surprises me the most about healthcare.  I said I did not understand why executives from the VA, UHS, Tenet, and CHS were not standing outside of Tandy’s Fort Worth headquarters gobbling up Radio Shack stores.

Healthcare executives who stand by the adage, “We don’t have customers, we have patients,” may soon find themselves in the position of having neither.  To be successful, it helps to sell what people are buying. It also helps to sell it in the manner they like to buy it and when they like to buy it.

I think that may be why children don’t set up lemonade stands in Minnesota in January.