Since nobody wants to sit through having to read twenty-three of anything, I’m going to try to make this easy for each of us.

These are a few of Roemer’s Healthcare Axioms:

• Axiom 1: Nobody knows what it costs to acquire a patient
• Axiom 2: Nobody knows what it costs to retain a patient
• Axiom 3: Nobody knows what it costs to prevent leakage—heck, nobody even knows if someone leaked; before treatment, after treatment. Leakage is one of life’s great mysteries
• Axiom 4: Patients and members, both new and existing, will tell you that healthcare marketing has zero impact on who they choose as their provider and payer
• Axiom 5: Providers and payers will continue to play a zero-sum game, spending money on marketing campaigns that do not resonate with anyone outside of marketing

So, here’s how I got to the number ’23.’ (You can come up with your own number using this same approach.)

I started thumbing through this month’s issue of Philadelphia Magazine, and I was gobsmacked by the number of full-page healthcare ads, so much so that I felt the need to count them. By the time I reached page sixty-six I had counted twenty-three ads.

Four providers and two payers paid for those twenty-three ads. Doing the math—four plus two, divided into twenty-three—indicates that each organization marketed to the magazine’s readers about four times in the first sixty-six pages.

I took some time to reach each ad, and to ask myself if there was anything in any of those ads that would compel me to take action. There wasn’t.

It is worth noting that all of the ads had the same look and feel. It was almost as though all of the marketing departments, independent of their firm, operated from the same marketing omnibus—it means compilation—of acceptable healthcare marketing strategies.

The only difference among the ads was the name of the institution doing the advertising. The ads each pictured one or two animated and healthy people having the time of their lives. The people were frolicking, picnicking, biking and jogging. They were carefree.

I suppose the ideas behind the ads were that even if you had cancer, that if you brought your cancer to one of these organizations, you could be frolicking by the time you finished reading the magazine. The ads do not show someone with any hair connected to an IV dispensing cisplatin. Perhaps the thinking is that ads about frolicking are preferable to ads about cisplatin.

The same kinds of ads are on billboards and on television. They are in your mailboxes and mine. If every healthcare organization is pitching the same message, is the effect on consumers the same as if they had pitched no message? I think it is. I think consumers think the same thing.

I am willing to bet my neighbor’s BMW that not a single reader of the October issue of Philadelphia Magazine will be influenced one iota about who to choose as their provider or payer based on a magazine ad, a billboard, or a television commercial.

If you want to get my attention, tell me that you designed a tool that will help me manage my care and wellness. Don’t give me frolicking. Give me care and then I will care.

I am amazed at the speed at which most of the world changes.

When I was young, drinking-water was free, and our rotary phone was attached to the kitchen wall.

We used to get two newspapers a day; the Baltimore Morning Sun and the Baltimore Evening Sun. As a result, we knew everything that had happened in the world before ABC, CBS, and NBC televised the evening news at 7 p.m.

Our television set was a piece of furniture the size of a dishwasher. To watch the television we had to adjust the rabbit ears to try to get the picture to stabilize. During storms, sometimes we had to attach a piece of aluminum foil to the antenna to stop the picture from fading. If we wanted to watch one of the other two channels, someone had to walk to the television and turn the selector knob. To be fair, rumor had it that there was also a UHF channel. That channel came with its own non-functioning antenna, but I never met anyone who was able to get the picture clear enough to watch.

Even so, we also watched the news, and when Walter Cronkite went from black and white to color, I knew technology had just about peaked. And then came portable television—television on wheels. Instead of something the size and weight of a chifforobe, televisions were so miniaturized that they could fit on a wheeled cart and could be moved from room to room. Naturally, we did not have to worry about connecting it to the cable outlet because there was no cable.

Next to the portable television, on the end table, was a spiral-bound, paper AAA map with the directions to get me from Baltimore to Vanderbilt in Nashville—stone age GPS.

As an aside, it occurred to me that the practice of healthcare and the practice of law have a lot of similarities—however, people don’t call having a thousand doctors on the bottom of the ocean a good step. The greatest commonality is that nobody wants to engage either a doctor or a lawyer until it’s already too late. I guess though that telling a lawyer that you were thinking of robbing a bank would garner about the same reaction as telling a doctor that you were thinking of taking up smoking.

So, back to the fact that many years ago what we thought of innovation as consisting of tap water, a morning and evening newspaper, color television, and a TV on wheels.

Almost everything has changed since then because of the rate of change of technology.

Almost everything.

I went to the hospital to get an MRI on my knee.  The clerk inserted a three-part carbon firm into her IBM Selectric typewriter and typed my admissions data.  I was instructed to go to the waiting room. A woman dressed like June Cleaver rolled a black and white television into the room and turned on the Get Smart. She told me there was bottled water in the avocado-colored refrigerator and that if I wanted to make a call, the phone was on the wall next to it.

The song from the Archies, “My Heart Went Bang-Shang-A-Lang” was playing on my transistor radio. I reached down and retied my Converse Jack Purcell sneakers. And folded neatly next to me, on the end table, was a copy of this morning’s newspaper and a spiral-bound map from AAA.

The business model of healthcare never left the 70’s.

McKinsey wrote in—Enabling Healthcare Consumerism—that consumers now control more than $330 billion of annual out-of-pocket healthcare spending and “the choices they make have the potential to affect 61% of all healthcare spending”.

That single statement is all one needs to understand to know why

This is a direct result of the large increases in the average deductible.

What does this mean for providers?  It means I decide what services I purchase and from whom I purchase them.

In the same paper, McKinsey found that over eighty percent of the people they surveyed believed digital solutions are the most effective way to perform healthcare activities.

Kaufman Hall’s “2017 State of Consumerism in Healthcare” reported that ninety percent of providers replied that improving the consumer/patient experience is a high priority, yet only eight percent of health systems stated that they have implemented some digital consumerism solutions with some demonstrated success.

The report went on to say, “Building digital capabilities should be integral to organizations’ efforts to improve the end-to-end consumer experience, yet many are taking a more siloed approach that is disconnected from a broader consumer engagement strategy”.

So, what do we know?

• Consumers control 61% of healthcare spending
• Over 80% of consumers want to manage all aspects of their healthcare digitally
• 90% of providers call consumerism a high priority
• Only 8% of providers are actively trying to implement digital consumerism solutions

Why is digital consumerism a business imperative? An article listed many internal provider business drivers of consumerism.  And there is the underlying failure point.  Consumerism is being driven by only one thing—consumers.  By the +80% of the people who want to access and engage digitally.

The underlying unmet business driver is the need for providers and payers to understand and meet consumer expectations.

There is a great disconnect between the discussion of patient experience and the discussion of consumerism.  Patient experience initiatives do one thing.  They measure, “How did we do when the patient was receiving care?”

Patient experience initiatives do not include any of the experiences patients have pre- and post-treatment.  They do not include any of the experiences of consumers—prospective patients.  And they do not account for anyone’s expectations.

There are more than 165,000 health-related apps on iTunes that do 165,000 different things.  iTunes is where people go to manage their health.  Get an app.  Get several.  And they go to the web.  The one place they do not go to meet their health needs is to your health system’s consumer portal and the reason they don’t go there is that your system doesn’t have a consumer portal.

Consumers, patients, and prospective patients are the new payers.  They are your customers and prospective customers.  Consumerism is the same thing as customer experience.  People who understand this know that consumers are not happy with what they are experiencing.