Let’s begin this piece with a survey question about how your organization views the importance of customer experience in consumerism. If you think your organization views customer experience as the most important component of having a successful healthcare consumerism program, type the letter ‘A’—case does not matter. Otherwise, type the letter ‘B’. Your answers will be revealed at the end of this post.

A number of you asked me to explain the role of design-thinking in enabling healthcare consumerism. To best understand the role of design-thinking regarding healthcare consumerism I find it helpful to consider the question, “What is the opposite of design-thinking?”

Maybe it is designing without thinking.

So, is that a big deal, or is it nothing worse than spilt milk?

Please consider these two examples for a moment. Imagine yourself in a meeting, and on the table in front of you are blank sheets of paper and a box of Crayola crayons. The facilitator of the meeting starts with the following icebreaker as an exercise—design a vase. Twenty minutes later you stand and tell the crowd why your vase adds value. The second part of the exercise is to design a better way for people to experience flowers. I’m guessing that nobody in the room is going to draw another vase.

Exercise number two is to design a way to serve coffee. Half of the people in the room draw something that resembles a coffee pot. Part two of the exercise is to design a better way for people to experience coffee. Everyone in the room draws something that represents Starbucks.

There is a huge difference between designing for function and designing to create an experience.

So, back to healthcare. Providers. Payers. Retail pharmacies.

A new meeting. This meeting takes place in your organization. Two months ago the executive team told you to design a solution to handle the fact that millions of the organization’s patients and customers call the firm each year. You display your first slide, a schematic of a big room with a bunch of phones in it. “It’s a call center,” you tell the executives. “People call us. What if we build a big room, buy a bunch of phones, and hire a bunch of people and get them to answer those calls? We won’t have to pay them very much because they don’t have do be highly skilled to talk on the phone.”

The executives nod to one another, and approve building a big room and buying a bunch of phones.

But what if the executives had asked a different question? What if instead of asking, how should we handle phone calls, the executives had asked you to design a way to provide a remarkable experience for someone each time they need to interact with us? Would that change the type of solution you proposed? Would anyone present a schematic of a call center as a way to provide patients and customers with a remarkable experience?

Function versus experience. Designing without thinking versus design-thinking.

The application of design thinking to healthcare consumerism is the ante to begin, and the lynchpin to succeeding. It is the most important determinant as to whether your firm offers healthcare and whether it can be recast to offer healthcare.

Think about your own health. Can you, with a high level of certainty know that you are 100% healthy today? Can you demonstrate with some degree of certainty that you are healthier this month than you were last month? You may be able to do so with regard to certain factors—your systolic blood pressure dropped three points; your resting heart rate is stable at sixty beats per minute.

And do you know what is special about this knowledge? You are the only person on the entire planet who knows that information. It is your secret. And secrets are no fun unless you can share them with someone.

Among the people who do not know your secret are your primary care physician, your cardiologist, your pharmacist, and your health insurance company. You have this data, but you have no way to share with with them, and they have not demonstrated any interest in knowing this information.

Now suppose the numbers about your blood pressure and resting heart rate were different. Suppose your systolic blood pressure had been increasing steadily during the past month, and today it was 150. And suppose your resting heart rate had risen from 60 BPM to 89 BPM.

This type of information is the type you want to share with someone, with someone who can tell you what you should be doing. And you will want to continue to share it with those same someones to learn whether what they told you to do is working, and you want to be able to do that on a habitual basis, and using a method that allows an interactive and cognitive exchange of information.

It would be nice to have CVS or your provider receive and assess your daily blood pressure data to determine if the medication is working instead of waiting for your next visit to the doctor. Taking the medication as prescribed every day for 60 days and having the doctor discover on day 60 that your systolic pressure had risen to 170 is not helpful.

So, here is my proposed first step to determining whether your organization wants to simply offer healthcare, or whether you also want to offer healthcare. A thirty-day challenge. Pull together a team of executives, and hopefully a consultant or two—because we have bills to pay, with the goal of answering the question, What would we design if we wanted to provide a remarkable experience for someone each time they need to interact with us? And could we use that design to enable people to share their health data with us daily?

So back to our survey. Fifteen percent of you answered with the letter ‘A’. I gave the same survey to all of the chimpanzees at the Philadelphia Zoo along with a Bluetooth clicker—chimps are crazy about technology—that had one button for ‘A’ and one button for ‘B’. Half of the chimps clicked ‘A’, and the other half clicked ‘B’.

Maybe the chimps should be on your thirty-day challenge team; or at least half of them.

Want to see if this idea has any basis in reality?  Try this North Face app and see what a cognitive customer experience looks like. (https://www.thenorthface.com/xps)

If you own a GM vehicle with OnStar you have already used a scaled-down version of cognitive self-service.  Your car uploads data about itself, GM analyzes it, and lets you know what is wrong with it and that you need to take it to a mechanic.

Healthcare could do the same thing if it only collected and analyzed data from your apps and wearables–you need to be tested for diabetes.

It could.  It just doesn’t.  And that is a shame.  Because to the first firm to do that it could be game, set, and match.

Any week when you learn two new useable phrases is a good week. The two I heard are ‘Strap a hog to my face and lead me to mud’, and ‘He looked like he was slapped in the face by a wet squirrel.’ If you have any favorites, please send them my way.

Did you know that the human eye could detect 7,000,000 colors? That figure sort of puts the use of primary colors and the color wheel to shame. When I look at a color wheel one thing that strikes me is that there is a fixed boundary between the colors—one area is blue and next to the blue is green.

There is no ambiguity in the demarcation among the primary colors. There is red and there is yellow and there is blue. To get orange, you have to combine two distinct colors; the same rule applies to get green. And while the literaturists would have you believe that there are only fifty shades of grey, there are actually an infinite number of shades.

Enough already; make your point.

In the same way the color wheel shows a fixed boundary between each color, healthcare’s approach to consumers and patients appears to adhere to that belief and operates according to the principle that there is a fixed boundary between consumers and patients—it’s like Binary Sudoku; you either are a patient, or you are not.

From the standpoint of the individual, we are all patients. Some of us are under care, a fair number of us should be under a doctor’s care, but we don’t know we have heart disease or hypertension, and the rest of us, those who are healthy will eventually be under a doctor’s care.

It’s like driving to Nebraska. Some of us already arrived, some are halfway there, and the rest of us are on our way. After you visited the German POW Urinal in Minden, Nebraska, you may leave. A few months later you may return and visit the shoe fence in North Port, Nebraska. (I need to add these to my list of fun things to do in Nebraska.)

In healthcare, unlike with colors, you can’t mix a patient and a consumer and make orange. The fixed boundaries between patients and consumers make for bad experiences because experiences were never designed for consumers. A provider’s call center and website have very little ability to meet the needs of prospective patients, care givers, family members, and referring physicians.

But then again, the call centers and websites have very little ability to meet the needs of patients either; unless of course the patient wants to know what time the gift shop opens—information that is easily found on most provider websites.

If I use the Domino’s Pizza app it knows I am a customer. It knows my address. It knows what I usually order, and it knows my preferred method of payment.

If I use the CVS app, it knows the moment I walk into their store.

If you have been a cancer patient for the last four months at Our Lady of Customer Indifference, and you call your health system, the person answering the phone does not even know your name let alone the fact that you are undergoing chemotherapy.

So perhaps I have overstated my case. Maybe there is no distinction between how healthcare treats patients and customers. From an experience standpoint, it seems both are treated equally poorly.

So, strap a hog to my face and lead me to mud.

Las Vegas has a variety of buffets. The buffet lines do not distinguish by IQ. Case in point, there was no sign near the cafeteria trays that read, “Those of you who think prime numbers have something to do with beef, please use the right hand lane.

Consequently, I was queued up behind a husband and wife team who I soon learned were in Vegas for vacation. It seems their Winnebago was double-parked in the Wynn parking lot. The husband, dressed in an untucked bowling shirt, matching shorts, and black wingtips and socks, preceded his wife down the aisle of salad accouterments.

His wife, Beverly, the non-bowler, wore a short-sleeved linen jacket, and wore a macraméd bag big enough to hold a hammock across one shoulder. Mixed greens. Two slices of cucumber. Shredded carrots. Cauliflower. And then we hit an impasse.

Peas. By their nature peas are round, not circular. Had they been circular, I may not have found the need to write you today. But round they were. And she had set her mind upon the task of moving those round peas with a fork from their bowl and placing them on her salad plate.

And round things, when pushed, roll. An equal and opposite reaction. Physics. A class in which Beverly had not excelled. She pushed them, pea by pea, from the left, and they rolled to the right. She reversed the direction of her pushing, and we both watched mesmerized as the peas rolled left. (Her husband, who I assumed had previously watched Beverly try to scoop peas had scooted further down the line and was wrestling with the chilled lo mein.)

I found myself thinking that I could put Beverly and I out of our respective miseries by simply smashing the peas with the heel of my shoe—then they would be circular—not round—and she could put them on her plate, and we could eat.

Minutes later we arrived at the food weighing station. Upon when Beverly announced to the skein of people who had by now backed up behind her like wounded F-4 Phantom fighter planes awaiting their turn to land on a carrier, I think I have a coupon someplace in my bag.

As she fumbled for her wallet in the bottom of her bag she bumped her tray. One of the round peas rolled off her plate and on to the service tray. At the sight of the migrating pea—assuming that peas do in fact migrate—the group of hungry travelers behind me moaned in unison, and we quickly took up a collection to pay for her meal.

That was my HIMSS experience. I hope yours was better.

Permit me to start the thinking man’s portion of today’s missive with a question. What is the difference between a thermometer and a thermostat? Between an elementary school hall monitor in elementary school and the principal. The thermometer and the hall monitor simply record things. They are not meant to take action.

LifeLock, the personal security identity firm that makes sure nobody is using your identity is running a commercial with a man dressed in a uniform standing in a bank. Robbers enter the bank, they see the man in uniform, and they are taken aback because they think they are about to be arrested. The uniformed man tells them that he is just a monitor. He does not take action.

His role is the same as your health apps and wearable devices. They monitor. They record. They do not take action. Heck, they do not even suggest that their wearer take action.

True case in point—mine. As you lay on your back on the macadam midway through your run, in a position yoga enthusiasts call the death pose, your running app notices that your pace has slowed. It notices that your lap time has increased and that the average number of calories you were burning has decreased.

Your headband, the one that analyzes your sweat is recording that the temperature of your sweat has cooled rapidly. And the chest strap you are wearing to detect your pulse, nattily storing each beat so that you can upload it later is issuing a warning to tell you to replace the lithium battery because while it knows it is still attached to your chest, it is no longer recording a pulse.

You were doing all of the right things, and you were right to be doing them. Dead right, as it turns out. Fortunately for me, and I kid you not, a cardiology nurse drove by, saw me, and called an ambulance. It turned out I was overreacting, but once you’ve done the stent thing, overreacting is wiser than under reacting.

Penn just released an app that displays your EKG on the screen of your phone. As a heart patient, I found that to be something I want to use. How do I send it to Penn to get my cardiologist to look at it? I asked Penn’s head of innovation? “You can’t,” he replied. Who reads it? I asked. “Nobody.”

It turns out that for wearables and apps there is no ‘I’ in innovation. And so, QED. If I am going to have 365 EKGs in a year, and only one of them is going to be read, do I really need the other 364?

And so as a heart patient I roll the dice every day and hope, as I have hoped every day of the last fourteen years that my only bad EKG happens on the exact same day as my annual visit to my cardiologist.

In Vegas people play craps. People using apps and wearables play craps with their health. So, having researched all of the wearables, here is the one I recommend. While it won’t tell you the time, it also won’t cost you four hundred dollars. Using a permanent pen, write these things on the back of your hand:

• Don’t smoke
• Don’t’ drink to excess
• Eat right
• Exercise
• Get enough sleep

Using my solution, you have to do the cognitive part, but you will be at least as healthy as using all of those apps.

We have traveled in a complete circle since you began reading this post. And together, if you and I have learned anything, we have learned that circles are easier to deal with than peas—which are round.

So when you are sitting on the highway in the middle of your run and wondering why it feels like an elephant is sitting on your chest, think back to what your mother told you—eat your peas.

Two consultants and a vendor walk into the convention center. Let me know if you’ve heard that one. I made a new friend at HIMSS. A friend who travels a lot. “How does that affect your life?” I asked her.

“No plants, no pets, no kids,” she replied. I told her she should delete her title from her business cards and replace it with that phrase.

I think the time has come to create an organization that mirrors HIMSS—HIMSS 2.0. The Healthcare Information Management Systems Society (HIMSS) uses IT to benefit those who need health care.

The Health Information Management Systems Society (HIMSS 2.0) will use IT to benefit those who need to improve their health.

One word—big difference.

In Las Vegas at HIMSS 2016, the emphasis was all about improving care. Vendors displayed hospital beds, hospital carts, and EMR systems; things for sick people, things for people undergoing procedures.

Patients.

Forty thousand people focused entirely on making patient care better. A good thing. An important thing. Saved my life, twice.

I began to think about all of those people. To my untrained eyes they all looked relatively healthy. They did not seem to have any use for the hospital beds, the medical carts, or the EMR. A bunch of stuff that could benefit them someday. Nothing among the hundreds of thousands of square feet of displays of medical devices and software to benefit them today.

And I wondered if what I was looking at was the ultimate chicken and egg argument. Cause and effect; which came first? Build stuff for patients because sooner or later everyone becomes a patient. Was it possible that individuals who became patients did so in part because healthcare management information systems focus all of their attention making ready for that eventuality? Was it inevitable?

But would there be less of a demand for healthcare information management if more resources were dedicated health information management?

I spent several hours visiting the vendors’ booths, and I asked many of the vendors this question. “I feel pretty health. What can you sell me to help me stay that way? Do you have anything I can purchase to help me know if I am healthy?”

Everyone is talking about wellness and about population health. People are also taking about going to Mars. But at this point all it is is simply talk. Knowing how to do something and doing it are two very different things.

So what would Health Information Management Systems look like? Perhaps it helps to examine what we have today, and determine what is missing. Today, instead of Health Information Management Systems, all we have is Health Data Capture.

Data about health is captured by apps and wearables. We can store it on devices, and we can move it among devices. Data is information; it is factual. I ate two thousand calories; I ran five miles. Data has no meaning until it is interpreted.

I ran six thousand steps. I had a heart attack. My device replied, “You are four thousand steps short of your daily goal.” Any interpretation relies on the user of the app of the wearable. Data without context is meaningless.

We have:

• Data instead of Information
• Capture instead of Management
• Silos instead of Systems

We have nothing to manage our wellness, and providers and payers and pharma offer no services with which to manage the health of the population. Knowing someone had his or her gallbladder removed three years ago tells you nothing about whether that person had heart disease or hypertension. And it tells you nothing about whether they have heart disease or hypertension.

And that is why I started HIMSS 2.0. Our first convention will be in Orlando next year. And because so few people have yet to buy in to the concept, the convention will be held in a Winnebago in the Denny’s parking lot next to the SeaWorld.

HIMSS Part Deux.

“You have only walked 1,500 steps today,” the patient’s phone announced. “You have exceeded the number of calories you were supposed to consume today.”

Nonplussed, the emergency room physician began his examination of the patient. “What are all of these things you are wearing?” The physician asked.

“They are my health wearables,” replied the patient. “This is my Apple watch,” beamed the patient as he pointed to his wrist. “And my belt tells me if I am getting fatter.”

“What is the bra for?”

“It is a Smart Bra. It tells me if I am engaging in emotional overeating . But they didn’t design it very well because the psychological sensors chafe me.”

The doc wondered what the else the sensors might be telling the patient. “But you are a guy.”

“That is what my counselor keeps telling me. My shoes track my steps and analyze the genomes from my sweat, and tell me if I am pregnant.”

“You are not pregnant,” the doctor replied. “You are a guy.”

“Never hurts to check,” replied the patient.

“What about your ear buds?”

“The left one analyzes my earwax to see if I am susceptible to extinct strains of Ebola. I’m not sure what the right one does, but it makes Celine Dion sound like she is singing just to me. And that helps me not worry so much about the Ebola.”

“Are you wearing a wig?”

“It’s a SmartWig, loaded with actuators, made from the hairs of free-range, gluten-free feeding yaks—I have always wanted to use the word ‘yaks’ in a blog. And the goggles monitor my brain activity. But they don’t seem to register anything.”

No kidding, thought the doc. “And, what are the Necomimi cat ears for?”

“They alert me about when I am focused on my health; the perk up.”

“And the underwear?”

“They are called Shreddies. They analyze my methane output.”

“So why are you in my ED?”

“Because I don’t feel well.”

“Don’t any of those things you are wearing tell you what is wrong?”

The patient puzzled over the doctor’s question until his puzzler was sore. “I don’t think they do.”

And therein lies the rub. They are all hat and no cowboy.   Tons of data, and no information. Wearables only work if someone can interpret the data they collect. Wearables don’t infer. They do not recommend. They do not tell you to stop whatever you are doing and dial 911. Their only value isn’t much beyond a slight chi-chi factor.

People who buy these do so because they have a keen interest in managing their wellness. They use smart apps for the same reason.

The problem with apps and wearables is that all they do is record numbers, numbers that mean nothing to the person collecting the numbers.

So why do so many people do that? Why are wearables a multi-billion dollar industry? Because people are trying to acquire wellness. Because they want to know they are healthy.

And because they have no other options. They cannot buy a wellness program from their provider, or from their payer, or from their pharmacy.

So as you lay out chum lines as you visit the myriad of wearable exhibitions at HIMSS, hoping to achieve alchemy in your quest for a healthier you, think twice.

Unless of course you are a guy. Because guys will try anything to make them stand out in a crowd. “Those cat ears make you look a lot taller.”

Women know better. They inherently know that most wearables don’t go well with sensible black pumps.

It has been a rough week. Within the last seven days two people told me I look like Jack Nicholson—frankly I do not see the resemblance. Add to that that the person cutting my hair volunteered, ‘You need to quit doing that comb-over thing; you are not fooling anyone.’

But now that I look at this picture, I think it is a good idea that I keep my hair pretty short.

Anyway, enough about my week.

Consumers will tell you that health systems cannot sell them anything even though those systems have large marketing and business development departments.  Patients are not sold healthcare by the health system, they purchase healthcare from the health system.  Consumers hold the power.

If you want to build your business stop trying to sell people your services.  Instead, make it easy for them to buy your services.  Become the health system that is easy to do business with.

Unfortunately, few if any health systems are doing that.

What would happen if a fifty-four hundred people (one person for every hospital) were standing together in a field, and they each took one step forward.  The next month they did exactly the same, and so forth and so on, ad nauseum.  The crowd would certainly have changed places, but relative to one another the individuals would all be about as far apart from each other as they were when they started.  Not much would have changed, at least not much that was noticeable. To a prospective buyer all they can see is a lot of chaff and no wheat.

Now what would happen if one person—or health system—decided to be innovative and did something disruptive and separated themselves from the crowd?  What if a system sprinted in a different direction?  They came to a fork in the road and they took it.

With every system’s focus on HCAHPs, it can be argued that they are all moving across the field somewhat in lock-step.  Now before anyone gets the notion that I am arguing that hospitals should stop focusing on HCAHPs that is not my intention.  Improving HCAHPs is a good thing.  Getting each health system moving towards one hundred percent in all categories is a good thing. Sort of.  Just remember, nailing HCAHPs is not the same thing as nailing patient or customer experience.

With every health system taking one step forward on their goal to improve the patient experience of each surveyed patient, who then is responsible for moving the organization forward for improving the satisfaction of everyone who interacts with the system?

Doing what every other health system is doing is not innovative.  It will neither drive patient acquisition or retention or referrals, nor will it improve the satisfaction of those people, patients and prospective patients, who try to access the hospital via the web or by using the phone.  It will also have little or no effect on those who were surveyed—they have already been discharged.  It will also have a similar effect on those who were not surveyed.

Innovation is the application of new solutions to meet needs or changing market requirements.  For innovation to work an organization must acknowledge a problem/opportunity.  Like a 12-step program. Hi, my name is Paul and we have a patient satisfaction problem.

The health system that chooses to separate itself from the pack will recognize that most of an individual’s satisfaction with their interaction with the health system happens outside of the hospital’s four walls.  It happens before they are admitted and after they are discharged.

I like to define it as follows:

The total quality of a person’s (patient & non patient) experience with their health system is equal to the sum of the Patient’s Experience (HCAHPs) plus their satisfaction of all of the other interactions they have with the health system.  If your health system has not totally reinvented those interactions in the last three years the access experience you are providing is well below what it could be.

That is a fact. That is also a fact that most health systems have ignored. It will not be fixed by adding valet parking or proudly serving Starbucks because customers on the phone and online are not worried about who is going to park their cars.

There were four of us in the car that was headed to the Dallas Fort Worth airport.

One of us was a male. The other three were not. The math is simple; the ride was not. The three non-male members of the group were each holding their smart phones and each of them was using Google Maps.

I asked, “How much further?”

‘Seven miles,’ one of them replied. Who replied neither adds to nor detracts from the telling of the story. Seven miles turned out to be a key data point. It was key because within ten more minutes we were thirteen miles from the airport.

I used to live in Dallas, and I knew we were now headed rapidly towards Waco. I thought briefly about adding my two cents, but as I already stated, one of us was male. Male and married, and I knew from personal experience that one-on-one was not a fair fight. Three on one was just plain silly.

And so while these Amerigo Vespucci’s of the highway continued to head south—we were now sixteen miles from the airport—I played binary Sudoku on my phone. From an elevated ramp on the interstate I asked, “Is that the Gulf of Mexico?” Fortunately, my remark fell upon deaf ears.

We don’t know where we are going, but we are making very good time. Or not.

Like people do, businesses try to use tools to help them meet their needs. Sometimes they use the tools advantageously, sometimes they do not.

People call us; let’s build a big room and put a lot of phones in it.

People like to use the Internet; let’s build a website, and get someone to write an app.

Your patients see what is going on, and they are each asking, “Is that the Gulf?”

Originally, manhole covers had four sides. Some were squares, and some were not, although I doubt many were parallelograms. Four-sided manhole covers were not very good. They were not very good because many of them, when removed, fell through the manhole. And so engineers designed a series of grates beneath the manhole covers to prevent the covers from falling to the bottom of the manhole.

In the initial days of our space program our scientists tried to invent a pen that could write in zero gravity.

The next time you see a manhole cover look at its shape. It is round. Why? Because it is impossible to drop a round manhole cover down a round manhole. While the NASA was trying to design a zero gravity pen, the Soviets used a pencil.

Easy problems have easy solutions. Those are the types of problems with which most organizations grapple. Create a committee. Build a plan, acquire funding and solve the issue.

Increase revenues by ten percent. Increase your HCHAPS scores by twenty percent. Executives mistakenly label those initiatives moonshots.

The thing missing from almost every healthcare business moonshot I have studied is the moonshot—and the rocket.

President Obama stated in this year’s state of the union message that Joe Biden’s new charter is to cure cancer.   Now that is a moonshot. That it is difficult is what makes it worthy of being called a moonshot.

JFK didn’t announce to the world in the early 1960’s, “Our goal is to get a man to Iowa and bring him home safely by the end of the decade.” His target was the moon, hence the term moonshot.

In business there are no fair fights. And sooner or later a healthcare organization is going to do something that makes its competitors state, “We never saw that coming.” Blockbuster never saw it coming. Neither did Sears. And you can bet your last dime that some of the executives in those organizations thought about developing a plan to try to mimic what Netflix and Amazon did; but they were too late.

So if you are going to have a moonshot you are going to need a rocket. The moonshot is the goal. The rocket is the means to achieving the goal. For those who remember the space program, many of the first rockets never left the launch pad. And several others exploded. The failures didn’t change the need for a rocket; they merely showed that other changes were needed.

Unfortunately, most firms that change an industry do not come from within that industry. MGM did not morph to become Netflix. Macy’s did not wake up one day and decide to become Amazon.

The organizations that changed the entire delivery model of healthcare started with nothing. They did not have a hospital. They did not offer insurance. And they did not make pills. They did not even have a patient.

Walmart and CVS and Walgreens and Rite Aid. But they figured it out, and strangely they each came to market at roughly the same time with roughly the same business model. And they still don’t make the pills and they still don’t provide insurance. In spite of those shortcomings they see and treat more patients each year than the largest health system.

Imagine the first conversation in the boardroom when Sally stood up and announced, “I have an idea.” Sally put up her first slide and said, “My idea is that by the end of the decade we can be treating patients in every state in the U.S. without every having to build or buy a hospital.”

“And just how will we do that?”

“People will just come. And they will tell their friends. And they will come many times each year. And while they are here we will also give them their medicine. And doctors will send their patients here to get their medicines. And those people will see that they don’t always have to go to the doctor. They can simply come here. And they can come without having to make an appointment, and we will change healthcare.”

That was a moonshot.

But it does not have to be healthcare’s only moonshot.   But it will be until somebody creates another one and starts building a rocket.

I think cognitive, cloud-based healthcare consumerism is the next moonshot, but few firms are even discussing it in a manner that makes it worthy of the term.

For those who need an idea to get started, here are two moonshot consumerism ideas.

• Within five years people will manage their health daily using natural language through a smart device.
• Within five years, on a daily basis providers and payers and retail pharmacies will be managing the health of people across the country whether or not they are our patients.

Now go build your rocket.

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 often overlooks 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 an 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 than 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  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.

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?