“If you’re in a horror movie you make poor decisions. It’s what you do.” A group of kids is running from a murderer in the middle of the woods when they stumble upon an old cabin. “Let’s hide in the attic. No, in the basement.” One woman starts breaking down and is in tears “Why can’t we just get in the running car?!” She is dismissed as crazy “Are you crazy?! Let’s hide behind the chainsaws.” They agree “Yea, smart.” They run behind the chainsaws but don’t notice the man standing behind them. The man gives them a look as if he can’t believe how stupid these kids are. They finally notice the murderer and run off “Head for the cemetery!”

Poor decisions. Head for the cemetery. Whether you are in the provider, payer, or pharma communities, we’ve all been in one of those meetings where someone suggests why can’t we get in the running car. And we dismiss her and run towards the chain saws.

Suppose the running car suggestion is, “We need to create daily habituation with our patients and consumers.” Stated more simply, we need to get them to interact with us daily, not just once every two to three years. If a patient or consumer only contacted us once a year, creating daily habituation means getting people to increase their rate of contact by 36,500%!!!

So, how do we achieve daily habituation, and what would it look like?

There is a great deal of activity in healthcare around cloud computing. Almost every health organization is doing something with a cloud, but only with their own cloud. But few if any health systems share their cloud any more than they share their cafeteria. Not only do they not share it with other providers, they don’t share it with payers, they don’t share it with pharmacies, and they do not share it with their patients and consumers.

For example, Philadelphia has several very good health systems. Imagine looking out from the top of one of the city’s highest buildings—what would you see? You would see a cloud hovering above the Hospital of the University of Pennsylvania (HUP). Across the street another cloud would be floating above CHOP. One above Thomas Jefferson; one above Einstein, Hahnemann, Cancer Treatment Centers, and the Philadelphia VA.

A few dozen individual clouds. Partly cloudy.

You continue looking, and you see that the sun is shining on all of the people entering and leaving the various health systems. That is because the clouds only cover the health systems. The clouds do not cover the patients or the visitors or the family members, and they do not cover them once they leave the buildings.

If you are asking yourself, so what, the answer to so what is the missing link for achieving daily habituation. As a matter of fact, that answer is the missing link for achieving any kind of habituation. People, your patients and your consumers, are missing the two things they need the most to drive any kind of habituation:

• They have no easy way to communicate anything about their health with you—we both know that your call center is not a communication tool; calling your organization is the last act of a desperate person
• Your organization has not given them a compelling reason to communicate with you more than they do

What healthcare needs are Healthcare Relationship Management to interconnect:

• Patients and providers
• Consumers—prospective patients—and providers
• Consumers and payers
• Consumers and pharmacies
• Providers to payers to pharmacies to consumers

Healthcare needs a Healthcare Relationship Management Cloud, a HRMC. An interactive (think 2-way) interconnected way of communicating about whatever one party wants the other party to know.

And what do patients and consumers want you to know about them? Nobody knows. And the reason nobody knows is that nobody ever asked them. Heck, if we are being honest, most providers do not even track why people call.

Last week I met with a senior executive of a very large payer. During our meeting, I drew a large, oblong shape to represent his customers. Way over on one end if the shape I portioned off a small bit of the shape to represent the fraction of his customers that interacted with them on a regular basis. Our discussion focused not on the tiny portion of people that communicated with his firm, but rather on the much larger group of members that never communicated with them. He said they call that group of members the tail. While the term probably was not intended to reference the idea of the dog wagging the tail, it could apply.

Providers also have a portion of the population they serve that represents the tail—patients and consumers who do not interact with them. So do pharmacies. Not interacting, and not needing to interact are two different things. Not interacting is a result of:

• No compelling reason to interact
• No easy way to interact

Now suppose consumers had an easy way to interact with your organization on a regular basis. And suppose they had a compelling reason to interact with your organization on a regular basis. Why would that be a good thing for both parties? These are a few things that spring to mind:

• Healthier people
• Improved care coordination
• Reduced admissions and readmissions
• Population health management
• Patient acquisition and retention

And that is why I wrote about the HRMC. While there are benefits from everyone having their own clouds, there are many more benefits to everyone being interconnected through a single cloud. Something like the NwHIN on steroids. Of course, that is overly ambitious, but there is no reason for a provider not to build one for its patients and consumers.

While working during the last few weeks I’ve semi-listened to wall-to-wall coverage of the election— fair and balanced white noise; or not.

Realizing that my head was ready to explode, I took a respite from the talking heads and changed to the National Geographic channel. And my mind melted. During the hour, the channel ran a piece about evolution. Admittedly, I am not a savant on the subject, but what caught my attention was the narrator’s explanation about the time millions of years ago when fish first walked from the sea.

I turned my eyes from the television and began to study the fish in my aquarium. I looked at them closely. Really closely. I stuck a magnifying glass into the tank trying to get a close up, but the fish were swimming in all directions and all of my attempts to look at their hindquarters proved fruitless. Did my fish not get the email about being able to walk?

I placed a tiny set of stairs in the tank to encourage them.  Did my fish not get the email about being able to walk?

And I started to think. Bad things happen when I let my mind wander. I pictured a pebble-strewn beach. Gentle waves pushing ever onward to the shore, the pebbles making little clicking sounds as they scraped against each other in the surf.

And then I saw thousands fish of fish pop their little fish heads up from under the water and look around. They began walking from the surf, unsure of where they were headed. Their mass exodus from the water made me think of the allied landing at Normandy.

One of the fish was wearing a wet stronger together t-shirt.  Many were wearing tiny pairs of Nikes to protect their little fish feet. About a minute into the onslaught, the leader of the fish bent from his waist and he reached down to his Nike’s. His left shoe had become untied.

He tried to tie his shoes with his little fish hands. But he did not have little fish opposable thumbs and his Nikes remained untied.

Maybe the National Geographic theory was all wet.

So, where did we leave off? At the end of the fish story, a television commercial was marketing a new disease. The spokesperson was Hollywood celebrity whose fame had faded, so now he was selling diseases. The premise of the commercial, like dozens of others that have popped up over the last few years, goes something like this.

“Do your fingers ever twitch at inopportune times, like when you are at dinner, and you are reaching for your glass of wine? You try to stop the twitching, and in doing so you knock over the glass. Your glass knocks over the lit candle. The candle catches the tablecloth on fire.

You dash away from the flames, forgetting the engagement ring you had purchased and left on your table, and you rush to the nearest exit. The next thing you know the entire restaurant is engulfed in flames, and your one chance to be engaged has been lost forever.

Has that ever happened to you? If your life has suddenly gone downhill, you may have TFS—Twitchy Finger Syndrome. There now is a cure for TFS. It’s called Twitchacin. Ask your physician about this wonder drug. Within six weeks your finger will stop twitching and you will be engaged and your life will be wonderful.”

Does it seem like big pharma has been creating new diseases out of whole cloth? Diseases you did not know you had? Some of these new diseases sound a little silly. The companies that make the drugs know you can’t tell your physician that you have twitchy finger syndrome of the left hand. Because if you said that, your doctor will simply tell you to use your right hand.

But, if you tell your physician that you have TFS and need a prescription for Twitchacin, he or she may check their PDR and write a script. Your fingers will stop twitching and your life will be wonderful.

And now that your fingers don’t twitch, if you should happen upon a fish whose shoes are untied, you will be able to bend over and tie his Nikes.

So the next time you see a commercial pitching a disease you didn’t know existed, think twice before you hit the mute button.

Three chairs were spaced evenly about my client’s round conference table.

A smallish elephant entered the room and sat in the third chair. The elephant wore a tightly fitted t-shirt printed with the phrase, “Stronger Together.”

“Why is he in my room?” My client asked me, nonplussed. The elephant looked at me and gave me a wink—he and I had already been in several meetings together. By he, I assumed she was asking about the elephant since I already knew I was a he. (The pay me for my broad powers of deductive reasoning.)

“You should know,” I told her, and I returned the elephant’s wink. “He’s your elephant. Besides, your other two elephants are busy meeting with your colleagues.” I removed a bag of roasted peanuts from my backpack. The elephant reached across the table with his trunk and grabbed the bag.

“What’s with his t-shirt?”

“He wore it to annoy me.” I showed her my baseball cap with the words, “Make Healthcare Great Again” embroidered on the front.

“Why are you feeding him?”

“If I don’t feed him he will talk during the entire meeting.”

“He talks?” The elephant cleared his throat and winked at her. “And what’s with the winking?”

“He winks because his eye leaks. The veterinarian says he suffers from winki-leaks. All elephants talk, but very few people listen to what they have to say. You and I have been working together for four months and this is the first time you’ve even mentioned the elephant.”

“Do you mean he’s been here before?”

“As I said, he is your elephant, not mine. He was here before you and I met the first time.”

“Can’t you make him leave?” She asked me.

“Now that you have acknowledged that he exists I can.”

Dear readers, the next time you are in a meeting and you see an empty chair ask yourself this question, “Is the chair really empty, or are you just not seeing your elephant?”

(And if you do see the elephant, tell him to take off that stupid t-shirt.)

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.

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

People think healthcare’s least understood concept is the relationship between payers and members (customers and patients). I believe the opposite to be true. People clearly understand the relationship, and it is that understanding that has such a negative impact on almost everything related to a person’s health.

The member/payer relationship not only discourages access, engagement, population health, accountable care, and wellness, it seems to do so in a particularly purposeful way. In fact, to members, it seems like payers are either guilty of designing it to be that way, or they are guilty of neglecting the member/payer relationship.

To give us a starting point for exploring this topic, I searched Google for the following: “t-shirt” and “I love Humana.”

I could have searched on any number of payers and received similar results. My search returned zero hits. (You get the same number of hits if you search for the phrase, “French military victories”.) If Google were more advanced, I think the number of hits for my search would have been negative. I also searched the phrase, “Why do people hate their insurance company?” That search returned 1,750,000 hits, and my laptop started laughing at me.

The relationship between members and their payers is a topic that is only mentioned behind closed doors. I wish I could state that both parties are culpable, but that is not the case.

Everyone who has ever called his or her payer to dispute a claim thinks the term ‘payer’ is an oxymoron. Their payment strategy for dispute resolution seems to be based on the premise that if they can get you to call them seven times, they know you will not bother to call and eighth time.

Wreck your car; your insurance company gives you a new one. Have a heart attack while driving, one company gives you a new car, the other company, your payer, tells you what is not covered—page seventy-two, section eleven, sub-paragraph six.

To be fair, payers do offer a number of other free benefits to offset the fact that they may deny some portion of or your entire claim. Someone in your HR department probably skimmed through those free benefits on January 2 when they were explaining your new and improved and more expensive health insurance. Very few of you or anyone else could probably list, or as ever made use of those benefits.

Stating that your firm wants its members to have a good experience, and delivering that good experience, is vastly different. Most payers only interact with twenty percent of their members on a regular basis. They either pay the members’ claims, or they do not pay their members’ claims. The one thing they do not know about those claims is whether the services their members claimed made them better.

I learned today that I have a torn meniscus and a stress fracture of my tibia. My orthopedist wants me to be on crutches for a month. Just for fun, I Googled the cost to repair the tear and to fix the stress fracture. The estimated cost to repair the tear is $5,000 and the cost to repair the stress fracture is around $16,000. Knees are expensive.

Crutches cost $40. I called my payer—let’s call them Hartford-Anthem-TIAA-Esurance (HATE), to find out if it will pay for repairing my meniscus tear and my stress fracture. The person with whom I spoke said HATE covers those procedures.

That was the good news.

Then I asked if HATE would cover the cost of crutches. Crutches, I was told, are not covered. Up until that moment I had considered buying an “I Love HATE t-shirt.” I asked to speak with a supervisor. No supervisors were available to speak with me—were they out buying their own crutches?  I asked.

An hour later I received an email from HATE. In their email was my Case Number, #38756. I replied to HATE’s email and told them that their Case Number was #00001. I received a new email from HATE telling me that my Case Number was #93852. I replied and told them that their new Case Number was #00002. I don’t know how long HATE’s patient engagement with me will continue, but I am prepared to play their game for as long as it takes.

HATE will pay about $20,000 for the two surgeries, but they will not pay $40 for crutches.

Payers spend tens of millions of dollars on data and they spend equal amounts on advertising. Their data, were they to look at it, would tell them that the outcomes from two surgeries and from using crutches are identical. Their data may tell them that someone with of my age and weight, who exercises six days a week, may have a higher probability of having a stress fracture and torn meniscus than, say someone who wears skinny jeans and who drinks lattes. The one thing their millions of dollars of data will not tell them is that you or I will injure our knee.

Payers spend almost nothing on my wellness or yours. They do not know how to lower their costs, engage members, improve member experience, and promote their wellness.

This is a true story. The names of the actors have been changed for literary purposes. It goes something like this.

In 1983, Jim lived in Dallas, Texas. He was working in Amarillo. Monday evening, Jim saw a news report about testicular cancer on the local news. Jim knew immediately that he had cancer. He knew he had because he had discovered a lump a few months ago. Jim did not know what to do because he had never had a lump. He went to his hotel room, opened the Yellow Pages, and started calling doctors until he found one that would speak with him at 8 p.m.

The doctor agreed with Jim’s diagnosis and agreed to see Jim in the morning.

Tuesday morning, the doctor made a few calls and referred Jim to MD Anderson. Jim called his parents. They called him back and told their son that they had scheduled an appointment for him at Johns Hopkins on Thursday. Jim flew back to Dallas.

Because Jim was twenty-seven and knew he was going to live forever, Jim did not have a primary care physician. Early Wednesday morning, Jim walked into Medical City Dallas. The only thing Jim knew about Medical City was that it was the hospital closest to his apartment.

He went to the front desk and told the receptionist he had cancer and he needed to see a cancer doctor. He would have said he needed to see and oncologist, but he did not know cancer doctors were called oncologists. That was because, as we already learned, Jim was twenty-seven, and Jim was going to live forever.

Late Wednesday afternoon, the cancer doctor examined Jim. Jim was scheduled for an MRI on Thursday. Jim, thinking he might have cancer, was a little nervous. He received an MRI and told the radiologist that he wanted to wait until the doctor told him if he had cancer. The radiologist told him that that was not possible. Jim was very worried.

The doctor told Jim to return on Thursday for a small needle aspiration because the MRI showed there was an abnormality in his right lung.  Jim again told the oncologist that he wanted to wait to learn if he had cancer. Again, the doctor told Jim that was not possible.

Jim called the doctor several times on Friday, and all day Saturday. Jim was very worried. Somebody whom Jim did not know told him there wasn’t anyone who could help him. On Sunday Jim went to Medical City and asked to see a doctor. Any doctor. The gift shop was open.  He was told that maybe somebody could help him on Monday.

He drove home, disappointed and worried.

Jim had waited seven days. By day seven, Jim was no longer certain he would live forever. On Monday, the cancer doctor told him to come to his office. Jim met with the doctor and he was told he had testicular cancer.

Jim would have preferred not to have spent his weekend wondering if he was going to live or die. In case you did not figure it out, I am Jim.

Thank God it was Monday, thought Jim.  For the 99% of the US population who will not be sleeping tonight in the hospital, healthcare is closed after five p.m. on weekdays, and all day on Saturday and Sunday–unless, of course, you go to CVS.

Every time I open my eyes I get more confused.  Yesterday, in a grocery store, I saw eleven magazines who’s front page featured an article about what is going on between Brad and Angelina.  Those that differed featured Kim Kardashian.  And what troubles me the most is that the people who are fascinated by Brad and Angelina and Kim are still covered by the part of the constitution that specifies one man, one vote.

(To be transparent, I asked someone, whose opinion I respect, about whether I should include a few other paragraphs in this post. We exchanged opinions about free speech, and I think we each reached the same conclusion—the benefits of free speech are applied much more liberally, and with more discretion, to the one doing the reading than to the person doing the writing. As such, I deleted those paragraphs. I tried learning how to paste the paragraphs using redacted text, but that made the post look too much like the copies of Hillary’s emails that the FBI made available to Congress. Whoops, I just vaulted over the free-speech barrier again, didn’t I?)

I am confused, but then, that is my normal state.  I have no answers for life’s big unanswered questions. I wonder, can Big Bird can fly, and why it is that SpongeBob SquarePants’s, who lives in the sea, Krabby Patties never get wet?

I have two dogs.  When I ask them if they want to go outside, they dash out of the open door like their tails are on fire.  They know, and I know, that they do not know why they are in such a hurry to be outside, they just are.  I think they expect that something wonderful awaits.  Expectations, especially those without a foundation constructed from reality, are seldom met.

Healthcare is fraught with unmet expectations. If I call your health system, I expect someone to answer the phone.  If someone answers the phone, I expect that they will be able to help me address whatever I need.  If I call at noon, I expect that someone will answer the phone instead of making me listen to a recorded message stating that everyone is at lunch. If I ask to speak with a clinician, I expect to be able to speak with a clinician, not a recording that tells me how important my call is and that someone will respond to my message in two to three days.  If I call at 8 p.m., I expect to be able to speak with someone, not to hear a recording that says, “You should have called Comcast; their call center is open until 11 and on weekends, and if you subscribe to HBO, they will schedule an appointment with you physician.

And then there are your websites.  When I go to your website, I go there for a reason.  I have never gone to a provider’s website to read about the provider.  If I just wanted to read something, I could be reading about Brad and Angelina and Kim.  If I wanted to make a donation, I would have called Goodwill.  If I wanted to find a doctor, I could have used the Yellow Pages. If I wanted to pay my bill, I would have already paid it.

Every person, whether or not they are a patient, who tries to access your organization, and who wants to be engaged by an employee of your organization, does so with a predefined set of expectations.

Had anyone at your health system asked, they would know of those expectations. But they haven’t asked, and they won’t.  And perhaps that is why so many people would rather spend their idle moments catching up on Brad and Angelina and Kim.

In five years people will look back out how healthcare worked for patients in 2016, and they will wonder about two things:

• Why was it so archaic?
• What did it take so long to change?

There is a lot of talk about having care go from being hospital-centric to being patient-centric. There is also a lot of talk about people living on Mars, but nobody is counting on receiving emails from anyone on Mars very soon.

Everyone who has been a patient is in favor of a patient-centric care model. Many people would be happy to explain what a patient-centric care model should look like. Unfortunately, nobody with the ability to change the care model is listening.

One of the healthcare sectors that seems to be a couple of Freedom fires short of a Happy Meal when it comes to even making an effort to engage consumerism is the pharmaceutical industry. Did he just write that? Somebody has to say that the emperor is running around sans clothes. (If you don’t like what follows, you can run my blog through BeachBit.)

Big pharma. Big consumer problem; at least if big pharma is really interested in improving population health, accountable care, and star ratings.

Pharma looks busy, and they run a lot of ads. But running ads has nothing to do with consumerism even though consumers see those ads. They spend a lot on big data, and they probably learn enough from it to be able to say with a high degree of probability that some hypothetical person, based on a slew of factors (slew is not a medical term) is more likely than others to have a certain medical condition.

So, if you put a thousand hypothetical people in a room, and add the data that pharma has crunched, pharma may be able to state that 22.7% of those people are more likely to get, let’s say, heart disease than the other 77.3%. Do you know what they cannot say? They cannot point to you or me and say that you will get heart disease.

I used heart disease, because as many of you may recall, I have it. I do not write this to tell you about me, but to explain how an actual patient, me, looks at the healthcare consumerism role big pharma chooses not play. I had a heart attack in 2002. And every day since then I have taken six different medications to manage my heart disease.

I bet that almost every single patient dealing with some disease is in much the same boat as I am. I have no idea which pharmaceutical firm makes any of my six medications. I know the impact they have on me based on fourteen years of actual experience.

There is a side effect of one of my medications, Niaspan. The pages of 3-point text that come with my prescription states, it may cause flushing. That is the equivalent of saying that hurricane Katrina may cause rain. Flushing, for those of you who have never been flushed, is a polite way of saying that every inch of your body will feel like it is on fire.

So, when I look at what big pharma is doing about consumerism (insert population health, accountable care, patient-friendly) and compare it to what it could be doing, big pharma has to look up to just to see the bottom.

For further evidence, all you have to do is to look at any of their drug advertisements extolling you to talk to your doctor about using their drug. Pharma’s commercials remind me of the last few seconds of a car commercial, the part when the announcer speed reads the onerous terms of the car’s lease agreement. Pay no attention to the man behind the curtain.

Their ads are all the same; ten seconds of the Cleaver family having a picnic followed by twenty seconds warning you of the drug’s possible side effects overlaid with footage of Beaver and Wally playing badminton while June pulls pieces of perfectly fried chicken from the wicker picnic basket. The only thing missing from those ads is the same kind of warning from the Surgeon General that you see on a pack of cigarettes. “The most serious side effects may cause feelings of suicide.” (How’s that picnic look now? June, please pass the potato salad.)

Big pharma markets its drug to health systems—it will help your patients. It markets its drug to payers—you should cover the cost of this drug. It markets its drugs to the national pharmacy chains—you should carry this drug. It markets its drug to consumers—if you use our drug you can have a picnic.

In general, the only people managing their care are the people under care. Essentially, we are on our own. One you leave the hospital, they do not know how you are—unless, of course, you are readmitted. They payer does not know if the treatment for which they are paying was effective. The retail pharmacy does not even know if you are taking the drug they dispensed—over thirty percent of prescriptions are never picked up. And, big pharma does not even know that you exist—but they have a lot of data about hypothetical people like you.

Consumerism is on the threshold of working. The only thing it is missing is real consumers, you and me.

Big pharma could create a version of Facebook for the diseases their medications treat. They could design super-functional online, interactive, and cognitive health groups. They could employ social media, design thinking, and an aggregator of apps that collect, monitor, and assess patient data at an individual level to help patients manage their care and wellness.

They could. But, they aren’t.

If you think that healthcare is competitive now, tomorrow’s level of competition will make the Hunger Games look like a family outing or a Cleaver picnic.

Gone will be the phrase, “The doctor will see you now.”

It will be replaced by the phrase, “The patient will see you now.”

And when the patient does, wouldn’t both parties be served better if the patient had actually spent the time between their appointments doing all of the things they needed to do to manage their care? And wouldn’t be even better if big pharma or the provider or the payer or some national retail pharmacy chain was part of that process?

So, I’m driving to pick my daughter up at her friend’s house, a friend who lives nine miles away. I fire up the GPS on my T-Mobile; estimated drive time of seventeen minutes.

The route is mostly back roads, and as soon as I reach the backest of the back roads I am informed, “GPS signal lost.” After having my way with the recording, I continue to drive. And drive. And you know the rest. I head to places with higher elevations, find a signal, and am directed to roads that even I know have nothing to do with where I am headed. My route is again transferred to another, and so forth and so on.

I am talking to myself, and yelling at drivers who look like they know where they are going. Squirrels on the side of the road point at me, and double over in laughter—I hope they choke on their acorns. After an hour and two minutes, I arrive at the house, upon which my phone chirps, “You have arrived.” I started screaming epitaphs in front of the squirrels.

An hour and two minutes is four minutes longer than I spent the other day trying to schedule an appointment with a large east-coast health system. The person with whom I spoke the longest had a pulse equal to that of a hibernating bear and, had he been a household pet, he would have been put down purely for aesthetic reasons.

I find it helpful to trace everything back to a seminal point like just prior to when the random swirls of gases in the chartless universe got together and formed the earth; or not, depending on which side of the Darwin bed you sleep.

From the side on which I sleep, the seminal point for patient access can be traced to the phone. If the people manning your health system’s phones cannot meet the basic needs and solve the problems of its callers, very little else matters because the callers will call somebody else.

Hammers, like phones, are very evolved tools. They haven’t changed for years. And why would they change?  Nails haven’t changed.  Nails have been the same forever. Therefore a hammer’s necessary features were worked out long ago. A heavy metal head and a handle. All you need, and nothing you don’t. Phones are also very evolved tools. The primary difference between a hammer and a phone is that if you do not have capable people on both ends of the call, you would do just as well speaking to a hammer.