Healthcare Consumerism: Ask Betty

I was awoken by a strobe of orange light flashing through my bedroom windows.  I peeked outside and saw a human caravan making their way to my backyard.  By the time I had dressed and made my way out the door one my deck, I saw two men hammering wood stakes into the wet ground, and a woman stringing what looked like crime-scene tape around those stakes.  A half-dozen other people were clustered on my property, talking on cell phones, and writing on clipboards.  A lone woman was collecting water samples in test tubes.

My yard was sodden from the recent rains. As I approached the group, a guy built like a Navy Seal approached me and asked, “Where do you think you are going, Skippy?”

“Why is everyone in my backyard and standing around my puddle?” I asked.

“It was your puddle, now it’s a wetland.  Go back inside voluntarily,” he said as he reached for what looked like a Taser.

To my left was another puddle, one they had yet to rope-off.  I flopped onto my back and started moving my arms and legs.  His Taser was now pointed at my head.  “What are you doing? He screamed.

“Making wetland angels,” I replied.  “Bu the way, I think I may have just been bitten by a rare, yellow-bellied newt.”

Our world is changing faster than I can yell tree-sloth, and I didn’t even get the email.

Several of you wrote asking me to give an example of the differences between a well-functioning call center and the scheduling centers found in most health systems.  This may help.

To help explain it, I met with James and Betty.  James works for your scheduling center; you’ve probably seen him in the cafeteria—tall, lanky…parts his hair on the left.  Betty works for Nordstrom.  I asked both of them to tell us what their job is like and what they do during their shift.

James began. “My job reminds me of one of those people I’ve seen at a driving range,” he said.  “If you’ve ever hit balls at a driving range, you may have seen a person driving around the range in what looks like a metal birdcage.  It looks like a wheeled metal box wrapped in wire, and it is pulling a long, rubber-grooved cylinder.  The grooves pick up the driving range balls, and they are dropped into a collection basket.”

“I’ve seen those when I golf,” I said.  “Everyone tries to hit the cart with their shots.”

“Exactly.  That is what it feels like answering calls at the scheduling center.  Everyone is shooting at me and I just must sit there and take it.  I bet you didn’t know that only about twenty percent of the calls I answer are from someone trying to schedule an appointment.”

“What do you do with the rest of the calls?”

“Sometimes I try to answer them, but I don’t have any of the tools or information I need.  So, I either tell them to call another number—that may or may not be the right number—or I transfer the caller to someone who may or may not be able to answer their call correctly.  Sometimes I find myself giving basic medical advice.”

“Don’t you have a nurse who can help them?”

“You’re kidding, right?  Heck, we don’t even have a decent enough scheduling system to help me to do my job.  I am only able to schedule sixty percent of the people who need an appointment.”

That was James. Betty’s response was just as interesting.

“Have you ever been to a big city park where they have dozens of chessboards set up?” I nodded affirmatively.  “Well, sometimes a master chess player will play dozens of games simultaneously, the master against all of the others.  That is what my job at Nordstrom’s call center feels like.  No two questions are the same, and I am expected to give the right answer to every caller the first time, every time.  But I have a CRM system that lets me provide the answer to every question.”

“So, let’s say I call you about a problem I had with a suit I purchased and had tailored at one of your Seattle stores.  Could you help me with that even though I live in Philly?”  I heard her enter my phone number into her system.

“The one you bought June 3rd, the Ted Baker pinstriped?  I see you called once before.  It looks like the alterations to the pants were incorrect, and they applied a credit to your account.  You shipped it back to be re-altered on the 11th.  The alterations were finished on the 23rd.”

“I still have not received it.”  More keyboard clicks.  “It shipped yesterday, overnight, along with a tie picked out by your personal shopper; no charge for the tie.  May I help you with anything else?”

There is a world of difference between what a health system’s call center can do and what a real call center can do.

After speaking with Betty I remembered that I was supposed to have scheduled my MRI yesterday.

What should I do?  What would you do?  I placed a call.  “Betty, there is one more thing you can help me with…”


“Your Insurance Policy Does Not Cover Ponies”

During my run, today I started thinking about the call I had with my healthcare insurance provider. It was not a pleasant experience.  The more I thought about the call, the more confused I became.

The payer, having no idea who was calling, asked me for my member number.  The term ‘member’, I think, is used to make us feel like we are being fawned over.  I thought about other organizations of which I was a member.  I was a member of the boy scouts. I belong to a gym; I am one of their members.  Being a member implies being a part of something bigger than myself.  It implies a sense of belonging, a sense of clubbiness, a sense of intimacy.

Sometimes it requires a payment—dues.  Having health insurance requires paying dues, but that is the only common thread of membership.  There is no clubbiness.  You become a member of an organization, you pay dues to that organization because you get something in return for those dues.  You get what you pay for.  Not only that, you get what you think you paid for.  There are no surprises.

At my gym, the attendant never tells me that my membership only entitles me to use the treadmill for thirty minutes.  I have never been told that page 37, paragraph 4, of my member agreement clearly states that I am not allowed to use the sauna.

The problem between me and my payer, and you and yours, comes down to a single point.  I want to accomplish one thing, and my payer wants to accomplish something totally different.  Even if my payer wanted to meet my needs, their customer experience strategy was not designed to meet them.

Their entire customer experience strategy is designed to do two, and only two things:

  • Maximize receivables
  • Minimize payables

Customer experience via their call center allows you to:

  • Buy a policy (a membership)
  • Make a payment
  • Add a family member
  • Update your personal information
  • File a claim
  • Try to dispute a claim—you can dispute it all you want, but this is a zero-sum game
  • Try to cancel your policy—the system is designed to make this very difficult

Online, your number of options are fewer.  Those options are designed to bring cash in, not to let it out.

I would not mind paying my dues if I knew that in doing so my payer would meet my expectations.  Like you, I have learned that the best a payer will do is meet a portion of our expectations. Your membership does not allow you to use the sauna.

There is no opportunity to use my membership to proactively manage my health and to drive my wellness.  In addition to maximizing receivables and minimizing payables, the entire payer business is designed to focus on what was—a treatment or a procedure.  It is all about cash flow.  Payers know nothing about the efficacy of your treatment or procedure.  They know nothing about your current health and the health you want to achieve.

Payers spend millions on big data.  They spend millions more analyzing that data.  Those millions tell them who and what to exclude.  They have a zillion data points about broad groups of people and zero data points about the current health of an individual.

People, members, want to be healthy and to stay healthy.  They want to be connected.

People want payers to know who they are and how they are.  It’s no more effective than a five-year-old wanting a pony.  Page 37, paragraph 4, of your insurance policy states, “your membership does not include ponies”.

Why Is Healthcare Trying To Sell Socks?

There are 1,541,335 people in the US named Paul.  Four thousand and thirty-five people are surnamed Roemer.  And there are twenty-one people named Paul Roemer.  Among those are a PhD economist, a basketball player, a few doctors, and a male model—and no, I am not the model.

All the Pauls are different, as are the Roemers, and the Paul Roemers.

What could someone who had something to sell market and sell specifically to the Pauls and the Roemers and the Paul Roemers?  They could sell a keychain with the name Paul attached to the fob.  And a nameplate for a desk to the twenty-one Paul Roemers.  And a headstone to the same twenty-one people.

There is nothing else they could market and sell if their intent was to sell a product or service targeting those specific groups of individuals.  The Wall Street Journal would not create a marketing campaign targeting the unique characteristics of the Pauls.  Ralph Lauren would not create a clothing line specific to the type of casual wear favored by the group referred to as the Pauls.

And I had a think.  I thought about marketing and selling and healthcare.

But if you think about the marketing campaigns of providers and payers and big pharma, their whole approach to marketing and selling is to sell to the Pauls–not to Paul.

Healthcare markets in one of two ways.  It markets to everyone, or it markets to specific groups of individuals.  It markets to prospective patients as though they were all gathered in a stadium.

A healthcare provider tells everyone listening to NPR about its unique cardiology treatment.  A payer runs a thirty-second ad about its coverage for cardiac patients.  And the pharmaceutical firm places an ad in People magazine extolling the wonders of its new Beta-blocker.

These campaigns fail first because they approach millions of cardiology patients, or any other group of patients, as a ubiquitous group—the Pauls.

The second reason it fails is because their entire approach is to purchase patients’ attention.  Healthcare’s approach is to market information.  Their strategy is outbound marketing—marketing information.  Outbound telemarketing is one example.

Patients and members want value, not information.  They want connected marketing and connected interactions.

While your organization is marketing to the masses, or even to a specific subset of individuals, patients, and members want you to connect with them—a specific Paul, not all the Pauls.  Elderly people are not all the same.  Nor are cancer patients or children.

While you are marketing to a stadium of people, the people in that stadium are interacting with you as individuals. There is only one caller on each call.  There is only one person at their computer or smart device looking at your website.  The same holds true for patient portals.  One patient portal does not fit everyone.

I want you to know me.  Healthcare does not know me.

The world has gone digital.  Healthcare has not.  In the digital world, individual patients go find what they need.  This requires healthcare to change how it approaches and interacts with people.  It requires inbound marketing.

Provider and payer call centers approach callers as though every caller is the same.

Payer and provider websites do the same thing.  One size fits all.  While that may work it you are selling socks, it does not work if you are trying to acquire patients and members, retain them, and manage their health.

Healthcare must change its strategy to be effective at consumerism and access and engagement.  Otherwise, you are just selling socks.

Healthcare Payer Business Model–The Grinch Who Stole Christmas

Karen, a good friend, dropped by this weekend.  She brought croissants and her Scottish terrier, I guess thinking we would eat one of the two.  The dog bared its teeth and growled at me, which made me divert my gaze to the croissant.  Fortunately for me, on the danger scale, terriers fall somewhere between guppies and sunflower seeds.  Karen has the fashion sense of an accordionist in a polka band.  One might argue, as she did, that I didn’t have the right to criticize her sartorial spender as I was dressed in bellbottom pants and was sporting a Puka shell necklace.

We talked politics.  When we do, it is a veritable Tennessee Williams play, akin to playing Twister on the edge of a cliff.  Our time together would have been more enjoyable had we simply agreed to listen to an eight-track tape of Abba. Ours was not a conversation for the junior varsity.  With or without the use of automatic weapons, to hold my own I had to step up my game with her.  Karen has always had a mind of her own—it’s how she uses it that keeps me awake at night.  Sometimes I feel as though our combined intellect could not solve the TV Guide crossword puzzle.

She was a Hillary acolyte and someone whose mission in life was wondering why Gilligan never left the island.  I however, was from the dark side and content to solve the world’s problems from the comfort of my Barcalounger.  I launched into defending my political position with as much trepidation as a middle school geography teacher trying to find Burma on a dated classroom map.  I would have had an easier time defending my position had I been trying to squeeze a hippo through a clarinet.

I tend to stand out even in a crowd of one.  Some people who know me think that I am the type of guy who might just walk into a Seven-Eleven and lose it just because the Slurpee machine wasn’t working.  That’s not true, unless, of course it was the blue Slurpee pump that was on the fritz.

Trump supporters.  When I speak of this, I speak in parenthesis to ensure I am not overheard.  Wondering what to do, I looked it up online. WWTDD—what would Tyler Durden Do? (The Fight Club).   The first rule of the Fight Club is that you don’t talk about the Fight Club.  The first rule of post-election politics is that you don’t tell anyone for whom you voted. I was disappointed to learn that there were no links on Google about anyone offering asylum to Trump supporters.

Being a Trump supporter is analogous to having a dirty secret.  While my friends and neighbors shared their political opinions incessantly prior to the election, everyone who had opined has gone into seclusion.  People get that way when the conservatism cat gets out of the bag; but I’m a dog person.

I grew up in Baltimore—70 miles from where I live as the crow flies; 90 miles if the crow were driving a pickup. My wife and I were supposed to be on our way to Baltimore but we were running late because one of us takes too long to put on our makeup and the other one of us gets impatient and threatens to leave.  This is when one of us decides to send the other one of us to a reeducation camp.  As someone who prides himself in knowing which way the wind is blowing, I changed out of my Brooks Brothers suit and dressed in rags and Birkenstocks.

So now you know how I spent the holiday.  I don’t have a segue, so let’s dive into this post and then you can get back to whatever it was you were doing.

The Wall Street Journal had an article about a drug that helps reduce the urge to smoke—Chantix.  The article wasn’t really about Chantix.  Rather, it focused on the fact that payers do not cover prescriptions for Chantix.

Healthcare just gets curiouser and curiouser.  If you’ve never smoked, smoke a pack a day for a month, try to quit, and then return to reading this post. Literature suggests it is easier to quit using heroin than to quit smoking.  I used to smoke.  I tried everything imaginable to quit. I even went to a hypnotist hoping that would help me quit smoking.  And the hypnosis worked.  Until I got in my car and immediately lit a cigarette.  (However, now, every time I hear my trigger word, “consumerism”, I stop whatever I’m doing and I launch into my version of Rosalind Russell singing Everything’s Coming Up Roses from the Broadway musical Gypsy.  It could have been worse. I could have been hypnotized to say the line from Silence of the Lambs, “It rubs the lotion on its skin; it does whatever it’s told.”)

I digressed.  So, I took Chantix, and I stopped smoking.

The WSJ article about why payers would not cover the cost of Chantix confused me.  After all, not smoking is a good thing.  Right?  Because not smoking would prevent several other illnesses.  A, implies B.  but that is not how payers look at the issue.  While they may be interested in preventing members from smoking, they have no financial interest in the fact that A leads to B for smokers.

When payers do the math, they know that some percentage of smokers are well on their way to B—contracting smoking-related diseases.  Smoking-related diseases that are expensive to treat.  Smoking-related diseases that do not count as pre-existing conditions.

Their logic makes financial sense to them.  We know smokers will cost us more in the long run.  So, if we cover Chantix, we are still stuck with paying for the diseases those smokers will incur once they quit smoking.  If we don’t cover smokers, we pay out less.

The payer care model for smokers seems to parallel Dickens’s line from A Christmas Carol—“Let them die and decrease the surplus population.”

Payers’ advertising buries that fact.  Their advertising continues to show healthy people picnicking and hang-gliding.  To be accurate, their commercials should depict a black and white clip of Alistair Sims explaining to the two men collecting charitable contributions, let them die and decease the surplus population.  Chantix only stops a percentage of smokers from smoking.  The let them die model is much more effective if your firm is responsible for paying smokers’ medical claims.

Once smokers die, the payers’ out-of-pocket costs are zero.

Healthcare Payers: To Pay Or Not To Pay

The gimlet-eyed woman sitting next to me on the flight looked like she probably knew ten ways to kill me using sesame seeds. She had precisely aligned, glimmering white teeth that indicated either magnificent genetic breeding or a wonderfully talented family dentist.

She asked. “What makes consultants different from the rest of the world?” I winked at her and said, “My one great accomplishment is that I once got elected treasurer of my third-grade class.  Unfortunately, my triumph was short-lived, since the election got overturned by the principal as soon as he learned I had a D in recess.  I don’t mention the second part to too many people. I just let them keep thinking that I served out my term with honor and distinction.”

Consultants, I told her, are the people in the movie theaters rooting for the iceberg instead of the Titanic.  “It helps if you know how to make rocks cry and can teach a dog to meow,” I said.  She gave me a look that seemed to indicate that if it were up to her, she’d save a special place for me in the guillotine line when the revolution went down.

In addition to all of our presumed flaws, some consultants are sycophantic enough to suck the bark off of a tree. Consulting even lets in a few Republicans now. Not in great numbers, certainly, but the odd token here and there.

Junior consultants can be a little paranoid.  The problem with paranoia is that it sneaks up on you. You start by wondering why the guy next door didn’t invite you to his barbecue.  Then you’re convinced the whole neighborhood’s in on the conspiracy.  Then you’re passing out literature about the Trilateral Commission.  Then before you know it, that same neighbor is telling a CNN reporter that there’s a guy on a rooftop with a high-powered rifle.

Some people dream of having Bill Gates’s money, not just his looks.  Consulting firms dream of making that kind of money.  A lot of them make money working with payers.  Big money.

One way they make all of that money is by helping providers save money.  The way they do that is by helping payers not pay a nickel more that they are obligated to pay their members.  Members like you and me.

It is easy to sell consulting if what you are offering is a way to save your clients money.  For payers, claims show up on their balance sheets as liabilities, the same way deposits show up as liabilities for banks.  If you are a payer, anything you can do to minimize your liabilities sounds like it ought to be a good thing.  Pay less, earn more.

It’s simple math, unless of course paying less causes members to leave, then the simple math gets very expensive.  The value of payers, like many other services firms, can be calculated based on the average value of its members times the number of its members plus free cash flow.

Reduce the number of members, and the cash flow (premiums) contributed by those members and their value decreases.

What if instead of a strategy that minimized payments of claims, payers decided to maximize them?  That would yield more members and more members paying their premiums.

It’s a simple strategy and a strategy not used by any of the firms.

Healthcare: If Everything Else Fails, Eat A Slim-Jim

I don’t play well in public.

Contrary to what you may believe, I do not have special powers of perception. Like you, I’m just a customer and a patient. However, I have a very short fuse when it comes to confronting stupidity.

Most people walk into a store, do what they need to do, and leave. I walk into a store and the consultant in me wants to start fixing things. I want to speak to the manager and ask him or her why they do some of the things they do.

Why have fifteen cash registers at Wegmans and only have three cashiers? Why does TSA have different security procedures at every airport?

I bought gas today. I parked my car between two pumping stations that were set ten feet apart. A built-in receptacle for depositing lit cigarettes stood a few feet from me. A structural metal pole stood midway between the two pumps. Attached to the pole was a metal box. Inside the box was a fire extinguisher. The box required a key in order to get to the fire extinguisher. (Do you see where this is headed?)

I’ve never worked at a gas station, nor have I been a fireman. Nonetheless, the stupidity wheels in my head started screaming at me. In an effort to temper myself, I looked around the complex and thought, if a fire was to break out, where would it happen? After a millisecond of thinking, I was able to eliminate all of the other places except for where I was standing. The minimart seemed pretty fireproof. The place where people pumped air into their tires looked like there was nothing to cause a conflagration.

And then it hit me. I was standing at ground zero. A very large tank below the ground held thousands of gallons of gasoline. That tank was connected to hoses whose only purpose is to move gasoline from the tank and out of those hoses as quickly as possible. Gasoline burns. Then bad things happen.

So, what would happen if there were a fire at one of the two gas pumps? There would be flames. Big flames. And it would be the job of Mr. Minimart, let’s call him Skippy, to put out the fire. Skippy, seated behind the minimart’s counter, would put down his copy of his Cliff Notes magazine, How to be an International Diplomat, and he would say to himself, I must do something. I should get the fire extinguisher and put out the fire.

And if Skippy is not a mouth breather—one of the fish NPR claims walked from the ocean, Skippy would remember that he locked fire extinguisher in the box—say it with me—that is located smack dab in the middle of the inferno. Skippy is out of options. From the minimart, Skippy calls the fire department and starts eating a Slim-Jim.

Stupid ideas have consequences. Every business is chocked full of stupid ideas that yield dumb processes that were made by people who never considered the consequences of their ideas.

Healthcare is not immune to dumb ideas.

“People call us. So, let’s build a big room and buy a bunch of phones so we can talk to them. If too many people have to be placed on hold, tell our people to talk less, and then they can talk to more people. And let’s buy some philodendrons and place them in the big room.”

“Should we give our people free coffee?” Asked the assistant vice president.

“I just gave them plants,” she replied. “Come to think of it, get them plastic plants. That way we can market ourselves as ‘going green’, by not having to water them.”

Dumb ideas.

Many health systems and payers have executives whose singular responsibility is to drive innovation. The results of the recent election should have a lot of healthcare executives wishing that they had written their strategic plan on an Etch-A-Sketch. Make healthcare great again is going to change the dogma of every aspect of healthcare. It is certainly going to shake up the Veterans Administration.

To be effective, the chief innovation officer should set aside a day and talk to patients and caregivers and family members of patients and referring physicians and prospective patients and ask them two questions:

  • What can we do to help people manage their health
  • What can we do to help people do business with us

And then he or she should go back to his or her office—I used both pronouns to try to be politically correct—and that person should rethink the definition of innovation. It is not about providing valet parking. It does not include serving Starbucks in the hospital’s fifty million dollar lobby. And innovation does not include free Internet.

What it requires is upping your game. It requires letting people do what they want, every time they want to do it, whenever they want to do it and using whatever device they want to use. And the vast majority of them want to do it without having to call you.

If that makes you uncomfortable, grab a Slim-Jim, and watch what your competitors are doing.

Healthcare: All And All It’s Just Another Brick In The Wall

It occurred to me while evaluating the contributions a select group of savants gave us over the last few hundred years, that the number of savants, at least in specific areas, has hit the innovation and transformative wall.

Classical music had Beethoven, Mozart, and Tchaikovsky. Art had Rembrandt, Picasso, and Van Gogh.

Rock and roll had the Rolling Stones, the Beatles, Led Zeppelin. Some would argue (include me in that group), that music post-1974 hit Another Brick In The Wall—Pink Floyd (I was the first kid on my block to buy everything and anything released by Pink Floyd, Genesis, and Queen). Those of you in the skinny jeans crowd may have to Google those bands.

So, back to the premise that Cream rises to the top (White Room–, and since then nobody has delivered anything that surpasses what happened many years ago. We are mired in the brilliance of what was.

Nobody’s playlist includes a classical piece of music composed in the last one hundred years. With the exclusion of Andrew Wyeth, nobody can name a painter whose paintings sell for millions of dollars.

Innovation hit a wall. And since no one is light years ahead of being mediocre, mediocrity looks pretty good to your board of directors. In business, The Pursuit of Excellence has a new standard bearer—In pursuit of mediocrity. We are no worse than every other firm. Define low expectations, and meet them. And then move on to your next challenge. Mediocrity is okay as long as all of the other firms are mediocre. You may be looking up at the bottom, but if all of the other firms are equally poor, being no worse than them is not a disadvantage.

Unless you consider your customers. Your patients. In healthcare, the people whose care your firm is supposed to be managing are looking for the next Mozart while your board is humming the latest hit from Lady Gaga.

Innovation and transformation are not defined as kicking it up a notch; going from mediocre to mediocre plus one. Giving the people in your call centers a cutting edge Bluetooth headset and adding skylights and free coffee is not innovative. Changing the font of your website and changing its color scheme to cerulean blue does not help you acquire patients or retain them. It does not improve care.

Lipstick on a pig.

But if you could get the pig to provide a remarkable experience for every person, every time, at any time, and on any device, you may have something.

Until then, download a copy of Pink Floyd’s Dark Side of The Moon, buy a poster of Van Gogh’s Sunflowers, and hope the stars align with your firm’s business strategy. If that doesn’t work, buy your favorite shade of lipstick, find a pig, cross your fingers, and hope for the best.