Can Healthcare Become User-Friendly?

[This post first appeared at on December 12, 2014.]

Healthcare is the most important, expensive, and complicated system most of us deal with in our lives. And it has an awful user interface and experience. Can, and will, the user experience be fixed in our lifetimes? Is doing so a business opportunity?

Here are the symptoms of healthcare user interface disease:

•  Medical customers struggle to get in touch with a providers. Appointments are mostly available months in the future during bankers’ hours, phone calls encounter IVR systems that would make the IRS blush, web sites are stuck in Internet 1.0, and electronic communication is strangely not available.

•  Medical people insist on using obfuscatory language for concepts that have perfectly good English words. Swelling is “edema” and pain is “discomfort”. This is pure tauran fecal matter.

•  The customer’s time has little value: e.g., medical office with a half dozen providers typically has a waiting room with at least 30 seats.

•  Cost to the customer is of small importance. Providers are usually unable to tell a medical customer what a service will cost before it is performed. They often refer to affiliates when options offering better value are visible: e.g., a doctor’s office referred a family member with classic UTI symptoms to the affiliated hospital emergency room ($1,000+ cost) despite a perfectly good urgent care option ($100 cost) three miles down the road. When asked about going to urgent care, they said, “Oh, yah, you could do that too.”

•  After treatment consumers receive impenetrable bills. As one entrepreneur put it, “An ‘Explanation of Benefits’ is anything but an explanation”.

•  Buying medical insurance is truly complicated, and about ten million people will do so this year from a web site developed by the U.S. Government, which is not known for user-friendly products.
•  People with medical needs (which is all people, eventually) are often treated with paternal condescension or objectified.

There is definitely a lot of customer pain here. What can be done about it? Actually, quite a bit.

The view from the Forbes Healthcare Summit. Photo (c) Todd Hixon 2014.

The view from the Forbes Healthcare Summit. Photo (c) Todd Hixon 2014.

The Forbes Healthcare Summit on Dec 4 did a great job of illuminating the future of U.S. healthcare in one day. Fixing the user interface was a common theme across many discussions, and collectively the featured initiatives covered a lot of the ground.

Tim Kelsey, the UK’s National Director for Patients & Information, reported that the UK will give every citizen real-time on-line access to medical records next spring, helping UK citizens take charge of their own health.

Jamie Heywood of PatientsLikeMe put the focus on value delivered for the medical customer. He points out that the healthcare system does not pay attention to whether or not the medical customer benefitted from a treatment, when all factors are considered. Rather it measures against clinical endpoints that often relate only partially to customer well-being. PatientsLikeMe connects 300,000 people to share their health data and personal experiences to achieve better holistic health.

Murray Aitken of IMS Health spoke about the advent of outcome-based payment: medical customers pay on the basis of the outcome achieved. This is an evolution of a big idea that the ACA has propelled forward: that providers should be payed for value delivered, measured in a variety of ways, rather than for procedures performed. The value-based approach aligns cost with customer value and makes it visible in advance.

Kevin Nazemi of Oscar Health Insurance described how Oscar puts a poweful, modern user interface on health insurance. 80% of Oscar customers provide health data so that Oscar can do the heavy lifting and recommend the best plan for them. Analysis of 2015 health plans on the public exchanges shows that consumers need to shop every year to get good value; HealthSherpa, another start-up, is building a TurboTax-like front end to the federal exchange that will enable customers to ease this process by automatically reusing previously-entered information and comparing plans.
Dena Bravata, CMO of CastLight Health, described how data empowers medical consumers to make better choices. “If you show [consumers] cost information alone, they usually choose in the middle, assuming low-cost options are low-quality. If you show the same cost data with clear and understandable quality info, [consumers] make different decisions and spend 14% less.”

John Sculley, a leading healthcare venture investor who earned his consumer marketing black belt as CEO of Pepsi and Apple, observed “healthcare has been slow to think about what’s in it for the consumer”. He believes that systematically improving the consumer experience while driving down cost could produce “the next Uber”. MDLive, in which Sculley is an investor, delivers a call-back from a primary care doctor, plus a great user experience and a local referral network for acute care, in less than ten minutes at a reasonable price. He sees similar opportunity in many areas of healthcare.

Caution is warranted here: the old ways still prevail in much of the healthcare system. But, consumerism is on the rise: close to 20 million Americans now have high-deductible health insurance which makes them responsible for the first $2 – $5 thousand of spending. Consumers buying the popular silver and bronze plans on the federal exchanges bear 30% to 40% of the cost of their healthcare. New distribution channels for healthcare like MDLive, Urgent Care, and drug store clinics make consumers aware that they have choices. Memes like “sitting is the new smoking” show that Americans are internalizing the idea that they are primarily responsible for their health. As more healthcare customers act like consumers, not like “patients”, providers that offer a poor user experience will suffer, and those that delight the customer will thrive.

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