Adapt to Stay Relevant

My last post laid out what I think will be the driving force behind the growth, adoption, and scaling of digital health services. It’s changing expectations from consumer and patients. These expectations have changed mostly because of consumer experiences outside of healthcare (education, banking, retail, etc.) There are also some generational and societal changes in expectations regarding convenience and access, as well as ownership and autonomy in decision making. As a society, we’re not quite as fond of paternalistic interactions as we used to be — we think we should have more of a say in decisions even if we don’t necessarily exercise that say. If you combine these changing expectations with services that are somewhat integrated with existing health delivery, we’ll start to see some of these digital health services scale.

Patients will come to expect easy access to data, resources, and clinicians. Providers and systems have to adapt to compete. If providers don’t adapt, they run the risk of losing market and mind share to other providers. What’s unique about healthcare is that there are a lot of turf wars and overlapping services that threaten providers.

Here’s an example to illustrate what I mean about turf wars. Primary care, depending on how you define it, can be delivered in different settings and by different health professionals — MDs, PAs, NPs, and several others. My point is not to debate who should ultimately be delivering care (as I know this can become a very lively debate) but it’s largely irrelevant because what providers think and what consumers think are not the same thing.

If consumers think they can access primary care at Walgreens, then they will. You can guarantee Walgreens will put considerable dollars to help create that thinking. Walgreens is a specific example, but you can replace it with other retail pharmacies or even some health systems that are establishing satellite centers. (As an aside, the confusion on the part of consumers about different types of health professionals is not made any less so by the fact that everybody in healthcare now wears a long white coat. Consumers can’t tell, appreciate, and/or understand the differences.)

Walgreens has 6,000+ locations, is worth something like $80 billion, has medicine (both OTC and Rx) readily available, gives vaccines, has pretty great mobile offerings (apps and SMS) for health, sells candy bars and lawn chairs, and now offers acute and chronic primary care and even some specialty services like travel medicine. As a consumer, that seems pretty damned appealing if I’m expecting convenience, which more and more people are coming to expect.

Contrast that to my experience with a traditional provider of calling to get an appointment, learning that the next available is next week, having to drive 20 minutes and not be able to find parking, getting a prescription that I then need to drive to Walgreens to pick up, and then having to deal with the billing department for the next month because my co-pay changed or they didn’t collect the right amount. But at least I have access to MyChart, right? Seriously, I need to want that level of care for reasons other than convenience.

But I do think health systems need to start assessing how far apart they are from what consumers increasingly expect and now are starting to see from other "providers" like Walgreens. Then systems and providers need to start planning on how to bridge some of the gap between expectations and reality. These alternatives access to care, many of which are much more convenient, are not going away, and fighting them through lobbying at the government level is not going to stop them either. I don’t think health systems can or should do it alone. Unfortunately health systems are not swimming in cash these days, so doing this while trying to meet Meaningful Use and move to ICD-10 is not an easy endeavor. I appreciate that challenge.

Health systems face a very similar challenge to what higher education faced (and still faces) from online educational platforms. In education, consumers can take college courses online for free and on their own time. There is no need to apply or move to be near a campus or even pay for courses. You don’t have to put your life on hold and go deeply into debt for an education, though you still do if you want to get the diploma. If you haven’t taken a course from Coursera or Udacity, you should. You won’t be alone, as thousands of people register for these courses, even though completion is low as a percentage of the total that start each course. And I’ve heard medical school, pre-clinical course content will soon be available on Khan Academy, so you can even learn how to translate some of that foreign terminology some doctors use in notes.

Higher education faced a challenge from these online offerings, which initially seemed largely competitive. Yet today, many of the larger and best-known educational institutions (Harvard, MIT, Stanford, etc.) have professors that offer classes through online platforms. The courses are clearly marked as being from a professor and from a university and advertise the same content and assignments as students who are formally enrolled at the universities. Many traditional, brick-and-mortar organizations have embraced this new way of learning, and I think the reason is that many large universities with big endowments have realized that these digital education platforms are not going away.

Online educational platforms can extend the reach and name of the universities and professors considerably. They still don’t really compete for the people who want to apply and enroll to take in-person degree programs. The universities keep their expensive and state-of-the art facilities but now are able to offer valuable content and resources beyond their four walls and gates. It’s a hybrid approach, but one that keeps the universities viable as the industry and consumer expectations change.

In healthcare, Mayo is good case study for this. Mayo operates large, beautiful, expensive campuses and employs big-name clinicians. But Mayo has also extended its reach using technology, both internally developed as well as through partners. Mayo offers its clinical content online, and I’ve noticed that Mayo has moved up considerably on search engine rankings over the last couple years. It’s now a clear alternative to sites like WebMD for patient education.

Additionally, Mayo has partnered with companies like mRemedy (now Axial Exchange), Preventice, and Better to extend its reach through partner apps and services. In its relationship with Better, Mayo offers Better app users telephone access to Mayo clinicians. This service is subscription based, almost a form of teleconcierge. The service is definitely not for everybody, but Mayo is offering what it thinks consumers are willing to access and pay for directly today. Mayo has effectively used its position and resources to change the way that consumers interact with it, meeting changing expectations of consumers. It’s securing its place in the digital health ecosystem. Mayo is different from most systems in terms of resources, and that’s why it’s able to be an early mover.

As a healthcare organization, the overwhelming difference and advantage over education, at least when it comes to competing with digital offerings, is that healthcare is local and will remain so. At the end of the day, degrees and certificates are a lot easier to give out online than shots, blood draws, or medical procedures. Maybe in some future state surgeries and procedures will be given remotely using robotic technology, but that’s not happening any time soon. Additionally, there is and will remain a large human component to healthcare, and large parts of the population will opt for in-person, higher touch healthcare.

Just as in education, consumers will self-select for different types of health services. Some people will prefer and choose convenience, cost, and access, even at the expense of quality. This may be in part because the quality of health service is not easily perceptible by consumers. Other consumers will self-select for quality and higher touch, be willing to put forth more effort to see a provider (wait times, parking, etc.), and be less sensitive to cost. This is the bucket of consumers that’s going to jump on the direct primary care bandwagon. 

Then, since everything is a spectrum these days, some people will want both types of care and base decisions largely on the specific situation. That’s why it’s imperative that systems offer different types of services, catering to both quality and convenience. Dr. Jayne has a great post from earlier this week related to this topic – quality vs. convenience in healthcare. Oh, and I think some people won’t have much of a choice at all, and likely be driven to the lowest cost options the majority of the time, only getting pushed to higher cost options, which they can’t afford, when something catastrophic happens.

The best future for healthcare is one in which healthcare organizations embrace and integrate with digital health, in the process helping to meet consumer expectations and to scale digital health adoption. Health systems continue to offer the same in-person experience, or ideally an improved version of the current in-person experience, while augmenting that with digital health offerings (apps, messaging, patient reporting, virtual visits, online scheduling, etc.) The idea is to go hybrid and find a way to co-exist with new and emerging digital health tools and changing consumer expectations and find a way to stay viable.

There is of course the possibility that some health systems, and probably more accurately some providers, will not embrace convenient care because of questions of quality of the care that can be delivered in satellite clinics or using telemedicine. That seems shortsighted. What do you think?



Travis Good is an MD/MBA involved with health IT startups. More about me.

  • Mobile Man

    GREAT take.

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