Health care’s Cyber Monday

It has happened. For the first time, consumers are purchasing more online than in stores. Even Black Friday 2016, with its emphasis on traditional shopping, saw more people buying online than in stores (44 percent compared to 40 percent). Mobile phone sales on Cyber Monday, at $1.07 billion, were up 34 percent over last year, and Cyber Monday sales exceeded Black Friday sales, according to Adobe Digital. Personally, I would rather chew off my right pinkie than visit a mall anytime, leave aside on Black Friday, but I did shop online taking two minutes, and without moving from my desk.

The traditional consumer-shopping world is changing at light speed, and this dramatic sea change is turning shopping malls inside out, literally and figuratively. In the process, Amazon has eaten the collective lunches of Macy’s, Penny’s, Kohl’s, and even Wal-Mart.

By way of example, Amazon offers a purchasing experience that makes use by smartphone an obvious choice for millennials, who must be served if businesses are to survive the next two decades. Online price shopping is quick and incredibly convenient. Returns are easy. What’s not to like in this age of little spare time?

Consequently, brick and mortar stores are like deer in headlights, reminiscent of companies such as Blockbuster, Kodak and Xerox, which fell prey to disruptive technologies, products and trends. The smart money is not investing in malls these days. As an article in the Digital Insurer noted: “Companies today have two choices: evolve with technology or go extinct.”

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So how does this relate to health care? For years, we have tried to keep commerce away from medicine, with the misguided thought that we were protecting the autonomy of physicians. What we really did was to create a system that today rewards waste and makes it incredibly difficult for diligent physicians to deliver top-flight care.

Normal, healthy competition is absent in health care and the health care industry has withstood consumerism with remarkable resilience over the years. Despite demands for transparency, the industry still holds secret such consumer-needed information as price and quality, making it nearly impossible to shop intelligently for health care.

But consumer demand will, sooner than later, recast the basis for success in health care from reputation and referrals to price, quality and outcomes (value).

Michael Porter, of the Harvard Business School, correctly defines “value” as “… the health outcomes achieved that matter to patients relative to the cost of achieving those outcomes.”

As an aside, quality of care is not a value. It’s a means to achieve value. We patients don’t much care about whether the care meets certain quality standards. We care about our outcomes. Quality of care is provider-centric; outcomes are patient-centric.

And what about convenience, which certainly is a value that matters to us? The CEO of the American Medical Association, at the AMA’s annual meeting last year, used the term “digital snake oil” when referring to consumer-friendly health care apps and technology that to some extent might obviate the need for office visits. While some apps indeed are not helpful, what was most troubling was the evidenced paternalistic attitude regarding the need for physician control over all things health care and the disregard for patient control and convenience. Today, consumers are increasingly demanding control over their own lives via technology. That is the way of it, and it will only intensify.

While there are noteworthy exceptions, most office visits are the epitome of patient inconvenience. Office visits often take four hours out of a busy working-mother’s day. What do they experience in exchange (after a brutal fight for parking)? Too often, a long wait beyond the scheduled appointment times in reception rooms, with outdated WebMD magazines and all the charm of a Spec 4’s Army office.

And this after filling out, yes by longhand on a clipboard yet one more time, personal-history information. Then what? Five to 10 minutes with an MD who is rushed beyond belief, spending the first half of the visit just being filled in by the nurse assistant. Suddenly, you’re out the door having wondered what just happened and having forgotten to ask questions you needed to ask.

Is it realistic to think that in 10 years, office visits will remain the consumer-unfriendly, in-person experiences that they are today? Just as retail shopping has gone digital, office visits will and must change dramatically to satisfy consumer demand for speed, convenience, cost and quality demands. I submit that the future will not permit health care to avoid retail competition.

To win in this future, health care providers will have to offer more of what consumers demand, such as demonstrably (provable) higher quality; reasonable (and published) prices reflecting that quality; personalized and convenient services; and more digital, rather than face-to-face, transactions. We don’t want to keep filling out personal-health histories longhand. We don’t want to invest four hours for a 15-minute visit. There are apps and digital equipment that can collect the vitals, such as weight, blood pressure and glucose-testing results. Skype or its successor will enable face-to-face, highly convenient sessions.

In summary, I am concerned that many of today’s health care providers will be left behind if they do not start to adapt to what will be, all too suddenly for them, an enormous wave of digital and convenience demand in health care. •

James E. Purcell is the former CEO of Blue Cross & Blue Shield of Rhode Island. He is also an attorney and operates a national consulting practice on workplace wellness.

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