#AIS: The Lanby's Tandice Urban on solving healthcare's customer service problem
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man. We open sort to the fans and got. Please welcome tennis.

Hi everyone.

So what I want to talk about today is the problem that i'm obsessed with, which is bad customer service and health care. So i'd like to start out by walking you through um a day, the doctor's office can look a little bit like this. You to start out by making appointment.

So you call in, you talk to someone very unpleasant on the phone. They put you on hold. You wait.

There's about whole music. You're waiting. You're waiting. They come back. You go back and forth a little bit on your calendars. You got an appointment.

It's in twenty one days now, it's twenty one days later. You go to the doctor's office, someone very unpleasant checks you in at the front deck. You sit down.

Super depressing waiting room, bad wallet, very old issues. Apparently magazine smells at pure in there. That's fine.

This is your hang out for a little bit now and now it's maybe thirty or forty minutes later someone calls you back as you may have guess, they're very unpleasant. They take you back to the exam rooms, very small blood forest and lighting everywhere. Um they take your vitals, they hand you essentially a shoot of printer paper.

They tell you to change into this now you're in sort of a secondary holding chAmber except this time you can hear the doctor and the other room and they're saying, hey, it's so great to see you and so you know, they're just getting started in there even though your appointment was an hour ago. At this point, pull up your phone, you start to go through your little question list, got up the courage to to ask everything you came in to ask. And then finally the doctor knocks, like he could possibly still be changing.

He comes in, does a little small talk with you. He goes and sits down, starts asking using questions, or maybe like eight minutes into the appoint. And at this point you're like, okay, also I have some questions and you put up your little questionless on your phone and you get through maybe like two or three of these questions and then the doctor started to to give you a look like let's SRAM this up um and so you wrap IT up, you ask three questions.

The appointment is over, you go outside, you check out if you're lucky, they will tell you how much. Oh, if not, you will just find out later in the mail. Um so my guess is that maybe many of you in this audience have concerns after, but most of us have had some iteration of this experience at some point.

There are a lot of terrible things about our health care system, but the one I want to complain about specifically today is why the customer service at the point at which are actually consuming the health care is so appalling ly bad. And when I refer to customer service that that anything that touches the patient experience, why why you're going to the doctor. So a long way time is as much um bad customer service as the unfriendly front test person.

There's this really great quote that I love from billed girly prolific investor and my relationship poll pass didn't know he was going to be here. The U. S.

Health care market is leased customer centers of any customer service industry. We are so long to the pain that we rarely object or complain. So that's part of what I think is so crazy about this is that we kind of just take IT. Um and so that got me curies to floor three questions I want to go through through with you here today.

Number one, why are things so bad? How did they get this way? Number two, why should we care that things are so bad? And number three, what can we do about IT? What's little something we can do to make a Better? So let's start with wire things so bad um a bit.

Part of this is our customer service problem is really more of a consumer service problem. And what I mean by that is patients are consuming the health care, but they are not exactly the customer in the traditional free market sense of the term. So who is um the U S.

Health care system, as we know, is an employer sponsored model. Um this was not very well thought out. It's more of the world war two relic that was came from a national Mandated wage fees in one thousand nine hundred forty two.

And we kind of just kept going with IT. And now today, the doctor is not getting out of bed in the morning for your fifteen dollar or copy. They're really making their money off of the major stakeholders in the industry who are the employer and the insurance companies.

They are the payers. They're the real customers in the story. And doctors don't love this either. By the way, there's major burnout in the medical community.

Um but when you play this all the way out, you're left with missile incentives between physicians and patients. Physicians in the traditional fee F A service model, which is our predominant del today where a physic are paid per patient encounter. Um they incentivized by volume and not by quality and not by good health outcomes.

So it's no surprise that practices are not designed to cater to the patient. And once that becomes the Normal, becomes the culture, every doctor's office can get away with. IT and I are left with these two really bad stats.

The first one is in primary care, specifically the average and P. S. For a provider is three.

That is so embarrassing. Number two, ninety six percent of patient complaints are about the service itself. Only four percent are about the care delivered. So patients are really noticing how bad the customer services.

And yet to go back to our earlier point, patients have this sort of stock hom syndrome when IT comes to go to the doctor specifically will like request a non talk of river because we don't feel like chatting with a driver or will leave a very skating yellow view for a restaurant. But when IT comes to this service, even though we're not easy to please generation, we become very submissive and it's the most important service across any service industry. So this is not a good thing.

Why is this happening and why should we care that we're having such a bad time at the doctors office? It's because bad service is bad for our health. So good medicine is a partnership between a patient who's coming in with real information on how they're feeling and then a physician who's coming in with real expertise to bring to information, and they worked together.

But if the patient is feeling very anxious and exhausted and the doctor is feeling very rushed and dismissive, you're left with losing a bunch of really important information that you need to make new on diagnostic and treatment plans. So to give you an example, doctors are far more likely to prescribe antibiotics in the afternoon than they are in the morning for the same patient with the same issues um because they're just running ly and they're dealing the decision and fatigue. If you leave with anything from this talk, IT should be to make more appointments.

Um and then patients, on the other hand, know all of this and they've felt this before. And so what many of them end up doing is differ ign treatment altogether. So patients feel like it's a hassle.

They're not getting anything out of IT. They will detect a red school friend. Health care has a patient buying problem because they're made the experience of going to the doctor's office so bad that we only go when we absolutely have to go.

And what do we lose when we go when we only absolute and we have to go preventive care. And preventive care is the really the reason it's so bad that we're not going to the doctor's s office. We lose out on going when things or early, we lose out on all the life saving, cost saving benefits um of prevention.

So i'm going to hit you with three states on that. The first one is forty percent of annual depth caused by the top five causes of death in the U. S.

Are preventable with good preventive care, according to the cdc, for whatever that's worth to avoidable chronic disease accounts for seventy five percent of our health care spend. And finally, on the other hand, patients with A P C P primary care doctor spends thirty three percent less on health care overall because they're front loading that spend toward prevention. So that for our health, what can we do about IT?

The good news is this, we are starting to see more and more practices shift towards models and incentivize positions to care about good customer service. So there are two models we can use here to change the compensation model to allow physicians to have time and space to think about service. So the first one is direct consumer, so that's making the patient, the customer again in this scenario.

And the second one is leveraging valley based care models where the insures are reivers based on um quality instead of our volume. And so in that case, the insure still the customer, but we're now we're warding different now come here. So those are kind of the two options that we can leverage.

But as we can see, we have the tools that we need. It's really now about shifting norms in the healthcare industry, and the industry is a very clunk y and it's red tape and it's sort of crochety at times. And so the change might feel a little bit slower than IT does in other industries, but we're starting to see more and more companies push back.

And as they pushed back patient expectations change, we start to expect more out of our health care. And now we're starting to treat health care the way we treat any other service that we interact with. And we started to say goodby e to that stockroom syndrome era.

But as we move towards these models that change the incentives for physicians, we still need a framework to think about, okay, how do we get that good customer service? How do we actually get the patient buying? How do we get people to want to go back to the doctors office because doctors and hospital administrators are not used to thinking about this or not used to training on customer service or bedside manner.

Um so we need to look to another industry, which is the hospitality industry. So brought you on this journey here today to tell you we need to be ceiling from the hospitality industry. They have figured this out already.

Um they know how to treat people like people. They know how to provide human to human service, which is ultimately today what health care still is. Um so I really think the definition of hospitality from danny mr.

Is really great steam restaurant on tour. My other relationship all pass. Hospitality is president when something happens for you.

IT is absent when something happens to you. So we want health care that happens for patients and not two patients. Really muslim worthy, or at least very a few of yet review worthy health care. And I want to share a few ideas on how I think we can get there. And the cofounder of a primary care membership service called the land bee um and we do we call a health care hospitality training with over two members over providers.

And I want to share a few central tenants from that training with you that I think where the ones can that can be applied into and you practice that can be implemented at very low cost um and can really start IT to shift the norms and shift the culture, which is what we need. Some of these may seem obvious um but they are not in health care. So here we go.

These are my top five. Number one followed the golden rule. Patients are entrusting us with their most precious resource, which is their health.

Treat them the way you would want to be treated at. The doctor would want your family to be treated. Number two, set clear expectations.

This is not a subway track. Nobody wins when we hold information like running a few minutes late to ourselves. Number three, be a good, active, empathetic listener.

Ask good questions to get good clues. Treat every case like it's a medical investigation. If someone didn't think something was important, they wouldn't brought IT up with us another janny mirela.

Be an agent, not a gatekeeper. So in agent, let's people in a gatekeeper builds up barriers to keep people out. We don't want to be that kind of practice.

If a patient has a good to be asking you to break one of our rules, and there is an easy way to break IT within the bounds of the law, then just break IT finally, for extra credit, surprise and delight, how can we make this the best interaction of a patient state, even if they're going through something really chAllenging? I think that's the fun puzzle of applying hospitality into the health care context is finding a way to bridge that gap. How can we remember something about someone and make them feel seen and make them feel like, yeah I want to come back to the .

doctor's office all right.

I don't have a super punchy ending here. I'm just onna wrap this up with um healthcare hospitality treats patients the way they deserve to be treated. We're all patients at some point and when that point comes, the stakes will feel inherently high. Too high to get worse service than you would at your favorite restaurant. Thank you.

I think the thing that struck me about our diffunce tional system is the bill girly quote. And then what you're doing there is no customer. And how does that change over time in america? Now you're what you're doing with your company is part of IT.

So how do we change that in americans perception? Because I got my nee done and I didn't know how much of cost. And then I found out just cleaning out my miniscule was sixty thousand dollars. And that was like how much sixty thousand dollars ten years ago, minister surgery in new york and then something said that actually like ten thousand and there's no menu. So we're going to a restaurant you know, when you go to the restaurant in italy like the one you go .

to and there's .

no Prices yeah that's you know your fact.

I love those.

Yeah you love IT you hear me the check like you didn't when we wear in vagues that time. So how do americans start changing how they perceive this? I think this part of the problem is that on definitely part of the problem .

is that we all are kind of just okay with that and assume that this is this industry where we're not supposed to know the Prices until afterwards. No other industry works this way. We don't put up with IT anywhere else.

And so I think direct consumer models play huge role in getting patients to think, oh, I can treat this like other services. It's not like we're not annoying consumers in other way as we already are. And so we just needed apply that same annoying attitude to health care. Um and then by laboring ing direct consumer models, part of this is getting on higher reduction plans who we start to treat our dollars more like Normal Normal dollars. Putting money into h sys and F S, says IT gets us to start thinking more like a traditional customer and think about where .

we're spending our mind and we see that a little bit with direct consumer drug companies. Hms her get room and all the stuff that freeburg uses to get ready for battle. David, nice to me.

You, how are you? How to prepare for war? Those are start, right.

people to see things from that one. Come on.

But this is part of IT that people are saying, so diffunce tional to go to the doctor. It's so diffunce tional to deal insurance company for certain things. I'm just gonna on a website in order that is part of the frustration, right? Yeah yeah.

That gives you a little taste of IT. And then alternative, believe you don't want to go to the doctor, you will go to urgent care, which has much more than easy pricing menu in many cases that you can look out. So again, we're starting to get a taste of IT. And I think patient expectations change and doctors will have to follow suit.

We tend to index the quality of american health care. When you look at the average life expectancy, first you do men, women, and then you look at White men versus black men versus Brown men, and White women versus black women. Eta and White men have always sort of been the standard bear.

And then this odd thing has happened over the last three or four years with their life expectancy is started to get worse and worse as our percentage chair of health care expenses as a percentage of GDP m gone up and everybody gets up enormous because they're like while wait, we can't. Something is clearly so structurally broken that we're spending fifteen, twenty, thirty percent a year increasing every year and we're dying now under the age of eighty where this thing should be a thing where we're living to one hundred. Why exactly is that thing happening? Like I understand like where you could say maybe it's segregated to you know minority men or women or something, but this is not this is basically everybody. So why are we dying sooner as we spend more?

Yeah because we are also increasingly spending on a lot of things that kill us. And we're not overspending on health care because we're spending on things that kill us and that our health care gets very expensive because we have terrible, terrible lifestyles and everyone is drinking way too much across all communities. Everybody is eating totally progress foods.

These are becoming more more readily available increasingly so every year. And so yes, in the very upper issues, there are sort of a movement towards wellness and more holistic lifestyle, but that has really swept the nation yet. And so we're all living really, really unhealthy lives, not caring about our preventive health and then spending a lot on healthcare on the line.

So you're saying it's really not we just can't out run our .

lifestyle exactly that, which is not our fault. I corporations make IT very, very difficult to live a healthy lifestyle.

And in the U. S. And do you find examples of countries that have gotten population level health issues, right, whether with respect to costs or outcomes, where you say that is directionally something that we can learn?

No, I have no good answer to that question because every company besides the U. S. Thinks that has like the bass health care system.

But at any time I talked to anybody in one of those countries, like I was speaking to people in canada the other week, and they hate their health care and things against the worst thing ever, and they like wait eight weeks to get uti medication. And so I just think it's too hard to compare our unwieldy country to other systems. And B I don't even know people who are that happy with other systems, so I don't have a good answer.

How how much of a rule do you think um medicare medicate cm s can do to break the logjam versus waiting for politicians to pass legislation like obama care to kind of try to reorient wrong?

I think I think IT really is both I think that H H H S and is playing a huge role and trying to get more morally based care models um through medicare. And they're making a huge push to do that. And so it's slow and clunky. But I think they have the right idea. They want us to move towards based care model.

I've been think a lot about mental health recently, seeing what we've seen during the pandemic. C. A lot of Young people, our kids having these two years alone and what the second order, third order affects of that. And just trying to get consensus in amErica around health care very hard.

But I think since we've all suffered some degree of mental health over the covet break, which I think draw ve a lot of people crazy and create a lot anxiety, is there any way for us to think about universal health care, but not have to have this nationwide discussion of all or nothing? And I was just thinking, mental health is something mean everybody can appreciate. It's not that expensive to deal with. It's not surgery.

Why can't we just agree as a country that anybody who wants to talk to a therapist or councillor, we will be able to do IT for a sliding scale or a very small amount of money and maybe be able to just chip off one piece of the puzo and say, you know what, therapy will be fifty box flat rate, that country will pick up the other fifty or hundred fifty, whatever IT is to get this done. And maybe you just speak about mental health as A A larger issue because IT IT does seem to have so many downstream effects in terms of our our physical health. Yeah, we thought about this.

A lot of the lab we've tried to figure out to waited to integrate mental health and away, but we would be able to make money and we can't um just yet. So so yeah there having a lot of models that came out during kova that allowed for you to text with somebody and do like virtual therapy. There are a lot of therapists who offer a slighting scale.

But part of the reason it's it's a little bit more difficult is that the patient panel size, the number of people they can take on is so much lower because it's such a higher touch experience. And so it's hard to integrate IT into the traditional primary care model where in the across the us, one physician has a panel of twenty three hundred patients on averages. And so you just can't do something like that for mental health.

Are there large population health issues that you'd love to just get on the radar? Folks in this room that are poorly understood? I'll give you an example like um there is somebody I follow.

She's a writer I think for the I can't members in your time something. And he said her best friend died of a heart attack in her forties, and then he had some thoughts about the incidents of heart disease among the women verses men. And I had always assumed that I was largely a male predominant issue until I saw those stats.

And I realized, my god, like this is a broadly pervasive issue. Maybe it's because of lifestyle ETC. So I learned something in that moment. I didn't know before, but any road population of issues that you think I are really important for folks here .

know about yeah I mean, sort of related to that, I would say nutrition label literacy is so hugely important. There are so much scary marketing that people have to educate themselves on, and it's such a part time job to have to learn about why this product that looks extremely healthy is like using the new brand colors that are not didi that looks like a be began organic is actually really bad for you. So having more education on what makes for good food, I think, would cut out a huge portion of our .

preventive life. stop. How can people find out more about the, its, Larry.

L A N D R Y, this is the night of my life. It's the land.

B L A N B Y, just right there. Yeah, i'm sure. How can they find out more about IT if they wanted to become a member? How do they become a member of their membership?

L N D Y.

A N A email or actually .

delly .

people like keep .

hearing.

I've art lived a life, lifelong candis life, and now I have like a mispronounce of the lambi all the time. So you can just go to the lambi dcom. You can apply for membership at the top of the website is in new york.

Can IT scale you going to raise money for this? Is you going to be a venture based investment because IT sounds fascinating to me as as a business model.

Yeah so raising our seat right now, we dominated raised money through our members so far, which has been really nice as having your consumers as investors um but yeah, I can regimental our scale because the way we're doing IT not to get to in the weeds is through a three person care team model. So we're able to take on more patients per panel because you're sign not just a doctor but also when you and a concious manager um who does .

all the patient home work for you raising a check. Sounds great. Let's thank tennis for hague and. Now when rainman give IT time, we open sources to the fans and we ve got crazy.

We should all just get a room, just have one big huge org, because they all just just like this, like sexual attention. But we just need to .

release somehow when you b, what your B, B, we need to get merges.