Mandatory Steps for Basic Healthcare Reform

W After ten years of driving healthcare reform with healthcare systems, medical device OEMs, and thought leaders, I have an opinion on how we can get it done. I posted this on social media recently:  “There are 2 parts to driving #healthcarereform of reducing cost and improving outcomes: 1) Who gets care and 2) How care is delivered. Both need a radical overhaul.”

Someone replied, “Can you provide more detail around those points? How do you envision rationing who gets care? How would you go about innovating the delivery [for] that care?”

This article is meant to hit the highlights for each of those three questions. To keep it short, I’m not going to include all of the statistics so you will have to research them yourselves.

Who Gets Care

With the discussion of Obamacare and its repeal, the topic of “medically uninsured” is top of mind for many people. Some argue that healthcare is a right and that inequality and disparity of outcomes is unacceptable. Maybe it is, maybe it isn’t. I will leave that to the politicians and social reform.

There is much we can do regardless of where we stand on that topic. There’s a significant amount of healthcare spend and poor outcomes with births, untreated chronic diseases, and end of life.

Babies and their moms

Our babies need to come healthy into the world. Costs can be driven up for their entire life if someone has a poor start in life. Many infant mortalities and complications can be avoided with simple, prenatal care that is unavailable or unused for or by too many people.

The Chronic Diseased

With 45% of Americans having at least one chronic disease, healthcare reform must address this. We have to care for people with chronic diseases before exacerbations. Ultimately, we would like to drive down the rates of diabetes, hypertension, asthma, and others, but we can make a significant improvement in healthcare by offering easier treatment and education plans that are non-hospital, non-clinic based with minimal physician involvement.

Those Dying

We need to start talking about end-of-life sooner. When a loved one is in the hospital, it’s too late. I have seen far too many instances of family members trying to extend the life of their loved one for weeks days or even hours however possible. Not only is it uncomfortable for the person dying, it’s outrageously expensive and ultimately ends in death anyway. We should move to having 100% of advance directives in place prior to hospitalization. We should also talk about death with dignity in a non-hospital environment.

How Care is Delivered

Any industry is going to protect the status quo and tradition. It’s easier because it doesn’t require the players to change. Healthcare is no exception. Its employees are the most educated in the world. They have significant incomes and tremendous power. They accept change when legally mandated or when it could negatively impact revenue or personal income. Healthcare reform demands a change in how care is delivered.

Location

Last week, two major academic institutions announced hospital projects. Total spend for two facilities is expected to be $8 billion! Both were claiming to advance medicine and offer the absolute highest level of care for patients. They used fancy words like artificial intelligence and precision medicine. With healthcare spend in the U.S. at nearly 20% of GDP, projects like this are fiscally irresponsible.

Hospitals should only be used for the highest acuity issues, academia should conduct research but everything else should be treated somewhere else. The smaller and more distributed treatment places are, the better. The centralized hospital model continues to drive unprecedented levels of inconvenience, cost, and societal impact. They increase traffic, have poor or expensive parking, require long patient commutes, have acquired infections and more. It also puts people in the worst healing environment: a hospital room.

Licensure

We have overqualified medical professionals treating patients with simple issues. For many health issues, we don’t need to see an actual doctor. A nurse, nurse practitioner or physician’s assistant is more than sufficient. For other issues, our primary care physician isn’t the best and we should talk to a specialist. We can’t overutilize the high-priced experts, though.

We must use specialists, subspecialists, and super subspecialists only when necessary to return a patient’s health to “normal.”

Method

We can’t continue to require a patient to schedule an appointment at a doctor’s office. It’s overkill. A significant number of appointments don’t require “hands-on” presence of a physician and they can be done via phone call, video conference, email or text. We must kill the office visit unless absolutely necessary.

Convenience

Having open hours when the majority of dual-income families are working is ridiculous. Opening at 9 AM and closing at 4 PM doesn’t work. Non-acute healthcare, especially primary care, needs to be available before normal working hours and after normal working hours. Finally, we can no longer have providers that reject evidence-based medicine and instead rely solely on their own experience. Too many physicians and offices are clogging their schedules with appointments that are medically unnecessary. This includes everything from annual physicals to how often and how early a woman should get a mammogram.

Innovating Care Delivery

We have to innovate our patient care model to achieve healthcare reform. As much as I would like to think that an existing healthcare system can do this, there is little evidence that they can. There are very few systems that even have an innovation center in place and even fewer that focus on the patient care model. Most want to be a tech incubator for new ideas from the surgeons or physicians. While I applaud those efforts, we can have a significantly higher impact by investing equivalent time and resources into care model changes.

This requires a systematic approach with a dedicated team. A hospital or healthcare system must invest in the minimal number of resources required to develop new care models. It is a skill set not possessed, taught or practiced in any healthcare environment yet we must establish and expand this skill set, everywhere.

We can’t expect corporate mega-conglomerates to come up with the best way to care for patients. They are focused on selling technology and solutions at a high-profit margin. They rarely understand the customer, the entire healthcare process or the people delivering it. You must have an immersive, ethnographic process, such as design thinking, coupled with technology development and change management. It must be internal- healthcare systems know their patients and market best.

Create Healthcare Reform

Now, when I say it only takes two things to impact healthcare reform, they are big things. However, I have personally led and experienced organizations that are taking the right steps. There are companies like CVS which are redefining care delivery.

Reform will happen. Time will determine the winners and the losers. It can’t be the patients. Check out my article on Population Health for a deeper dive.

Value Proposition Sells, Not Technology

Here’s My Marketing Plan

I met with the marketing lead of a tech startup recently. He was developing his 2018 marketing plan and wanted my feedback. The company’s business model was B2B with a focus on “industry distributors” as the sales force to the end customer, employers. My first question was, “What is your value proposition?”

He had a great timeline that included the appropriate different campaigns, content, and targeting. He told me the areas he would be focusing on. It was all good stuff but with a limited budget, it would not maximize the results. He was highly underselling the value of their disruptive offering by promoting the wrong elements.

What Problems Does It Fix

The most important of all marketing dimensions is your actual value proposition. What is it that your product or service does better than anyone else? Why would someone want to buy what you have over what they are currently using? If you can answer those, without listing features, you have your value proposition. As innovation guru, Clayton Christianson would ask, “What job does it do?”

This should answer questions such as: Does it make my work easier? My life better? Is it cheaper? Can I expect higher performance levels using it? Particularly with B2B models, you are displacing an incumbent and must show a significant improvement to be worth the extra hassle of dealing with a new vendor.

Technology for technology’s sake is not good.

Although people may be wowed by it, your technology is not the value proposition, it simply enables it. Technology for technology’s sake is not good. It must solve a problem. The more widespread the problem, the higher the potential for success. The better it solves the problem the more people will be willing to spend.

If you can clearly articulate the one to three customer “pain points” solved by your solution, you can get a buyer and you can easily enable your salesforce. The harder it is to articulate a value proposition, the more difficult it will be to sell your product.

The Value Proposition Sells Itself

As you can see, your go-to-market strategy should be a natural extension of your product development. Even if your salespeople can sell ice to an Eskimo, it’s better to give them messaging that makes their job easier and you will sell much more. It can be as simple as a clever rewording of the information you uncovered during the early design thinking stage. You will have an excellent message.

With everything in development, it should be tested. It’s very easy to get early feedback by meeting face-to-face with the sales members and key customers. Do this at least once prior to campaign launch to ensure success.

Lead with what your solution can do, not what makes it do it.