How much of the Uber experience can actually translate to patient experience?
At the primary care level, a lot, says Sean Duffy, CEO for Omada Health. “If you look at what technology can do, it’s really about routing, simplifying processes, guiding people down different paths, scalability, and mass customization,” he says.
Duffy cautions that these changes will take time — longer than they might in the consumer market. “The challenge is you’re retooling a big people-based system and reengineering the ways that people think about how they fit in it.”
It’s important to note, adds Stacey Chang, Executive Director for the Design Institute for Health, that Uber originated by recognizing the unutilized downtime of taxi drivers. “If you took that notion from Uber and applied it to the health care system, you’d see some interesting findings for the system itself,” says Chang. What do no-shows, for example, mean in terms of a health system’s efficiency and efficacy?
We have to flip our thinking about doctor’s appointments, Duffy says. When a patient calls the doctor’s office with a complaint, the typical response is to make an appointment for that patient to come in. Instead, Duffy encourages practitioners to ask: “What can we do to solve this for you without getting you in?”
“If [health care] really wants to get to an Uber experience, an in-person visit should be the last resort,” he says. “The question should always be: What clinical outcome or patient outcome do we want to achieve, and how do you do it over the other end of an Internet connection?”
Chang agrees, noting that telemedicine can result in greater patient satisfaction. In a major pharmacy chain’s telemedicine study on urgent care visits, for example, patients either saw a practitioner in person or via a telemedicine suite, and those in the telemedicine suite were happier with the quality of care they received. “The real insight was that when they were using the technology to look at the strep throat, the patient was seeing the same evidence that the diagnosing physician was,” explains Chang. “And their belief went up because they were not just having to trust what the doctor was perceiving, but they were actually seeing it for themselves.”
“I’m optimistic that a lot of the shifts in health care financing that are happening as we move away from a fee-for-service visit-based system to one that’s more based on value will drive this innovation much faster,” adds Kevin Volpp, NEJM Catalyst’s Patient Engagement Theme Leader. A major motivation for seeing patients in the office is because that’s how physicians typically bill and get paid. But visits can also be conducted by more convenient email and phone conversations. “Hopefully we can stop having the financing of health care be a barrier to that kind of patient-enhancing innovation,” he says.
From the NEJM Catalyst event Hardwiring Patient Engagement to Deliver Better Health at Kaiser Permanente Southern California, April 13, 2017.