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Healthcare Tsunami Tom Peters/ 09.12.2004. HealthCare2004 Consumerism X Demographics X IS/Internet X Quality X Information Consolidators X Genetics & Devices Revolution = YIKES!.
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HealthCare2004Consumerism X Demographics X IS/Internet X Quality X Information Consolidators X Genetics & Devices Revolution =YIKES!
Golden Age of Patient-centric, Genetics-driven Healthcare Looms!Current status: $1.3T.30M-70M uninsured. 90K killed and 2M injured p.a. in hospitals. 85% treatments unproven. Cure depends on locale in which treated. 50% prescriptions do not work. 2X docs. 2X hospitals. IS primitive. Accountability & measurement nil.And everybody’s mad and feels powerless: docs, patients, nurses, insurers, employers, pharma & device cos, hospital administrators and staff.
Anne Busquet/ American ExpressNot: “Age of the Internet”Is: “Age of Customer Control”
“The Web enables total transparency.People with access to relevant information are beginning to challenge any type of authority. The stupid, loyal and humble customer, employee, patient or citizen is dead.”Kjell Nordstrom and Jonas Ridderstrale, Funky Business
“Parents, doctors, stockbrokers, even military leaders are starting to lose the authority they once had. There are all these roles premised on access to privileged information. … What we are witnessing is a collapse of that advantage, prestige and authority.”Michael Lewis, next
“Teens and young adults are flocking to the Web for health-related information as much as they are downloading music and playing games online and more often than shopping online, according to a national survey from the Kaiser Family Foundation.” —Reuters
“A seismic shift is underway in healthcare. The Internet is delivering vast knowledge and new choices to consumers—raising their expectations and, in many cases, handing them the controls. [Healthcare] consumers are driving radical, fundamental change.”Deloitte Research, “Winning the Loyalty of the eHealth Consumer”
“We expect consumers to move into a position of dominance in the early years of the new century.”Dean Coddington, Elizabeth Fischer, Keith Moore & Richard Clarke, Beyond Managed Care
Today’s Healthcare “Consumer”:“skeptical and demanding”Source: Ian Morrison, Health Care in the New Millennium
“Medical care has traditionally followed a ‘professional’ model, based on two assumptions: that patients are unable to become sufficiently informed about their own care to allow them a pivotal role, and that medical judgments are based on science.”Joseph Blumstein, Vanderbilt Law School
“He shook me up. He put his hand on my shoulder, and simply said, ‘Old friend, you have got to take charge of your own medical care.’ ”Hamilton Jordan, No Such Thing as a Bad Day (on a conversation with a doctor pal, following Jordan’s cancer diagnosis)
“If healthcare organizations don’t wake up, smell the coffee—and get online with real services, transactions, and more for these e-consumers to do—the newly empowered e-consumers will become even more disgruntled with the hornet’s nest of paperwork that plagues the system.”Douglas Goldstein, e-Healthcare
“It may be the most far-reaching evolution of them all: the metamorphosis of passive patient into consumer – and well-informed, assertive consumer at that. The defining axiom of traditional medicine – ‘doctor’s orders’ is being turned on its head. These days it’s the patients who are armed, the doctors who must get wired to keep nimble.” “E-health is the new house call.”Richard Firstman, “Heal Thyself,” On Magazine
“What’s needed are comprehensive strategies that leverage the latest technology and provide the services that eHealth consumers are demanding, including convenience and customized services such as online physician interaction or online management of health benefits and customized disease management programs.”Deloitte Research, “Winning the Loyalty of the eHealth Consumer”
“Consumerism”: HMO backlash (e.g., plans with more choice). Alternative Medicine, Wellness & Prevention bias. Info availability (disease, health, docs, support groups, outcomes). Boomers (“I’m in charge!” Discretionary $$$$ to spend:cosmetic surgery, vision improvement, fertility, etc.). Self-care (chronic disease). High expectations (genetics, etc.) …
Consumer ImperativesChoiceControl (Self-care, Self-management)Shared Medical Decision-makingCustomer ServiceInformationBrandingSource: Institute for the Future
“E-consumers …want knowledgeare already connectedwant conveniencewant it to be all about themwant control.”Douglas Goldstein, e-Healthcare
“Savior for the Sick”vs. “Partner for Good Health”Source: NPR
“No one currently ‘owns’ the eHealth Consumer. It’s an open playing field.”Deloitte Research, “Winning the Loyalty of the eHealth Consumer”
“We find that eHealth consumers are willing to pay—and even switch health plans—for the services they most want.”Deloitte Research, “Winning the Loyalty of the eHealth Consumer”
“The ‘curative model’ narrowly focuses on the goal of cure. … From many quarters comes evidence that the view of health should be expanded to encompass mental, social and spiritual well-being.”Institute for the Future
“In many ways, the nursing profession is the mostqualified to respond to current changes in the health system. Nurses’ training focuses more on the behavioral and preventive aspects of health care than does that of physicians.” Institute for the Future
“A 7-year follow-up of women diagnosed with breast cancer showed that those who confidedinatleastoneperson in the 3 months after surgery had a 7-year survival rate of 72.4%, as compared to 56.3% for those who didn’t have a confidant.”Institute for the Future
Internet User, F41$63,000 HHI64% work FT54% moms6 hours/week onlineSource: NetSmart Research
“Self-medication is the wave of the future, whether the [pharmaceutical] industry likes it or not.”Wall Street Journal
DTC > ProfessionalsClaritinPravacholZybanEvistaPropeciaPrilosecPrimeraSource: JAMA
Make time for your most important asset. Your health.Ad for Mayo Clinic Executive Health Program/Jacksonville, Orlando Airport
“Online Medical Records Seen Empowering Patients”Source: Headline, Boston Globe, re 1K docs and 700K patients @ CareGroup
Determinants of HealthAccess to care: 10%Genetics: 20%Environment: 20%Health Behaviors: 50%Source: Institute for the Future
“NOT ACTING THEIR AGE: As Baby Boomers Zoom into Retirement, Will America Ever Be the Same?”USN&WR Cover
50+$7T wealth (70%)/$2T annual income50% all discretionary spending79% own homes/40M credit card users41% new cars/48% luxury$610B healthcare spending/74% prescription drugs5% of advertising targetsKen Dychtwald, Age Power: How the 21st Century Will Be Ruled by the New Old
Boomer World“From jogging to plastic surgery, from vegetarian diets to Viagra, they are fighting to preserve their youth and defy the effects of gravity.”M.W.C. Howgill, “Healthcare Consumerism, the Information Revolution and Branding”
“Pick up any copy of Glamouror Men’s Health, and you’ll see pages of advertisements encouraging readers to enlarge their breasts, retard baldness, correct their vision, improve their smile, or relieve stress through herbs, massage therapy, acupuncture—you name it.”Coddington, Fischer, Moore & Clarke, Beyond Managed Care
Message Boomer: (1) “There arel-o-t-s of us.” (2) “We have the $$$$$$. (3) “We’re/I’m in charge!” (4) “We’ll take no guff from from anyone.” (5) “We know the emperor has no clothes.”
“Some grocery stores have better technology than our hospitals and clinics.”—Tommy Thompson, HHS SecretarySource: Special Report on technology in healthcare, U.S. News & World Report (07.04)
Info RevolutionConsumerism(research, consultation, B2C, etc.)Clinical Info Systems(guidelines and outcome measurement, etc.)100% Web-based (internal) SystemsElectronic Medical RecordsPatient-physician email-consultationTelehealth-Remote Monitoring(biosensors, home testing, etc.)Telemedicine (consultation, invasive treatment, “global medical village,” etc.)
“We’re in the Internet age, and the average patient can’t email their doctor.”Donald Berwick, Harvard Med School
Want email consultation: 90% patients, 15% docs.Evidence: Patients do not pester docs. Time is saved. No one has sued (shows “care & connection”—the absence of which is the major cause of suits).Source: New York Times
Henry Lowe, U. of Pitt. School of Medicine: “Broadband, Internet-based, ‘multimedia’ electronic medical records”
“Doctors Without Borders”World Clinic/Dr. Daniel Carlin: e-mail consultation & treatment for ex-pats, global execs, etc. Developing world: “They have the primary care doctors, but no infrastructure to train specialists. We become the specialists.” More: “Telemedicine Kiosks in Central America.” Etc.Source: On Magazine
Telemedicine: E.g. …HANC* [Home Assisted Nursing Care]*BP, ECG, pulse, temp
Telemedicine …Reduces days/1000 patients and physician visits for the chronically illDecreases costs of managing chronic diseaseExpands service areas for providersReduces travel costs to and from medical ed seminarsDouglas Goldstein, e-Healthcare
Detroit Med Center: $100M IS MakeoverExperiment: Surgical residents equipped with Palm IIIxe. Med Director: “It’s not unusual to have a team of 5 or 6 residents responsible for the patients of 25 doctors. For each resident, that could mean seeing 40 patients spread across 10 floors and 5 buildings.” Records work was manual; but “Now you export the list of patients to your Palm, with the room number for each patient and with lab results from the last 72 hours.”
“Patient by patient, problem by problem—drug reactions, hospital caused infections—Salt Lake City’s LDS Hospital has attacked treatment-caused injuries and deaths. One of the secrets of LDS’s success is a custom-built clinical computer system that may serve as a national model for how to save patient lives.”Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson
