Tom Valenti
You should walk away from anyone who says there can be an “Uber for healthcare.” It is the equivalent of someone saying they “have a bridge to sell you.” Or, more precisely, it shows a complete lack of understanding for how healthcare works and how positive health outcomes are actually achieved.
Why do we keep hearing “Uber for healthcare”?
Generally, when one says “Uber for X,Y or Z,” what one really means is making something easy and convenient. Uber is an incredibly convenient service. “On-demand” services like Uber and Netflix have reached mainstream status, while entrepreneurs are cranking out new on-demand businesses for nearly every type of goods or service that touches our lives.
Today, I can watch more than 15,000 different streaming titles on Netflix while my personal chauffeur from Uber drives me around. The Jetsons could never do that!
Meanwhile, with healthcare, we have a very outdated and inconvenient system: We need to call a doctor 2 weeks in advance for an appointment, wait 30 minutes in a waiting room and then talk to a doctor for only 15 minutes while he types away on a laptop, only occasionally making eye contact with us. And, all of this for a huge cost that is growing at an unsustainable rate.
Thus, the U.S. healthcare system seems like the antithesis of easy and convenient. To us Average Joes who must deal with this unending frustration, we are begging to have healthcare “Uberized.”
Think different
Unfortunately, our desire to Uberize healthcare demonstrates a hole in our overall thinking.
What do I mean?
Uber and Netflix are successful because they have streamlined the time it takes to get a job done. Say you need a ride to the airport — no need to find a neighbor to drive you or hail a cab, just pull out your phone and someone will pick you up. In a sense, the friction or pain necessary to complete a transaction is removed.
On-demand services like these work great for individual transactions.
Therein lies the problem: Healthcare is not a transaction business; it is a relationship business.
One cannot “get healthy” with a one-time, immediate transaction. Instead, positive health outcomes are achieved over a long time period through a treatment plan developed in conjunction with a trained physician with whom a patient has a strong relationship.
For comparison, healthcare is more similar to education or a sports team than it is to getting a ride or renting a movie. One cannot “get healthy” on-demand, just like one cannot “get smart” or become a championship-winning athlete on-demand.
As the research of the highly regarded Dr. Barbara Starfield from Johns Hopkins proved, what matters to good health is the strength of the relationship between a patient and their primary care physician. Similarly, what matters to learning outcomes in the education field is the strength of the relationship between a student and teacher. Again, I don’t know of a single successful sports team that did not have a relatively decent coach, and a good coach cannot simply show up to one practice per season, snap his fingers and expect a team to be successful.
Now, would someone ever try to build an “Uber for a football team”? What about an “Uber for Third Grade”?
Then what makes one think that an “Uber for healthcare” is a good idea?
Easy and convenient healthcare already exists — and it’s not helping
Naturally, we desire convenience. That is why telemedicine and urgent care clinics are growing rapidly. In addition, standalone ERs, not tied to a specific hospital, are popping up. One could say these businesses are trying to be Uber for healthcare because they focus on easy and convenient transactions — simply walk in or make a call, get in the queue and finish with a prescription.
Overall, such businesses are great for the occasional sniffle and sprain — health conditions that are typically treated with transaction-like care. But these business will not actually improve our healthcare cost and poor health outcome problems because they focus on transactions and not relationships.
In fact, a recent, highly respected study found that urgent care clinics do indeed increase healthcare costs.
Let’s fix the root of the problem
If we want ease and convenience along with lower cost and better health, we must fix the root of our healthcare problem.
Instead of trying to create the Uber of healthcare by implementing services that overlay some aspect of our existing dysfunctional healthcare system (e.g. telemedicine, urgent care, care coordination), we should be working to fix the root of the problem by removing the barriers between patients and the front-door of the U.S. healthcare system — primary care.
If we really want ease, convenience, lower cost and better health, rather than saying, “I want to be able to call a doctor, therefore I will build an app to call a doctor,” we instead should focus on ways to break down the barriers between patients and their very own, local primary care physicians.
Why does it take so long to get an appointment? Why do we wait in waiting rooms? Why can’t we text with our own doctor? Addressing how we deliver and pay for primary care will remove these barriers, and that requires us to examine how the U.S. insurance-based healthcare system pays for primary care and how primary care physicians are required to deliver care in order to receive such payment.
Therefore, we come full circle: The reason these barriers between patients and primary care physicians exist is because the U.S. healthcare system has been treating healthcare as a transaction business, not a relationship business, all along.
How do insurance, Medicare and Medicaid pay primary care physicians? They pay physicians to perform transactions — to “do stuff.” The more patients primary care physicians see, the more they get paid. Hence, primary care physicians see 25+ patients per day as quickly as possible, while insurance, Medicare and Medicaid mandate an incredible level of administrative work in order to make primary care physicians justify payment for each transaction.
Furthermore, primary care physicians are paid little to nothing for anything outside of the typical face-to-face office visit; no payment for phone calls, emails, texts or any other technology that could enhance the patient-physician relationship.
So let’s stop with the constant talk about the Uber of healthcare and the continual focus on healthcare as a transaction business.
Instead, let’s figure out ways to free-up primary care physicians from insurance-based coding, paperwork, payment and mandates. As consumers, patients and employers, we need to stop paying primary care physicians to perform transactions and start demanding strong relationships with primary care physicians (as visionary primary care providers Iora Health and Qliance have proven with outstanding results).
Doing so will open up incredible opportunities: (1) physicians will have the time and financial freedom to innovate and experiment with new, easy and convenient ways to create strong patient-physician relationships, (2) it will allow us as patients the ability to form strong relationships with our own doctors, on our terms and in ways that leverage the latest technology to conveniently fit in to our busy daily lives and (3) most importantly to Silicon Valley, it will open up the door to entrepreneurs to build new tools and technologies that will enhance patient-physician relationships, not undermine them.
And, strong research shows, costs will be reduced and health outcomes will improve.
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