Saturday, August 29, 2015

More About Us, Less About Them

Something Amazon just did is worth those of us in health care paying attention to.  It doesn't have anything to do with their long-rumored interest in health care, and it wasn't even The New York Times disturbing profile of Amazon's supposedly brutal workplace culture.  Instead, it was the layoff of "dozens" of engineers at Lab126, Amazon's hardware development center, as first reported by The Wall Street Journal.  These were the first layoffs in the division's history.

Lab126 is responsible for Amazon's consumer devices, including their very successful Kindle e-reader and the new Fire TV.  More notably, though, they were less successful with the Fire tablet and they failed spectacularly with the Fire smartphone.  Connect the dots to the layoffs as you wish.
What makes this is a cautionary tale for the rest of us is that even Amazon -- which is noted for their prowess with their online consumer experience -- can't necessarily get the physical consumer experience right.  I think Wired captured the problem best, asserting that Amazon's consumer devices would have been more successful "if Amazon focused more on consumers, and less on consuming."

Now perhaps the relevance to health care may be clearer.

Consumer devices are all the rage in health care.  The global mHealth market is predicted to be $49b by 2020, with some 73 million units shipped in 2015 and an eye-opening CAGR of 47.9% expected from 2013 to 2020 (although other analysts already see slowing demand).  J&J, which knows a little something about consumer marketing and about health care, is teaming up with hardware manufacturer PCH to help spur the development of hardware for the consumer health space.  They plan to "accept everything from medical devices to consumer-facing activity trackers, provided they target an area of unmet need."

Some people -- e.g., Yuri Teshler, writing in Forbes -- think that all this consumer-oriented technology will help consumers "fix" health care.  That'd be nice, but I'm not so sure.

At the core of Amazon's devices is the goal to, well, get consumers to buy more stuff from Amazon.  They make it ridiculously easy to purchase almost anything consumers want to buy, and are constantly looking at how to expand their reach.  When that coincides with what people actually want to do, such as with the Kindle, it works out well for everybody.  When what consumers want is a smartphone that is the equivalent of an iPhone, and what it actually is best at is buying things, then not so much.

So I wonder: what is the goal of consumer devices in health care?  Are they intended to help us achieve better health -- or to consume more health care services?  I hope for the former but I fear it may end up being the latter.

Of course, none of this is limited to consumer health devices.  It's something that permeates the health care system.  Think about your most recent experience with the health care system: did you really feel your better health was the uppermost concern throughout the experience, or was it more about generating more services that you (or someone) had to pay for?  That may sound harsh, but I've sat too long in too many waiting rooms, filled out too many forms that I've already filled out elsewhere, and gotten too many confusing bills for wildly overpriced services to be nicer about it.  And I don't even use all that many heath services.

I was struck a couple of weeks ago by an opinion piece in JAMA: "Obstacles to Developing Cost-Lowering Health Technology."  It's authors, doctors Kellerman and Desai, note that:
The inventor’s dilemma is that creating a product that improves health is not enough; the product must also be able to generate a healthy return on investment. In the United States, the surest way to generate a healthy return on investment is to increase health care spending, not reduce it.
They cite a 2013 Rand report that reached much the same conclusions, and which offered a number of policy recommendations that, as best I can tell, no one is in any hurry to implement.  Rand concluded: "The longer we wait to institute fundamental reforms, the more money we will spend on health care offering little or no health benefit."

Yet we keep getting more of the same, to the point where, for example, even oncologists think cancer drug prices are too high.

Think about the terminology used in health care.  It speaks volumes about the underlying culture and its attitudes towards us.  Health care providers call us "patients."  Health plans call us "members."  Medicare and Medicaid call us "beneficiaries."    The name for one of the newest fads -- "patient centered medical homes" -- serves to remind us that we're not normally considered the center of our health care, and that the focus is on our medical care, not our health.

At least "consumer-directed health plans" pay lip service to us being in charge.

From what I understand, the term "patient" became part of medical terminology due to the Latin term for "one who is suffering," and the more general adjective "patient" reflects the implicit expectation that, as patients, we're expected to suffer in silence, not complaining about the pain or the various indignities we may endure.  

Well, the hell with that.

I've written before on this terminology problem, although I haven't heard any groundswell of suggestions for better terms to describe us when it comes to health care.  "Consumer" or "customer" are words that might describe us in other industries, but we're still not quite there when it comes to health care.  Perhaps they should just call us "Benjamins," as in "it's all about the Benjamins."

I'm all for people and organizations making money in health care, but I don't like to be seen as some kind of ATM for them either.  The health care industry needs to realize that we don't really want to be its customers, don't want to need to consume their services, and certainly don't want to have to be unduly patient about it when we do.

What we want is to be healthy.  Give us the devices, services, and experiences that make that as simple as possible and then you can call us whatever you want.

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