No Forms For You!

What do you hate worst about health care?  It could be the uncertainty about diagnoses, or the impreciseness of treatments.  Or there is the opaqueness about the actual performance of our providers.  Maybe it is the drabness and/or confusing layout of many health care settings, or the interminable waiting we do in them.  But somewhere on the list has to be having to fill out all those forms, over and over, at practically every stop along the way.

If only someone would do for health care what Amazon is trying to do with grocery stores with Amazon Go.

If you've missed the many stories about Amazon Go, or don't want to bother with the above video, it goes something like this:

• You scan an app on your mobile phone when you enter the grocery store.
• Each time you pick up an item from the shelf, it registers in your "virtual cart" (don't worry, if you decide to put it back, it gets deducted).
• When you are done shopping, you simply walk out with your items, and the total is charged to your account (presumably using one of your Amazon payment options).

No waiting in lines, no putting items on the conveyor belt, no cashiers -- not even a self-serve checkout.  As Amazon says, "grab and go."

At this point, Amazon is just testing the concept with a prototype convenience store, but The Wall Street Journal reports that the pilot could lead Amazon to open up as many as 1,000 locations by the end of 2017.  It is one of at least three grocery store concepts Amazon is testing.

Take that, Walmart.

Grocery stores have jumped on board with self-service checkouts, with that option having been widely available for several years.  They do help cut labor costs, but also are believed to double the losses from shoplifting, which arguably wipe out any financial advantage the self-service offers.  

With Amazon Go, though, the store "knows" what you take from the shelves and charges you for every item, so shoplifting would become much harder (of course, installing the technology to track what you take would not be inexpensive).  No missed items hiding in your cart (or pocket), no items that did not scan in the checkout.  Checkout is finished as soon as you are done shopping.

Contrast this to most health care visits:

• The front desk insists on verifying your current coverage, even if you were there the day before.  They may take a photocopy of your insurance card (s).
• If you are a first time patient, or haven't been in for a few months, you have to fill out various forms: health history (including family histories), prescription list, contact details, notice of privacy policies, source of problem (e.g., work related or auto accident), and current complaint/symptoms/reason for visit.  It doesn't seem to much matter if the information is already in an EHR, even theirs.
• If you are lucky, the office may have let you fill out some of these forms online, or at least print out the forms so you can fill them out in advance, but odds are you are not seeing the provider until you have completed some piece(s) of paper.  
• When you leave, of course, they're likely to ask you for some payment, to the extent they know it at the time.  In any event, at some future point they'll likely submit a claim to your health insurer, which will eventually lead to you being billed whatever it ends up that you owe them (assuming that neither they nor the insurer made any mistakes, in which case you start over).

It all makes a trip to the grocery store look pretty pleasant.  And you don't even end up with any cookies.

Let's imagine what the process might look like it someone like Amazon re-imagined it:

• Your phone (or other device) has access to all the pertinent information: insurance, health records, and any information you want the providers to know about the need for the current visit.  For example, this could be stored in the patient-facing EHR app.
• Upon entering the office, you could either scan the app through a reader or have it communicate via Bluetooth through a secure connection.  That automatically updates the provider's records.  
• As services are provided to you, they get uploaded to your care summary -- ideally, using consumer-friendly terminology and actual prices.  You can see it at any point.
• Any prescriptions that result from the visit (e.g., drugs, PT, imaging) get added to your app, which you can then share with the applicable provider(s)..  
• When you are all done, you pass the front desk entirely, and the care summary (or a version of it) gets sent to your insurer as the claim.

I know, it sounds too easy, and it probably is too simplistic.  The hard part, though, isn't the part about the forms.  That all seems entirely feasible, if EHR and billing vendors offered a modest of cooperation (all right, that's not a given).  

Even itemizing services shouldn't be terribly difficult, since health care is full of standardized lists of services and procedures.  Admittedly, it's not like picking out a UPC code from a can of soup, but it's not impossible to imagine doing in real-time or near real-time.

Getting the prices right, especially with the right negotiated/allowable rates is probably the hardest part, which speaks to why health care needs to get away from its absurd list charges and to more retail-oriented price lists.   And, even in the short term, there are plenty of vendors (e,g,,  Castlight Health, Healthcare Bluebook, or HealthSparq) who would probably say they could assist.  

Over its history, Amazon has done a great job of reinventing our retail experience.  Many probably didn't expect that the grocery experience would be one of those, but not many thought buying books online would work 20 years ago, or that moving beyond books would also succeed.  You have to give Amazon credit for pushing the envelope about how to make the purchasing process easier.  

Unfortunately, health care isn't quite as good about reinventing its experience.  

It's not that we want people to buy more health care services (although help in getting us to buy health services more prudently would be greatly appreciated).  But we could certainly make the process of dealing with all those forms easier.  

Maybe Amazon should go into the retail clinic business.