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The “Last Mile“
It’s an expression that has been running through my mind for quite some time over the past year. I think that I first heard it used to describe the frustrating gap of getting everyday consumers/households connected to high-speed internet svc with the belief that if only our Parents and the guy that works at the bowling alley could surf the internet at high-speed for a reasonable price, then people would flock to (nay… DEMAND) rich media experiences such as music, videos, pictures, etc.
There existed an ever growing fat pipe of rich content just sitting… waiting… to entertain and engage people on the internet backbone and trunk-lines that ran into the cities and across the country – If only people had faster internet than their old 56k dial-up modem via home telephone lines in order to connect at blindingly faster speeds across that figurative last mile gap of connectivity from a person’s home to the internet-backbone connection point in the community . Of course, much more expensive internet access was available but only eager techies and early adopters were willing to pay the much higher costs to access this pipe of richer information. I’m sure that i’ve botched the exact specifics, but hopefully I’ve jogged your memory enough to understand the issue of the time – that palatable yet intangible Last Mile of connectivity, of rich and engaging User experience.
Healthcare Consumerism
So what the heck does that Last Mile stuff have to do with American healthcare? Well, i’ve begun to feel a growing sense of Deva Vu. There has been an ever increasing explosion of healthcare technology and web-based services that was first aimed at payors, then TPAs, then employers, and now the burgeoning and highly befuddled individual consumer. And as more emphasis and focus has been placed on individuals becoming both financially and personally accountable for their health and all related costs – I am left with a seriously nagging question: As the arsenal of tools and information available to consumers grows…what is the Last Mile of healthcare consumerism?
Unfortunately, I don’t have a clear ‘answer’. I’m just not that smart. But as I think about it, I thought that I’d lob some characteristics of the Last Mile of Healthcare Consumerism out to the blog-o-sphere to ponder and see what you guys throw back:
The 6 Things Needed to Shorten the Last Mile of Healthcare Consumerism
(e.g. the ingredients needed to cause Joe Average to actually care about and desire to get the best value for the his dollar spent on healthcare services received)
In no particular order, make ‘it’…
- Relevant – People just don’t care about information or services unless it relates to them directly and to the specific issues that they face NOW. A 30yr old male doesn’t care about and becomes miffed when he gets a flurry of emails reminding people of the importance of mammograms. Actually, I think that Relevance AND Specificity go hand-in-hand. One big challenge of keeping communication and tools relevant to individuals is that something that IS relevant now, may not be relevant 3 months from now. Just as something that isn’t relevant now, may be relevant 2 months from now. Yep, us healthcare consumers are a fickle lot.
- Timely – It seems like people have a loosely defined horizon of what conversations and information are ‘timely’. Any communication beyond two weeks of when I needed it just seems worthless. And printed materials that are more than a month old, seem out-dated and irrelevant. Timeliness, fortunately, is a dimension of communication that falls into the ‘perception is reality’. It’s not that the information or communication has to be newly created but rather that it is presented within close proximity to when the person needed it.
- Simple – Yep, often the hardest thing to do is make complex things simpler and less confusing. I like the adage of ‘Keep It Simple Stupid’ and yet healthcare consumers are overwhelmed by the complexity of rules, plans, choices, communications and multitude of various entities involved in a basic healthcare service transactions. It’s sad when an insurance company has to create for its members an Explanation of its Explanation of Benefits.
- Easy – Just because something is Simple… doesn’t mean that it is Easy (as in nearly effortless or without much thought). Just as people can use Mint.com to gain insight into their finances and GoodRec.com to review/find what people say about local restaurants – the tools available and services accessed should require minimal effort to get started with. As a general rule of thumb, the more effort or interest that is exerted, then the derived insight and resulting value should dramatically increase. Honestly, this is one aspect that we (change:healthcare) continued to struggle with but are making some significant strides (and announcements) in the coming months to overcome this barrier. Healthcare data has been historically locked up in separate or proprietary silos but soon, we’ll be breaking it free! Viva Consumers!
- Trustworthy – Without trust, consumerism will stall and wither. I know that many of you have thoughts about where, when and how a trusting relationship is established and perpetuated… but i’ll summarize it as my Dad did once for me, “Trust is earned, often fragile, and hard as hell to earn back once lost.” What are the qualities of sites/Brands that you trust with your healthcare information, transactions, and tools?
- Controllable – I’d argue that when it comes to healthcare data and information, that people are actually LESS concerned about being secretative or isolated BUT RATHER care more about controlling who or what other parties has access to or sees their healthcare issues and related data. In fact, my guess is that the more control individuals are given over their own data, the likely people will begin to share and exchange personal information that can help others… aka healthcare transparency of choices made, perceived quality and experiences, and the costs thereof.
Final Questions
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Chris:
Great post . . . think that you’ve identified a good model for thinking about the problem here. Here’s what I’d add:
As an employee of a payor (Humana) I can say that we’ve been collectively surprised at people’s reaction to “consumer driven plans” like High Deductible Health Plans paired with HSAs.
We honestly believed that we were providing exactly what John Q Public needed for insurance . . . a low-premium product that would help them build up a rainy day fund – that they control – to actually *manage* their health expenditures. And when we saw more and more people buying HDHPs, we figured that consumers agreed.
But the fact of the matter is that they’re buying what they perceive to be “the wal-mart of insurance” – it’s cheap, but you get what you pay for. So their expectations of us have never been lower – at the same time as their needs have increased as never before. So smart companies like Google, Microsoft and some of the health communities like Patients Like Me are stepping in to fill the void.
Anyway, that’s an awful lot of preamble leading to this:
– We need to reccognize that there is an “anchor” – a family health manager – in nearly every family. It’s almost always the mom. We need to recognize that mom needs the tools not just to manage her health, but everyone’s. That can be challenging given that every family member can have not only different providers but different insurers.
– We need to stop telling people what to do, and start making the things they *already* like doing more healthy. That’s why my team in Humana’s Innovation Center is doing what we do with bikes, games, social networks, etc.
If we can address these two problems, we’ll start making a dent in “the last mile.” Would love to continue this dialog here and elsewhere . . . let’s get in touch!
I would also add that it needs to be Accesible or Information Accessible. There is so much information out there on healthcare options – like you mentioned in the Simple aspect, it’s important to make it easy to understand. But more along the lines of accessible, if the people who actually really NEED to get involved in these options don’t know about it, then it fails right there.
All of these great options don’t mean a thing if Joe Average doesn’t know about it.
Greg – Man, that’s a preamble! I know that HIC is doing a ton a research and I esp agree with the notion of a Family Health Manager (heh, saw that in the Microsoft presentation in DC so it must be true… wink wink) and that a ‘family’ can and prob will have more than one Insurer (eg Humana for my immediate dependents AND Medicare for my ailing parent). So that concept makes sense – which then leads me to ask for clarification of your preamble. Yes, I know that the reason I chose a high deduct plan was because it signif lowered my premium HOWEVER my expectations of the Insurer is that I have access to the tools (or my claims data is easily portable) to self-manage and make smarter, less expensive for the same clinical experience. I do not think that paying less means lower expectations, rather that paying less means more responsibility on my part and therefore I want tools and information to help me deal with that new found responsibility.
Hows that for a twist? Less actually means More… more respons on my part, more data liquidity, and more tools for me.
I also had a chance to poke around the HIC site (killa!) and would love to visit further around transparency. You absolutely right in that people don’t like to work to take care of themselves or their healthcare finances. They call it ‘work’ for a reason b/c it is perceived as hard or requiring effort. Yet, for personal finance we moved from paper statements from the banks, to computer software like Quicken, to effortless and almost (i did said almost) entertaining and informative sites like Mint.com. We’ve got to enable that same ease of insight and decision-making for consumers of healthcare.
YES, yes, yes I know about privacy (which is paramount) but that is an assumed milestone of achievement… Users/Consumers must control their own data and then have access to tools and resources that make all of the confusing words and codes and forms MUCH much easier to understand, be meaningful, and relevant… awww jeez, now i’ve started to ramble and rant.
I really appreciated your comment and keep’em coming!
I think this speaks to your points of relevance and trustworthiness, but as consumerism grows, won’t healthcare orgs need to “differentiate or die” like other retailers? If I see one more hospital ad on “care, close to home” I’m gonna start throwing shoes. Not only communicate but also *demonstrate* differences more clearly. Greg’s example of Humana’s Innovation Center is strong.