Right now, there’s a woman waiting for a colonoscopy, asking the surgical center’s reception staff the Hail Mary of all questions: “What does this procedure cost? The front desk staff can’t give her an answer, as much as he’d like to, even though she’s now downgraded the question to a ballpark figure or even a range.
Her question is a common one. For patients, the lack of transparency on cost exists throughout the healthcare system.
All the patient is trying to do in this scenario is figure out how the cost of this procedure will eat into her paycheck and could potentially eat into her ability to pay her other bills.
She’s not confused that she is at a flea market or yard sale, and trying to bargain to get her price down—yesterday’s horrible procedure preparation, her extremely sore bum and empty stomach would not let her give in to such fantasies—as much as she’d like to convince herself she is anywhere else but at a colonoscopy center.
Healthcare is complex, and this is the way it has been for decades. However, the logical side of my brain rebels against this. I can’t come up with another good or service that we purchase and then consume—before knowing what it will cost.
The woman in the example above also asked her doctor’s office about costs prior to the procedure, to no avail. She could’ve called her insurance company, for sure, but we all know that is a 30-minute exercise at minimum that is at best extremely frustrating, at worst, utterly futile.
Odds are that 30 minutes that she would have spent researching colonoscopy costs would be more be much more effectively spent playing Sudoku. Certainly, Sudoku would be a better option than calling her health insurance company, as far as her blood pressure is concerned. Ironically, blood pressure is generally accepted as a vital sign of one’s health.
Even though most insurance companies now have web tools that let plan members compare costs, not all costs for an episode of care can be researched and dissected. In this example, the patient could potentially cost compare the price of the actual colonoscopy but not the price of the doctor’s fee, the fee for the anesthesiologist and other parts of the procedure.
Patients also can’t easily compare how doctor or anesthesiologist fees would differ by the location of the procedure. Last I checked, location is a fundamental driver of cost, whether we are talking about paying for colonoscopies, apartments or fresh vegetables.
Why is the process of understanding cost and consuming healthcare overly complex and inefficient for patients? If you believe otherwise, I have a bridge to sell you, and a friend with a great investment opportunity for you. The investment opportunity is this: give him your money and you get a 150% return in 2 months, risk free. Yeah, his name is Peter Ponzi.
In any system, inefficiencies are often enormous business opportunities for those who find a better way to do things, sometimes from the outside.
Think about what happened to malls and department stores. In the not so distant past, you’d spend your Saturday making a list and then running to the mall, parking miles away, suffering through the cold and wind, only to get inside and navigate throngs of crowds, confusing signage and—don’t even think of it—the food court. At your local department store, usually named for a wealthy family with a hundred-year-plus legacy of retail history, you’d easily spend hours navigating through its various departments to ultimately find the items that you are looking for.
And if you’ve had the pleasure of a department store trip in the last few years, then you are aware that if you need help from a sales associate, you also need good luck to locate one. Often it is just best to just find the checkout, wait in line, and then head back to the parking lot to fight the cold and the 3 inches of snow that you must now brush off your car.
So, what happened to this inefficiency in retail? Amazon happened. Zappos happened in shoes. Overstock happened for liquidated merchandise. And in housewares, Wayfair happened. Just to name a few.
Lack of efficiency in the current ways of doing business was an opportunity for these e-commerce businesses. Those retailers that didn’t adapt now struggle or became ancient history, just like many malls (Anyone remember Circuit City?). In the future, you might even find evidence of the malls at the American Natural History Museum as human cultural artifacts, “Images of Retail, selling through the Ages,” after the hall of Minerals and Gems, between Mammals and Marine Invertebrates.
Right now, there is another scenario playing out in healthcare. Young eager beavers with Ivy League degrees with endless ambition are working at startups, most with plenty of funding are sitting at their Macs eating Chipotle, working nightly until 2 a.m.
What are they up to? What are they doing? They are working on solving the inefficiency in healthcare.
Some companies are already servicing patients more efficiently today.
- Though 2016 was a tough year when the company pulled back from several markets and reduced its provider network by half, Oscar Health is still out to prove that ecommerce, mobile apps and talking with doctors for free online or over the phone is a more efficient way to purchase health insurance.
- Each month, a steady stream of consumers use Zocdoc.com to find in-network neighborhood doctors, instantly book appointments online, see what other real patients are saying and get reminders for upcoming appointments and preventive checkups.
Many other companies and startups are well on their way to cracking the healthcare nut of inefficiency, in favor of transparency and understandable pricing. Companies such as Oscar Health and ZocDoc see the enormous opportunity. They see healthcare as a holdout industry in the efficiency and transparency that digital affords. And as far as affording their ambitious plans and expansion strategies, whether they have private equity or family funding, these entrepreneurial companies are determined to break the mold of inefficiency in healthcare.
The only question is, who will successfully capitalize on this inefficiency first? Will startups? Or will the established healthcare industry players like insurers and health systems? In the end, the answer may be both.
As the incumbent, established healthcare organizations have both the burden and the advantage of leading this change. The advantage is there, and there for the taking.
Digital and data are truly (and literally) on the industry’s side. Existing healthcare companies have the data, they understand it, and know where it comes from (or someone in their organization does), and how it is used. Those nascent startups are working all hours to cull, pull and connect the data—and most are doing so from the outside.
The lack of transparency, inefficiency and pain for both sides—providers and patients—could be on its way out. There are healthcare companies out there today that have leveraged the transparency and competition that digital brings to form effective strategies that give them a competitive advantage. Here’s one example:
In September of last year, UnitedHealthcare Group, the biggest commercial health insurer, rolled out an updated app for its plan members. The app’s primary aim is making healthcare easier and more efficient for consumers to use.
New features in the mobile app automatically alert plan participants about preventive services and when they miss recommended medical treatments or tests, and make it easier to estimate costs and pay bills.
Several other several new features make it more convenient for plan members to access and use their health benefits, including fingerprint-enabled sign-in, ApplePay to enable people to pay medical bills, and a button on the app’s main page to help users connect directly with a UnitedHealthcare customer service representative.
Another new feature lets patients search for pharmacies and estimate drug costs while still at the doctor’s office, refill medications and review prescription claims.
Oscar Health, ZocDoc and UnitedHealthcare are among the companies that took an inefficiency that existed, created a solution using the web, e-commerce and digital technology and healthcare more transparent and accessible for consumers.
In this scenario, patients win, providers win, companies win and a better and more efficient way of delivering and managing healthcare is born.
Amy Madonia is a New York ecommerce and marketing consultant, writer and a frequent speaker at digital marketing events. She has served as the digital marketing and ecommerce lead at multiple consumer brands including Wrangler, New York & Company, Nautica and Hanes.