The document discusses healthcare consumerism and its implementation. It makes the following key points: 1. Consumerism in healthcare affects all stakeholders, including patients, families, physicians, and prospective patients. However, consumerism experiences are generally negative for patients. 2. Simply defining consumerism is not enough - healthcare organizations must champion it, incorporate it into strategies and budgets, and develop executable plans. 3. CMS heavily influences healthcare business strategies and definitions of concepts like patient experience, but its approach is limited and excludes important stakeholders and touchpoints.

1.
Pink
Unicorns
are
as
common
as
a
healthcare
firm
that
has
mastered
consumerism.
Nobody
wants
to
talk
about
it,
but
someone
has
to
drag
the
elephant
into
the
room.
I
am
the
person
who
is
dragging
the
elephant—
come
on,
Fido.
That
is
what
I
do.
Without
disruption,
there
is
no
capacity
for
change.
And
after
all,
why
join
the
navy
if
you
can
be
a
pirate?
And
remember,
if
there
is
no
elephant
in
your
room,
most
likely,
you
are
in
the
wrong
room.
Churchill
said,
“I
am
not
one
who
needs
to
be
prodded.
If
anything,
I
am
the
prod.”
Saddle
up.
If
you
want
to
be
king
of
the
rabbits,
it
is
best
to
buy
a
pair
of
floppy
ears.
Several
of
you
emailed
me
asking
me
to
summarize
my
writings
on
healthcare
consumerism
in
the
form
of
a
white
paper.
To
those,
and
to
whoever
else
may
be
interested,
I
hope
you
find
the
following
pages
worth
a
few
minutes
of
your
time.
Either
way,
I
learn
from,
and
I
appreciate
your
feedback.
Consumerism
is
impossible
to
implement
if
you
are
afraid
to
define
it.
Let’s
begin
with
a
definition
of
consumerism.
I
use
the
term
consumerism
as
a
placeholder
for
several
different
terms:
patient
and
consumer
access,
engagement,
experience,
and
consumption.
1. “In
all
seriousness,
Healthcare
can
be
pretty
funny.”
If
I
may
borrow
a
phrase
from
the
unending
discussion
of
presidential
politics,
it
is
impossible
to
solve
a
problem
without
the
willingness
to
name
it.
I
meet
and
speak
regularly
with
top
executives
across
all
of
the
healthcare
segments—providers,
payers,
life
sciences,
and
national
retail
pharmacies.

2.
Simply
giving
consumerism
a
label
does
not
equate
to
having
defined
it,
championed
it,
made
it
a
part
of
a
business
strategy,
budgeted
for
it,
or
developed
an
executable
plan
to
implement
it.
A
rose
by
any
other
name
would
be
just
as
useless.
2. Who
is
impacted
by
consumerism?
Pretty
much
everybody,
but
the
impact,
for
the
most
part
is
negative
if
you
happen
to
be
the
patient
or
the
consumer.
Everybody
in
the
US
can
be
grouped
into
one
of
two
categories;
patients
and
prospective
patients.
Unfortunately,
regardless
of
which
category
you
happen
to
belong
to,
consumerism
experiences
are
the
same—awful.
To
be
succinct,
consumerism
affects,
and
is
demanded
by
the
following
groups
of
stakeholders:
• Patients
• Family
members
• Caregivers
• Referring
physicians
• And,
drum
rolls
please…everyone
else.
Prospective
patients.
o Sick
people
who
think
they
are
healthy
o People
whose
lifestyles
are
likely
to
turn
them
into
unhealthy
people
o Healthy
people
If
healthcare
businesses
were
any
other
business,
say
retail
or
professional
services,
healthcare
would
have
gone
the
way
of
Blockbuster,
Circuit
City,
and
Borders.
That
is
because
healthcare
still
operates
under
the
same
bricks
and
mortar
business
model
as
Radio
Shack
did
at
its
heyday.
Over
the
last
fifty
years,
healthcare’s
single
strategic
attempt
to
adapt
to
how
businesses
operate
today
is
having
a
website.

3.
In
2016,
healthcare’s
business
strategies
continue
to
be
entirely
influenced
by
one,
and
only
one,
factor.
CMS.
CMS
says—Jump!
“How
high
shall
we
jump,
sirs?”
Implement
a
four
hundred
million
dollar
EMR?
Absolutely.
Pretend
that
meaningful
use
is
meaningful—you
betcha.
Paint
the
parking
lot
pink—just
tell
us
what
shade
of
pink.
Implement
population
health
without
knowing
anything
about
the
health
of
the
individuals
who
comprise
the
population
we
serve—let
me
at
it.
Drive
accountable
care
without
knowing
what
any
of
the
services
we
deliver
cost—let
the
accountants
figure
it
out.
CMS
has
everyone
in
healthcare
believing
that
the
only
thing
that
matters
about
patient
experience
can
be
summed
up
by
the
answers
to
32
questions.
There
are
two
insurmountable
problems
with
CMS’s
definition
of
patient
experience:
• It
excludes
most
of
a
health
system’s
stakeholders—referring
physicians,
caregivers,
family
members,
and
prospective
patients—consumers.
• And,
it
excludes
where
most
of
those
experiences
happen—
prior
to
treatment
and
after
treatment.
3. “Fake
plants
die
if
you
do
not
pretend
to
water
them.”
So
do
patients
and
customers
if
you
do
not
pretend
to
care
about
their
experiences.
It
seems
like
a
poor
business
strategy
to
spend
millions
of
dollars
trying
to
get
new
patients,
or
millions
of
dollars
telling
your
members
about
how
much
you
care
about
them,
or
millions
of
dollars
telling
people
about
your
new
wonder
drug
if
your
relationship
is
nothing
more
than
an
ad
campaign.
Sooner
or
later
you
have
to
offer
something
more
than
talk.
People
know
when
companies
are
faking
it.

4.
4. “If
consumerism
isn’t
our
biggest
problem,
it
will
do
until
a
bigger
problem
comes
along.”
People
ask
that
healthcare
organizations
be
able
to
answer
two
questions:
who
am
I?
And
how
am
I?
Most
healthcare
organizations
cannot
answer
either
of
those
questions.
And
that
is
a
problem,
a
problem
on
many
fronts.
Population
health.
Accountable
care.
Patient
acquisition
and
retention,
care
management,
and
wellness.
None
of
these
initiatives
are
achievable
for
organizations
whose
ideas
of
customer
access
are
to
have
people
call
a
call
center
whose
hours
of
operation
are
half
the
number
of
hours
of
Comcast.
Providers,
payers,
life
sciences,
and
national
retail
pharma
chains
are
all
on
the
hook
for
improving
care
and
wellness.
But
they
are
ill
equipped
to
succeed.
Its
like
coming
unarmed
to
a
battle
of
the
wits.
The
goal
of
the
Affordable
Care
Act
was
to
make
these
initiatives
realistic.
The
goal
was
to
reinvent
healthcare
in
the
hope
that
doing
so
would
raise
all
boats.
What
we’ve
learned
is
that
although
the
boats
are
being
raised,
if
you
happen
to
be
the
patient
that
the
Affordable
Care
Act
chained
to
the
dock,
you
are
going
to
drown.
• Once
a
person
leaves
the
hospital,
providers
do
not
know
if
the
treatment
they
provided
worked.
Unless
the
patient
is
readmitted,
and
then
they
know
that
the
treatment
was
not
effective.
• Payers
do
not
know
anything
about
the
condition
of
the
patient
other
than
the
claims
that
were
submitted.
• Pharmacies
only
know
whether
the
patient
picked
up
his
or
her
medication.
They
do
not
know
if
the
medication
worked.
• Life
sciences
firms,
with
all
of
their
big
data
have
no
data
about
the
person
using
their
drugs.
For
providers,
almost
all
access
happens
by
phone.
People
call
a
call
center
that
is
usually
nothing
more
than
a
scheduling
center.
The
call
center
has
no
CRM.
As
a
result,
the
person
answering
the
call
has
no

5.
knowledge
of
the
fact
that
the
caller
has
been
undergoing
chemotherapy
for
the
last
three
months.
They
health
system
does
not
know
who
you
are
or
how
you
are.
CRM,
where
it
exists
at
a
provider,
is
used
for
business
development
and
telemarketing.
It
is
used
to
get
people
interested
enough
it
its
services
to
pick
up
the
phone
and
request
those
services.
Unfortunately,
when
someone
calls,
the
person
who
answers
their
call
has
neither
the
knowledge
nor
the
tools
to
help
the
caller.
Unfortunately
for
providers,
only
about
twenty
percent
of
calls
has
anything
to
do
with
scheduling.
The
other
eighty
percent
of
the
calls
are
transferred
to
someone
else
in
their
organization
that
does
not
have
the
tools
to
meet
the
caller’s
needs.
5. History
is
the
sum
total
of
things
that
could
have
been
avoided.
Healthcare
in
the
US
are
wonderful
institutions,
especially
if
you
need
treatment
within
their
four
walls.
Sick
people
enter,
and
most
of
the
time
exit
healthy.
I
am
one
of
those
people.
I
owe
my
life
to
a
team
of
oncologists
and
at
another
time
to
a
team
of
cardiologists.
Those
institutions
are
less
wonderful
if
all
you
need
to
do
is
to
speak
with
someone
to
schedule
an
appointment
or
to
speak
with
a
clinician.
One
of
my
clients
did
not
have
a
solution
for
anyone
who
needed
to
speak
with
a
clinician.
Ninety
percent
of
the
people
who
called
to
speak
with
a
clinician
were
sent
to
voicemail.
The
message
on
the
voicemail
said
that
someone
would
return
his
or
her
call
in
two
to
three
days.
In
those
two
to
three
days
that
person
could
have
gone
to
the
Minute
Clinic
and
have
been
half
way
through
their
prescription
of
amoxicillin.
Because
this
was
a
large
health
system,
when
I
extrapolated
the
results,
I
concluded
that
the
system’s
inability
to
provide
a
clinician
to
speak
with
those
callers
resulted
in
about
ten
thousand
additional
visits
to
the
ED
that
year.

6.
At
another
one
of
my
clients,
a
children’s
hospital,
I
discovered
that
ninety-­‐four
percent
of
their
asthma
patients
received
treatment
at
the
ED
instead
of
scheduling
an
appointment
at
a
clinic.
Their
reason
for
doing
so
was
because
the
ED
was
available
24x7,
it
did
not
require
an
appointment,
and
there
was
no
copay.
At
one
client,
instead
of
calling
the
system
to
cancel
an
appointment,
patients
went
to
the
clinic
to
cancel
their
appointment
because
going
to
the
clinic
was
easier
than
calling
the
system.
One
specialty
provider
just
launched
a
new
website.
I
tried
the
link
to
add
myself
as
a
new
patient
and
schedule
an
appointment.
When
I
got
to
the
forty-­‐seventh
question
I
gave
up.
The
system
should
have
at
least
recorded
my
email
address,
user
name,
and
password,
but
it
didn’t.
Hence,
the
system
has
no
record
of
my
attempt
to
become
a
patient.
That
same
system
had
a
“Contact
Us”
box.
I
entered
a
question,
and
the
reply
stated
that
someone
would
get
back
to
me
within
two
to
three
days.
That
probably
seemed
like
a
good
idea
to
the
person
in
the
system’s
IT
department,
but
that
is
where
a
lot
of
good
ideas
go
to
die.
In
the
last
fifty
years,
the
biggest
innovation
in
patient
access
was
that
patients
went
from
using
rotary
phones,
to
using
touchtone
phones,
to
using
smart
phones.
Other
that
providing
an
Internet
connection
in
waiting
rooms,
there
have
not
been
any
patient
access
innovations
at
most
health
systems.
6. “Hello,
Kitty.”
When
we
went
on
vacation
I
asked
my
brother
to
keep
an
eye
on
my
house,
water
the
plants,
feed
the
cat,
and
check
in
on
my
mom.
My
brother
and
I
spoke
every
other
day.
One
day
my
brother
tells
me,
“Your
cat
died.”

7.
“You
can’t
just
tell
me
that
my
cat
died,”
I
told
him.
“You
have
to
ease
me
into
it.
First,
maybe
call
and
tell
me
that
the
cat
got
out.
Then
tell
me
that
the
cat
is
on
the
roof
and
won’t
come
down.
Then
tell
me
that
you
called
the
fire
department
and
a
fireman
brought
a
ladder
to
try
to
get
the
cat
off
of
the
roof.
Then
call
me
again
and
tell
me
that
the
cat
fell,
but
that
the
fireman
is
performing
CPR.
Then
tell
me
that
the
cat
died.”
“Sorry,
I
should
have
been
more
considerate,”
said
my
brother,
who
was
quite
embarrassed
at
this
point.
Two
days
later
I
asked,
“How
is
mom?”
My
brother
hesitated
a
few
seconds
before
replying.
“Um,
mom
is
on
the
roof….”
So,
how
is
healthcare
consumerism
fairing?
Healthcare
consumerism
is
on
the
roof.
“We
are
fully
half-­‐confident”—"I
don't
want
yes-­‐men
around
me.
I
want
everyone
to
tell
the
truth,
even
if
it
costs
them
their
jobs."
While
the
services
delivered
by
healthcare
may
be
world-­‐class,
the
business
model
by
which
those
services
are
delivered
is
a
0.2
business
model.
And
it
is
difficult
to
fix
that
model
without
the
willingness
to
acknowledge
that
the
model
is
flawed.
It
is
especially
flawed
when
it
comes
to
how
healthcare
interacts
with
its
patients,
prospective
patients,
family
members
and
caregivers.
It
doesn’t
interact
well
Monday
through
Friday
between
8
a.m.
and
6
p.m.
It
doesn’t
interact
at
all
in
the
evenings
or
on
weekends.
7. "The
light
at
the
end
of
the
tunnel
has
been
turned
off
due
to
budget
cuts."

8.
Everything
patients
and
consumers
need
begins
and
ends
with
access.
Without
access
there
is
no
engagement.
Without
engagement
there
is
no
care
management
and
no
patient
acquisition.
Health
systems
will
tell
you
that
they
worry
about
leakage.
Leakage
is
a
polite
term
for,
“We
do
not
know
what
is
going
on.”
Leakage,
in
the
vernacular
of
healthcare,
is
the
same
thing
as
the
term
churn
is
in
retail.
It
means
that
patients
disappear
after
treatment.
Health
systems
do
not
know
where
those
patients
went,
why
they
left,
or
if
they
will
ever
return.
What
nobody
seems
to
understand
is
that
patient
leakage
prior
to
treatment
may
be
a
hundred
times
higher.
People
call
to
get
an
appointment
and
they
give
up.
People
go
to
the
website
because
they
are
interested
in
purchasing
healthcare
and
they
give
up.
People
cancel
appointments
or
they
simply
don’t
show
up
for
their
appointment.
I
have
yet
to
come
across
a
health
system
that
focuses
on
front-­‐end
leakage.
I
have
yet
to
come
across
a
health
system
that
focuses
on
“keepage.”
Suppose
that
a
patient’s
worth
to
a
health
system
is
somewhere
between
$180,000-­‐$250,000
over
twenty-­‐five
years.
People
may
disagree
about
what
the
exact
value
is,
and
that’s
fine.
But
whatever
the
dollar
value
is,
losing
a
thousand
patients
is
a
big
financial
loss.
On
one
hand,
the
health
system
is
spending
millions
of
dollars
on
marketing
to
acquire
patients,
and
on
the
other
hand
it
is
spending
nothing
to
capture
those
patients.
That
is
why
I
do
not
recommend
that
healthcare
organizations
focus
on
patient
experience
management.
I
recommend
that
those
organizations
focus
on
Patient
Equity
Management.
Treat
patients
and
prospective
patients
as
though
they
are
worth
six
figures,
and
manage
those
experiences
accordingly.

9.
8. "The
key
to
being
a
good
manager
is
keeping
the
people
who
hate
you
away
from
those
who
are
still
undecided."
One
thing
overlooked
when
it
comes
to
understanding
customer
experience
is
that
your
customers’
experiences
are
cumulative.
Harvard
Business
Review
wrote
that
fifty
percent
of
the
people
who
call
an
organization
are
calling
because
they
were
unable
to
accomplish
what
they
wanted
when
they
went
to
the
business’s
website.
It
also
wrote
that
twenty-­‐five
percent
of
callers
are
likely
to
churn
(leak)
simply
because
they
had
to
call.
Nobody,
or
at
least
almost
nobody,
wants
to
talk
to
your
firm.
Think
about
it.
My
children
have
smart
phones,
but
I
have
never
seen
them
use
their
phones
to
call
anyone.
When
was
the
last
time
you
saw
someone
wearing
a
t-­‐shirt
printed
with
the
words,
“I
love
Aetna,”
or,
“I
love
HCA?”
To
put
it
succinctly,
people
do
not
want
to
work
hard
to
do
business
with
your
institution.
Customers
are
like
water—they
seek
the
path
of
least
resistance.
If
you
make
them
work
hard
to
purchase
your
services,
or
to
conduct
business,
they
will
seek
an
easier
solution.
9. “Never
try
to
teach
a
pig
to
sing;
it
wastes
your
time
and
it
annoys
the
pig.”
By
limiting
access
to
your
organization
through
a
call
center
you
are
trying
to
force
the
pig
to
sing.
Simply
having
a
website
or
a
mobile
app
is
like
putting
lipstick
on
the
pig.
Healthcare
publishes
a
list
of
health
systems
that
are
“Most
Wired.”
While
that
may
be
helpful
in
a
hospital
setting,
it
is
particularly
unhelpful
to
patients
and
consumers
during
all
of
those
times
when
they
are
not
in
the
hospital
or
clinic.
If
you
really
want
to
drive
consumerism,
seek
to
become
the
“Most
Unwired”
health
system.
After
all,
other
than
using
a
phone,
being

10.
wireless
is
the
only
way
for
a
patient
or
for
someone
who
wants
to
buy
services
from
your
health
system
to
access
it.
10.
If
you
make
it
idiot
proof,
someone
will
design
a
better
idiot.”
Well,
not
someone
in
healthcare.
There
are
plenty
of
idiots
out
there
who
cannot
find
their
villages.
Two
of
the
buzz
phrases
associated
with
patient
engagement
and
patient
access
are
human-­‐centered-­‐
design
and
design
thinking.
Consumerism
is
one
of
the
most
popular
terms
spoken
by
healthcare
executives.
It
is
also
one
of
the
least
understood
terms.
Healthcare
is
noteworthy
in
its
attempts
to
solve
problems
that
do
not
exist.
Those
efforts
remind
me
of
people
who
want
to
rescue
cats
that
have
climbed
trees.
I’ve
looked
at
a
lot
of
trees.
And
I
have
never
seen
a
skeleton
of
a
cat
in
a
tree.
The
cat
rescuers
are
trying
to
solve
a
problem
that
is
not
a
problem.
The
same
holds
true
for
healthcare
executives
and
their
attempts
to
solve
the
patient
experience
problem
by
only
looking
at
the
problem
from
the
perspective
of
CMS.
The
good
news
is
that
all
of
the
ways
people
access
your
health
systems
were
designed
by
humans.
But
before
you
think
that
gives
you
a
leg
up
on
how
to
deal
with
access
and
engagement,
those
business
processes
were
all
designed
without
thinking—that’s
like
multiplying
design-­‐thinking
by
negative
one.
And
those
processes
were
certainly
designed
without
ever
asking
a
patient
what
their
expectations
were,
without
asking
what
would
constitute
a
good
user
experience
for
them.
Almost
every
patient
and
consumer
experience
that
happen
outside
of
the
four
walls
of
your
institution
is
the
result
of
experiences
that
simply
evolved
over
time;
those
experiences
were
never
designed.
And
that
is
why
those
experiences
are
so
poor.

11.
11.“It
is
difficult
to
lead
a
cavalry
charge
if
you
think
you
look
funny
sitting
on
a
horse.”
And
so,
if
you
want
to
get
the
customers
experiences
right,
you
had
better
ask
a
customer,
or
preferably
and
lot
of
customers,
and
you
had
better
be
pretty
committed
to
designing
experiences
that
meet
or
exceed
what
those
customers
want.
But
suppose
you
are
the
executive
slated
to
lead
that
charge.
What
do
you
do,
and
what
should
you
do?
Let’s
start
with
a
few
givens
about
how
customer
experiences
are
going
to
change
over
the
next
few
years.
Fewer
and
fewer
customers
are
going
to
call
your
system.
Your
call
center,
if
it
still
exists,
will
become
an
escalation
center
for
very
specific
customer
needs.
And
how
do
we
know
that
is
true?
We
know
that
because
some
very
successful
companies
don’t
have
call
centers—Netflix,
Amazon,
and
eBay.
And
do
you
what?
Those
companies
never
had
call
centers.
Each
company
designed
their
customer
access
processes
in
a
way
that
eliminated
the
need
for
a
call
center.
Customer
service,
and
the
resultant
experiences
from
those
services,
happens
online.
And
not
only
do
they
happen
online,
they
happen
the
same
way
every
time.
Without
variation.
They
happen
that
way
on
a
PC
and
on
a
tablet
and
on
a
smart
phone.
So,
while
you
worry
about
how
funny
you
will
look
sitting
on
that
horse;
start
to
think
about
what
experiences
you
need
to
create.
In
a
health
system,
you
will
have
to
design
two
categories
of
experiences;
one
set
that
involves
patient
care,
and
another
set
that
includes
the
processes
of
having
to
do
business
with
the
health
system.
12.
“Artificial
intelligence
is
no
match
for
stupidity.”
It
may
not
be
a
good
match
for
stupidity,
but
it
is
a
great
match
when
it
comes
to
perfecting
customer
experience.
Let’s
focus
one
last
time

12.
one
your
call
center.
While
there
are
numerous
problems
with
call
centers,
the
one
problem
that
cannot
be
designed
away
is
the
inherent
variability
of
each
call.
If
six
people
call
with
the
same
question
they
will
likely
get
six
different
answers
based
on
whom
they
speak
with.
By
default,
it
is
not
possible
to
create
six
different
best
experiences
for
the
same
problem.
It
is
possible
to
design
a
singular
excellent
experience
for
a
singular
need.
And
that
is
where
artificial
intelligence,
and
natural
language
processing,
and
soon
augmented
reality
should
be
used
to
create
the
right
experience.
What
that
tells
me
is
that
the
more
human
interaction
you
can
remove
from
the
delivery
of
the
patient
and
customer
experience,
the
better
those
experiences
will
be.
13.“The
road
to
wellness
is
paved
with
good
intestines.”
There
are
three
groups
of
people
in
this
world;
sick
people,
healthy
people
who
do
not
know
that
they
are
sick,
and
healthy
people
who
will
become
sick.
Although
millions
of
people
want
help
managing
their
wellness,
wellness
isn’t
for
sale.
At
least
not
on
a
level
where
you
or
I
could
purchase
wellness.
But
that
is
rather
silly
given
that
every
healthcare
institution
is
on
the
hook
for
providing
wellness,
for
care
that
is
accountable,
and
for
managing
the
health
of
the
population.
Population
health
and
accountable
care
have
a
lot
of
cachet
in
the
boardrooms
of
heath
institutions.
Unfortunately,
that
cachet
never
translates
into
healthier
people.
A
four
hundred
million
dollar
EMR
that
knows
what
that
Sally
had
her
gallbladder
removed
three
years
ago
tells
you
nothing
about
how
Sally
is
today.
We
are
much
better
at
knowing
how
someone
was,
but
we
know
almost
nothing
about
how
someone
is.
There
are
also
two
rules
about
healthcare:

13.
• Rule
1:
Everyone
will
get
sick
• Rule
2:
Doctors
cannot
change
Rule
1
That
said,
a
lot
of
improvement
could
be
made
with
regard
to
Rule
2.
The
only
thing
missing
is
a
willingness
to
find
and
implement
a
solution.