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[Music] and they've just gone crazy with them uh please welcome tandis hi everyone
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[Applause] so what i want to talk about today is the problem that i'm obsessed with which is
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bad customer service and health care so i'd like to start out by walking you through
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a day at the doctor's office can look a little bit like this you have to start out by making an
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appointment so you call in you talk to someone very unpleasant on the phone they put you on hold
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you wait there's bad hold music you're waiting you're waiting they come back you go back and forth a little bit on
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your calendars you've got an appointment it's in 21 days now it's 21 days later you go to the
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doctor's office someone very unpleasant checks you in at the front desk you sit down super depressing waiting room bad
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wall art very old issues of parenting magazine smells like purell in there that's fine
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this is your hangout for a little bit now and now it's maybe 30 or 40 minutes later
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someone calls you back as you may have guessed they're very unpleasant they take you back to the exam room it's very
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small blood fluorescent lighting everywhere they take your vitals they hand you essentially a sheet of printer
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paper they tell you to change into this now you're in sort of a secondary holding chamber except this time you can
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hear the doctor in the other room and they're saying hey it's so great to see you and so you know they're just getting
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started in there even though your appointment was an hour ago at this point pull up your phone you start to go
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through your little question list got up the courage to ask everything you came in to ask
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and then finally the doctor knocks like you could possibly still be changing he comes in does a little small talk with
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you he goes and sits down starts asking you some questions you're maybe like eight minutes into the
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appointment at this point and you're like okay also i have some questions and you pull up your little question list on
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your phone and you get through maybe like two or three of these questions um and then the doctor starts to give you a
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look like let's wrap this up and so you wrap it up you ask three questions the appointment is over you go
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outside you check out if you're lucky they'll tell you how much you owe if not you will just find out later in the mail
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so my guess is that maybe many of you in this audience have a concierge doctor but most of us have had some iteration
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of this experience at some point there are a lot of terrible things about our healthcare system but the one i want to
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complain about specifically today is why the customer service at the point at which you're actually consuming the
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health care is so appallingly bad and when i refer to customer service that's that's anything that touches the patient
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experience while you're why you're going to the doctor so a long wait time is as
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much bad customer service as the the unfriendly front desk person there's this really great quote that i
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love from bill gurley prolific investor and my relationship hall pass [Music] didn't know he was going to be here um
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the u.s healthcare market is the least customer-centric of any customer service industry we are so numb to the pain that
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we rarely object or complain so that's part of what i think is so crazy about this is that we kind of just
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take it um and so that got me curious to explore three questions that i want to go with
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you through with you here today number one why are things so bad how did they get this way number two why should we
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care that things are so bad and number three what can we do about it what's a little something we can do to make it
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better so let's start with why are things so bad a big part of this is our customer
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service problem is really more of a consumer service problem and what i mean by that is
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patients are consuming the health care but they're not exactly the customer in the traditional free market sense of the
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term so who is the u.s health care system as we know is an employer-sponsored model
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this was not very well thought out it's more of a world war ii relic that was came from a national mandated wage
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freeze in 1942 and we kind of just kept going with it and now today the doctor is not getting out of bed in the morning
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for your 15 copay they're really making their money off of the major stakeholders in the industry who are the
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employers and the insurance companies they're the payers they're the real customers in this story
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and doctors don't love this either by the way there's major burnout in the medical community but when you play this
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all the way out you're left with misaligned incentives between physicians and patients
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physicians in the traditional fee for service model which is our predominant model today where our physicians are
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paid per per patient encounter they're incentivized by volume and not by quality and not by good health
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outcomes so it's no surprise that practices are not designed to cater to the patient and once that becomes the
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norm it becomes the culture every doctor's office can get away with it and now you're left with these two really
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bad stats the first one is in primary care specifically the average nps for a provider is three
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that is so embarrassing number two 96 of patient complaints are about the service itself only four
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percent are about the care delivered so patients are really noticing how bad the
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customer service is and yet to go back to our earlier point patients have this sort of stockholm syndrome
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when it comes to going to the doctor specifically we'll like request a non-talkative uber because we don't feel
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like chatting with the driver or we'll leave a very scathing yelp review for a restaurant but when it comes to this
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service even though we're not an easy to please generation we become very submissive and
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it's the most important service across any service industry so this is not a good thing why is this happening and why
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should we care that we're having such a bad time at the doctor's office it's because bad service is bad for our
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health so good medicine is a partnership between a patient who's coming in with real information on how they're feeling
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and then a physician who's coming in with real expertise to bring to that information and they work together but
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if the patient is feeling very anxious and exhausted and the doctor is feeling very rushed and dismissive
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you're left with losing a bunch of really important information that you need to make nuanced diagnostic and
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treatment plans so to give you an example doctors are far more likely to prescribe antibiotics
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in the afternoon than they are in the morning for the same patient with the same issues because they're just running
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late and they're dealing with decision fatigue if you leave with anything from this talk it should be to make morning
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appointments um and then patients on the other hand know all of this and they've felt this before
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and so what many of them end up doing is deferring treatment altogether so patients feel like it's a hassle they're
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not getting anything out of it they will just text their med school friend healthcare has a patient buying problem
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because they've made the experience of going to the doctor's office so bad that we only go and we absolutely have to go
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and what do we lose when we go when we only absolutely have to go preventive care
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and preventive care is really the reason it's so bad that we're not going to the
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doctor's office we lose out on going when things are early we lose out on all the upstream life-saving cost-saving
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benefits um of prevention so i'm going to hit you with three stats on that the first one is 40 of annual deaths caused
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by the top five causes of death in the u.s are preventable with good preventive care
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according to the cdc for whatever that's worth to you avoidable chronic disease accounts for
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75 percent of our health care spend and finally on the other hand patients with a pcp a primary care doctor spend 33
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percent less on health care overall because they're front loading that spend toward prevention so bad service is bad
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for our health what can we do about it the good news is this we are starting to see more and more
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practices shift towards models that incentivize physicians to care about good customer service so there are two
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models we can use here to change the compensation model to allow physicians to have the time and space to think
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about um service so the first one is direct to consumer so that's making the patient the customer again in this
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scenario and the second one is leveraging value-based care models where the insurers
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are reimbursing based on quality instead of over volume and so in that case the insurer is still the
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customer but we're now rewarding a different outcome here so those are kind of the two options that we can leverage but
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as we can see we have the tools that we need it's really now about shifting norms in
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the healthcare industry and the industry is very clunky and it's red tapey and it's sort of
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crotchety at times and so the change might feel a little bit slower than it does in other industries but we're
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starting to see more and more companies push back and as they push back patient expectations change
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we start to expect more out of our health care and now we're starting to treat healthcare the way we treat any other
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service that we interact with and we start to say goodbye to that stockholm syndrome era
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but as we move towards these models that change the incentives for physicians we
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still need a framework to think about okay how do we get that good customer service how do we actually get the
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patient buy-in how do we get people to want to go back to the doctor's office because doctors and hospital
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administrators are not used to thinking about this they're not used to training on customer service or bedside manner
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so we need to look to another industry which is the hospitality industry so i brought you on this journey here
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today to tell you we need to be stealing from the hospitality industry they have
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figured this out already they know how to treat people like people they know how to provide human to
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human service which is ultimately today what healthcare still is so i really think this definition of
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hospitality from danny meyer is really great esteemed restaurateur my other relationship hall pass
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hospitality is present when something happens for you it is absent when something happens to you
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so we want health care that happens for patients and not two patients really michelin worthy or at least very
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effusive yelp review worthy health care and i want to share a few ideas on how i
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think we can get there i'm the co-founder of a primary care membership service called the landby
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and we do what we call a healthcare hospitality training with all of our team members all of our providers and i
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want to share a few central tenants from that training with you that i think are
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the ones can that can be applied into any practice they can be implemented at very low cost um and can really start to
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to shift the norms and shift the culture which is what we need um some of these may seem obvious
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but they're not in healthcare so here we go these are my top five number one follow the golden rule patients are
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entrusting us with their most precious resource which is their health treat them the way you would want to be
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treated at the doctor or you'd want your family to be treated number two set clear expectations this
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is not a subway track nobody wins when we hold information like running a few minutes late to ourselves
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number three be a good active empathetic listener ask good questions to get good
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clues treat every case like it's a medical investigation if someone didn't think something was
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important they wouldn't have brought it up with us another danny meyer line be an agent not
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a gatekeeper so an agent lets people in a gatekeeper builds up barriers to keep people out we don't want to be that kind
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of practice if a patient has a good reason to be asking you to break one of our rules and there's an easy way to
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break it within the bounds of the law then just break it finally for extra credit surprise and
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delight how can we make this the best interaction of a patient state even if they're going through something really
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challenging i think that's the fun puzzle of applying hospitality into the healthcare context is finding a way to
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bridge that gap how can we remember something about someone and make them feel seen and make them feel like yeah i
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want to come back to the doctor's office all right i don't have a super punchy ending here so i'm just going to wrap
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this up with healthcare hospitality treats patients the way they deserve to be treated we're
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all patients at some point and when that point comes the stakes will feel inherently high
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too high to get worse service than you would at your favorite restaurant thank you
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[Applause] i think the thing that struck me about our dysfunctional system is uh the bill
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gurley quote and then what you're doing there is no customer and how does that change over time in
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america i know you're what you're doing with your company as part of it so how do we change that in americans
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perception because i got my knee done and i didn't know how much it cost and then i found out just cleaning up my
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meniscus was sixty thousand dollars and that was like how much sixty thousand dollars ten years ago for
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a meniscus surgery in new york and then somebody said that should cost like ten thousand
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and there's no menu so we're going to a restaurant you know when you go to the restaurant
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in italy like the ones you go to and there's no prices yeah that's how you know you're [ __ ] i love
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those yeah you love it and then you hand me the check like you did when we were in vegas that time
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um so but how do americans start changing how they perceive this i think that's part of the problem is it
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not definitely part of the problem is that we all are kind of just okay with it and assume that this is this industry
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where we're not supposed to know the prices until afterwards no other industry works this way we don't put up
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with it anywhere else um and so i think direct to consumer models play a huge role in getting patients to think oh i
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can treat this like other services it's not like we're not annoying consumers in
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other ways we already are and so we just need to apply that same annoying attitude to health care um and then by
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leveraging direct to consumer models part of this is getting on higher deductible plans so we start to treat
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our dollars more like normal normal dollars putting money into hsas and fsas it gets us to start thinking more like a
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traditional customer and think about where we're spending our money and we we see that a little bit with
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uh direct to consumer drug companies um hymns hers get roman all the stuff that freeberg uses to
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get ready for battle david nice to meet you how are you good your hair looks great to prepare for
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war um those are a start right people just say nice things from now on come on i love
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it yeah um but this is part of it that people are saying it's so dysfunctional to go to the doctor it's so
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dysfunctional deal my insurance company for certain things yeah i'm just going to go on a website in order yep
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that is part of the frustration right yeah yeah that gives you a little taste of it and then alternatively if you
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don't want to go to the doctor you'll go to urgent care which has much more of an
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easy pricing menu in many cases that you can look at so again we're starting to get a taste of it and i think patient
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expectations will change and doctors will have to follow suit we tend to index the quality of american
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health care when you look at the average life expectancy first you do men women and then you you
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know you look at white men versus black men versus brown men you know white women versus black women et cetera and
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white men have always sort of been the standard bearer and then this odd thing has happened
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over the last three or four years where their life expectancy started to get worse and worse as our percentage share
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of health care expenses as a percentage of gdp have gone up and everybody gets up in arms because
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they're like well wait a minute we can't something is clearly so structurally broken
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that we're spending 15 20 30 a year increasing every year and we're dying now under the age of 80
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where this thing should be a thing where we're living to 100. why exactly is that thing happening like
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i could understand like where you could say maybe it's segregated to you know minority men or women or something but
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this is not this is basically everybody so why are we dying sooner as we spend more yeah because
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we're also increasingly spending on a lot of things that kill us and we're not we're overspending on
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health care because we're spending on things that kill us and then our health care gets very expensive because we have
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terrible terrible lifestyles and everyone is drinking way too much across all communities everybody is eating
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totally processed foods these are becoming more and more readily available increasingly so every year and so
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yes in the very upper echelons there's sort of a movement towards wellness and more holistic lifestyle but that has not
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really swept the nation yet and so we're all living really really unhealthy lives
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not caring about our preventive health and then spending a lot on healthcare down the line so you're saying it's
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really not we just can't outrun our lifestyle exactly exactly which is not our fault i mean corporations make it
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very very difficult to live a healthy lifestyle in the us and do you find examples of countries that have gotten
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population level health issues right whether it's with respect to costs or outcomes where you say that is
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directionally something that we can learn no i have no good answer to that question because
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every company besides the us thinks it has like the best health care system but that anytime i talk to anybody in one of
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those countries like i was speaking to people in canada the other week and they hate their health care and they think
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it's the worst thing ever and they like wait eight weeks to get uti medication and so a i just think it's too hard to
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compare our unwieldy country to other systems and b i don't even know people who are that happy with other systems so
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no i don't have a good answer how how much of a rule do you think um medicare medicaid cms can do
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to break the log gem versus waiting for politicians to pass legislation like obamacare to kind of try to reorient
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what's wrong i think it's i think it really is both i think that um hhhs and is playing a huge role in trying to get
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more and more value-based care models um through medicare and they're making a huge push to do that and so it's slow
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and clunky but i think they have the right idea they want us to move towards a value-based care model
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i've been thinking a lot about mental health recently seeing what we've seen during the pandemic a lot of young
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people our kids having these two years alone and what the second or third order effects of that
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and just trying to get consensus in america around health care is very hard but i think since we've all suffered
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some degree of uh mental health over this covet break which i think drove a lot of
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people crazy and created a lot of anxiety [Music] is there any way for us to think about
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universal health care but not have to have this nationwide discussion of all or nothing and i was just thinking
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mental health is something that everybody can appreciate it's not that expensive to deal with it's not surgery
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why can't we just agree as a country that anybody who wants to talk to a therapist or counselor
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will be able to do it for a sliding scale or a very small amount of money and maybe be able to just chip off one
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piece of the puzzle and say you know what therapy will be 50 bucks flat rate the
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country will pick up the other 50 or 150 whatever it is to get this done uh and maybe you just speak about mental
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health you know as a larger issue because it does seem to have so many downstream effects in terms of our
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physical health yeah we've thought about this a lot at the land because we've tried to figure out a way to to
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integrate mental health in a way where we would be able to make money and we can't um just yet so
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so yeah there have been a lot of models that came out during covet that allow for you to text with somebody and do
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like virtual therapy there are a lot of therapists who offer a sliding scale but
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part of the reason it's it's a little bit more difficult is that the patient panel size the number of people they can
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take on is so much lower because it's such a higher touch experience and so it's hard to integrate it into the
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traditional primary care model where in in the across the u.s one physician has a panel of 2 300 patients on average
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and so you just can't do something like that for mental health are there um large population health issues that
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you'd love to just get on the radar folks in this room that are poorly understood i'll give you an
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example like um there is somebody i follow she's a writer i think for the i can't remember it's in new york times
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something and she said her best friend died of a heart attack in her 40s but then she had some stats about the
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incidence of heart disease amongst women versus men and i had always assumed that
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it was largely a male predominant issue until i saw those stats and i realized my god like this is a broadly pervasive
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issue maybe it's because of lifestyle etc so i learned something in that moment i didn't know before but any
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broad population level issues that you think are really important for folks here to know about yeah i mean sort of
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related to that i would say nutrition label literacy is so hugely important there's so much scary marketing that
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people have to educate themselves on and it's such a part-time job to have to learn about why this product that looks
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extremely healthy and is like using the new brand colors that are not doritoey that looks like it should be vegan and
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organic is actually really bad for you so having more education on what makes for good food i think would cut out a
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huge huge portion of our preventive lifestyle how can people find out more about the it's landry l-a-n-d-r-y this
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is the nightmare of my life it's the land b-l-a-n-b-y on the big screen it's just right there yeah i'm sorry
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how can they find out more about it if they wanted to become a member how do they become a member are there a
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membership available right there l-a-n-b-y there's got to be a website i'm assuming or you have an email or
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something and then yeah it's getting can it be the website is actually landing mostly people call it the lamby like a
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lamb so the landry that's i keep hearing people mispronouncing it it's i've already lived a life
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lifelong candace life and now i have like a mispronunciation of the lambie all the time um
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so you can just go to lambie.com you can apply for membership at the top of the website it's in new york can it scale
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and and are you going to raise money for this is it going to be a venture-based investment because it sounds fascinating
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to me as a business model yeah so we're actually raising our seed right now we predominantly raised money through our
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members so far which has been really nice as having our consumers as investors um
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but yeah it can reach venture scale because the way we're doing it not to get to in the weeds is through a
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three-person care team model so we're able to take on more patients per panel because you're assigned not just a
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doctor but also a nutritionist and a concierge manager um who does all the patient homework for you so raising a
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seed and yeah let me know where to send the check i'm in sounds great um let's thank candice for
00:22:24
taking the time okay now we'll let your winners ride rain man [Music] we open source it to the fans and
00:22:39
they've just gone crazy with it [Music] besties [Music] we should all just get a room and just
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have one big huge orgy because they're all just useless it's like this like sexual tension that they just need to
00:23:06
release [Music] we need to get back [Music] i'm going on [Music]