#AIS: The Lanby's Tandice Urban on solving healthcare's customer service problem

[Music] and they've just gone crazy with them uh please welcome tandis hi everyone [Applause] so what i want to talk about today is the problem that i'm obsessed with which is bad customer service and health care so i'd like to start out by walking you through a day at the doctor's office can look a little bit like this you have to start out by making an appointment so you call in you talk to someone very unpleasant on the phone they put you on hold 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

your calendars you've got an appointment it's in 21 days now it's 21 days later you go to the doctor's office someone very unpleasant checks you in at the front desk you sit down super depressing waiting room bad wall art very old issues of parenting magazine smells like purell in there that's fine this is your hangout for a little bit now and now it's maybe 30 or 40 minutes later someone calls you back as you may have guessed they're very unpleasant they take you back to the exam room it's very small blood fluorescent lighting everywhere they take your vitals they hand you essentially a sheet of printer

paper they tell you to change into this now you're in sort of a secondary holding chamber except this time you can 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 started in there even though your appointment was an hour ago at this point pull up your phone you start to go through your little question list got up the courage to ask everything you came in to ask and then finally the doctor knocks like you could possibly still be changing he comes in does a little small talk with you he goes and sits down starts asking you some questions you're maybe like eight minutes into the

appointment at this point and you're like okay also i have some questions and you pull up your little question list on your phone and you get through maybe like two or three of these questions um and then the doctor starts to give you a look like let's wrap this up and so you wrap it up you ask three questions the appointment is over you go 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 so my guess is that maybe many of you in this audience have a concierge doctor but most of us have had some iteration of this experience at some point there are a lot of terrible things about our healthcare system but the one i want to

complain about specifically today is why the customer service at the point at which you're actually consuming the health care is so appallingly bad and when i refer to customer service that's that's anything that touches the patient experience while you're why you're going to the doctor so a long wait time is as much bad customer service as the the unfriendly front desk person there's this really great quote that i love from bill gurley prolific investor and my relationship hall pass [Music] didn't know he was going to be here um the u.s healthcare market is the least customer-centric of any customer service industry we are so numb to the pain that

we rarely object or complain so that's part of what i think is so crazy about this is that we kind of just take it um and so that got me curious to explore three questions that i want to go with you through with you here today number one why are things so bad how did they get this way number two why should we 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 better so let's start with why are things so bad a big part of this is our customer service problem is really more of a consumer service problem and what i mean by that is

patients are consuming the health care but they're not exactly the customer in the traditional free market sense of the term so who is the u.s health care system as we know is an employer-sponsored model this was not very well thought out it's more of a world war ii relic that was came from a national mandated wage 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 for your 15 copay they're really making their money off of the major stakeholders in the industry who are the employers and the insurance companies they're the payers they're the real customers in this story

and doctors don't love this either by the way there's major burnout in the medical community but when you play this all the way out you're left with misaligned incentives between physicians and patients physicians in the traditional fee for service model which is our predominant model today where our physicians are paid per per patient encounter they're incentivized by volume and not by quality and not by good health outcomes so it's no surprise that practices are not designed to cater to the patient and once that becomes the norm it becomes the culture every doctor's office can get away with it and now you're left with these two really

bad stats the first one is in primary care specifically the average nps for a provider is three that is so embarrassing number two 96 of patient complaints are about the service itself only four percent are about the care delivered so patients are really noticing how bad the customer service is and yet to go back to our earlier point patients have this sort of stockholm syndrome when it comes to going to the doctor specifically we'll like request a non-talkative uber because we don't feel like chatting with the driver or we'll leave a very scathing yelp review for a restaurant but when it comes to this

service even though we're not an easy to please generation we become very submissive and it's the most important service across any service industry so this is not a good thing why is this happening and why 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 health so good medicine is a partnership between a patient who's coming in with real information on how they're feeling and then a physician who's coming in with real expertise to bring to that information and they work together but if the patient is feeling very anxious and exhausted and the doctor is feeling very rushed and dismissive

you're left with losing a bunch of really important information that you need to make nuanced diagnostic and treatment plans so to give you an example doctors are far more likely to prescribe antibiotics in the afternoon than they are in the morning for the same patient with the same issues because they're just running late and they're dealing with decision fatigue if you leave with anything from this talk it should be to make morning appointments um and then patients on the other hand know all of this and they've felt this before and so what many of them end up doing is deferring treatment altogether so patients feel like it's a hassle they're

not getting anything out of it they will just text their med school friend healthcare has a patient buying problem 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 and what do we lose when we go when we only absolutely have to go preventive care and preventive care is really the reason it's so bad that we're not going to the doctor's office we lose out on going when things are early we lose out on all the upstream life-saving cost-saving 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

by the top five causes of death in the u.s are preventable with good preventive care according to the cdc for whatever that's worth to you avoidable chronic disease accounts for 75 percent of our health care spend and finally on the other hand patients with a pcp a primary care doctor spend 33 percent less on health care overall because they're front loading that spend toward prevention so bad service is bad for our health what can we do about it the good news is this we are starting to see more and more practices shift towards models that incentivize physicians to care about good customer service so there are two

models we can use here to change the compensation model to allow physicians to have the time and space to think about um service so the first one is direct to consumer so that's making the patient the customer again in this scenario and the second one is leveraging value-based care models where the insurers are reimbursing based on quality instead of over volume and so in that case the insurer is still the customer but we're now rewarding a different outcome here so those are kind of the two options that we can leverage but as we can see we have the tools that we need it's really now about shifting norms in

the healthcare industry and the industry is very clunky and it's red tapey and it's sort of crotchety at times and so the change might feel a little bit slower than it does in other industries but we're starting to see more and more companies push back and as they push back patient expectations change we start to expect more out of our health care and now we're starting to treat healthcare the way we treat any other service that we interact with and we start to say goodbye to that stockholm syndrome era but as we move towards these models that change the incentives for physicians we

still need a framework to think about okay how do we get that good customer service how do we actually get the patient buy-in how do we get people to want to go back to the doctor's office because doctors and hospital administrators are not used to thinking about this they're not used to training on customer service or bedside manner so we need to look to another industry which is the hospitality industry so i brought you on this journey here today to tell you we need to be stealing from the hospitality industry they have figured this out already they know how to treat people like people they know how to provide human to

human service which is ultimately today what healthcare still is so i really think this definition of hospitality from danny meyer is really great esteemed restaurateur my other relationship hall pass hospitality is present when something happens for you it is absent when something happens to you so we want health care that happens for patients and not two patients really michelin worthy or at least very effusive yelp review worthy health care and i want to share a few ideas on how i think we can get there i'm the co-founder of a primary care membership service called the landby

and we do what we call a healthcare hospitality training with all of our team members all of our providers and i want to share a few central tenants from that training with you that i think are the ones can that can be applied into any practice they can be implemented at very low cost um and can really start to to shift the norms and shift the culture which is what we need um some of these may seem obvious but they're not in healthcare so here we go these are my top five number one follow the golden rule patients are entrusting us with their most precious resource which is their health treat them the way you would want to be

treated at the doctor or you'd want your family to be treated number two set clear expectations this is not a subway track nobody wins when we hold information like running a few minutes late to ourselves number three be a good active empathetic listener ask good questions to get good clues treat every case like it's a medical investigation if someone didn't think something was important they wouldn't have brought it up with us another danny meyer line be an agent not 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

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 break it within the bounds of the law then just break it finally for extra credit surprise and delight how can we make this the best interaction of a patient state even if they're going through something really challenging i think that's the fun puzzle of applying hospitality into the healthcare context is finding a way to bridge that gap how can we remember something about someone and make them feel seen and make them feel like yeah i 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

this up with healthcare hospitality treats patients the way they deserve to be treated we're all patients at some point and when that point comes the stakes will feel inherently high too high to get worse service than you would at your favorite restaurant thank you [Applause] i think the thing that struck me about our dysfunctional system is uh the bill gurley quote and then what you're doing there is no customer and how does that change over time in america i know you're what you're doing with your company as part of it so how do we change that in americans

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 meniscus was sixty thousand dollars and that was like how much sixty thousand dollars ten years ago for a meniscus surgery in new york and then somebody said that should cost like ten thousand and there's no menu so we're going to a restaurant you know when you go to the restaurant in italy like the ones you go to and there's no prices yeah that's how you know you're [ __ ] i love those yeah you love it and then you hand me the check like you did when we were in vegas that time

um so but how do americans start changing how they perceive this i think that's part of the problem is it not definitely part of the problem is that we all are kind of just okay with it and assume that this is this industry where we're not supposed to know the prices until afterwards no other industry works this way we don't put up with it anywhere else um and so i think direct to consumer models play a huge role in getting patients to think oh i can treat this like other services it's not like we're not annoying consumers in other ways we already are and so we just need to apply that same annoying attitude to health care um and then by

leveraging direct to consumer models part of this is getting on higher deductible plans so we start to treat our dollars more like normal normal dollars putting money into hsas and fsas it gets us to start thinking more like a traditional customer and think about where we're spending our money and we we see that a little bit with uh direct to consumer drug companies um hymns hers get roman all the stuff that freeberg uses to get ready for battle david nice to meet you how are you good your hair looks great to prepare for war um those are a start right people just say nice things from now on come on i love

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 dysfunctional deal my insurance company for certain things yeah i'm just going to go on a website in order yep that is part of the frustration right yeah yeah that gives you a little taste of it and then alternatively if you don't want to go to the doctor you'll go to urgent care which has much more of an 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 expectations will change and doctors will have to follow suit we tend to index the quality of american

health care when you look at the average life expectancy first you do men women and then you you know you look at white men versus black men versus brown men you know white women versus black women et cetera and white men have always sort of been the standard bearer and then this odd thing has happened over the last three or four years where their life expectancy started to get worse and worse as our percentage share of health care expenses as a percentage of gdp have gone up and everybody gets up in arms because they're like well wait a minute we can't something is clearly so structurally broken

that we're spending 15 20 30 a year increasing every year and we're dying now under the age of 80 where this thing should be a thing where we're living to 100. why exactly is that thing happening like i could understand like where you could say maybe it's segregated to you know minority men or women or something but this is not this is basically everybody so why are we dying sooner as we spend more yeah because we're also increasingly spending on a lot of things that kill us and we're not we're overspending on health care because we're spending on things that kill us and then our health care gets very expensive because we have

terrible terrible lifestyles and everyone is drinking way too much across all communities everybody is eating totally processed foods these are becoming more and more readily available increasingly so every year and so yes in the very upper echelons there's sort of a movement towards wellness and more holistic lifestyle but that has not really swept the nation yet and so we're all living really really unhealthy lives not caring about our preventive health and then spending a lot on healthcare down the line so you're saying it's really not we just can't outrun our lifestyle exactly exactly which is not our fault i mean corporations make it

very very difficult to live a healthy lifestyle in the us and do you find examples of countries that have gotten population level health issues right whether it's with respect to costs or outcomes where you say that is directionally something that we can learn no i have no good answer to that question because every company besides the us thinks it has like the best health care system but that anytime i talk to anybody in one of those countries like i was speaking to people in canada the other week and they hate their health care and they think 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

compare our unwieldy country to other systems and b i don't even know people who are that happy with other systems so no i don't have a good answer how how much of a rule do you think um medicare medicaid cms can do to break the log gem versus waiting for politicians to pass legislation like obamacare to kind of try to reorient 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 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 and clunky but i think they have the right idea they want us to move towards a value-based care model

i've been thinking a lot about mental health recently seeing what we've seen during the pandemic a lot of young people our kids having these two years alone and what the second or third order effects of that and just trying to get consensus in america around health care is very hard but i think since we've all suffered some degree of uh mental health over this covet break which i think drove a lot of people crazy and created a lot of anxiety [Music] is there any way for us to think about universal health care but not have to have this nationwide discussion of all or nothing and i was just thinking

mental health is something that everybody can appreciate it's not that expensive to deal with it's not surgery why can't we just agree as a country that anybody who wants to talk to a therapist or counselor 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 piece of the puzzle and say you know what therapy will be 50 bucks flat rate the country will pick up the other 50 or 150 whatever it is to get this done uh and maybe you just speak about mental health you know as a larger issue because it does seem to have so many downstream effects in terms of our

physical health yeah we've thought about this a lot at the land because we've tried to figure out a way to to integrate mental health in a way where we would be able to make money and we can't um just yet so so yeah there have been a lot of models that came out during covet that allow for you to text with somebody and do like virtual therapy there are a lot of therapists who offer a sliding scale but 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 take on is so much lower because it's such a higher touch experience and so it's hard to integrate it into the

traditional primary care model where in in the across the u.s one physician has a panel of 2 300 patients on average and so you just can't do something like that for mental health are there um large population health issues that you'd love to just get on the radar folks in this room that are poorly understood i'll give you an 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 something and she said her best friend died of a heart attack in her 40s but then she had some stats about the incidence of heart disease amongst women versus men and i had always assumed that

it was largely a male predominant issue until i saw those stats and i realized my god like this is a broadly pervasive issue maybe it's because of lifestyle etc so i learned something in that moment i didn't know before but any broad population level issues that you think are really important for folks here to know about yeah i mean sort of related to that i would say nutrition label literacy is so hugely important there's so much scary marketing that people have to educate themselves on and it's such a part-time job to have to learn about why this product that looks extremely healthy and is like using the new brand colors that are not doritoey that looks like it should be vegan and

organic is actually really bad for you so having more education on what makes for good food i think would cut out a 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 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 how can they find out more about it if they wanted to become a member how do they become a member are there a 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 something and then yeah it's getting can it be the website is actually landing mostly people call it the lamby like a

lamb so the landry that's i keep hearing people mispronouncing it it's i've already lived a life lifelong candace life and now i have like a mispronunciation of the lambie all the time um 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 and and are you going to raise money for this is it going to be a venture-based investment because it sounds fascinating to me as a business model yeah so we're actually raising our seed right now we predominantly raised money through our members so far which has been really nice as having our consumers as investors um

but yeah it can reach venture scale because the way we're doing it not to get to in the weeds is through a three-person care team model so we're able to take on more patients per panel because you're assigned not just a doctor but also a nutritionist and a concierge manager um who does all the patient homework for you so raising a seed and yeah let me know where to send the check i'm in sounds great um let's thank candice for taking the time okay now we'll let your winners ride rain man [Music] we open source it to the fans and they've just gone crazy with it [Music] besties [Music] we should all just get a room and just

have one big huge orgy because they're all just useless it's like this like sexual tension that they just need to release [Music] we need to get back [Music] i'm going on [Music]