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[Music]
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and they've just gone crazy with them
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uh please welcome tandis hi everyone
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[Applause]
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so
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what i want to talk about today is the
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problem that i'm obsessed with which is
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bad customer service and health care
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so i'd like to start out by walking you
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through
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a day at the doctor's office can look a
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little bit like this
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you have to start out by making an
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appointment so you call in you talk to
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someone very unpleasant on the phone
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they put you on hold
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you wait there's bad hold music you're
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waiting you're waiting they come back
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you go back and forth a little bit on
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your calendars you've got an appointment
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it's in 21 days
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now it's 21 days later you go to the
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doctor's office someone very unpleasant
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checks you in at the front desk you sit
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down super depressing waiting room bad
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wall art
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very old issues of parenting magazine
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smells like purell in there that's fine
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this is your hangout for a little bit
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now and now it's maybe 30 or 40 minutes
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later
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someone calls you back as you may have
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guessed they're very unpleasant they
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take you back to the exam room it's very
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small blood fluorescent lighting
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everywhere they take your vitals they
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hand you essentially a sheet of printer
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paper they tell you to change into this
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now you're in sort of a secondary
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holding chamber except this time you can
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hear the doctor in the other room and
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they're saying hey it's so great to see
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you and so you know they're just getting
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started in there even though your
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appointment was an hour ago at this
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point
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pull up your phone you start to go
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through your little question list
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got up the courage to ask everything you
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came in to ask
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and then finally the doctor knocks like
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you could possibly still be changing he
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comes in does a little small talk with
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you he goes and sits down
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starts asking you some questions you're
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maybe like eight minutes into the
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appointment at this point and you're
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like okay also i have some questions and
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you pull up your little question list on
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your phone and you get through maybe
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like two or three of these questions um
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and then the doctor starts to give you a
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look like let's wrap this up
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and so you wrap it up you ask three
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questions the appointment is over you go
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outside you check out if you're lucky
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they'll tell you how much you owe if not
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you will just find out later in the mail
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so my guess is that maybe many of you in
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this audience have a concierge doctor
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but most of us have had some iteration
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of this experience at some point there
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are a lot of terrible things about our
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healthcare system but the one i want to
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complain about specifically today is why
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the customer service at the point at
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which you're actually consuming the
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health care is so appallingly bad and
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when i refer to customer service that's
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that's anything that touches the patient
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experience while you're why you're going
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to the doctor so a long wait time is as
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much
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bad customer service as the the
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unfriendly front desk person
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there's this really great quote that i
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love from bill gurley prolific investor
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and my relationship hall pass
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[Music]
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didn't know he was going to be here um
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the u.s healthcare market is the least
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customer-centric of any customer service
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industry we are so numb to the pain that
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we rarely object or complain so that's
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part of what i think is so crazy about
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this is that we kind of just
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take it
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um and so that got me curious to explore
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three questions that i want to go with
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you through with you here today number
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one why are things so bad how did they
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get this way number two why should we
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care that things are so bad and number
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three what can we do about it what's a
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little something we can do to make it
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better so let's start with why are
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things so bad
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a big part of this is our customer
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service problem is really more of a
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consumer service problem and what i mean
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by that is
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patients are consuming the health care
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but they're not exactly the customer in
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the traditional free market sense of the
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term so who is
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the u.s health care system as we know is
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an employer-sponsored model
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this was not very well thought out it's
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more of a world war ii relic that was
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came from a national mandated wage
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freeze in 1942 and we kind of just kept
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going with it and now today the doctor
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is not getting out of bed in the morning
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for your 15 copay they're really making
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their money off of the major
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stakeholders in the industry who are the
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employers and the insurance companies
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they're the payers they're the real
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customers in this story
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and doctors don't love this either by
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the way there's major burnout in the
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medical community but when you play this
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all the way out you're left with
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misaligned incentives between physicians
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and patients
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physicians in the traditional fee for
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service model which is our predominant
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model today where our physicians are
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paid per per patient encounter
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they're incentivized by volume and not
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by quality and not by good health
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outcomes so it's no surprise that
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practices are not designed to cater to
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the patient and once that becomes the
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norm it becomes the culture every
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doctor's office can get away with it and
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now you're left with these two really
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bad stats the first one is
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in primary care specifically the average
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nps for a provider is three
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that is so embarrassing
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number two 96 of patient complaints are
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about the service itself only four
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percent are about the care delivered so
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patients are really noticing how bad the
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customer service is and yet
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to go back to our earlier point patients
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have this sort of stockholm syndrome
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when it comes to going to the doctor
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specifically we'll like request a
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non-talkative uber because we don't feel
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like chatting with the driver or we'll
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leave a very scathing yelp review for a
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restaurant but when it comes to this
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service
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even though we're not an easy to please
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generation we become very submissive and
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it's the most important service across
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any service industry so this is not a
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good thing why is this happening and why
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should we care that we're having such a
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bad time at the doctor's office
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it's because bad service is bad for our
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health
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so good medicine is a partnership
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between a patient who's coming in with
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real information on how they're feeling
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and then a physician who's coming in
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with real expertise to bring to that
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information and they work together but
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if the patient is feeling very anxious
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and exhausted and the doctor is feeling
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very rushed and dismissive
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you're left with losing a bunch of
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really important information that you
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need to make nuanced diagnostic and
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treatment plans
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so to give you an example doctors are
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far more likely to prescribe antibiotics
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in the afternoon than they are in the
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morning for the same patient with the
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same issues because they're just running
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late and they're dealing with decision
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fatigue if you leave with anything from
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this talk it should be to make morning
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appointments um
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and then patients on the other hand know
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all of this and they've felt this before
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and so what many of them end up doing is
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deferring treatment altogether so
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patients feel like it's a hassle they're
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not getting anything out of it they will
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just text their med school friend
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healthcare has a patient buying problem
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because they've made the experience of
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going to the doctor's office so bad that
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we only go and we absolutely have to go
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and what do we lose when we go when we
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only absolutely have to go
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preventive care
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and preventive care is really the reason
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it's so bad that we're not going to the
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doctor's office we lose out on going
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when things are early we lose out on all
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the upstream life-saving cost-saving
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benefits um of prevention so i'm going
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to hit you with three stats on that the
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first one is 40 of annual deaths caused
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by the top five causes of death in the
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u.s are preventable with good preventive
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care
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according to the cdc for whatever that's
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worth to you avoidable chronic disease
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accounts for
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75 percent of our health care spend and
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finally on the other hand patients with
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a pcp a primary care doctor spend 33
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percent less on health care overall
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because they're front loading that spend
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toward prevention so bad service is bad
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for our health
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what can we do about it the good news is
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this
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we are starting to see more and more
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practices shift towards models that
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incentivize physicians to care about
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good customer service so there are two
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models we can use here to change the
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compensation model to allow physicians
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to have the time and space to think
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about um service so the first one is
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direct to consumer so that's making the
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patient the customer again in this
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scenario
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and the second one is leveraging
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value-based care models where the
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insurers
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are reimbursing based on
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quality instead of over volume and so in
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that case the insurer is still the
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customer but we're now rewarding a
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different outcome here
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so those are kind of
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the two options that we can leverage but
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as we can see
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we have the tools that we need
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it's really now about shifting norms in
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the healthcare industry and the industry
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is very clunky
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and it's red tapey and it's sort of
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crotchety at times and so the change
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might feel a little bit slower than it
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does in other industries but we're
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starting to see more and more companies
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push back and as they push back patient
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expectations change
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we start to expect more out of our
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health care
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and now we're starting to treat
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healthcare the way we treat any other
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service that we interact with and we
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start to say goodbye to that stockholm
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syndrome era
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but as we move towards these models that
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change the incentives for physicians we
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still need a framework to think about
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okay how do we get that good customer
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service how do we actually get the
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patient buy-in how do we get people to
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want to go back to the doctor's office
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because doctors and hospital
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administrators are not used to thinking
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about this they're not used to training
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on customer service or bedside manner
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so we need to look to another industry
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which is the hospitality industry
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so i brought you on this journey here
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today to tell you we need to be stealing
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from the hospitality industry they have
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figured this out already
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they know how to treat people like
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people they know how to provide human to
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human service which is ultimately today
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what healthcare still is
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so
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i really think this definition of
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hospitality from danny meyer is really
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great esteemed restaurateur my other
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relationship hall pass
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hospitality is present when something
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happens for you it is absent when
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something happens to you
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so we want health care that happens for
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patients and not two patients really
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michelin worthy or at least very
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effusive yelp review worthy health care
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and i want to share a few ideas on how i
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think we can get there
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i'm the co-founder of a primary care
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membership service called the landby
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and we do what we call a healthcare
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hospitality training with all of our
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team members all of our providers and i
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want to share a few central tenants from
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that training with you that i think are
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the ones can that can be applied into
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any practice they can be implemented at
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very low cost um and can really start to
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to shift the norms and shift the culture
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which is what we need um some of these
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may seem obvious
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but they're not in healthcare so here we
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go these are my top five number one
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follow the golden rule patients are
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entrusting us with their most precious
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resource which is their health
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treat them the way you would want to be
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treated at the doctor or you'd want your
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family to be treated
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number two set clear expectations this
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is not a subway track nobody wins when
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we hold information like running a few
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minutes late to ourselves
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number three be a good active empathetic
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listener ask good questions to get good
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clues treat every case like it's a
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medical investigation
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if someone didn't think something was
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important they wouldn't have brought it
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up with us
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another danny meyer line be an agent not
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a gatekeeper so an agent lets people in
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a gatekeeper builds up barriers to keep
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people out we don't want to be that kind
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of practice if a patient has a good
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reason to be asking you to break one of
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our rules and there's an easy way to
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break it within the bounds of the law
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then just break it
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finally for extra credit surprise and
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delight
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how can we make this the best
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interaction of a patient state even if
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they're going through something really
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challenging i think that's the fun
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puzzle of applying hospitality into the
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healthcare context is finding a way to
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bridge that gap how can we remember
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something about someone and make them
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feel seen and make them feel like yeah i
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want to come back to the doctor's office
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all right i don't have a super punchy
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ending here so i'm just going to wrap
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this up with
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healthcare hospitality treats patients
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the way they deserve to be treated we're
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all patients at some point and when that
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point comes the stakes will feel
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inherently high
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too high to get worse service than you
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would at your favorite restaurant thank
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you
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[Applause]
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i think the thing that struck me about
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our dysfunctional system is uh the bill
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gurley quote and then what you're doing
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there is no customer
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and how does that change over time in
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america i know you're what you're doing
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with your company as part of it
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so how do we change that in americans
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perception because i got my knee done
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and i didn't know how much it cost and
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then i found out just cleaning up my
00:12:52
meniscus was sixty thousand dollars and
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that was like how much
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sixty thousand dollars ten years ago for
00:12:58
a meniscus surgery in new york and then
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somebody said that should cost like ten
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thousand
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and there's no menu so we're going to a
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restaurant
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you know when you go to the restaurant
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in italy like the ones you go to and
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there's no
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prices yeah
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that's how you know you're [Â __Â ] i love
00:13:12
those
00:13:13
yeah you love it
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and then you hand me the check like you
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did
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when we were in vegas that time
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um
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so but
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how do americans
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start changing how they perceive this i
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think that's part of the problem is it
00:13:28
not definitely part of the problem is
00:13:30
that we all are kind of just okay with
00:13:31
it and assume that this is this industry
00:13:33
where we're not supposed to know the
00:13:34
prices until afterwards no other
00:13:36
industry works this way we don't put up
00:13:37
with it anywhere else um and so i think
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direct to consumer models play a huge
00:13:42
role in getting patients to think oh i
00:13:44
can treat this like other services it's
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not like we're not annoying consumers in
00:13:47
other ways we already are and so we just
00:13:49
need to apply that same annoying
00:13:51
attitude to health care um and then by
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leveraging direct to consumer models
00:13:56
part of this is getting on higher
00:13:57
deductible plans so we start to treat
00:13:59
our dollars more like normal normal
00:14:01
dollars putting money into hsas and fsas
00:14:04
it gets us to start thinking more like a
00:14:06
traditional customer and think about
00:14:07
where we're spending our money and we we
00:14:09
see that a little bit with
00:14:11
uh direct to consumer drug companies
00:14:13
um hymns hers get roman all the stuff
00:14:16
that freeberg uses to
00:14:19
get ready for battle david nice to meet
00:14:21
you
00:14:21
how are you good
00:14:25
your hair looks great to prepare for
00:14:27
war um
00:14:29
those are a start right people just say
00:14:31
nice things from now on come on i love
00:14:32
it yeah um but this is part of it that
00:14:34
people are saying it's so dysfunctional
00:14:37
to go to the doctor it's so
00:14:38
dysfunctional deal my insurance company
00:14:40
for certain things yeah i'm just going
00:14:42
to go on a website in order yep
00:14:45
that is part of the frustration right
00:14:47
yeah yeah that gives you a little taste
00:14:49
of it and then alternatively if you
00:14:50
don't want to go to the doctor you'll go
00:14:51
to urgent care which has much more of an
00:14:53
easy pricing menu in many cases that you
00:14:55
can look at so again we're starting to
00:14:56
get a taste of it and i think patient
00:14:58
expectations will change and doctors
00:15:00
will have to follow suit
00:15:02
we tend to index the quality of american
00:15:05
health care when you look at the average
00:15:06
life expectancy
00:15:09
first you do men women and then you you
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know you look at white men versus black
00:15:12
men versus brown men you know white
00:15:14
women versus black women et cetera and
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white men have always sort of been the
00:15:18
standard bearer
00:15:19
and then this odd thing has happened
00:15:20
over the last three or four years where
00:15:22
their life expectancy started to get
00:15:23
worse and worse as our percentage share
00:15:26
of health care expenses as a percentage
00:15:28
of gdp have gone up
00:15:29
and everybody gets up in arms because
00:15:31
they're like well wait a minute we can't
00:15:33
something is clearly so structurally
00:15:35
broken
00:15:36
that we're spending 15 20 30 a year
00:15:39
increasing every year and we're dying
00:15:41
now under the age of 80
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where this thing should be a thing where
00:15:45
we're living to 100.
00:15:48
why exactly is that thing happening like
00:15:51
i could understand like where you could
00:15:52
say maybe it's segregated to you know
00:15:56
minority men or women or something but
00:15:57
this is not this is
00:15:59
basically everybody so why are we
00:16:01
dying
00:16:02
sooner as we spend more yeah because
00:16:05
we're also increasingly spending on a
00:16:07
lot of things that kill us
00:16:09
and we're not we're overspending on
00:16:11
health care because we're spending on
00:16:12
things that kill us and then our health
00:16:13
care gets very expensive because we have
00:16:16
terrible terrible lifestyles and
00:16:18
everyone is drinking way too much across
00:16:21
all communities everybody is eating
00:16:22
totally processed foods these are
00:16:24
becoming more and more readily available
00:16:26
increasingly so every year and so
00:16:28
yes in the very upper echelons there's
00:16:30
sort of a movement towards wellness and
00:16:32
more holistic lifestyle but that has not
00:16:34
really swept the nation yet and so we're
00:16:35
all living really really unhealthy lives
00:16:38
not caring about our preventive health
00:16:40
and then spending a lot on healthcare
00:16:41
down the line so you're saying it's
00:16:43
really not we just can't outrun our
00:16:44
lifestyle exactly exactly which is not
00:16:47
our fault i mean corporations make it
00:16:49
very very difficult to live a healthy
00:16:50
lifestyle in the us and do you find
00:16:53
examples of countries that have gotten
00:16:55
population level health issues
00:16:57
right whether it's with respect to costs
00:16:59
or outcomes where you say that is
00:17:01
directionally
00:17:02
something that we can learn no i have no
00:17:04
good answer to that question because
00:17:06
every company besides the us thinks it
00:17:08
has like the best health care system but
00:17:10
that anytime i talk to anybody in one of
00:17:11
those countries like i was speaking to
00:17:13
people in canada the other week and they
00:17:15
hate their health care and they think
00:17:16
it's the worst thing ever and they like
00:17:18
wait eight weeks to get uti medication
00:17:20
and so a i just think it's too hard to
00:17:22
compare our unwieldy country to other
00:17:24
systems and b i don't even know people
00:17:26
who are that happy with other systems so
00:17:28
no i don't have a good answer
00:17:30
how how much of a rule do you think um
00:17:33
medicare medicaid cms can do
00:17:36
to break the log gem versus waiting for
00:17:39
politicians to pass legislation like
00:17:41
obamacare to kind of try to reorient
00:17:43
what's wrong i think it's i think it
00:17:45
really is both i think that um hhhs and
00:17:49
is playing a huge role in trying to get
00:17:50
more and more value-based care models um
00:17:53
through medicare and they're making a
00:17:54
huge push to do that and so it's slow
00:17:56
and clunky but i think they have the
00:17:58
right idea they want us to move towards
00:17:59
a value-based care model
00:18:01
i've been thinking a lot about mental
00:18:03
health recently seeing what we've seen
00:18:05
during the pandemic a lot of young
00:18:06
people our kids having these two years
00:18:08
alone
00:18:09
and what the
00:18:11
second or third order effects of that
00:18:13
and just trying to get consensus in
00:18:15
america around health care is very hard
00:18:17
but i think since we've all suffered
00:18:19
some degree
00:18:20
of uh mental health over this covet
00:18:23
break which i think drove a lot of
00:18:25
people crazy and created a lot of
00:18:26
anxiety
00:18:27
[Music]
00:18:29
is there any way for us to think about
00:18:31
universal health care but not have to
00:18:33
have this nationwide discussion of all
00:18:35
or nothing and i was just thinking
00:18:37
mental health is something that
00:18:38
everybody can appreciate it's not that
00:18:40
expensive to deal with it's not surgery
00:18:43
why can't we just agree as a country
00:18:45
that anybody who wants to talk to a
00:18:47
therapist or counselor
00:18:48
will be able to do it for a sliding
00:18:51
scale or a very small amount of money
00:18:53
and maybe be able to just chip off one
00:18:56
piece of the puzzle and say you know
00:18:57
what
00:18:58
therapy will be 50 bucks flat rate the
00:19:00
country will pick up the other 50 or 150
00:19:02
whatever it is to get this done uh
00:19:05
and maybe you just speak about mental
00:19:07
health you know as a larger issue
00:19:10
because it does seem to have so many
00:19:12
downstream effects in terms of our
00:19:14
physical health yeah we've thought about
00:19:17
this a lot at the land because we've
00:19:18
tried to figure out a way to to
00:19:20
integrate mental health in a way where
00:19:22
we would be able to make money and we
00:19:23
can't um just yet so
00:19:26
so yeah there have been a lot of models
00:19:27
that came out during covet that allow
00:19:29
for you to text with somebody and do
00:19:30
like virtual therapy there are a lot of
00:19:33
therapists who offer a sliding scale but
00:19:36
part of the reason it's it's a little
00:19:37
bit more difficult is that the patient
00:19:38
panel size the number of people they can
00:19:40
take on is so much lower because it's
00:19:41
such a higher touch experience and so
00:19:43
it's hard to integrate it into the
00:19:45
traditional primary care model where
00:19:48
in in the across the u.s one physician
00:19:50
has a panel of 2 300 patients on average
00:19:52
and so you just can't do something like
00:19:54
that for mental health are there um
00:19:56
large population health issues that
00:19:59
you'd love to just get on the radar
00:20:01
folks in this room that are
00:20:03
poorly understood i'll give you an
00:20:04
example like um
00:20:06
there is somebody i follow she's a
00:20:08
writer i think for the
00:20:09
i can't remember it's in new york times
00:20:10
something and she said her best friend
00:20:12
died of a heart attack in her 40s but
00:20:14
then she had some stats about the
00:20:16
incidence of heart disease amongst women
00:20:18
versus men and i had always assumed that
00:20:20
it was largely a male predominant issue
00:20:22
until i saw those stats and i realized
00:20:23
my god like this is a broadly pervasive
00:20:26
issue maybe it's because of lifestyle
00:20:27
etc so i learned something in that
00:20:29
moment i didn't know before but any
00:20:31
broad population level issues that you
00:20:32
think are really important for folks
00:20:34
here to know about yeah i mean sort of
00:20:35
related to that i would say nutrition
00:20:37
label literacy is so hugely important
00:20:40
there's so much scary marketing that
00:20:42
people have to educate themselves on and
00:20:44
it's such a part-time job to have to
00:20:46
learn about why this product that looks
00:20:48
extremely healthy and is like using the
00:20:50
new brand colors that are not doritoey
00:20:52
that looks like it should be vegan and
00:20:53
organic is actually really bad for you
00:20:55
so having more education on what makes
00:20:57
for good food i think would cut out a
00:20:59
huge huge portion of our preventive
00:21:00
lifestyle how can people find out more
00:21:02
about the it's landry l-a-n-d-r-y this
00:21:06
is the nightmare of my life it's the
00:21:08
land b-l-a-n-b-y
00:21:10
on the big screen
00:21:11
it's just right there yeah i'm sorry
00:21:14
how can they find out more about it if
00:21:15
they wanted to become a member how do
00:21:17
they become a member are there a
00:21:18
membership available right there
00:21:19
l-a-n-b-y there's got to be a website
00:21:22
i'm assuming or you have an email or
00:21:23
something and then yeah it's getting can
00:21:24
it be the website is actually landing
00:21:28
mostly people call it the lamby like a
00:21:30
lamb so the landry that's i keep hearing
00:21:32
people mispronouncing it it's i've
00:21:34
already lived a life
00:21:35
lifelong candace life and now i have
00:21:37
like a mispronunciation of the lambie
00:21:39
all the time um
00:21:41
so you can just go to lambie.com you can
00:21:42
apply for membership at the top of the
00:21:44
website it's in new york can it scale
00:21:47
and and are you going to raise money for
00:21:49
this is it going to be a venture-based
00:21:50
investment because it sounds fascinating
00:21:52
to me as a business model yeah so we're
00:21:54
actually raising our seed right now we
00:21:56
predominantly raised money through our
00:21:58
members so far which has been really
00:22:00
nice as having our consumers as
00:22:01
investors
00:22:02
um
00:22:03
but yeah it can reach venture scale
00:22:05
because the way we're doing it not to
00:22:06
get to in the weeds is through a
00:22:08
three-person care team model so we're
00:22:09
able to take on more patients per panel
00:22:11
because you're assigned not just a
00:22:13
doctor but also a nutritionist and a
00:22:14
concierge manager um who does all the
00:22:17
patient homework for you so raising a
00:22:18
seed and yeah let me know where to send
00:22:20
the check i'm in
00:22:22
sounds great um let's thank candice for
00:22:24
taking the time
00:22:26
okay
00:22:27
now
00:22:29
we'll let your winners ride
00:22:32
rain man
00:22:33
[Music]
00:22:37
we open source it to the fans and
00:22:39
they've just gone crazy with it
00:22:44
[Music]
00:22:49
besties
00:22:52
[Music]
00:23:00
we should all just get a room and just
00:23:01
have one big huge orgy because they're
00:23:03
all just useless it's like this like
00:23:04
sexual tension that they just need to
00:23:06
release
00:23:11
[Music]
00:23:13
we need to get
00:23:15
back
00:23:17
[Music]
00:23:23
i'm going on
00:23:24
[Music]
