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WHERE IS THE HEALTHCARE REVOLUTION?
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JAY PARKINSON, MD, MPH
CHIEF MEDICAL OFFICER
CANADIAN-BASED
HEALTHCARE IT
HEALTHCARE SERVICES
NAT FINDLAY, CEO
VP OF CLINICAL STRATEGIES
CARDINAL HEALTH
23 EMPLOYEES
16 DEVELOPERS
PRIVATELY FUNDED
STARTING THE REVOLUTION
PEDIATRICS & PREV MED
FEW OPTIONS TO PRACTICE
NO OPTIONS TO USE TECHNOLOGY
I HAD TO STEP BACK IN TIME
10 YRS TO USE TODAY’S HEALTH IT
I AM A MILLENNIAL DOCTOR
WELL...ALMOST
I’M 32
I COMMUNICATE LIKE A MILLENNIAL
I USE MILLENNIAL TECHNOLOGY
GEN X AND MILLENNIAL PATIENTS
THEY USE MILLENNIAL TECHNOLOGY
AND THEY NEED A DOCTOR
WE USE THE NET TO COMMUNICATE
WE USE THE NET TO CONNECT
IT’S VERY EFFICIENT
IT’S VERY FUN
IT’S JUST PLAIN NORMAL
YOU CAN’T CONNECT WITH DOCTORS
I CHANGED THAT.
WORLD’S FIRST “VIRTUAL” PRACTICE
I DIDN’T HAVE AN OFFICE
I HAD A WEBSITE
AND A NEIGHBORHOOD
AND YOUR APARTMENT
I CONNECTED WITH MY PATIENTS
EMAIL, IM, SMS, VIDEO CHATS
I SAW THEM IN THEIR HOME
I HAD ALMOST NO OVERHEAD
$1500
TECHNOLOGY GAVE ME FREEDOM
WE COMMUNICATED HOW WE WANTED
AND WE DID IT EFFECTIVELY
AND EFFICIENTLY
THAT’S WHAT THE NET DOES
TELL ME THEIR SYMPTOMS ONLINE
BRANCH LOGIC QUESTIONNAIRE
LOOK AT MY GOOGLE CALENDAR
SCHEDULE THEIR OWN APPT
iPHONE ALERTS ME I HAVE AN APPT
I SEE THEM IN THEIR APARTMENT
I CHARGED A REASONABLE FEE
$100 - $150 PER HOUSE CALL
AND PEOPLE PAID ME CASH
0
75
150
225
300
SEPT OCT NOV DEC
MY PRACTICE
TRADITIONAL PRACTICE
THREE TIMES THE RATE
HALF WERE INSURED
STILL PAID ME CASH
I WAS ACCESSIBLE
I COMMUNICATED NORMALLY
WE HAD A RELATIONSHIP
THAT WE BOTH VALUED
CLIENTS WERE WILLING TO PAY
A REASONABLE PRICE
VALUABLE, ACCESSIBLE SERVICE
I AM A DOCTOR IN BROOKLYN
WHO HUNG UP HIS SHINGLE
VIA THE WEB
7,000,000 HITS IN 3 MONTHS
WHY?
I SAW A NEED
AND I FILLED IT
STRAIGHT TO THE CONSUMER
MEET THE NEEDS OF...
|kənˈsoōmər|
WHAT IS THAT?
TWO DEFINITIONS
a person who purchases goods and services for personal use1
a person or thing that eats or uses something2
WHICH APPLIES TO HEALTHCARE?
I SAY #2
AN ANALOGY
YOU NEED TO BUY CLOTHES
EVERYONE NEEDS CLOTHES
LUCKY YOU
YOUR OWN PERSONAL SHOPPER
YOU HAVE NO FASHION SENSE
YOU DESPERATELY NEED HELP
HE’LL CHOOSE YOUR CLOTHES FOR YOU
HE HAS A GRADUATE DEGREE FROM F.I.T.
HE TRAINED THERE FOR NINE YEARS
HE’S VERY OVERWORKED
BECAUSE EVERYONE NEEDS CLOTHES
YOU WAIT HOURS
HE’S THE BOTTLENECK
THE ALTERNATIVE = NAKED
ONLY THE BEST FOR YOU
YOU LOOK GOOD = HE LOOKS GOOD
COST ISN’T AN ISSUE
WHY?
HE DOESN’T KNOW, NOR DOES HE CARE
HE’S TOO BUSY FOR SUCH TRIVIALITIES
AND LUCKY YOU
YOU DON’T CARE EITHER!
SOMEONE ELSE IS PICKING UP THE TAB!
HE TAKES YOUR MEASUREMENTS
HIS TOOLS ARE SO PRECISE
TAPE MEASURE = $50,000
HE’S PARTICULAR ABOUT HOW YOU LOOK
AND IF YOU’RE NOT HAPPY...
YOU SUE HIM!
HE WRITES THE ORDER
YOU PICK UP YOUR SUIT
FROM THE MOST CONVENIENT STORE
PAY YOUR $10
AND LEAVE WITH YOUR $5000 SUIT
OBVIOUSLY CRAZY
EVEN CRAZIER THAN PRE-INTERNET
STORES COMPETED IN LOCAL PAPERS
NO EASY WAY TO COMPARE COSTS
ALONG CAME THE PRICE REVOLUTION
THE DINOSAURS WERE SCARED!!!
LITTLE DID THEY KNOW...
THIS WOULD ACTUALLY INCREASE REVENUE
CUSTOMERS = MORE, SIMPLIFIED!SELLERS = LESS, COMPLEX!
CONSUMER IGNORANCE = $
BUT IN FACT...
CONSUMER KNOWLEDGE = $$$
THEN CAME THE QUALITY REVOLUTION
THE DINOSAURS WERE SCARED!!!
SELLERS HAD TO BE ACCOUNTABLE
YOUR BUSINESS DEPENDS ON YOUR REP
PRODUCTS HAVE TO BE ACCOUNTABLE
AGAIN...
THE DINOSAURS WERE SCARED!!!
SALES DEPEND ON YOUR QUALITY
THE DINOSAURS THAT DIDN’T CHANGE
SIMPLY DIED
WAS IT A METEOR?
NO...
IT WAS AN UNCOORDINATED
SMOLDERING ATTACK
FROM A BUNCH OF GENIUS NOBODIES
THAT CHANGED BUSINESS FOREVER
THAT CHANGED THE WORLD FOREVER
WHERE IS THE HEALTHCARE REVOLUTION?
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IT’S SIMPLY NOT HAPPENING
WHY?
HEALTHCARE IS OFFLINE
NO ONLINE HEALTHCARE TRANSACTIONS
ONLY HEALTH INFORMATION
NO PROVIDER-PATIENT CONNECTIVITY
THE PAYORS ARE IN THE WAY
AGAIN...THE PAYORS ARE IN THE WAY
DOES PAYPAL GET IN THE WAY OF EBAY?
NO!
PAYPAL ENHANCES EBAY
DOES VISA GET IN THE WAY OF AMAZON?
NO!
VISA ENHANCES AMAZON
WHAT ARE THE NEXT STEPS?
FOLLOW THE EVOLUTION OF THE NET
START TRANSACTING ONLINE
MAKE DOCS MORE ACCOUNTABLE(SELLERS)
MAKE THEIR PRODUCTS MORE ACCOUNTABLE(DOCTOR SERVICES)
QUESTION CURRENT QUALITY PRACTICES
WHAT IS PHYSICIAN QUALITY?
THE DEGREE TO WHICH HEALTH SERVICES FOR INDIVIDUALS AND POPULATIONS INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES AND ARE CONSISTENT WITH CURRENT PROFESSIONAL KNOWLEDGE
HUH?
WHAT DOES THIS REALLY MEAN TO DOCS?
DO I DELIVER GOOD HEALTHCARE?
HOW DO I KNOW?
I LIKE TO THINK I DO
BUT DO I REALLY?
THE BMJ RECKONS THAT 50% OF THE TREATMENTS I USE IN GENERAL PRACTICE AREN’T PROVED, AND 5% ARE PRETTY HARMFUL BUT I STILL USE THEM
HOW DO I PROVE I IMPROVE OUTCOMES?
IN MY PAPER CHARTS
OMG!
I HAVEN’T DONE A CHART REVIEW
SINCE MEDICAL SCHOOL
BUT THE REAL QUESTION IS...
WHAT DOES THIS MEAN FOR PATIENTS?
DID MY DOCTOR INCREASE MY LIKELIHOOD OF FEELING BETTER?
DID SHE USE CURRENT PROFESSIONAL KNOWLEDGE TO HELP ME FEEL BETTER?
GEEZ...I HOPE SO
BUT HOW DO I KNOW?
WHERE IS THE INFO TO PROVE THIS?
IN MY PAPER CHART IN MY DOC’S OFFICE
OMG!
I CAN’T EVEN READ THE HANDWRITING!
AND WHAT DO YOU MEAN???
$100 TO FAX IT TO ME!
FOUR WEEKS FROM NOW!
HERE’S THE POINT
MEASURING INDIVIDUAL PHYSICIAN QUALITY WITH THE CURRENT INFRASTRUCTURE IS IMPOSSIBLE, UNREALISTIC, AND FAR FROM THE ACCEPTED SCIENTIFIC METHOD
HEALTHCARE DATA = PRE-EXCEL ERA
HEALTHCARE DELIVERY = 1960’s
HEALTHCARE TRANSACTIONS = PRE-EBAY
WE ARE SCIENTISTS
WE EXPECT RANDOMIZED, CONTROLLED, DOUBLE-BLINDED STUDIES
JUST LIKE MEDICATIONS
PHYSICIAN QUALITY IS AN INTERVENTION
DO YOU THINK YOUR PATIENTS ARE A RANDOMIZED, CONTROLLED, DOUBLE-
BLINDED STUDY?
DO YOU THINK YOU HAVE ENOUGH SIMILAR PATIENTS TO MAKE THIS DATA
RELIABLE AND REPEATABLE?
MOST DOCTORS ARE AVERAGE DOCTORS
WE FOLLOW A BELL CURVE
SOME ARE REALLY GOODMOST ARE AVERAGE
SOME ARE REALLY BAD
HOW ARE YOU SUPPOSED TO KNOW??
DOCTOR RATINGS?
COME ON ALREADY!
CONSUMER INFORMATION IS FREE!
10,000 TVs = 36 RATINGS
2,000 PATIENTS = 5 RATINGS?
RELIABLE RATINGS DEPEND ON VOLUME
VOLUME DEPENDS ON INCENTIVES
THERE ARE NO INCENTIVES
BLOWING OFF SOME STEAM
TELLING STRANGERS HOWWONDERFUL YOUR DOCTOR IS
LET’S RETHINK QUALITY “RATINGS”
WHAT DO PEOPLE EXPECT FROM DOCS?
HOW DO CONSUMERS VIEW QUALITY?
THOROUGHNESS
THEIR OWN, REGULAR DOCTOR
A WARM, FRIENDLY DOCTOR
TIMELY APPOINTMENTS
APPOINTMENT OPTIONS
WHAT DOES THIS MEAN?
CONSUMERS WANT:
THEIR OWN THOROUGH, FRIENDLY DOCTOR WHO WILL SEE THEM WHEN AND
HOW THEY WANT TO BE SEEN
HOW CAN WE MAKE THIS HAPPEN?
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START TRANSACTING ONLINE
TAKE LESSONS FROMEBAY, AMAZON, AND KAYAK
WE NEED TO STOP PRODUCING MORE CONSUMER HEALTH INFORMATION
FOCUS ON TRANSACTIONS
USE THE NET TO CONNECT PATIENTSWITH THEIR NEIGHBORHOOD DOCTORS
FACE-TO-FACE AND ONLINE
PAID FOR BY INDIVIDUALS, NOT PAYORS
SUSANNAH FOX
*former editor of US News & World Report
*current Director of Pew Internet and American Life Project
RECRUIT DOCTORS.GO MOBILE.
LET E-PATIENTS LEAD.
START RECRUITING DOCTORS1
PCPs ARE GETTING RESTLESS
THEY’RE SICK OF WORKING LIKE DOGS FOR SOMEONE ELSE’S PROFITS
THEY’RE SICK OF NOT BEING ABLE TO DO THEIR JOB WELL
BECAUSE THEY GET PAID FOR VOLUME
AND THAT PAY DECREASES EVERY YEAR
SOCIAL NETWORKING DOCTOR BLOGS
“HYPERLINKS SUBVERT HIERARCHY”
-THE CLUETRAIN MANIFESTO
TAKE ADVANTAGE OF HYPERLINKS
BOTTOM UP APPROACH
TO CREATE A UNIFIED PHYSICIAN VOICE
THE INTERNET ORGANIZES GROUPS
WE HAVE TO GIVE DOCS ALTERNATIVES
OPPORTUNITIES TO BE ENTREPRENEURS
A PROFITABLE BUSINESS MODEL
TECHNOLOGY AND TOOLS TO CREATE“THE CONSUMER EXPERIENCE”
DIFFERENTIATE THEMSELVES FROM“THE COMPETITION”
COMPETITION:TRADITIONAL, OVERWORKED,
UNDERPAID, INSURANCE-TAKING, TOO BUSY TO CARE DOCTORS
ADVERTISING AND MARKETING SUPPORT
BECAUSE DOCS DON’T DO THIS WELL
THIS WILL SPREAD VIRALLY WITHIN DOCTOR COMMUNITIES
WE’RE ALL LOOKING FOR A BETTER WAY
GO MOBILE2
INTERNET COMMUNICATION IS NORMAL
SMS, IM, VIDEO, FACEBOOK, MYSPACE
IT’S HOW WE COMMUNICATE
IT’S ACCESSIBLE.
IT’S UBIQUITOUS.
IT’S EFFICIENT.
THERE IS NO DIGITAL DIVIDE
WE NEED TO CREATEFACEBOOK FOR HEALTHCARE
A WEB PLATFORM
WHERE DOCS CONNECT WITH THEIR PATIENTS
ONLINE AND IN-PERSON
TO COMMUNICATE AND COORDINATE
A MARKETPLACE BASED ON CASH
WITH ABSOLUTELY NO PAYORS
NO MIDDLEMEN
PATIENTS AND PROVIDERS CONNECTING DIRECTLY
TRANSACT ONLINE
LET E-PATIENTS LEAD3
WHAT ARE E-PATIENTS?
e-Patients represent the new breed of informed health consumers, using the Internet to gather information about a medical condition of particular interest to them.
The term encompasses both those who seek online guidance for their own ailments and the friends and family members who go online on their behalf.
e-Patients report two effects of their online health research—better health information and services, and different (but not always better) relationships with their doctors.
CONNECT DOCTORS WITH E-PATIENTS
USE THE INTERNET AS A TOOL
TO EDUCATE PATIENTS
HAND-PICKED INFORMATION
PERSONALIZED TO YOU.
WHO ARE E-PATIENTS?
THOSE WITHOUT AN ACCESSIBLE PCP
E-PATIENT #1THE UNINSURED WHO HAVE TO PAY CASH
WHO ARE THE UNINSURED?
47 MILLION
70% (33.4 MIL) ARE AGE 18-55
38% HAVE INCOMES > $50K
20% HAVE INCOMES > $75K
80% OF PEOPLE AGE 18-34ARE ON FACEBOOK
YOUNGWIRED
NOT POORRELATIVELY HEALTHY
PRONE TO ACUTE INJURIESPRONE TO ACUTE ILLNESSES
SPEND $900 PER YEAR ON HEALTHCARE
E-PATIENT #2THE INSURED WHO WANT INFORMATION, ACCESSIBILITY, AND COMMUNICATION,
AND ARE WILLING OR HAVE TO PAY OUT-OF-POCKET FOR IT
OUT-OF-POCKET HEALTHCARE EXPENSES$250 BILLION PER YEAR
ANNUAL REVENUES:EBAY = $7.7 BILLIONAPPLE = $24 BILLION
GOOGLE = $11.4 BILLIONAMAZON = $13.5 BILLION
MICROSOFT = $51.1 BILLION
OUT-OF-POCKET DOCTOR SERVICES EXPENSES:
$75 BILLION PER YEAR
AND NOT A SINGLE COMPANYHAS GONE AFTER THIS MARKET
UNTIL NOW
hellohealth
CONSUMER BRAND
HEALTHCARE DELIVERY
THE MYCA WEB PLATFORM
“THE FACEBOOK OF HEALTHCARE”
CONNECT DOCTORS AND PATIENTS
BOTH ONLINE AND IN-PERSON
DOCUMENT THESE INTERACTIONS
BILL FOR THESE INTERACTIONS
NEIGHBORHOOD-BASED OFFICE
MUCH LIKE STARBUCKS IS A NEIGHBORHOOD STAPLE
NEW HEALTHCARE CONSUMERS
WHO EXPECT MORE
WHO EXPECT BETTER
IT’S ABOUT TIME
OF HEALTHCARE
FOR THE WHOLE FOODS CROWD
THEY EXPECT ACCESS
THEY EXPECT SERVICE
THEY EXPECT VALUE
THEY EXPECT THE EXPERIENCE
THEY PAY FOR “EXPERIENCE”
THEY’RE HAPPY TO IF IT’S REASONABLE AND TRANSPARENT
JUST ASK
SUCCESSFUL CONSUMER BRANDS
PEOPLE NOW INTERACT WITH BRANDS
PEOPLE EXPECT
PEOPLE EXPECT
BUT IN HEALTHCARE
THE HEALTHCARE CONSUMER EXPERIENCE
SIMPLY DOESN’T EXIST
UNTIL NOW
hellohealth
INTERACTIVENEIGHBORHOOD-BASEDCONSUMER-BRANDEDHEALTHCARE DELIVERYPLATFORM AND SERVICE
VERY LOW OVERHEAD
USED TECHNOLOGY
TO STREAMLINE PROCESSES
STREAMLINE COMMUNICATION
CUT OUT THE MIDDLEMEN
PEOPLE WANT TO CONNECT
PEOPLE WANT THEIR OWN DOCTOR
PEOPLE WANT TO MAKE THEIR APPTS
BUT DOCTORS ARE INACCESSIBLE
AND TOO BUSY
TO PROVIDE THE EXPERIENCE
TECHNOLOGY NOW EXISTS
TO CONNECT PEOPLE
THE INTERNET HAS CHANGED
IT’S ALSO CHANGED EVERYTHING
IT REVOLUTIONIZED INDUSTRIES
IT REVOLUTIONIZED RELATIONSHIPS
IT REVOLUTIONIZED THE ECONOMY
IT WILL CONTINUE THE REVOLUTIONIZING
IT CREATES OPPORTUNITY
IT FOSTERS CREATIVITY
IT STREAMLINES PROCESSES
IT SAVES MONEY
IT CREATES MARKETS
IT CREATES COMPETITION
IT KEEPS US HONEST
IT KEEPS THINGS FAIR
HEALTHCARE
BUT THINGS ARE CHANGING
WE CONNECT YOU
WITH YOUR NEIGHBORHOOD DOCTOR
USING A STRONG CONSUMER BRAND
AND A CASH-BASED “ECONOMY”
hellohealth
BRANDEDADVERTISEDMARKETEDDESIGNED
the barbarian group
1,000,000,000 HITS
WHAT DOES EACH hellohealth LOOK LIKE?
TWO DOCTORS
TWO MID-LEVELS
TRIAGE SPECIALISTTHIS PERSON MANS THE DASHBOARD
5000 PATIENTS
EACH PATIENT PAYS $25/MONTH
TO BE A MEMBER
IT’S NETFLIX-LIKE, “SO LOW I DON’T EVEN THINK ABOUT IT” MONEY
+ PER EPISODE FEES
$75 TO $150 PER IN PERSON VISIT
INTERNET COMMUNICATION
DOCS ARE PAID BY THE HOUR
ONE NEIGHBORHOOD
50% HOUSE CALLS
INITIALLY
50% OFFICE VISITS
MORPH INTO ONLY OFFICE VISITS
FIT INTO ANY NEIGHBORHOOD
ANYWHERE IN AMERICA
TECHNOLOGY REPLACES STAFF
JUST YOU AND YOUR OLD-TIME NEIGHBORHOOD DOCTOR
LOTS OF TECHNOLOGY
COMMUNICATING NORMALLY
POWERED BY MYCA
A VERY INNOVATIVE PLATFORM
FACEBOOK MIXED WITH AN EMR
MIXED WITH iGOOGLE WIDGETS
FACEBOOK AND MYSPACE
THE OS FOR SOCIAL NETWORKS
THE OS FOR SEARCH AND CLOUD
THE MYCA PLATFORM
THE OS FOR PRIMARY CARE
UI IS 100% WIDGET BASED
EMR WIDGETS
HERE’S A SNAPSHOT
SCHEDULING WIDGETS
COMMUNICATION WIDGETS
EMAIL, IM, SMS, PHONE, VIDEO
FEDEX LIKE LOGISTICAL ENGINE
TO ANALYZE AND PLAN MY DAY
SO SIMPLE
COMPLETELY CUSTOMIZABLE
CHOOSE YOUR WIDGETS
FROM MYCA’S WEBSITE
ORGANIZED BY SPECIALTY
ORGANIZED BY FUNCTION
ORGANIZED BY INTERFACE
ORGANIZED BY WORKFLOW
IT’S PICK-N-CHOOSE
IT’S DRAG-N-DROP
IT’S REARRANGE
JUST ENOUGH TO MAKE YOUR UI PERFECTLY EFFICIENT
JUST FOR YOU
NOT TOO COMPLEXNOT TOO SIMPLE
JUST FOR YOUR NEEDS
STUNNINGLY BEAUTIFUL
SIMPLY iGOOGLE-LIKE INTUITIVE
THE OS OF PRIMARY CARE
hellohealth FREES DOCTORS
INCREASES THEIR REVENUE
SIGNIFICANTLY
$125,000 PER MONTH OF CONSTANT REVENUE
hellohealth STREAMLINES
hellohealth IS EFFICIENT
WE GIVE CONSUMERS
THE EXPERIENCE
MOST IMPORTANTLY
WE CONNECT WITH THEM
AND MAKE GOOD MONEY DOING IT
WE DISRUPT THE OLD WORLD
WITH NEW TECHNOLOGY
STARTING WITH CASH
A STRONG CONSUMER BRAND
FOR NEW DOCTORS
AND NEW CONSUMERS
WHO SIMPLY EXPECT BETTER.
WE’RE OPENING JULY 1
WILLIAMSBURG, BROOKLYN
105 BERRY STREET
hellohealth
ANY QUESTIONS?
