Imagine your recommended medical treatment came with this warning label: “Your results may vary. Your results are not guaranteed. Outcomes can include preventable complications, up to (and including) hospital-acquired infections, hospital readmission and premature death.”
Caveat emptor or, “buyer beware,” has never been truer than in today’s healthcare system.
The use of evidence-based medicine) protocols delivers higher quality, lower prices and improved outcomes throughout the country for many different treatments. Scientific studies have proven the efficacy of following best-practice guidelines. Achievable results include reduced premature mortality, improved quality of life and better clinical outcomes, which means faster recovery.
By no means is this a blanket assertion that the practice of all medicine can be reduced to a checklist, a differential diagnosis and a universal treatment regimen. The seven billion human beings on this planet each have trillions of cells and billions of possible variations. In addition, there are many social determinants of health, including social, economic and physical environmental factors.
The fact is, no treatment regimen works 100% of the time on 100% of the people.
However, there are proven, evidence-based strategies that effectively deliver higher quality and better outcomes with scale (which means lower costs). Therefore, it is incumbent upon healthcare providers and purchasers to live up to their fiduciary responsibility to act in the best interest of the consumer and the insured employee.
So, what happens in the practice of medicine that results in so much variability in treatment?
Today’s medicine is part science and part art. Unfortunately, for too many years, perverse reimbursement incentives have clouded and conflicted an industry that requires incredibly nuanced judgment on conditions with many variables and possible outcomes.
Outcomes are largely determined by the skill and experience of a physician or team of physicians. Parity may exist in professional sports, but that is not the case in the practice of medicine.
As a result, the practice of medicine is significantly influenced by individual providers and their practice patterns, beliefs, biases, needs and preferences, what we call “10 Reasons Why Medical Quality, Price and Outcomes May Vary.”
Depending on your location, your level of engagement and your particular treatment, the quality, price and outcome are likely to be affected by the actual provider of services. The following list includes 10 reasons why the practice of medicine is driven by the attitude, behavior and skill of the provider:
The typical American healthcare consumer still believes he is a patient and acts accordingly to eliminate the illness, not always recognizing the role he plays in his outcomes. The irreversible change taking place is that individuals have to learn to become consumers of healthcare by becoming engaged and taking responsibility for both their life outside the medical system and the choices they make when accessing medical care. The risks are real.
Understanding the risk can empower recognition and awareness that acting like a consumer is in your best interest, and that might just save your life. For additional free assistance on avoiding wasteful, unnecessary or poor quality medical tests, treatments or procedures go to www.choosingwisely.org.
Finance. Taxis. Television. Medicine. What do these have in common?
They’re all on the long–and growing–list of industries being turned upside down by disruptive technology.
The examples are legion. Once-sure-bet investments like taxicab medallions are at risk of going underwater. Bitcoin is giving consumers the power to bypass banks. Traditional television is at risk from online streaming.
Insurance Is No Different
In fact, innovative players have been disrupting the insurance market since before “disruption” was the buzzword it is today.
Look at Esurance, which in 1999 rode the dot-com wave to success as the first insurance company to operate exclusively online. No forms, no policy mailers–it didn’t even mail paper bills.
By going paperless, Esurance told customers that it was the kind of company that cared about their preferences–and established itself as a unique player in an industry that places a premium on tradition. Insurance isn’t known for being innovative.
Most insurance leaders operate under the assumption that if it ain’t broke, you shouldn’t fix it. And in a heavily regulated industry, that’s not totally unreasonable.
But you only have to look at the scrappy start-ups that are taking down long-established players to understand what awaits the companies that aren’t willing to innovate.
Remember the “Marco Polo” series that cost a reported $90 million? Neither does anyone else. But for every “Marco Polo” there’s an “Orange Is the New Black.” Highly successful programs on a subscription model show that Netflix’s willingness to take risks is carrying it past industry juggernauts.
To a consumer population weaned on technology like Uber and Venmo, the insurance industry seems positively antiquated. Facebook can advertise to you the brand of shoes you like–so your insurance company should be able to offer a product that you actually want.
The Information Importance
According to Accenture, “Regulated industries are especially vulnerable” to incumbents. When there are barriers to entry based on licensing requirements or fees, competition is lower. Decreased competition, in turn, leads to less incentive to innovate. This can leave regulated industries, such as insurance, healthcare and finance, in a highly vulnerable position when another company figures out a way to improve their offerings.
Narrow focus: If a brand focuses entirely on cost savings, convenience or innovation, it isn’t effectively covering its bases. A disruptor that manages to offer two or three of these factors instead of just one has a near-immediate advantage.
Small scope or targets: Failing to expand offerings to all demographics can mean that industries or service providers aren’t able to replicate the broad reach of disruptors.
Failing to innovate: Disruptors don’t always get their product right on the very first try. Companies must innovate continuously and figure out ways to build continuous improvement into their business model.
Tech start-ups use information as an asset. How can you tell if information is a valuable weapon in the battle you’re fighting?
“Big data” isn’t just a buzzword; industry analysts are calling it the wave of the future. At Citi, they’re talking about “the feed”: a real-time data stream that leverages the Internet of Things to reshape risk management.
For most insurance companies, incorporating an unknown element into the way they operate is daunting.
But talk to any cab driver, grocery store clerk or travel agent, and they’ll tell you that the only way to survive in a technology-driven world is to innovate.
Look at the insurance technology market to see what improvements you can incorporate into your organization, and think expansively about how you can use information: for agency management, to attract new customers and retain old ones, to expand your profit margins or to streamline operating costs.
Many tasks and actions have been replaced by digital solutions. This is nothing new. However, sometimes nothing beats a face-to-face with a customer. Now, using a VideoTech platform, Silicon Valley start-up LiveMed replicates the physical face-to-face with a digital one.
I’ll start with an event that happened to me last year. I’ll skip the details, other than to say I was required to confirm my identity and sign a document by a department in a financial institution.
With my passport and utility bill in hand, I went in search of a branch (which isn’t as easy as it used to be, even in Central London). It didn’t help that the fax machine at the first branch I found was out of order, so I had to find another one, which I did! After much back-and-forth on the phone between the department, the branch and me, we completed the process, and I was on my way.
What struck me at the time was how out-of-date this financial institution was. Not just technically or digitally but also in terms of customer experience. And it was completely unnecessary.
Digital FinTechs and InsurTechs have been onboarding new clients in less than 10 minutes, without any physical interaction. Identities can be proven and verified in a matter of minutes with background checks, a photo of your passport and a selfie.
The use of eSignatures is widespread. In the U.S., the Electronic Signatures in Global and National Commerce Act is a federal law put in place to facilitate the use of electronic signatures in commerce (long-form definition on Wikipedia, here). In the European Union, the equivalent regulation is the Electronic Signature Directive (see Wikipedia reference here) that defines the use of eSignatures in electronic contracts within the E.U.
Both these legislative frameworks require the same thing, which is that electronic signatures are regarded as equivalent to written signatures.
Given all this, was it really necessary for me to spend several hours inconvenienced and, frankly, wasting time?
This week, I move to the front end of the insurance process—client onboarding and policy administration—and talk to LiveMed. To tell me how their solution brings together the use of video, customer identification and eSignatures, I Skyped with Silicon Valley-based co-founder and CEO Yair Ravid.
Ravid explained to me, “LiveMed is a platform that allows financial institutions to confirm customer identity remotely, collect signatures remotely and provide a video record of the customer engagement.”
The way it works is simple.
When a face-to-face discussion is required, the insurer emails a link to the customer. This can be for events such as confirming a customer’s understanding of the insurance policy conditions or witnessing the signing of all parts of the policy agreement.
The customer activates the link and is connected via a live video to an insurance agent. The agent uses the LiveMed platform to conduct a secure, face-to-face discussion with the client. The platform allows documents to be shared between the two parties, which they can both review and amend in real time, before both parties sign electronically and the document is locked down.
The whole session is recorded and kept for several years in case a customer disputes the policy conditions or that he even signed the policy in the first place. (If you are interested in an example of a policyholder disputing an electronic signature, read this article in the Insurance Journal about Bonck v White.)
Knowing whom you’re talking to
While digital facial recognition technology (and other biometric measures) are advanced and sophisticated, humans remain better at visual identification. In some jurisdictions, that remains the only option because biometrics are not yet permitted for identity verification.
“Humans understand the face holistically,” according to the study “The Limits of Facial Recognition” by Tim De Chant. And visual identification still carries great weight in the process of verifying a customer’s identity and in fraud detection. Humans are better at assessing if we are who we say we are or if our claim is suspect.
There will always be occasions when a face-to-face meeting is required to complete a transaction. LiveMed enables this human interaction without requiring the customer to go to a branch or an insurance agent to visit the customer’s home.
More than a VideoTech platform
Behind the video interaction, LiveMed’s algorithms verify the authenticity of documents supplied by the customer. Ravid told me, “When a customer brings in a fake document, we have a high success rate at identifying if it is a fake. We’ve developed a solution that takes real IDs, studies different parameters against them and then compares these with the documents being presented. The institution still relies on human judgment, but LiveMed gives the agent a reliable tool to help with the decision.”
The LiveMed platform uses webRTC, an open-source platform that provides browsers and mobile applications with real-time communications (RTC) capabilities via simple APIs. It also runs as a cloud or an on-premise solution to cater to an institution’s specific requirements and policies on security, data and technology.
It is a device-independent platform that delivers both mobile and web. Ravid explained, “We’ve worked hard to make this very easy to use for the customer. Simply click on the link, go online with the agent, finalize or review the document, open the signature box and then sign with their finger. Simple!
“We take any format document or webpage, whatever, and turn them into a series of pictures. This allows changes, sketches and amendments on the screen by both parties, [in] real time. Then these pictures, or pages, are locked and put together and sent to both parties as a record. We are patenting the technology because we believe it to be unique.”
The old-fashioned ways are no longer viable
Asking a customer to come into a branch carrying paper documents just isn’t going to cut it any more. Nor is the cost of sending a representative to meet the customer. In this digital, mobile age, time is precious, and money is tight.
We are also in the consumer protection age of regulation. Financial institutions need to be able to prove beyond doubt that their conduct is acceptable and that customers fully understand the financial decisions they are making.
With LiveMed, the finance institution “sees” the person in real time without the inconvenience or cost of a physical, in-person meeting. And because the transaction is completed there and then, the insurer doesn’t have to wait for documents to be sent and processed. And both parties can be certain there are no mistakes (that it’s right the first time) because everything is checked and verified on the video call.
What next for LiveMed?
Ravid is one of three co-founders who bootstrapped LiveMed and took the start-up through the UpWest Labs accelerator in Palo Alto. LiveMed has now raised its first $400,000 from seed funding on its way to raising $1.5 million in a Series A. The minimally viable product (MVP) is built and in pilot with several financial institutions, and the new funding will enable the LiveMed to launch the platform into the U.S. financial services market.
A good story with the headline, “Do Annual Physicals Do More Harm Than Good?”, was posted recently on CCN, written by Nadia Kounang. Click here to read the full article.
This is not a new question about annual physicals. Leading physicians have been asking this question for decades. Yet the public and professional wellness vendors persist in having blind and uninformed faith in what is an expensive and potentially harmful ritual.
Dr. Ateev Mehrotra, an associate professor of healthcare policy and medicine at Harvard Medical School, says, “This specialized visit hasn’t proven anything in terms of staying healthful.”
He further says annual physicals “…make sense in theory, but it hasn’t borne out in reality.”
According to the story, “More doctors are saying the annual physical is unnecessary – and can even be harmful.”
Personally, in my career running benefit plans for large corporations, I’ve seen first-hand numerous people seriously harmed by annual physicals, through false positives on unneeded tests that resulted in medical harm to employees. Plus, such false positives cause stunning and unnecessary anxiety, as in “we-said-you-had-cancer-but-oops-my-bad.”
This is a good time to take a hard look at this ritual and consider if precious health dollars could be used better elsewhere.
If your wellness vendor is recommending annual physicals for your employees, you should drop that vendor ASAP. Period.
In my capacity as benefits consultant, I often hear employees say they know we have the most expensive system in the world, but they feel that is a fair trade-off because we have the U.S. healthcare system is the best in the world.
Well, let me disavow you of that notion. Every metric measurable shows that we have a mediocre system, at best! The World Health Organization ranks the U.S. healthcare system as 37th in the world, strictly based on outcomes. That puts us tied with Slovenia but significantly behind Costa Rica, Saudi Arabia, Colombia and the bankrupt country of Greece.
Part of the reason for the poor results, I believe, is because we don’t ask hard questions on the quality of care we receive (and likely wouldn’t get answers, if we did). Does anyone know the readmission rate or infection rate of the hospital they are about to have a surgical procedure in?
Stephen Dubner of Freakonomics fame asked the following question: There are two major cardiology conferences each year, where more than 7,000 of the top cardiologists and thoracic surgeons go for one to two weeks each; what happens to the quality of care in their facilities while they are gone?
I tried to imagine: Would I want to even go to the hospital knowing the top doctors were away?
To get to the answer on quality of care, Dubner used 10 years of data from Medicare looking at more than 10,000 patients with emergency types of heart conditions (like heart attacks) so that patient choice of facility is largely removed as a variable. The baseline for the comparison against the work of these top doctors was data from teaching hospitals, even though conventional wisdom says, “Take me to the facility with the top doctors and keep me away from a teaching hospital. I don’t want any residents cutting their teeth on me!”
The answer: If you were brought to a teaching hospital for a heart attack, your mortality rate was about 15%. Mortality rate at a non-teaching hospital, with those top doctors, the week before or week after the convention was 25%! This is a HUGE swing! This means that, for every 100 heart attacks brought in, 10 more people die when the top doctors are around!
Let me put this in perspective. If you look at all treatments given for a heart attack, like beta blockers, Plavix, stents, angioplasty, aspirin….all these COMBINED reduce mortality by 2% to 3%!
Here is another interesting point. The amount of invasive treatments, like angioplasty and stents, are used in about 33% FEWER cases when the cardiologists are away.
Okay, so wait a second. Did I just say that better care is given when the top doctors are away, and, at the same time, less severe treatments are being administered and fewer dollars are being spent?
That sounds pretty counter-intuitive. Let me give my take on why.
When I think of a “top” cardiologist, an image comes to mind. He has lots of gray hair (not sure why my mind imagines a male, but it does), and has been doing cardiac surgery for decades. Does this sound about right?
Well, this doctor was trained in medical techniques 30 or 40 years ago, and he has likely been sued for malpractice, perhaps multiple times (which leads to “defensive” medicine). He frequently has ownership or at least compensation tied to the profitability of the facility where he practices. These traits lead to more care and often inappropriate (or unnecessary) care. The younger doctors, meanwhile, are less jaded by malpractice, less engaged in profits and more recently trained.
I ask you to question EVERYTHING when it relates to care. Assume nothing. One thing is clear; the more involved the patient is in her own care, the better the outcomes (and the lower the costs, too)!