Dear healthcare system, the phone call is dead

Published in

Make Great Software

7 min readFeb 23, 2018

And it is causing all types of big problems for payers, providers, Pharma, and consumers

tl;dr

Our poll showed that 77% of millennials would rather go to Urgent Care than make a phone call to their doctor. The nurse hotline is no longer the front lines of healthcare. Problems for payers, providers, and Pharma are:

Utilization costs: “WebMD convinces me I have cancer.” If so many people say this, then it is easy to see how people convince themselves to go to the ER or Urgent Care. Payers know this issue all too well.
Leakage: Referrals by Google Maps — Location and online reviews are driving referrals and causing referral management issues for providers. Network leakage and siloed care breaking the continuum of care becomes the result.
Missing data when understanding the lifecycle of the patient: Payers spend big money to understand patient life cycles, but they don’t have the correct high-funnel data to actually analyze this important part of the patient journey. Payers can’t truly asses their risk profiles and providers then miss out on providing a full range of care for their patients.
Patient engagement issues: Second opinions and medication questions are fielded by Yahoo answers, chat forums, and Facebook mom groups. These sources result in misinformation and often create more work for doctors when consumers finally come into their office, after trying to self-educate online.
Pharmaceutical research, side effects, and off label usage: Pharmaceutical companies also loose control of their messaging to consumers. Consumers turn to online search for medication research on their own.

The front lines of healthcare used to be nurse hotlines and calling the doctor directly. That medium for getting answers to health questions is dead, and has been replaced with online searches. The cost to the healthcare system is enormous and we need to bring nurses back to the front lines of healthcare.

Utilization Costs

Millennials would rather go to the local urgent care than make a phone call to their doctor’s office. Urgent care costs $120 to $300 per visit on average. That’s mostly out-of-pocket costs in the form of $30 copays and high deductibles that result in the full cost being billed to the patient in the mail later that month. Why on earth would people choose this method of getting answers to their health questions over making a phone call? And what is the big deal anyway?

Twitter Poll 77% of millennials would go to Urgent Care than make a phone call. (77% by subtracting out the 31% of votes cast just to see the poll results– 53%/69% = 77%)

When used correctly, urgent care is on-demand, convenient, available on nearly every corner in US neighborhoods, staffed with doctors, nurse practitioners, registered nurses, and amazing healthcare staff. The experience is consistent as you walk in, wait your turn, see a practitioner, and be on your way.

But urgent care hasn’t replaced the nurse hotline as the front line of healthcare. Online search has. In fact, it is online search that is making these “referrals” to urgent care. Or worse, it is sending people to the emergency room. ER visits cost over $1,200 on average. Copays for ER visits are $500 to $1,000. High deductibles send the rest of that bill back to the consumer in the mail later in the month. The #1 response we get in customer interviews and open answer in any survey we’ve done is “WebMD convinces me I have cancer.” If so many people say this, then you can easily see how this mentality can also convince people to go to the ER or Urgent Care when they don’t need to go.

The nurse hotline, once the frontline of healthcare, prevented this problem from happening. Nurses are trained to triage. Patient stress, anxiety, and outright fear would be met with a friendly and trusted nurse, who would calm the person down with empathy and support. Triage would include:

Self care and home treatment of minor illness and injury

Education on when to contact a health professional
Advice on when to go to the ER or urgent care, and when to contact 911 and emergency services.

Now, consumers largely do this on their own, with help from information from Yahoo Answers and chat forums. The cost to the consumer and the healthcare system is enormous.

Leakage

Referrals today are often made by Google Maps, not the primary care doctor. A big issue in healthcare spending is caused by what insurance companies call “leakage.” This is when a patient goes to an out of network doctor or specialist. Large insurance companies spend billions to identify when this happens and to educate primary care doctors on which referrals they should and shouldn’t be making. It isn’t just a cost problem either. Going to a specialist outside the network can also create healthcare silos and wreak havoc on managing a patient’s care. Going out of network can mean that your care is no longer centralized, and providers are not working together to treat patients in a coordinated effort. If a patient goes to an urgent care center outside of their network, or even an ER visit out of network, the primary care doctor will almost never find out.

But Yelp and Google Maps suggestions don’t care. Distance and online ratings are the key decision-making metrics that are shared with the consumer as they make their decisions on specialists, urgent care, and even ER visits. According to Pew Research Center, 44 percent of internet users look online for information about doctors or other health professionals. Again, nurse hotlines, once the frontline of healthcare, prevented this problem from happening. Now WebMD scares you into going to the ER and Google Maps refers you to the closest ER, one with a “nice seating area” 5 Stars!

Missing Lifecycle Data

Healthcare is all about “Big Data” these days, but big data is only helpful if you have the right data. Payers spend big money to understand patient life cycles, but they don’t have complete data to actually analyze this.

Finding gaps in care, population health, and analyzing cohorts properly requires a full understanding of the patient lifecycle. As the consumerization of healthcare grows, the patient lifecycle starts long before the healthcare system is ever contacted. Add in the leakage situations mentioned previously, and there is no longer a full dataset for healthcare to analyze, gain insights from, and react. The result is a system that can no longer properly adjust and improve the system as a whole. When patients once called their nurse hotline, that information was collected and analyzed from the beginning of the patient lifecycle. Now Google has that data, not the healthcare system.

Patient Engagement Issues

Second opinions and medication questions are fielded by Yahoo Answers, chat forums,Facebook mom groups, and other online communities. Nurse hotlines once helped patients engage with the healthcare system. Calling a nurse hotline provided patients with helpful answers to questions such as:

How to effectively communicate with your doctor
How to prepare for specialist or primary care visits
How to make wise decisions about tests, medications and procedures
How to make lifestyle choices to improve your health
Understanding your prescription medications and how to make them work for you

Yep, you guessed it. Today, this is all done online. Healthcare spends billions of dollars on patient engagement. Keeping patients engaged has been shown to lower costs of care, and results in better outcomes. Keeping in touch with health professionals after an appointment, helps keep patients on target with their at-home care and health maintenance to ensure the best possible health outcomes. Leaving this to internet searches reverses a lot of the value of treatments provided to patients in the doctor’s office.

Pharmaceutical Usage

The resistance to make a phone call to a doctors office also exist for making a phone call to a pharmacist. Making a phone call isn’t the medium people want to use anymore. Compounding this issue with online prescription ordering and delivery, the opportunity to ask the pharmacist a question when picking up a prescription at the drug store will also be gone. Pharmaceutical companies, already constrained with how they can legally communicate with consumers, have relied on doctors, nurses, and pharmacist communicate and market their product to consumers. As online search replaces even those trusted marketing channels, the consumer drug research on side effects and even off label usage is left to the consumer to figure out online.

The Solution

As consumers favor typing into a search box over making a phone call, a costly side effect has been the reduction in nurse hotlines and doctor’s offices being on the front lines of care. Payers, providers, pharmaceutical companies, and most importantly consumers have paid the price. As I’ve talked about before, a few unsuccessful attempts to rectify this problem have been made using chatbots. Unfortunately, chatbots are not what people want to chat with when worrying about a health concern. Chatbots can’t show support or empathy, or even remotely compare to the communication styles of a nurse. North West London tried this and abruptly ended their pilot early after trying a chatbot to run triage for them. The findings in this article from the Independent in the UK showed that patients admitted they would manipulate the system by exaggerating symptoms to see a practitioner quicker. People wanted to speak with a person, not a bot, and this led to an increase in utilizations. That’s the exact opposite of what we want to happen.

The problem won’t fix itself. The healthcare system needs to become a direct to consumer service. As my team has researched this area, we’ve found that insurance companies are understanding this more and more. Acquisitions in the space are picking up as payers are merging with providers. Providers are merging with retailers such as CVS, Walgreens, and companies like Apple and Amazon are taking big steps into healthcare. The healthcare industry is complicated, large scale, and the risk is consumers’ health. It will take time, but new solutions need to understand the different aspects of the healthcare system while truly understanding consumer behavior. As payers, providers, pharmaceutical companies merge, transform, and partner with tech companies to get closer to the consumer, one thing shouldn’t be lost. Nurses powered the triage hotline and they properly held the frontlines of healthcare. Maybe we should find a way to bring nurses back to the frontlines.