If You’re Not the Customer, You’re the Product

I just read an interesting post by Seth Godin titled “The Choke Point”.  Seth is talking about Facebook and LinkedIn and Google and warning us all that ‘Again and again, we see that if you’re not the customer, you’re the product. “Free” usually means, “you’re not in charge.” The race continues to be one for attention.‘.

It made me think about healthcare and especially employer provided healthcare insurance.

Healthcare insurance is usually not completely free (although at Microsoft, when I was there, it was), but even though we are paying a greater and greater share of the insurance premiums, we are fooling ourselves if we think that we are the real customer making healthcare purchasing decisions in a real market.

How much is your employer paying for your healthcare insurance – do you have any idea how much it really costs? You are not the insurance companies customer – the employer is. How much did your doctor charge your insurance company for your last office visit?  Which diagnosis and procedure codes ended up on the claim submitted to the insurance company and how much was actually paid? Did you have any say in the matter? Of the $2.6 trillion spent on healthcare last year in the US, how much of that was spent “on” you? You are not even your physician’s real customer – the insurance company is.

The media is starting to peel back the curtain on the healthcare market and expose the alternate reality that it operates in. $100k for a knee replacement in the US vs $13.6K in Brussels – that is so utterly ridiculous that I’m at a loss for words (and that really is saying something!).

Could the reason that this alternate reality market was able to develop be due to the fact that the end-consumer of healthcare is not the customer – but as Seth put it, the patient is actually the product?

It is no wonder that nobody is spending any real money on prevention – that would de-value the product. If you take care of your joints when you are in your 30’s, 40’s, 50’s – then you won’t be worth $200,000 to replace your knees in your 60’s.  Where’s the profit in that?

How the hell did we end up with such a mess?

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Step Up and Flex Those Behavior Change Muscles

Fitbit, Jawbone, Basis, Misfit, Withings, Lark, Nike.. the list of activity tracking devices continues to grow. Which to choose? There are plenty of opinions – but most of the discussion comparing them tends to focus on hardware specific features such as comfort, accuracy, and ease of data synchronization and I have also read many comments simply claiming: “I would never buy one, this is nothing but an expensive pedometer”.


Business Insider: Jawbone Up VS. Fitbit Flex: Which Is The Best Fitness Band?

While I agree that getting the device right is a critical element of success, I believe that the real goal here is to facilitate behavior change – to create new habits – and in the process establish a new healthy/active identity. If we simply think of these devices through the lense of a fancy pedometer, then they are destined to end up in the junk drawer after a few months of use. The choice should be based on which one is more effective at facilitating lasting behavior change as oposed to which one holds a charge longer.

In this post I am going to suggest a few quick ideas for how these apps could distinguish themselves as behavior change agents. Continue reading

Posted in Healthcare lifestyle, Healthcare technology | 2 Comments

Employer-provided Health Insurance Is … well … Killing Us

Participation in the healthcare system in this country is largely tied to your employment. If you need healthcare, get a job. If your employer doesn’t offer healthcare insurance,  you are likely to simply go without. Stay at your current job for another 8 years, no matter how much you hate it so your coverage will continue when you retire.  For a majority of the population, this is unfortunately the current paradigm. application-benefits

Ross Douthat just published an op-ed in the New York Times that suggested that “Employer-provided health insurance is an idea whose time has passed”.

I strongly agree. Continue reading

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To Keep Me Engaged, Make It Meaningful

I believe that consumer tracking devices such as the Jawbone Up and Fitbit can have a long-term positive impact by helping people to establish healthy behaviors and habits. However, at the handful of consumer health oriented conferences I’ve been to, there is always a loud voice of skepticism from health care professionals who claim that all of the evidence suggests that they don’t result in lasting change; people use the device for a month and then it goes into a drawer and old habits return. What I have not heard a lot of in response to these skeptics is how the complete application experience of these various devices is being architected for long-term engagement and behavior change.

So with this “use-it-until-the-novelty-wears-off” problem in mind, I’ve been studying some basic behavior economic and behavior/habit design principles presented by a variety of well known researchers and authors in this space such as BJ Fogg, Dan Ariely, Daniel Kahneman, and others. How can wearable devices leverage all of this behavior research to create more long-lasting engagement and behavior change? This post and others I plan to write represent some of my thinking in this area.

Make it Meaningful

Continue reading

Posted in Healthcare, Healthcare lifestyle, Healthcare technology | 2 Comments

Behavior Change Is (maybe not so) Hard.

I learned something recently that I wish I had learned 10 years ago: Self-motivation is not the way to create new daily behaviors that stick. The trick is to construct a new simple habit and just let it happen. Motivation is hard and tiring and not at all reliable but creating a habit and just doing it because it is a habit is actually quite easy. I credit BJ Fogg’s Tiny Habits program (more on that later) for triggering this profound shift in perspective.

10 Years of Going to the Gym…

I joined a gym 10 years ago – at first of course I was inspired and eager to get there and lift_weightswork out, but before long, trying to motivate myself to go 4 times a week – forever – became hard. I have been going very regularly, about 3 times a week ever since, but just about every time I went, I first had to have this internal conversation to talk myself into it. Sometimes it worked, sometimes it didn’t and when it didn’t, I subsequently felt a sense of having failed at sticking to my goals. But whether I made it to the gym or not, the internal motivational dialogue took a tremendous amount of energy.

For 10 freakin years, I have been having this internal battle to motivate myself to go to the gym, 3 or so times a week. Not any more. Continue reading

Posted in Healthcare, Healthcare lifestyle, Healthcare technology, Lifestyle | 6 Comments

Imagine if your health plan was …

Suspend your understanding of your relationship with your health insurance company as it stands today and imagine something different with me…Imagine

Imagine your health plan is a wellness “club”. In addition to providing insurance to help cover the cost of being sick, you opt in to the plan’s Wellness Club – a community with tools, expertise and social engagement opportunities to enable members to work together in order to live healthy and happy lives. Imagine choosing to join a health plan not because it was the better of 2 bad choices provided by your employer but because your friends and neighbors were members and you saw that they were getting together on weekends and having fun and working together towards the bigger goal of reducing our national defecit and increasing our national productivity. Continue reading

Posted in Healthcare, Healthcare Insurance, Healthcare lifestyle, Healthcare technology, Lifestyle | Tagged | 1 Comment

HxD 2013 Pass Giveaway Extravaganza!

Here are some creative healthcare ideas and thoughts of mine in response to questions posted in preparation for the Healthcare Experience Design Conference (#HxDConf) in Boston on March 25 and a possible chance to win a free pass.

(I’m currently between gigs – looking for my next healthcare startup – and am flying out to Boston for this event on my own dime, so wish me luck!!!)

Without further chatter, here are the 3 questions I chose to answer and my answers:

  1. Describe a creative way to encourage healthy behavior. It could be your own original idea, or an existing project/solution you admire.
  2. If you were given $1 million and one year to improve the health outcomes in your community, what would you do?
  3. What are the best digital offerings or practices from the consumer world that could be applied to positively impact health care? If you could only pick one…what would that be?

Continue reading

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Is this really a problem to be solved by an MD?

I’ve been quiet.

Been working at a healthcare startup for the past year now – can’t post too much about what I’m working on, no time to post about other stuff. But this front page article in the New York Times has inspired me to start writing again: Young, Obese and in Surgery

It’s the story of Shani Gofman (that’s her in the photo below) who at 17 years of age was 5’1″ and 250lbs and whose pediatrician, that’s right, pediatrician, first started suggesting to her that weight loss surgery might be the answer.

From the article, the conversation with her pediatrician went like this:

“I’ll lose weight,” Ms. Gofman assured her doctor. 

Dr. Vayner said, prophetically, “It’s not your fault, but you’re not going to be able to do it.”

Those are encouraging words from your doctor, who most look to as being responsible for their health. Hmm… I wonder if she is going to succeed. But, wait, it gets better. Continue reading

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Big Pharma Cashing in on Fee-For-Service

This article in today’s New York Times: Genentech Offers Secret Rebates for Eye Drug caught my eye… err… attention. It highlights one way that drug companies take advantage of our current fee-for-service system to drive their profit.

The current fee-for-service approach to reimbursing providers for care is often held up as a core problem in our “disease-care” system.  By reimbursing doctors and hospitals for individual services such as doctor visits, tests, and procedures we create incentives to provide more technical and more expensive services rather than the most effective and appropriate care.

It turns out that doctors have the option of using 2 different drugs for a monthly procedure they perform in their office to treat age-related macular degeneration, the leading cause of blindness in the elderly.  One of the drugs, Lucentis, costs $2,000 per dose.  The other, Avastin, costs $20 – $50 per dose.  Genentech happens to make both of these drugs but it seems they ‘prefer’ that doctors use Lucentis. Continue reading

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Man In The Mirror

Since health 2.0 is at least partially about shifting responsibility from the doctor to the consumer, I figured I’d start my journey into healthcare technology with, as Michael Jackson put it, the “Man In The Mirror”. (This photo is my reflection in “The Bean”, a stainless steel sculpture in Chicago’s Millennium Park).

Getting started with a PHR and self-tracking.

I see a doctor every couple of years, he tells me my blood pressure is fine, my blood glucose is fine and my cholesterol is a bit high but nothing to worry about. “Keep doing what you’re doing, we’ll see you next year.” He has to focus on people with problems that need to get healthy and doesn’t really have the energy or resources or billable insurance codes to help me stay healthy.

A month ago if you had asked me what my blood pressure was I would have answered: “a hundred somethin over somethin less than that”. How has it been trending in the past 5 years? Yea, right. Of course I know that high blood pressure is the “silent killer”, but I’ve always just left it up to the doctor’s office to measure it and tell me if it was high or low… well that doesn’t sound very health 2.0 now does it? Continue reading

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