Anyone reading this article knows that the healthcare industry accounts for nearly a fifth of the U.S. economy. ‘Big Tech’ companies like Amazon and consumer-focused giants like Walmart know it too. Companies with deep technology capabilities, unmatched capital, and...
Virgil Bretz, CEO of MacroHealth
Anyone reading this article knows that the healthcare industry accounts for nearly a fifth of the U.S. economy. ‘Big Tech’ companies like Amazon and consumer-focused giants like Walmart know it too. Companies with deep technology capabilities, unmatched capital, and customer-friendly reputations are making renewed investments in the healthcare industry. Technology and consumer-facing companies this large cannot ignore a market this large.
The response of the health industry has ranged from panic to unconcern (‘seen it before’). Amazon’s acquisition of One Medical last year caused many health industry leaders to reassess primary and virtual care models and cost structures.
On the other hand, many technology companies have already lost billions trying to enter and ‘disrupt’ the market, only to find out that the industry is incredibly complex, has powerful entrenched interests, and requires substantial subject matter expertise. Is anyone still using Microsoft Health Vault (RIP: 2007–2019)? How did giants like JP Morgan, Berkshire Hathaway, and Amazon perform with Haven (RIP: 2018 – 2021)? These are brilliant companies. Healthcare isn’t easy.
The real issue here is the consumerization of healthcare, and the reasons why. The news story isn’t that Amazon or Big Tech will take over the market. The news is that everyone will need to address the consumer demands that the healthcare industry is currently failing with, which Amazon and others want to deliver. The industry is being prompted to change by consumer demand – and Amazon thinks they can deliver on this. Maybe big tech will succeed (I hope so), maybe not. But eventually, some health leaders will deliver. Those that do not will disappear over time.
Consumers want healthcare experiences that are convenient, real-time, and personalized – just like the experiences they expect in other aspects of their lives. However, the U.S. healthcare industry’s legacy administrative technology infrastructure is simply unable to support these expectations. Payer health market and administration professionals find themselves with the impossible task of delivering a caliber of experience similar to that of an Uber app with outdated systems that rely on four-decade-old EDI connections and incomplete data, resulting in limited real-time data updates and analytics datasets that are updated monthly.
In contrast, behind their app, Uber’s infrastructure is coordinating information about your location (and thousands of other passengers), your driver’s location (and thousands of other drivers), your destination, and all the traffic in between, along with payment, trust, and other data…all in real-time. Imagine if Uber updated its operational data once a day and refreshed its analytics data once a month. We would all still be standing on a street corner, waiving our arms around, hoping a taxi would drive by.
The healthcare industry’s version of spending 20 minutes waving for a taxi is waiting an average of 20 days to get an appointment with a new family physician. By the way, this is the wait after searching provider network directories to find providers that are in-network and willing to take on new patients.
According to a 2022 survey conducted by Merritt Hawkins and AMN Healthcare and cited by the AAFP, the average wait time for a new family physician appointment is 20.6 days. This compares to 26.6 days for a new cardiology appointment and 31.4 days for a new OB/GYN. New market competitors see an opportunity.
Five years ago, the wait was even worse: the 20.6-day average wait for a new family medicine appointment is a 30% reduction in wait times since the last survey in 2017. The four other specialties experienced average wait times that increased by a range of 7% to 48%. What changed? During this period, there was a rapid expansion of virtual, urgent, and retail primary care. Providing more consumer-friendly hours, 24/7 virtual care access, and remote patient monitoring will improve customer experiences.
But the modernization needed in healthcare must also happen deep, within the plumbing and wiring of information technology that moves clinical, administrative, and financial data around the healthcare ecosystem. Even if new market entrants update the consumer experience at their respective care endpoints of the healthcare system, they must still either work with the other ‘nodes’ of the system, such as other providers and payers…or they can opt-out and force their consumers patients to coordinate these administrative tasks themselves.
Amazon furthered its market entry by making access to One Medical virtual and in-person care more available to Amazon Prime members. Yet Amazon/One Medical and its members will still need to coordinate this care, and all its clinical, financial, and administrative information, within a broader healthcare ecosystem.
Healthcare data is still moved around using slow, document-based X.12 EDI and stored in narrow siloes––when it is meaningfully stored at all. Driven by government mandates, there have been real efforts to enable more fluid sharing of clinical EHR data, but there has still been very little government or industry effort to make administrative and financial healthcare data more interoperable and usable in real time.
To continue with the Uber analogy, this would be like app-enabling the passenger and driver match but then requiring the parties to haggle on price, and then co-pay with cash or a credit card for part of the ride and bill a third party for the remainder.
While new entrants can provide better consumer experiences for parts of the patient journey, all market participants, including end-payers, end-providers, and all the parties in between, will need to update the data routing and storage infrastructure that enables our healthcare system to function if we aspire to provide better end-to-end customer journeys.
The industry urgently needs innovators and collaborators to create modern platforms and sharing standards to provide the seamless experiences consumers demand. Otherwise, change to customer experience will only be superficial and app-deep.
About Virgial Bretz
Virgil Bretz is the co-founder and CEO of MacroHealth, a platform Healthcare FinTech company. He has more than 25 years of entrepreneurial and executive experience in the American and international health technology and insurance industry. Previously he was a co-founder and Partner at VIDA Health Ltd, a health insurance, technology and capital advisory firm that was merged into MacroHealth in 2017. MacroHealth connects and optimizes payer relationships with health solution partners. Partners that provide payers services such as out-of-area coverage options, out-of-network options, or specialty networks, which could include pharmacy management solutions or fertility solutions, as examples. MacroHealth does this by using its proprietary platform called the MacroHealth Intelligent Exchange (MiX). It is a first-of-its-kind SaaS platform that uses a transparent digital healthcare marketplace ecosystem, allowing payers to easily make informed business decisions and collaborate with their partners in a way that saves time and money.