3PHealth Blog

Digital Healthcare Delivery Reimagined – with Minimal Risk.

Thursday, June 22nd, 2017


One of the things that has really struck me lately with some very large prospects is there reluctance to change. While everybody is content to talk about change, when it comes down to executing on it there’s nothing but ‘crickets’.

So as usual I asked myself why five times. Which resulted in the attached three slides – the last one is the focus of this post.

If I asked a healthcare CEO if he/she would like to save $70m a year or $1B a year the answer would be obvious. On face value the $1B wins every time. However that’s NOT the whole story. While digging in with those large prospects we learned that when it came to execution, those tasked with it had almost no room to innovate. 90% plus of their budgets were already used up by headcount and so introducing ’transformative change’ was simply a non starter.

So what does this mean – the $70m proposal is likely to get more traction than the $1B proposal because when it comes to change incremental is seen as less risky and more achievable than transformative. So tactically it’s just easier to execute on incremental change due to the level of risk.

However the savings only ever amount to one or two percent which can easily disappear in other parts of the business. In days of old this used to be enough – unfortunately times are a changing – costs are exploding, margins are declining and as they descend below 1.5% insolvency looms.

If I was a healthcare CEO I would be looking at those declining margins and hunting hard for transformative change – but for the business and operational requirements I would look for a solution that allows for incremental steps to be taken first, so as to reduce overall execution risk followed by ‘unlimited upside’.

And therein lies the core design philosophy of Choice®.

Our model allows for incremental change with a transition to transformative change with minimal risk. There is no change to existing infrastructure, there is no need to increase or decrease headcount, there is instead the ability to drive new operational efficiencies for each part of the value network.

The winners will be those that embrace change with a ‘side of downside risk mitigation’, the others will continue to support incremental change and hope for a miracle to occur to reverse declining margins.

Remember ‘hope’ is not a strategy, and these days miracles are in short supply.

What the Populism Movement Can Teach Healthcare About Listening, Change and Choice

Friday, May 5th, 2017

All over the globe, citizens are opting for big changes.  People feel disenfranchised.  They feel they have lost their voice, and identity, and that their elected officials have done nothing to protect their rights, culture, jobs or quality of life.   In England, it was Brexit.  In the U.S., it was the election of Donald Trump, in the EU it is the GDPR privacy regulation, and now in countries like France, we see non-traditional candidates rising to the top.

Now let’s look at the business world through a similar lens.  The recent United Airlines incident provides the perfect example.  It took a horrific customer service incident and a lawsuit for United to fix bad policies that should have been addressed years ago.  Here is an excerpt from the letter I received from Oscar Munuz, CEO of United Airlines:

“We will increase incentives for voluntary rebooking up to $10,000 and will be eliminating the red tape on permanently lost bags with a new “no-questions-asked” $1,500 reimbursement policy. We will also be rolling out a new app for our employees that will enable them to provide on-the-spot goodwill gestures in the form of miles, travel credit and other amenities when your experience with us misses the mark. You can learn more about these commitments and many other changes at hub.united.com.

 While these actions are important, I have found myself reflecting more broadly on the role we play and the responsibilities we have to you, and the communities we serve.

 I believe we must go further in redefining what United’s corporate citizenship looks like in our society. You can and ought to expect more from us, and we intend to live up to those higher expectations in the way we embody social responsibility and civic leadership everywhere we operate. I hope you will see that pledge express itself in our actions going forward, of which these initial, though important, changes are merely a first step”

Healthcare can learn from the above examples.  Somewhere along the way, we stopped listening to the customers’ needs.  We broke the value chain.  We turned the employers, who should function as an insurance reseller or distributor, into customers; and turned customers/patients into subscribers.    We made
supply side deals without regard to patient impact.  Just like the politicians, we disenfranchised the real customer and stripped them of their voice and negotiating power.  And they are pushing back hard – just like they’ve been doing at the polls.

Consumers are presented with lousy healthcare choices.  This drives unwanted behaviors – avoiding the doctor, not taking meds, gaming the exchanges.  None of these behaviors s good for the individual or your business – population health declines and costs continue to rise.  Just like any out-of-balance system, it is simply not sustainable.

We must make real changes to bring balance and health back to our healthcare ecosystem.  We need to make hard choices, and offer patients better choices if want to avert a United-like crisis.  Choices that give patients a stronger voice and make it easier to change their health, and your bottom-line, for the better.

The Path to Better Health – It’s Paved with Choices

Tuesday, May 2nd, 2017

The Path to Better Health – It’s Paved with Choices

What has true coercive power in any economic system? Who can affect real change? True customers. Those people or organizations who can walk away from a deal, who have alternatives, who have information, or who have multiple providers competing for their business on price, quality and experience. Those who have a real stake, both personal and financial, in getting the best deal for themselves and/or their employees or families. (Source: Joe Flower)

So, if satisfying the needs of these true customers is a key to improving healthcare, and I sincerely believe it is, then the question becomes, “How?”

As in, “How do we offer the choices and help the customer identify the options … that most closely meet their needs?” (Source: Alex Hurd, Walmart).

To answer the question, we must return to the story of the elephant, the rider and the path. In a previous blog: GDPR: The Story of Me and the Cost of Healthcare I introduced the following definitions:

  • The Elephant and the Rider: Inside each of us (Me) there is an emotional side the Elephant, and the rational side the Rider.
  • N of 1. (link) An n-of-1 experiment is the smallest study you could possibly do: one that involves just a single subject – Me.
  • Path The notion that if you want someone (Me) to change, then you must guide Me along a familiar path like my current environment.

In the image below I describe how technical innovation can appeal both to the elephant and the rider in Me. Each part of Me wants something familiar and logical, otherwise it will be almost impossible to adopt and sustain a desired change. Similarly, IT departments need solutions that leverage the familiar and logical to them, in order to minimize disruptions commonly associated with change.



Nothing could be more familiar to me than using a browser to find what I desire over the Internet. For IT, nothing could be more familiar than HTML/JavaScript and Web-based content and service delivery. These familiar and established tools serve as our starting point. Now, let’s extend these tools and strategies by adding two new capabilities coupled with elements of logic to lead each consumer along a desired action path.

Two items:

  1. A Database of Me. A secure privacy setting inside the browser where my choices and motivators can be changed and shared in real time. These are items meaningful to me and can drive a change in my behavior if presented back to me in the right way.
  2. An Individualized User Interface. One based on familiar navigation menus that can be programmed using HTML, combining server-stored data and data from my Me Database to present, connect, and guide me on my new path, based on the choices I’ve shared.

Remember, change is hard. To guide me along a desired path, the experience must resonate with both the elephant (my emotional side) and the rider (my logical side). It requires something familiar to both Me and IT or we’re creating barriers to change, rather than tearing them down.

We can leverage Web standards — like a browser, but we also need innovation, like programmable menus that can be individualized for Me, the true patient/customer. Connecting me to what I need, when I need it. Menus that reflect not only my needs (logic), but also my choices and personal motivators (emotion).

Choices that guide me along my path, and that can be adjusted, as needed, without confusing me. A single app featuring MY menus — that make the complex task of navigating healthcare simple for me…and every other individual user.

We’ve now appealed to both the Elephant and the Rider. We’ve created an aligned experience that is personal and meaningful to patients/customers – one that can make a difference to your bottom line. An experience I’m more likely to engage with daily, rather than once or twice a year, or worse yet, once and done.

But, our riders fatigue more quickly than our elephants. Most of us need support from our family, friends and community to keep us on our paths when we are tired or scared. Technology can only go so far, without an inclusive engagement strategy. Can we apply its logical connections in new ways to provide even more emotional support and keep Me on my chosen path?

Well, that’s a story for next time…

Insanity vs. Results in Healthcare Delivery

Wednesday, December 14th, 2016

As we embark on this new era of virtual care delivery, it is important to examine how we got here and why we are all working so diligently to transform healthcare into something better and more affordable than it is today.  And what better to honor that commitment to progress, then to remember the sage words of Albert Einstein:




So you might be saying, huh?!  What we are doing IS different.  It’s video services, and apps, and secure messaging.  It’s way more efficient than it’s ever been.  While this may be true from one perspective, it is important to stand back and look at the bigger picture.

We have patient portals.  We have apps for diabetes, fertility, asthma and Parkinson’s. We have services for scheduling appointments and social media sites for peer support and discovery.  We have a whole constellation of apps and services – most in their own delivery and data silos.  Sounds a lot like the digital equivalent of our current health system of speciality physicians, clinics and hospitals.

So, we must ask ourselves are we doing the same thing over again? Are we simply shifting the “place” of care delivery, without addressing the root cause of the problem?

As your care delivery organization determines its virtual or digital care delivery strategy, it’s worth heeding the good Professor’s words.  Think beyond the disease or condition. Think beyond improving access to care.   Think beyond the app or service.  Remember to include a means to unify, individualize and connect your patients or members with their care support team in a meaningful way.  Consider strategies that build and reinforce good health behaviors on a daily basis, rather than simply making it easier to access care when you are sick.  Consider what tools, data and resources are required to facilitate that active collaboration and engagement, and who will need access to them – and when.

If we don’t change our behavior, how can expect a different result?

Pulling the Plug on Old-School Care Delivery Strategies – Lessons from Marketing

Tuesday, December 6th, 2016

Many years ago, when Mac computers were little smiling boxes, I accidentally pressed the “yes” button when asked if I wanted to reformat my hard drive.  A nanosecond later, my error sunk in, and I dove across my office to pull the plug before years worth of  my company’s data was erased from this earth.  Later, I became a product manager for a tape backup company.  Because I had experienced the panic of data loss at such a personal level, I understood why preventative measures were so important.   I was now marketing insurance for a possible future event.  Not an easy sell. Nobody wants to pay for something that might happen, and even if they do, it doesn’t mean they’ll back up their computer everyday.  Just as in health insurance, the consequences of taking, or not taking an action are so far removed from the decision point, itself, it’s like trying to get an 8-year old child to understand why regularly drinking soda, which tastes good and makes them feel good, may cause diabetes some day.  Good luck with that.


We have become used to marketing and education on illness instead of health. Forget the “happy” ads promoting the benefits of a healthy lifestyle if you only eat well, exercise and live a balanced life with your perfectly happy family. Seriously?  This is not our reality.  What I see on TV is not what I hear in the doctor’s office or when I search for a health policy online.  This disease is covered, that disease is not.  This provider, not that one.  Yes you can have a mammogram, but oh, not that kind.  What is marketed vs. what is delivered are inconsistent – misaligned.  Add to that, when you go to the doctor’s and hear things like, lose weight, quit smoking, or cut back on salt – without a specific, mutually agreed upon plan to get there – chances are, we won’t succeed. Changing lifestyle behaviors are not easy, even with help.

If we want people to change their behavior we must engage them in a way that matters to them.  We must make the consequences of their decisions relevant to their life – RIGHT NOW – not what might happen 30 years from now.  Recently I saw one video, sponsored by Stride Health, which is taking this long-overdue approach to health marketing by telling a young person’s story about the lifestyle choices he makes and why.  Now, good marketing won’t solve healthcare’s problems, but it does provide instructive insights on how to reach different populations, build aligned health ecosystems, and how we might repackage healthcare delivery to better achieve the Triple Aim.

People demand convenience, choice and relevance.  We now have the tools to deliver the individualized content consumers need, and connect them to the people, devices and community resources that can help them make real and sustainable lifestyle changes.  We have the means to support them in their daily decision making.  Buying insurance doesn’t make someone healthy, nor does getting an annual “wellness” exam ensure you or I will magically start managing a chronic health condition.  It’s only the first step.  We’re focusing on the wrong the problem.  Engaging people on their terms, in their communities, and on a regular basis is the key to improving health outcomes and reducing the cost of care delivery.


Email Subscription