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HCIT Insights from Starbucks?

July 2, 2010
by Joe Bormel
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HCIT Insights from Starbucks?

Yesterday, I stopped at one of half a dozen neighborhood Starbucks within five miles of my home. Note that Starbucks has solved for convenience, or in healthcare parlance, access. There were two new programs the company rolled out that day. One, free WiFi (previously it was available for a fee); and two, calorie information next to price information … everywhere. On the menu, in the display case and, as in the past, on a printed flyer.

Hmmm. Raspberry Scone for 500 calories, or Vanilla mini-Scone for 140? (see comment graphic below for the data.) Both were a couple of bucks. Incidentally, I was planning on no scones when I entered the store, so this information actually raised my ticket price from the iced coffee I had planned.

Fast forward to healthcare, HCIT, and healthcare reform, with community-rating, individual mandates and heighten cost awareness and consumer decision making futures. Doctors and patients may not need calorie data, but they will need to know more than treatment costs. They'll need to know referral timing expectations for their specific treatment group, stratified by problem, allergy, and medication data assured by HITECH. We will be in a better position to label the scones of diagnosis and treatment. Who will provide that information to consumers? The Geissingers/Mayos/Hopkins? The independent community physicians? The health plan via a PHR service? Will we be buying more Raspberry Scones with our fat MSAs? These are some of the biggest strategic issues for providers and payers in our brave, new, post-HITECH world.

I went to that Starbucks after having my semi-annual teeth cleaning at my dentist. Upon check out, they told me that my payer would cover a quarter of my visit cost. That more than covered the coffee and the scone!
 

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Comments

Joe, interesting post, I am all in favor of a more educated informed consumer, but I have a problem with comparing scones to surgery...even if it is elective.

Let's see, the tummy tuck is only $5k, and the breast implants are just another $10k...ah shucks, why not? Oops, wait a minute the fine print on the menu says the chance of complications/ death doubles with a tandem procedure. Maybe not today...

Really though, the Starbucks analogy can only apply to elective procedures, which make up a small piece of the health care cost equation. Your not going to care about what's on the medical menu as you run to an ER, or, a doc tries to figure out what's causing the pain in your back for six months.

I think we need to be a little more careful with our assumptions. Delivering a healthy baby is a tad bit more comlpex than a latte & scone.

Part of writing a blog causes one to get more excited about things they see in the world, like Starbucks decision to broadcast more health-related information.

The other part with noting is the private email replies that no one else sees. One of those commented that calories, while interesting, is almost useless to them. They are following a low-carb diet, not a low-cal or a low-fat, or a no trans-fat, or a high protein, or adequate Calcium, or ...





. . .



So, a single number like Calories in a Scone is inadequate.  What would be adequate?  Are you ready for a PHR in your mobile device that integrates diet, exercise and your health goals?    Where do you want that App from?  Your provider, with access to scheduling, lab results, blood pressures, weights, and the rest of some sort of PHR?  Your health plan, with access to benefits, and recommendations that combine cost, quality and (location-based) access information?  Your government (Medicare, VA, public health via AHRQ, CDC, and/or FDA) with their data on comparative effectiveness on providers, treatments, and comparative benchmarks based on national experience?  Or, simply from independent software producers you find in an App store?  Think about that on your next coffee break!

Apparently, based on Starbucks market research, the consumer appetite for this dietary information is both there in large enough numbers, and, according to their research, will drive revenues up, for the market segment they target.  Per my original post, it did drive my ticket price up!  (If you read the comments to the Starbucks link, you'll notice that I'm in the market segmentation that they know they serve; different from Dunkin Donut.)

I think this is all great news for those of us in HCIT, since this is exactly the kind of clinical decision support that we know can help the people we serve.

Joe, I like your Starbucks blog.

I'm wondering if a Starbuck Latte is the same as a Caribou Coffee Latte. And does Starbucks offer the Caribou Pomegranate Vanilla Oolong Tea Latte (200 calories)? Do we have a shared, controlled coffee vocabulary that is information rich and standardized to help all us coffee professionals record, store, analyze and exchange information?

Standards sure would help make this coffee information more meaningful and useful - ultimately helping coffee lovers improve their coffee experience and have better outcomes.

A few weeks later here.... I took my son to a McDonalds after a wonderful hike. The menu was dense with newly added calorie data. I was pleased that the salad data was more competitive than I thought. And, like StarBucks, it more likely increased our ticket price and loyalty.

Joe,
A fun post that is actually quite profound. You might say, a scone with meat.

I thing we too often make the access issues of HCIT more complicated than need be. There is value in stepping back, taking a deep breath, and trying to look at our challenges in simpler terms. Just as you have done here.

In my opinion, the more talented, fertile minds that understand what needs to be accomplished at the most basic level, the better. HCIT could use a healthy dose of fresh thinking, new ideas, and perhaps more options as to how we can accomplish our goals.

However, it does appear that the more entrepreneurial companies that played a major role in launching HCIT are being stifled by, for instance, the costs and complexities of things such as system certification. To me, this seems counterproductive.

Am I off-track here, or do you see some of the same?

Jack

Joe,
I definitely agree on the 'tier' concept. The best example of that is in Lasik eye surgery. When it first got govt approval in the mid 90's as an elective procedure the costs were betw $5k-7k per pair of eyes. Now today with competition and an informed public (inundated with marketing info) you can get it done for $1k per pair! Just make sure you pick the right optho surgeon.

But again in regard to tiers, all the literature I see says this country spends 80% of the health care dollar in the last 20% of life, which makes making an informed economic /quality decision far more difficult. Particularly in a society that believes death is to be conquered at almost all costs.

Lastly I think Chip has a very valid point...and we can start by defining 'good health care'.

Frank Poggio
The Kelzon Group

Mark and Jack,
Thanks for the kind words. I'm glad this post resonated with you both.

Mark, as you point out, the Healthcare reform is so much more than HITECH. Aside from the individual and employer mandates, there's other very real implications about accountability for all the stakeholders. To expand on your generous use the adjective "slender", way too few of us can claim that description. I know, I just returned from the beach. I was not looking remotely slender ... but thanks.

Jack, you're exactly right on. There are a few eHealth 2.0 companies, mobile apps, and service providers to help with using HCIT and achieving goals. It's far from ubiquitous. I cannot argue with those who say that it needs to be.

-Joe

Joe,
Terrific post, thank you! One of the key things you touch on is a theme I've often written about and spoken of, in my public speaking, and that is that real, consumer-usable information still remains almost bizarrely obscure, unavailable, or unsable, in healthcare compared to any other industry that touches consumers. It is only in a few organizations, such as at Geisinger Health System, that a certain level of transparency has begun to make itself evident. The demands of meaningful use under HITECH will force some changes, but it would be great if hospital leaders could get ahead of the curve in this area. Meanwhile, fortunately, you're slender and could afford the 500-calorie raspberry scone...! But your fundamental point is an excellent onewhy can't healthcare be more like Starbucks? It's a question that's long been asked and about whose answer purchasers and payers are becoming more and more impatient over time.

Frank,

Thanks for your comment. I agree that the analogy breaks down completely with consumer decision making related to new-onset, catastrophic care. Of course, consumers are not involved in those decisions today either.

I am, unapologetically, suggesting that comparing consumer behaviors with discretionary purchases (coffee and scones) to healthcare purchases (including surgery) is a useful exercise.

The broad category of elective surgery isn't as simple as you suggest. Marketing campaigns do drive demand, influence provider choice or both in many cases. Most of us are all too familiar with the local providers whose radio, tv, print, billboard, and other marketing campaigns have made this work for them. Most don't lead with price or quality data; when they do, it's often distorted.

Do you consider carotid endarterectomy in an asymptomatic patient elective? The care providers involved in a friends current situation clearly do. They did communicate complications and death rate data to the patient involved. And it was in the Starbucks fashion, in that it was intended to steer the patient to the provider's product, a surgical procedure.

There is utility to looking at the consumer market in tiers, as both Starbucks does, and distinguished HCIT experts like Erica Drazen. In a three-tiered model, the top two tiers of consumers are increasingly making healthcare choices, factoring in economic and other considerations. If even ten percent of them are making Scone-type behavioral decisions today, there are billions of dollars of discretionary revenues and costs in play.  This is the unmistakable unreality of healthcare reform.

Chip,
Thanks for bringing me back to reality. Frank tried and was ultimately successful :)

Let me tell you how I read your comment:

In the consumer world, we discriminate the quality and experience of some products. Although a SB Latte and a CC Latte are at a high level (parent terms) Latte, we don't necessarily think they're equal to each other. They probably do have different fat and carbs, and are not equally pleasant in terms of the service experience.

In the healthcare payment world, the model is that services are treated as commodities. A new patient visit for a single problem with a specific provider is at the same as any other new patient visit for any other single problem with any other provider. At least in terms of fair and reasonable reimbursement for the service, in a fee-for-service model, you pay the same thing for a 20 thousand dollar car or a 60 thousand dollar car.  At least at the level of basic services payment.  That's very different than the non-medical consumer world.

The healthcare reform has a consistent theme, where the patient pays more directly to healthcare than in the employer-based, experience rated model we're coming from.

I learned recently a bit more about what's going on here. In my county, there was an ordinance that went into effect on July 1st. Chain restaurants with at least 20 stores were required to post nutrition information. Careful inspection over the ensuring months has revealed the practice to be common.


“This is all about public health,” said Councilmember Leventhal. “Everyone looks to government to reduce the crime rate and improve highway and pedestrian safety. Yet heart disease kills far more Americans than traffic accidents and homicide. I do think it is valid for us as policymakers to consider what we are doing to improve public health.”


Will our local experience of the obesity epidemic be impacted by this information therapy approach?  For me, it's a step in the right direction.

Joe Bormel

Healthcare IT Consutant

Joe Bormel

@jbormel

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