The Doctor Will See You Now

Mechanical arms outfitted with surgical instruments help a doctor perform a gallbladder operation through a tiny incision, improving precision and reducing the chances of a complication. Patients with end-stage heart failure have a mechanical heart pump implanted that keeps them alive until a donor heart can be found. These are just a few of the countless technological advances that have dramatically improved medicine in the 21st century. But as sophisticated as healthcare itself is, the coordination and ease of use — in short, the customer experience of healthcare — have remained stubbornly tech-averse. Most of us still need to call the doctor’s office to make an appointment, though we’ve been booking airline travel online for years. We consult with a physician in person, though we hold business meetings with videoconferencing software. And that’s not to mention the authorizations and referrals that have to be faxed — faxed! — between offices.

But new technologies and systems are emerging that make healthcare delivery more convenient and potentially more effective. Though adding technological tools to the relationship between healthcare practitioners and patients may have drawbacks, these advancements help make accessing medical care less of a headache. Customers are eager for these innovations, especially since they are so accustomed to technology increasing convenience in other areas of their lives, explains Patrick Pilch ’89, who leads the healthcare advisory practice at BDO, an international network of public accounting, tax, and advisory firms.

“Who wants to wait in line anywhere? I renewed my driver’s license online. That level of access is taking over,” he says, adding that millennials, who are especially attuned to convenience and comfortable with technology, are the chief drivers of such innovations. “Because they are so facile with technology, they are accustomed to speed and instant response, and therefore open to demanding better, more efficient access to healthcare.”

No More Waiting on Hold

After rupturing his eardrum while on an airplane, Cyrus Massoumi ’03 struggled for four days to get a doctor’s appointment, making futile calls to numerous physicians in his medical plan. The experience led him to create Zocdoc, a site that allows people to book medical appointments online, rather than calling an office and being placed on hold or talking to a rushed receptionist. “I worked at my dad’s medical practice, and I knew that about 25 percent of people cancel their appointments at the last minute,” he says. “There’s a hidden supply of healthcare, and people want to access that.” Every day, doctors who subscribe to Zocdoc release the times they suddenly have free, allowing people like Massoumi with his ruptured eardrum, to fill them on short notice. Doctors can also use Zocdoc to allow patients to book appointments far in advance, thus freeing up office staff.

Millions of patients now use Zocdoc each month to book appointments. The site also reminds patients of regular appointments and tests they should be scheduling.

Massoumi says creating Zocdoc was a cumbersome process because there were more than 1,400 systems used by doctors to manage their schedules. “Innovation is limited because healthcare is so massive, and there are so many adjacencies,” says Massoumi, who stepped down as CEO of Zocdoc in 2015 and is now a venture capitalist and entrepreneur. “People get lost in the morass, and the only way to truly disrupt is to pick off a little piece.”

Picking Up Healthcare at the Local Drugstore

Major drugstore chains have also emerged as disruptors when it comes to tackling the problem of not being able to get a doctor’s appointment when you’re actually sick. Their solution? Retail health clinics — walk-in primary-care centers in stores such as Walmart, which allow people to have their sore throats or other minor health issues addressed immediately. Typically staffed by nurse practitioners or physician assistants, who can write prescriptions, retail health clinics have extended hours, so

they’re often open when doctors’ offices are not, and they make use of technology — for instance, allowing patients to sign up for an appointment and be notified by text when their turn comes.

Retail health clinics have proliferated in recent years, with their numbers exploding by 900 percent between 2006 and 2014, according to a Robert Wood Johnson Foundation study. The largest such clinic, with about 50 percent of the market share, is MinuteClinic, owned by CVS Health, which also owns the CVS drugstore chain. The company now has 1,100 MinuteClinic locations. “The clinics are easy to access; we meet consumers where they are,” says Tracy Bahl ’04, executive vice president of health plans at CVS Health. “We serve more than five million patients each year, with consistently high rates of patient satisfaction.”

Bahl says that MinuteClinic is looking to further expand the convenience of retail health. The company recently tested a pilot program, MinuteClinic Connect. The program takes patients waiting in line at a busy clinic and connects them via a videoconferencing app to a less busy nurse practitioner at another location. The pilot yielded a 95 percent satisfaction rating among those who were surveyed, according to Bahl.

The Doctor Will See You Now — On-Screen

Though some experts are wary of telemedicine — Massoumi says investors are “underwhelmed” by it — others say it holds great promise. This is especially true for the elderly, says Tom DeRosa ’88, CEO of Welltower, a $40 billion enterprise-value, NYSE-listed healthcare infrastructure company. Welltower specializes in residential care for the frail elderly and elderly with dementia in the US, Canada, and the UK.

“Telemedicine means you don’t have to move the 88-year-old man who is frail and cognitively impaired to get him to two doctor appointments every week,” DeRosa says. The patient is visually connected to his physician from his home, and technology used by a nurse’s aide transmits vital signs, such as temperature and blood pressure, to the doctor.

In 2020, Welltower plans to open a residential-care community on Manhattan’s east side that will mainly serve patients with dementia and Alzheimer’s. The building will have 160 units, each with full telemedicine capabilities. “The goal is to handle a large percentage of doctor or emergency room visits remotely,” DeRosa says.

Older patients may be hesitant to talk to someone on a screen, but this technology could help them access care they otherwise would have difficulty getting. “What if the elderly patient is living in a walk-up apartment building on the third floor? This can really help them,” he points out.

More study of telemedicine is needed, DeRosa says, but he personally knows how effective it can be. His daughter, a college student, had a bump on her ankle that she wanted to get checked, but the school’s health clinic was closed. Through her insurance plan, she was able to consult a physician using her smartphone. “She put her iPhone up to the bump, and the doctor knew she had a staph infection and told her to get to a doctor or hospital immediately,” he says. “She could have wound up seriously ill.”

Retail health clinics have proliferated in recent years, with their numbers exploding by 900 percent between 2006 and 2014, according to a Robert Wood Johnson Foundation study.

Managing All the Information

With people juggling work and family, complicated demands on their time, and an ever-growing ocean of information, healthcare practitioners are increasingly using technology to help patients manage their own care.

Bahl says CVS is using technology to make it easier for patients to keep up with complicated drug regimens. In 2015, it began offering ScriptSync, which reaches out to patients’ doctors to get their medications renewed at regular intervals on the same day of the month, reducing confusion and increasing convenience. So far, 1.5 million patients have signed up to use the service, which has been shown to improve people’s adherence to their medication regimens by up to 10 percent, according to Bahl. The company also offers a multidose packaging program, which sends patients all their medications in labeled packages that indicate the day and time that they need to be taken. “You get a Monday breakfast package, and all you have to do is rip off the pack and take it,” Bahl says.

It’s not only patients who are demanding more tech-savvy, user-friendly medical experiences. Physicians, too, are perpetually in need of technologies that will help them more effectively monitor their patients’ health while also streamlining doctor-patient interactions. Among the practitioners on the quest for such tools is Joseph Habboushe ’07, CEO and co-founder of MDCalc, which provides smartphone apps and websites that give doctors medical calculators and critical data to help in making diagnoses. As a practicing emergency physician and assistant professor at NYU Langone Health, he sees firsthand the need for more-sophisticated healthcare delivery systems and the potential that technology can offer.

“Technology is providing a lot of benefits in hospitals and provider settings,” he says. Plus, there are new products that monitor people at home and alert doctors to early signs of illness, which could help reduce hospital visits. Habboushe adds that he’s working on a platform to address one of the key challenges technology brings to medicine — the difficulty of sifting through seemingly endless amounts of information to find accurate, relevant sources. Doctors today often find themselves correcting misinformation patients have dug up online, and struggling to communicate the right information clearly and effectively. “Patients have wanted this information forever, and now that they have the internet, they go to WebMD,” he says. “The problem is how to provide patients with the right information.” Habboushe’s company is conducting a pilot project with the Mayo Clinic to provide doctors with access to Mayo-designed websites with medical data for specific conditions presented in an accessible way. Doctors and patients review the website together so that physicians can walk patients through complex material. Adds Habboushe, “If we can get them to look in the right place and give information in a way they can understand, there’s a huge benefit.”

Smartphone Health

As is often the case, the smartphone is, of course, a key tool for many of these innovations. Amanda Parsons ’03, vice president of community and population health at Montefiore Health System, sees smartphones helping patients get personalized care. Recently, Montefiore ran a pilot program that offered smartphone–enabled peer-to-peer coaching for patients with poorly controlled diabetes. The program, run by InquisitHealth, matched the patients with mentors who had demonstrated that they could manage their own diabetes and undergone training to become peer coaches. They communicated for several months by text message and phone calls with their coaches, who worked mostly on emphasizing the importance of healthy eating, self-management, and physical activity. The mentoring led to an average 1.3-point drop in blood sugar levels, while patients without mentoring averaged a 0.4-point drop in the same period.

“We know that when it comes to disease management, many patients don’t learn as well from their providers as they do from people who are similar to them,” Parsons says. Montefiore is looking into expanding the program to other diseases for which peer support can be helpful, such as asthma and HIV.

It may seem that relying on smartphones would disadvantage poor patients, but Parsons says that’s not the case. Smartphones are ubiquitous among Montefiore’s patient population, about 45 percent of whom receive Medicaid and 40 percent of whom receive Medicare, she says. Using technology to avoid a trip to a medical practitioner lifts a financial burden for patients.

“For a lot of our patients, coming to the doctor means paying for transportation, taking time off work, and paying for childcare, so it’s important for us to use technology to be accessible in a variety of ways,” Parsons says.

But there can be a downside to care that is more available, says Linda Green, the Cain Brothers & Company Professor of Healthcare Management in the Decision, Risk, and Operations Division, who this semester is teaching The US Healthcare Industry: Structure and Strategies and Transforming the Delivery of Healthcare Services. “Making healthcare more accessible can lead to people seeking care when they don’t really need it, which can result in unnecessary costs,” she warns.

Clearly, patients are grateful when healthcare is delivered close to home and without a wait. But it’s also critical that, as medicine embraces these advances, practitioners ensure that technology does not get in the way. Green cautions that a more convenient health provider may be disconnected from a patient’s regular caregiver and may not have adequate access to the patient’s medical records, which could lead to ordering unnecessary tests.

And relying too much on smartphones and computers, says Parsons, could mean losing the human touch. “I’m cautious about technology replacing the touchy-feely aspects of care. Patients need to feel they are connected to their providers and care teams. Technology should enhance care, not replace it.”

Visit www.gsb.columbia.edu/healthcare for more on the Business School’s Healthcare and Pharmaceutical Management Program.