Audio Jambalaya

After being in New Orleans for three days of industry meetings, yes, I am mixing my metaphors, just like some good jambalaya… a little of this, a little of that. 

As several of us strolled the French Quarter one evening, our ‘business casual’ attire making us stand out as the weirdos, one woman had her phone out, camera rolling.  It was her maiden voyage to Bourbon street.  The sometimes-jarring mix of sights, smells and tastes is the embrace of the Crescent City. 

After some great Cajun food, we struck out hunting for good live music. The Quarter didn’t disappoint.  And this was a Monday night.  Dueling pianos with sing-alongs, old white guys playing Chicago and Journey covers, kids in the street drumming rhythms on a paint bucket.  Country, rap, old rock and roll.  You can find it all. 

Then finally we hit The Big Easy pay dirt – a jazz quartet with a drummer who looked homeless, a lead singer wearing a borrowed suit that was too big, and an old, beat up saxophone.  The boys could play.

Thinking about the sounds of this unique place is fitting because I’ve had sound on my mind a lot of late, specifically the rapidly emerging innovative edge around AI-enabled voice assistants.  Siri, Alexa, Cortana, Nina, Bixby, Watson and others are coming to healthcare and it may be some of the best new technology news that physicians have had since the EMR era began.

There is a long list of criticisms we could level against the current EMR solutions, but without question tops on that list would be the negative impact that clinical and billing documentation has had on physician time, satisfaction and patient care. Pick one of a million stats that make the case.

Fortunately, it looks like help is on the way.  Now that the base infrastructure and capabilities for voice-enabled assistants is in place, there is race in the market – big tech players, established voice-recognition solution providers, a hundred start-ups – to tailor this capability to the specific needs of physicians. Some of the stuff that is coming looks really interesting…as in, ‘get you your life back’ interesting.  Start kicking these tires.

Let me close with a little side rant. 

We wrote several years ago that while the billions of government EMR subsidies did get healthcare digitized quickly, it came at the cost of jacking up the natural order of how new technology solutions evolve and improve in a competitive market, especially early. 

We predicted then that the historical pattern of it taking 20-30 years to get right any enterprise-level software, like the EMR-PM combo, would still apply and we’ll stand by that thought.  These voice-enabled improvements are one example of what ‘getting it right in the first place’ would have entailed.  But well-intended government intervention means that we’ve all had to live in the middle of this mess instead of letting the early market solve it the right way.  

Let the market work.  Fortunately, it is.

There Goes the Neighborhood

I was in New York last week and found the debate between local Democrat party leaders about Amazon’s new headquarters fascinating.  Some welcome the move into the Queens neighborhood across from Manhattan and the 25,000 high paying jobs it will bring, while others have pronounced it as all sorts of evil for the displacement gentrification will bring to current residents.

When somebody big moves into the neighborhood, things change.  Whether it is good or bad all depends on where your bread is buttered.  Personally, mine is buttered all over.  Don’t judge me.

Speaking of big and loud folks moving in, CVS recently opened three new Health HUB concept stores in the Houston area.  These provide a glimpse into how the 9,600-store retail chain is thinking about its increasing focus on healthcare, starting with the bright red ‘Welcome to the Health HUB’ branding on the front door.

Slow moving retail items have been shuttered to devote more square footage to health and wellness products.  More space means the Minute Clinics can expand services to include phlebotomy, diabetic screening and even sleep apnea assessments.   Pharmacists are expanding their role in patient education; registered dieticians provide one-on-one support and teach onsite classes.

Speaking of which, the space is configured so that areas can be blocked off for yoga classes.  Don’t have a mat?  Don’t worry, they are right over there by the durable medical equipment section.

If this sounds like a lot and maybe a tad confusing, never fear.  The ‘care concierge’ is there to help you get everything you need from your visit to the doctor/pharmacy/health club/lab/grocery store/tire and lube center.  Yep, they are even taking on the Walmart Greeter.

Throw in a separate announcement about CVS’s video visit service ($59 via your smart phone, all major credit cards accepted), which will soon be covered by CVS’s new insurance company once the Aetna acquisition closes, and you start to see what is being cooked up in the board room there in Woonsocket, Rhode Island.

This all begs the question, ‘Who is CVS NOT competing with?’

We could detail out of all the segments of healthcare they are looking to consume, but I think the more interesting angle on all of this is how they are positioning themselves against the aforementioned wheat thrasher from Seattle, another outsider with its sights set on the $3.5 trillion healthcare market. 

Do you really think taking yoga class market share from the local Y matters a whit to the $69 billion-dollar company that CVS will be when the Aetna deal closes?  Please. 

But what does matter are all of those smiling human beings located in the store, right there on your way to work.  This is the opposite of the ubiquitous brown boxes dropped off by the UPS guy.

Oh, and it is pretty different from that big imposing thing called a ‘hospital’ as well.

Yes kids, the neighborhood is changing.

The Warm and Sleepy Anura Myth

Dr. Victor Hutchison is a herpetologist at the University of Oklahoma, a job title with an unfortunate pronunciation that probably causes him problems at parties.  No, he doesn’t study what you think he studies.  Amphibians, not sexually transmitted diseases, are his field of work. On second thought, his work might make him very interesting at a party.

In one study, Hutchison examined the ‘critical thermal maxima’ of several species in the Anura order of the Chordata phylum. Yes, he tested to see if, in fact, if you put a frog in cool water and gradually heated it up if the frog would or would not jump out.

Oh yes, this guy makes the party cook (hey, we were overdue for a really bad pun).

Fortunately, for the frogs at least, no one is testing the first half of the metaphor and dropping frogs in boiling water.  Scientists all agree that would not go well unless the animal’s legs are being used in a Cajun dish.

However, the core of the analogy doesn’t hold up.  According to Dr. Hutchison’s research, ‘As the temperature of the water is gradually increased, the frog will eventually become more and more active in attempts to escape the heated water.’

The legend is a lie, the frog is not stupid and eventually hops out of the pot.  The next time some dolt uses this overwrought analogy in your meeting, smack them with intellectual superiority.

We bring this up because the water is getting really warm and the frog is not happy about it.

A few years ago, some researchers published a measure of healthcare affordability in an article in JAMA.  Their Healthcare Affordability Index was calculated by simply dividing the average cost of employer-provided family health insurance by median household income. 

Sure, you can take issue with this measure (e.g. what about out of pocket spending?), but it is valuable because of its straightforward nature than can be calculated by a 4th grader, which also means there is a 50/50 chance it can also be understood by members of Congress.

More than half of Americans get their coverage through their employer. Additionally, these rates are negotiated, not dictated by the government, so this is a pretty fair proxy for what is really happening.

The study notes that in 1999, the index was 14.2%.  Year over year increases took it to around 25% in 2008.  The public concern on affordability was, in part, what put President Obama in the White House.

The index jumped dramatically in 2011 and hit a peak of 31.4% in 2014.  The good news is it came down almost a point over three years, ending 2017 at 30.6%.

The bad news…2018 was 31.5%, a new record.  A family policy cost $19,616.  Median income was just over $61,000. 

Rising denominator + flat numerator = index moving higher.  That is just math.

The frog – voters, employers, the 3,145 people running for the Democrat nomination – is getting restless.