It’s Uber for [Insert Noun Here}

Okay, I get it.  Uber is uber-cool.  You call, a car shows up where you are in a few minutes and takes you where you want to go.  Good stuff, love using it.

But now, suddenly, Uber is the uber-metaphor for startups, particularly in healthcare.  Everyone has a story about how their company is “Uber, but for [fill in blank].”  The latest I saw (courtesy of Paul Sonnier’s very valuable Story of Digital Health site) is “uber for doctors” or actually if the story were more accurate, “uber for rich guys who need doctors at their houses stat.”

A few weeks ago I saw a company that was “uber, but for massage therapists,“ a so-called healthcare company for people who need a massage at home right this damn second (yeah, I know, I thought the same thing you are currently thinking about this concept, world’s oldest profession-wise).  I have seen “uber for medical device delivery to hospitals” and “uber for prescription refills” and an uber-large number of others that I can’t even remember because my brain is uber-overloaded with uber metaphors, or is it similes? I can’t remember.  Now that I think about it, I’m pretty sure it’s a simile.  Maybe someone can help me out by building an “uber for English teachers,” so one can come right over and ensure I am in full compliance with Strunk and White Elements of Style.  Or maybe I can wait until tomorrow.

It is so interesting to think that people suddenly need everything healthcare RIGHT NOW and in the most convenient manner imaginable just because it’s possible.  Yes, mobile technology has the capacity to enable anytime, anywhere healthcare, but is that always necessary?   Or even good?  A large number of healthcare ailments just cure themselves free of charge if you neglect them long enough.

I can certainly think of situations where rapid home delivery of health care is a positive.  There is a big move towards community paramedicine, for instance, where paramedics and EMTs who are not busy responding to emergency calls are deployed to the home to help with high-touch care management for those with serious chronic conditions who cannot readily leave the home or who are trying to avoid re-hospitalization.  That makes a lot of sense to me. Certainly it is better to have house calls on demand for children who require urgent attention in the middle of the night, so long as parents don’t forgo the emergency room when there is a real emergency.

But here’s a question: if you can get any medical care you want any time you want, isn’t that asking for healthcare costs to rise?  If you make it so easy for people to consume healthcare services, won’t they have a tendency to consume too many of them?  I suppose if the consumer is required to pay beaucoup bucks for the service at hand, they might use it judiciously (assuming they are not too rich not to care what it costs), but one of the truisms of American healthcare is that making it easy to get tends to get more of it utilized.  It is possible that personal financial responsibility will temper demand, but it is equally possible that it will drive up utilization among those who expect their insurance to pay for it, particularly as the services seek to “upsell” clients by offering point-of-care testing and other accessory capabilities. With two diagnostic tests, you get an egg roll.

One of the reasons people want medical care to show up at their home as easy as Domino’s Pizza is because going to the doctor can be a real drag, not just because of the inconvenience of travel, but because you sit there and wait, uncompensated, while the physician is MIA, and you, all the while are not having a not particularly good customer experience.  There is little worse than sitting in a room full of coughing people, your confidentiality compromised by the fact that you can see each other, while you wait for a late appointment; this is made particularly annoying when you know that the doctor would have charged you for missing your appointment time and you, the inconvenient patient, have no such recourse in return.

Would people be more interested in visiting the doctor’s office if the experience were a good one?  I note that Henry Ford Hospital in Detroit turned itself into a “destination” hospital for guests (not patients) after hiring a Ritz Carlton executive as CEO.  Among the hospitals features are a tea sommelier and a 1,500-square-foot greenhouse to grow organic produce for patients.  I wonder if their cucumbers get Medicare reimbursement?  Anyway, this gentleman has recently left Henry Ford to apply his magic at Cancer Centers of America.

In a world where consumers hold the checkbook more directly, as is happening in the US healthcare system, these amenities will matter in attracting patients to provider facilities.  I suspect we will see far more hospital-focused health systems transform themselves into holistic patient health and wellness experience zones that are actually worth visiting.  Sometimes anyway.

And yet with mobile phones and cloud-based computing and sophisticated logistics software and online payments and interconnectivity with insurance, we may actually see far more of the “uber for [insert proper noun here]” phenomenon since people are, fundamentally, lazy and love convenience.  Will these services have to differentiate themselves by adding in pizza delivery and a promise of curing you in 30 minutes or less?   Hey wait, maybe this is how we actually drive our healthcare system to measure outcomes.  It’s like Dominos for appendectomies, hold the pepperoni.