The Uber lessons for medicine

As the rugged beauty of the Pacific Coast unfolded in all of its splendor, I was in awe of the entirely different experience: the one created by our Uber driver, Calvin (name changed to protect anonymity).

My friend and I, attending our annual cardiology meeting in sunny San Diego, carved out a few hours of rest and relaxation. We were heading to La Jolla, a scenic seaside community about 20 minutes away from the downtown hotel zone. The taxis were at the ready. The bellhop jumped to summon one of them, but we had to stop him. “We are calling Uber,” we said. “Uber?” he beamed. “You will get there at half the price!” He was clearly impressed with our tech savvy even though it cost him a tip.

Both of us were not habitual Uber riders. We are used to hailing the yellow cabs off the New York City streets, at any time of the day or night, even in a snow storm. So, why Uber? Was a $10 per person fare discount such an important factor?

No, it wasn’t. In fact, it was only a minor consideration. Plus, Uber is known for its surge pricing, and there are different categories of Uber rides, so certainly the cost is not always lower for comparable taxi rides.

Uber, currently valued at $40 billion, is delivering its ride sharing services in a highly regulated, contested, politically and legally complex environment. It is faced with rising overhead, government scrutiny, entrenched philosophies, and fierce competition.  The Uber business space evokes several parallels with our health care system: At the current spending of $2.7 trillion annually, it operates with its drivers (physicians and other medical professionals) and riders (patients) in a complex and regulated space, with strong emphasis on cost containment.  Yet medicine, as a profession and as a business enterprise, is just waking up to the whole concept of customer service. Customer service is a defining feature of Uber global operations, and the most powerful force behind its popularity and reduced fares.

Fundamentally, the Uber app did not offer any groundbreaking technology, certainly not of the scale comparable to Apple or Google. It did not invent a new mode of transportation. Rather, it re-invented the process, making it at least ten times better (a must for success according to Peter Thiel, co-founder of PayPal). Ultimately, Uber alleviated the customer pain of dealing with uncertainty and unpredictability  of  personal transportation while keeping drivers and riders happy.

There are valuable lessons we can learn from Uber to help us reshape and re-focus our health care system. The shocking truth is that while Uber practices are in full force in the business realm, most physicians, and other health care stakeholders shy away from breaking the status quo, stubbornly  holding on to the previously erected barriers. Such strategy is a dead end. Our customers — the patients — will take their business away from those who fancy themselves immune from or not in need to abide by the service mandate!

Lesson #1: Availability. Not theoretical but actionable and transparent. Less than 2 minutes after our request, the driver pulled up. We knew his name, make and color of his vehicle, his license plate, and his cell phone number before he arrived. We could see additional vehicles in the area, and check their status in the app, and it felt good to know that we had options. Knowing our driver’s info before his arrival made us feel safe.

I am about to test the concept of actionable availability in pilot studies of the innovative triage platform for patients with acute symptoms. Yes, I know that it requires unusual openness and willingness to break the mold: but it is no longer a question of “if” but simply of “when.”

Lesson #2: Affability and ability. The driver was courteous, his car was spotless, and he provided us with route overview and useful information about La Jolla, underscoring his ability to do the job well.

This is by far the most rapidly developing  venue of the patient service mandate. Social media engagement by physicians is a must. We all should learn how to market our skills to attract more patients.

Lesson #3: Price transparency. We knew our fare before we embarked on our trip, with a swipe of a finger. There were no hidden fees, behind-the-scenes handshakes or any other uncertainty. The driver knew the fare as well, and there was no need to discuss it any further. It was simply agreed upon by all parties. There were no intermediaries holding the keys to the kingdom-a very refreshing and powerful factor. Uber makes a commission on every ride, and the riders know of the existing price difference between basic and premium services. Unlike medical insurance companies, Uber does not dictate or regulate how the services of personal transportation are to be performed. Drivers fees include a tip, eliminating a concern on the part of the driver that his services may be undervalued. I bet we would see less overpayment and overutilization of medical services if the price transparency were to be the norm.

Lack of price transparency is the single most painful experience for both physicians and patients. Check out Elizabeth Rosenthal series Paying Till It Hurts for multiple poignant examples. There is no shortage of technology to avail ourselves of price transparency. We have a shortage of political will to do so.

Lesson #4: A bi-directional feedback loop. I was surprised to learn that while we get to rate the driver, he gets to rate …us! It created an awkward situation when the driver inquired why one of us was previously rated as a 3-star. After a brief conversation, he felt that a 5-star rating was more appropriate.

The rating systems for physicians are not without peril. My own recent 1-star review on Zocdoc.com, sticking out like a sore thumb in a sea of salutatory testimonials, is a reflection of the volatile and misguided power abused by some patients. A forward-thinking telemedicine provider, Heathtap, allows doctors to rate patients partaking in the virtual visits with them. Physicians need to have their voices heard. Patients ARE NOT always right!

Lesson #5: Competitive innovation. This lesson was epitomized by Calvin.  Calvin was our Uber driver on a way back to San Diego. As we stepped into his black Mercedes SVU, this Uber experience included: free chilled bottles of water, snacks for the ride, a laptop for our viewing and music listening pleasure, and a pair of iphone 6 chargers (he had Android too). A brief video presentation introduced Calvin to us. Calvin was clearly outshining the competition by providing a higher level of customer service, innovating on top of the Uber concept! When we hit a pocket of traffic right in sight of the freeway, he registered our unease, and immediately provided an updated route overview, discussing all options based on his GPS. He made sure we were comfortable with the route he suggested, and the updated time of arrival. We gladly gave him a 5-star rating, and a generous tip (on top of the one included in his fare).

In medicine, we struggle to personalize our patients’ experiences while being responsible for managing populations at risk. Uber is certainly not a mass-level transportation solution, and, despite operating in 45 countries and 122 cities, it does not provide infrastructure to address population level transport needs. All of its drivers are independent contractors, working at will. But, by creating a highly satisfactory customer service experience, Uber is creating a community of users, a self-selected group of riders whose interests are aligned with the drivers. This user community is rapidly growing, and promulgating disruptive changes in the industry that has not seen any significant changes in decades. These disruptive changes are already impacting the population level transportation providers. To change our health care system, we need to deliver a highly impactful, Uber-like customer service solution.

Regina Druz is a cardiologist and can be reached at Integrative Cardiology Center of Long Island.

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