#AIS: The Lanby's Tandice Urban on solving healthcare's customer service problem

**Jason Calacanis** (0:18)
Please welcome Tandis.

**Tandice Urban** (0:19)
Hi everyone.
So, what I want to talk about today is the problem that I'm obsessed with, which is bad customer service and health care. So, I'd like to start out by walking you through a day at the doctor's office. It can look a little bit like this. You have to start out by making an appointment. So, you call in, you talk to someone very unpleasant on the phone. They put you on hold. You wait, there's bad hold music. You're waiting, you're waiting. They come back, you go back and forth a little bit on your calendars. You get an appointment, it's in 21 days.
Now, it's 21 days later. You go to the doctor's office, someone very unpleasant checks you in at the front desk. You sit down, super depressing waiting room, bad wall art, very old issues of parenting magazine, smells like Purell in there. That's fine. This is your hangout for a little bit now, and now it's maybe 30 or 40 minutes later. Someone calls you back. As you may have guessed, they're very unpleasant. They take you back to the exam room. It's very small, black fluorescent lighting everywhere. They take your vitals, they hand you essentially a sheet of printer paper. They tell you to change into this. Now you're in a secondary holding chamber, except this time you can hear the doctor in the other room and they're saying, hey, it's so great to see you and so you know, they're just getting started in there, even though your appointment was an hour ago at this point.
Pull up your phone, you start to go through your little question list. Got up the courage to ask everything you came in to ask.
Then finally, the doctor knocks, like you could possibly still be changing. He comes in, does a little small talk with you. He goes and sits down, starts asking you some questions. You're maybe like eight minutes into the appointment at this point and you're like, okay, also I have some questions and you pull up your little question list on your phone and you get through maybe like two or three of these questions. Then the doctor starts to give you a look like, let's wrap this up.
So you wrap it up, you ask three questions, the appointment is over, you go outside, you check out. If you're lucky, they'll tell you how much you owe. If not, you will just find out later in the mail.
So my guess is that maybe many of you in this audience have a concierge doctor, but most of us have had some iteration of this experience at some point. There are a lot of terrible things about our healthcare system, but the one I want to complain about specifically today is why the customer service at the point at which you're actually consuming the healthcare is so appallingly bad. When I refer to customer service, that's anything that touches the patient experience while you're going to the doctor. So a long wait time is as much bad customer service as the unfriendly front desk person.
There's this really great quote that I love from Bill Gurley, prolific investor and my relationship hall pass.
Didn't know he was going to be here. The US healthcare market is least customer centric of any customer service industry. We are so numb to the pain that we rarely object or complain. So that's part of what I think is so crazy about this is that we just take it. That got me curious to explore three questions that I want to go through with you here today. Number one, why are things so bad? How did they get this way? Number two, why should we care that things are so bad? Number three, what can we do about it? What's a little something we can do to make it better? Let's start with why are things so bad?
A big part of this is our customer service problem is really more of a consumer service problem. What I mean by that is patients are consuming the healthcare, but they're not exactly the customer in the traditional free market sense of the term. So who is? The US healthcare system, as we know, is an employer-sponsored model. This was not very well thought out. It's more of a World War II relic that came from a national mandated wage freeze in 1942, and we kind of just kept going with it. And now today, the doctor is not getting out of bed in the morning for your $15 copay. They're really making their money off of the major stakeholders in the industry who are the employers and the insurance companies. They're the payers. They're the real customers in this story. And doctors don't love this either, by the way. There's major burnout in the medical community. But when you play this all the way out, you're left with misaligned incentives between physicians and patients.