Despite the overwhelming evidence of the benefits of digital health over the traditional analog services, we have seen significant barriers to adoption that have resulted in what I refer to as the Ten Paradoxes of Digital Health. This article will address the Satisfaction Paradox.
The Veterans Administration (VA) and the National Health Services in the United Kingdom (NHS) have both implemented comprehensive digital health service offerings focused on the chronically ill. As part of their offerings they have conducted surveys among the consumers/patients, as you would expect any successful digital company to do like Google, Amazon, Apple, etc. The results have shown customer satisfaction levels in the high 80s and low 90s – satisfaction performance you would expect to see at Apple. Other organisations, like Medtronic, that provide remote monitoring for cardiac rhythm management patients have seen similar levels of satisfaction.
So why such high levels of satisfaction?
Because digital health offerings fixes a flaw in our healthcare system that we never talk about. It provides a dynamic feedback loop to support and help the consumer/patient change their behaviours and overcome health problems. Face it, there is no feedback loop in healthcare today. For your typical problem you visit your doctor, spend a few precious minutes with her and then leave, often unclear as to what you should do next or differently. No one from the office calls to check up on you. No one is monitoring your behaviour to see if you are doing what you should and to find out if they can help you. You are on your own to figure these things out, or not.
What we know from behavioural psychology is that for a feedback loop to be effective it must be constant and in the moment. That is it must be dynamic enough to provide me the feedback I need at the time that I need it. Getting feedback from my doctors two months after I did something I shouldn’t have won’t change my behaviour. But getting feedback within a day or moments after the behaviour has a real impact.
So what consumers/patients like about digital health is that they are being watched over, guided, supported and helped in their efforts to be healthy. Amasingly, in the patient satisfaction surveys they don’t indicate any concerns regarding “Big Brother constantly monitoring me.” They express greater confidence that the monitoring helps them become more compliant because if someone is watching them they are more likely to do what they should. They have greater confidence that if something goes wrong then it will be fixed more quickly. They are confident that an expert will intervene to help them if something catastrophic occurs. This greater level of confidence based upon digital services is what drives greater consumer/patient satisfaction.
So why don’t we do this as the standard of care in healthcare? In any other industry, a service that had this level of consumers/patients satisfaction would be the market leading solution and the standard of excellence.
There are three primary reasons: 1) no academic medical centers teach and train medical students and young clinicians that this should be the standard of care; 2) no payers have been willing to pay for a service that is not the standard of care; and 3) our healthcare system is designed to be physician-centric not patient-centric.
Fortunately, all three of things are starting to change. Patients are increasingly calling the tune in healthcare and demanding the same type of services and satisfaction in healthcare they experience in the digital areas of their life. Starting January 2015 the Center for Medicare and Medicaid Services will start paying $42 per consumer/patient per month for digital services. And with money now flowing and patients demanding digital services we have begun to see leading academic medical centers like the Mayo Clinic develop and deliver these types of services with impressive results. So with any luck, the Satisfaction Paradox will be reversed and digital health will become the standard of care.