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Learning from Past Failures: Challenges Faced by Non-Traditional Players in the Health Care Industry
Featuring Lucienne Ide, MD, PhD, founder and CEO of Rimidi
Explore the challenges faced by non-traditional players like Walmart in making a lasting impact in health care and the impact of their closures on underserved communities, while examining lessons learned from past failures and discussing strategies to prioritize quality outcomes and building trust with patients.
Lucienne Ide, MD, PhD: I'm Dr Lucienne Ide. I'm the CEO of Rimidi. I am a physician by training. I initially pursued a career as an academic clinician, earning an MD, PhD, and training in OBGYN. However, my previous career in technology and venture capital led me to a lot of curiosity and frustration with the use of technology and health care. I left clinical practice about 12 years ago to start Rimidi.
Why do you believe that non-traditional players like Walmart are struggling to make a lasting impact in the health care industry?
Ide: There has been a lot of talk about this since Walmart's exit from health care. I keep coming back to a comment that the head of health care for a major tech company made at a conference I was out about two years ago. She challenged the audience of providers, health systems, and clinics by saying you have the most precious asset that we all want, which is the trust of patients, and it's yours to lose. It was kind of a warning shot like, “We're coming for your patients and we're coming for health care delivery, but we recognize you have this thing we don't have.”
That is number one. I think part of why Walmart didn't succeed is they didn't generate the demand they needed or the volume of patients, because of that lack of trust. I actually tested this hypothesis out by going into some of the Walmart locations that had clinics here in Georgia, where I live, several years ago when they were on version 2 or 3 of their health care journey. I spoke with some of their employees and asked if they had been to the clinic. There was this inherent lack of trust even though, as an employee, it was free. The employees seemed concerned that once they visited the clinic, the providers would suggest the employees undergo costly tests. The underlying question likely posed by the employees’ concerns is one of trust: Did the clinic genuinely prioritize health care, or was it driven by revenue-generating opportunities? In my opinion, trust is the number one and the biggest reason.
The second issue at play is the complexity of the US health care system, which involves three separate groups: those who pay for health care, those who provide care, and those who receive care. The disconnect creates a system that doesn’t function as a free market. In a typical sector with a free market, a big company like Walmart or Google could come in and disrupt the health care system by offering a better service at a better price; however, the health care system doesn’t work that way.
How does the closure of Walmart Health impact underserved communities?
I think access is obviously one of the big issues for underserved communities, and that's where there has been a lot of hope that folks like Walmart or Dollar General or others could have a major impact by bringing health care to those communities. We've all watched over the past 5 to 10 years now and had concerns around the closure of rural hospitals and critical access hospitals. Again, referencing my home state of Georgia, more than half of our counties don't have an OBGYN, and that's only getting worse because of other complicating factors in the maternal health space right now, plus the lack of providers wanting to come to states like Georgia. It's a big deal.
As I have engaged with folks following this announcement and this discussion, I think that's one of the biggest disappointments. We have to solve for that access issue. I run a technology company so of course we think technology can help bridge some of those access issues in underserved communities. But it's not the whole solution. We still need providers who are serving those patients and that is a major concern.
What lessons can be learned from the failures of Microsoft HealthVault, Google Health, and now Walmart Health?
Ide: I think everyone who has been involved in health care is learning to think a little bit differently about the word “disruption.” It's a word that's probably been overused – I can agree in principle it needs to be disrupted. It is almost 20% of our GDP and yet we have arguably some of the worst life expectancy numbers of any developed country in the world. It's this huge mismatch between what we spend and the outcomes we achieve. That is worth disrupting. But I think one of the lessons is we must solve some of this from within. We can't just say, "The current system isn't working, let's build something new and better that is more cost-effective,” because of the complexity of the payment model that I mentioned earlier.
I was traveling abroad earlier this month and speaking with relatives in Europe about the health care system in the US, and it's really hard to explain to people who live in a single-payer economy the misalignment of incentives that we have. But it's the system we have, and it's not going to change anytime soon. I think not thinking about pure disruption, but thinking about where we can make real progress in a stepwise fashion is important.
What I always say is, if you're really sick, there's nowhere you'd rather be than in the US. We have, hands down, some of the best health care in the world. The problem is everything upstream of that.
In what ways do you think the health care industry can prioritize quality outcomes and cost-effectiveness over convenience and accessibility?
I think it has to be both. I say that because the appeal of a Walmart-type situation is to the consumer. We all want convenience and accessibility; we want health care to innovate into the future the way that other industries have. The banking industry is a great parallel that people often use. You don't go to a bank anymore; you can do all these different financial transactions on your phone. They figured out how to make all the interoperability work behind the scenes. Consumers aren't going to stop demanding convenience and accessibility. It's our job in the health care industry to meet that need while achieving quality outcomes and cost reduction. The current health care system delivers quality really well, consumer-based models deliver convenience, and capitated models deal with cost – there are these different buckets and we have to figure out how to bring those models together.
How can health care providers build trust and continuity with patients to address their core health care needs?
Ide: For providers, this is their fundamental asset. When I was a provider, I found it to be the most awe-inspiring part. A patient you’ve never met before puts this trust in you because of your training and role. How do we support that amazing relationship and that trust that exists with models that get to better efficiency, better cost-effectiveness, improvements of quality, and access to underserved communities? It’s about how we build around that existing part of health care that isn’t broken. The genuine desire of providers is to help patients achieve better outcomes. It is our obligation on the tech industry side and for other innovators to bring the tools to them. Instead of trying to create something on the side in parallel and ‘disrupt’ them, we need to focus on bringing the tools to them and enabling them to meet demands.
On the flip side, I know providers who are incredibly burnt out. A lot of my peers are coming up on midlife and thinking about leaving. That is awful because that is when people are really at the prime of their practice. None of us, as patients, should want providers who are just hitting their peak knowledge to leave the industry, but they're so burnt out. So, we need to address the burnout. We need to address the rising cost, all of those things. But I think we need to do it from within and think about how to bring the right resources, through partnerships, maybe with some of these outside entrants, working hand in hand with existing parties.
Do you believe there is a place for non-traditional players in health care, or is it best left to established health systems?
Ide: I absolutely think there is. It is such a complex industry. Nobody is going to be an expert at all of it. I think the value is in fresh eyes and bringing things from other industries that have worked there and applying them to health care. It’s about bringing the expertise and technology or data or AI or whatever it may be into health care. But I think we'll see success happen when there are more partnerships rather than disruptions.
Sometimes for people who work in this industry, it can feel frustrating to see some of these big companies come in and spend a bunch of money and then walk away. But I try to take the optimistic, positive view that we all learned something from that. And hopefully, it made the industry better even if that particular model didn't work. That's the optimistic entrepreneur in me who thinks we're always moving the ball forward, even if everything doesn't work.
