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

Problem Statement: The speaker identifies "bad customer service" in US healthcare as the primary dysfunction, noting that the system is the "least customer-centric" of any industry despite high spending.

• Patients are often the consumers of care but not the traditional "customers" or payers, with employers and insurance companies acting as the actual stakeholders.
• The predominant fee-for-service model incentivizes physician volume over patient quality of life or health outcomes.
• Data indicates the average Net Promoter Score (NPS) for primary care providers is only 3.
• 96% of patient complaints relate to service delivery, while only 4% relate to the actual medical care provided.

Impact on Health Outcomes: Poor service experiences directly correlate with worse health outcomes and higher systemic costs.

• Anxiety and rushed interactions cause physicians to be more likely to prescribe antibiotics in the afternoon due to decision fatigue compared to morning appointments.
• Patients frequently defer treatment due to friction, resulting in missed preventive care opportunities.
• 40% of annual deaths from the top five causes are preventable through effective preventive care.
• Avoidable chronic diseases account for 75% of total healthcare spend.
• Patients with a Primary Care Physician (PCP) spend 33% less overall than those without one.

Proposed Solutions and Shifts: The speaker advocates for shifting from volume-based to value-based or direct-to-consumer models.

• Direct-to-Consumer Models: Making the patient the direct customer (e.g., membership models like "Lanby") to re-align incentives.
• Value-Based Care: Reimbursing insurers based on quality outcomes rather than visit volume.
• Hospitality Framework: Adopting service standards from the hospitality industry to treat patients as "people" rather than cases.
  • Five core tenants for improving patient experience: follow the Golden Rule, set clear expectations, practice active listening, act as an "agent" (not a gatekeeper), and "surprise and delight" patients.

Systemic and Cultural Barriers:

• The US healthcare model is a legacy of 1942 WWII-era wage freezes, creating structural misalignment.
• Patients exhibit "Stockholm syndrome" regarding bad service, accepting poor treatment that they would reject in other industries.
• Transparency is lacking; patients often do not know costs until after care is delivered, unlike other service sectors.
• Lifestyle factors (processed foods, alcohol consumption) are identified as major drivers of declining life expectancy despite rising healthcare spending.
• No other country offers a perfect model for comparison; even systems with lower costs (e.g., Canada) suffer from long wait times and patient dissatisfaction.

Q&A Highlights:

• Mental Health: Integrating mental health into primary care is challenging due to low physician panel capacity (avg. 2,300 patients) required to offset the high-touch nature of therapy.
• Nutrition Literacy: Misleading marketing on nutrition labels contributes to lifestyle-related diseases; better education is needed to improve prevention.
• Company Details: "Lanby" (pronounced Lamby) is a primary care membership service operating in New York, currently raising seed funding.
  • Uses a three-person care team model (physician, nutritionist, concierge manager) to increase panel efficiency.
  • Website: lanby.com.

Forward-Looking Statements:

• Patient expectations will continue to shift toward demanding "restaurant-level" service, forcing providers to adapt or lose relevance.
• Value-based care models are being pushed by CMS/HHS but face slow adoption due to industry "red tape."
• Direct-to-consumer trends (e.g., Hims, Roman, urgent care with transparent pricing) are beginning to disrupt the traditional payment opacity.