Health or Healthcare? Why Primary Care for the Healthy Fails (11 mins)

Have you noticed there are a lot of companies diving into primary care and then quickly exiting--or how many of these ventures carry the term "health" in their title rather than "healthcare"? This episode explores the dichotomy of healthcare that treats the sick and health companies that provide primary care for the healthy, including recommendations for how these companies could recover and thrive.
Key Points:
-Healthcare for the Healthy
-Holistic Care
-Unmet Needs and Opportunities

References:
-Fox, S (2024). Rebel Health: A Field Guide to the Patient-Led Revolution in Medical Care. Highbridge Company.

Transcript

Health or Healthcare? It makes a differenceThis week, Walmart announced that they were closing the doors on Walmart Health, adding their name to the long list of companies who dove into primary care head-first only to make a 180-degree turn shortly after.

I’ve heard many theories about why that could be – they lacked experience in the industry, they misunderstood primary care models, there were staffing issues, technology barriers, the stringent regulations impeded business, etc. But experience doesn’t have to matter if you listen to experienced people within, and the regulations are workable for other organizations. Can any of these reasons really explain cause of failure? In fact, I have an entirely different take for this repeated patten in our illustrious industry. While healthcare is a trillion-dollar industry, the margins aren’t all that great. It’s quite expensive to treat sick people. So, a lot of the companies that got into the health business wanted treated people who were healthy instead. Think about it. Most of the companies that are going under use the word “health” instead of healthcare. Caring for the sick was never part of the business plan.

Clearly, I’m excited about innovation in healthcare; otherwise I wouldn’t make podcasts and write articles about the industry. I read all the new tech and service models, and I’m an excited early adopter when it comes to this stuff. So, I’ve eagerly tried several of the primary and urgent care options made available via telehealth from these companies, and I’ve spoken with friends who tried using the walk-in clinics and similar resources. All of us were turned away if we actually needed treatment. If it was something we could treat at home with over-the-counter medicines, then they were willing to treat us. And that useless assessment and explanation of their limitations cost each of us somewhere between $30-$50. I walked away thinking it had to be a scam. If you require no service, we’ll serve you for $50, but if you actually need help – God forbid, you should actually get sick and need care – well, then we’re not the right choice for you. You should go and see a provider that caters to sick people.

And that is why they are closing. The healthy don’t need a physician, and we dare not forget it, lest we forget the “care” in healthcare. Everyone gets sick and needs primary care at some point, but healthy people don’t want to go to the doctor. Health plans have to literally pay people to get a physical and labs. Clearly, treating the healthy is not a sustainable business goal for a primary care clinic. Most people learned within one visit or one bad review that there was actually no service being delivered, and they stopped going.

Which leads me to ask why these businesses thought healthcare could be divorced from caring for the sick in the first place? Where else could this sneaky lie be propagating in our industry?

Maybe in our electronic medical record, where medical data is increasingly monetized by large corporations eager to gain greater and greater control of health information, and it doesn’t seem to matter if patients get better as long as they sign the privacy waiver on their personal data.

Maybe in the pharmaceutical industry where long-term maintenance treatment is favored over cures for pernicious diseases?

You can see how investors would get confused because these sectors pull some of the biggest profits in the industry. Those overworked primary care docs are working themselves to death doing things other than caring for people, and they still have to see all those sick people too. But medical records and pharmaceuticals are so nice and clean. So tidy and profitable. And no sick people.

This is where the gut check comes in. Why are the workers who carry all the risk and workload getting paid the least? Why are rural hospitals closing while luxury outpatient surgery centers grow rich on unnecessary operations?

Because we’ve taken the care out of healthcare. The healthcare industry has goals structured around patient outcomes, but the health industry has goals structured around profit. Healthcare provides products and services that patients need to keep living, working, and surviving, but health charges for products and services that have little benefit for patients. The Health industry is not an industry that I want to be a part of. I cannot imagine divorcing care from healthcare, and I won’t abide by it.

For millennia, vulnerable sick people have always been the reason for healthcare. Without them, there is no industry. My recommendation is that companies who are looking for a quick buck in primary care should focus on supportive services, like a holistic approach that offers products and services that are specific to a disease category rather than a financial category would do better. I don’t see any companies offering medication management classes with organizers to sell and deals on prescription programs specific to their disease, but I can say that if you took a stand as an advocate for patients with kidney disease, heart disease, or diabetes, you could begin earning trust with a large population of faithful clients who struggle to manage their complex conditions.

Basically, we need to acknowledge that healthcare is for sick people and then consider what sick people actually need. In her book Rebel Health, author Susannah Fox makes the salient point that there are forums across the web full of eager patients asking for products that do not yet exist – yet this resource is largely untapped by researchers.[1] She observes that a Natural Language Processing AI model could certainly survey these forums and provide meaningful feedback to investors looking for something that people would actually need and buy.

Along the same lines, we also need CEOs and investors who have at least spent a day in the hospital sometime in their lives, or perhaps cared for someone with a chronic illness, to help steer these business decisions in a more worthy direction. The financial leaders who thought that primary care for healthy people was a good idea are the ones who think they will never die because they ate kale twice a week. Unfortunately, people who eat kale have heart attacks too, and companies that provide a service that nobody actually needs or wants tend to go bankrupt. How many hospitals have to go under before their vendors start to see their bottom line drop. I imagine it will happen fast and unexpectedly just like Walmart closing its Health venture.

A company like Walmart in particular would have done better to provide something relevant to their current merchandise and skills, such as a natural weight loss clinic with coupons for new clothes when the patient’s size changes, or healthy meal planning and shopping lists that provide aisles and prices to help patients find nutritious items within their budget. And these holistic helpers are unavailable at primary care clinics right now, but they are desirable, because it increases health and quality outcomes for everyone while reducing cost. Such services are also some of the top motivators for a successful, goal-oriented weight management program: Things like community, rewards, feeling attractive, and having expert support while learning are things that could have packed an empty Walmart clinic.

In my opinion, companies exploring the primary care world should do what they do best by picking a specific disease specialty that affects a significant population, and then excel in the delivery, efficiency and patient engagement around those everyday needs experienced by so many people across the nation. Caring for the health and needs of their customers. The longer they stay alive, the more money they’ll spend at your store after all.

Another idea that I wish would happen is for Amazon to offer medication management training and help patients find the single best pill organizer on the market. Or what if you could search by impairment? If you could click a button and see utensils and other products for hand weakness, or easily search for household improvements to help with balance problems because those products were all grouped together based on the patient’s need rather than the product characteristics, it would be really helpful in caring for a patient’s health.

So instead of trying to do the something we already have but without the hard parts, or making ridiculous health claims like “we’re really innovative because we use AI,” companies that want to build both an investor base AND a customer base should do something more focused and niche in healthcare that plays to their strengths and then expand from there.

I think Walmart shouldn’t give up. I think Amazon should keep trying. Healthcare desperately needs innovation right now – this industry is like a dry and weary land of burned-out exiles waiting for an oasis to appear. But don’t try to copy the system, gasping like an exhausted animal, which just escaped being drowned. Be different. Be an oasis. Because when I’m sick, that’s where I’d like to go.

[1] Fox, S (2024). Rebel Health: A Field Guide to the Patient-Led Revolution in Medical Care. Highbridge Company.