Minimal updates to our business model canvas.
We are may include hospitals & health care facilities into our channel strategy and key partnerships.
I went to the Alta Bates Medical Center in Berkeley on Friday to talk to someone knowledgeable about medical directives. After being turned down/ redirected by three different people, I finally found someone at the hospital who was willing to talk. Keiisha Norman is the supervisor for the Patient Access department where she has experience talking to patients when they first arrive at the hospital and before they the leave. She asks every patient who comes in to fill out a medical directive and has a physician consult with them through the process. In her opinion, having a medical directive is very important and most people do not have one because they are unaware of the problem.
Being in the medical industry, she understands this problem first hand and tried searching for online resources to plan her medical directives. Unfortunately, the information was scattered and there really wasn’t a place that had organized all of the important documents into one location. She mentioned that LegalZoom is in the document creation business but they do not provide a comprehensive solution for some to complete their medical directive or other end of life wishes. She would be interested in using this service for her mother who is in her 60s. She believes that there should be a choice between a subscription model and a fixed price for the premium feature, because depending on a person’s age, they may expect to live for a certain number of years. If they are too young, then a high annual subscription might turn them off.
She thinks that if we can create a very reliable and easy to use system, the hospital may use our website to extract important information on medical directives and may refer their patients to our resources. They currently refer their patients to State provided guidelines and service. Before the hospital can officially endorse us, we need present our case to their compliance department to make sure that the wording is appropriate to be handed out on behalf of the hospital (there is a lot of liability involve for the hospital). Although this may be a fairly difficult process, it could be a potential strategy for the future if we want to use the hospital as a channel to reach new customers.
When doing a cold approach at a hospital, expect to get turn down about 3 times before someone is willing to speak with you.
The hospital and physician may be a channel to reach new customers.
I interviewed Jamie (43 year old) a mother of 3 with divorced parents. She is the eldest of her siblings (and the only daughter) and is the de facto responsible child to take care of her parents when they age.
The Trigger – 7 years ago her husband’s mother died and that triggered the creation of a will and DNR for herself and her husband.
Jamie and her relationship to her parents’ EOL Planning
- Jamie’s dad has given her a folder with copy of will and other documents
- Before the time of our conversation Jamie had never looked in the folder
- Together during the interview she looked through it for the 1st time and need to talk to her husband (who handles administrative major things) to explain what she was looking at
- She believes her mother has many of the necessary documents but she has not seen any of them
Jamie believes that a tool that does the following would be very useful.
- A list/coach of all the things that should be considered for comprehensive EOL planning
- A safe, online storage place for her parents to keep the documents
- Yearly updates to explain any changes in law that are pertinent to eol planning (i.e. trust laws changing or new technology for eol care)
In terms of willingness to pay. Jamie would be willing to pay 50 per year for secure storage. She thinks that anything less than 25 per year would be questionable in terms of its trustworthiness. She would expect a family discount for multiple users. She also expects to pay a one-time setup fee (using as an analogy the service the preserved her recently born children’s umbilical cord blood.)
I spoke with Karolyn from the Berkeley Pine’s long term care center today. Karolyn has been working in the healthcare industry for about 10 years so she has experienced many instances where having a plan in place would have resolved some serious problems.
At her facility, the nurses encourage patients to fill out an advance directive form but most people post pone this until it’s too late. She was kind enough to share three stories which really highlights the importance of a medical directive.
Several months ago, there was a residence in her care who did not have a medical directive. Her kids who became the de facto decision makers of her care wanted to keep her alive for as long as possible. It turns out that the kids were living in her home and cashing her social security checks. Social security pays about $2000 a month and medicare cover $3250 a month for the patient, so the children were motivated financially to keep her alive. The care facility wanted to stop treatment but they were obligated to do whatever necessary to keep the patient alive even if it meant ordering unnecessary procedures or sending her back and forth to the hospital (something that is very expensive). The nurses ended up filing a report to an ethics commission on the grounds of financial abuse. It was very unfortunate that “she [the patient] no longer had a choice because her family was making the decision.
There was a patient not too longer ago who had entered the facility with a massive stoke. He was comatose, on medication, and ate through a feeding tube. His condition was so bad that what came out the feeding tube was almost the same as what came in. His body had deteriorated to a point that it could no longer take in nutrients. His family could not let go so they insisted that the facility do whatever is necessary to keep him alive. His daughter prayed for a miracle that the nurse do not think is possible. None of his sons wanted to be the one to pull the plug on their father.
Story number 3 comes directly from Karolyn’s family. A couple of years ago, her mother-in-law was admitted into a long term care facility. The mother’s son (who is her husband) and the patient’s husband wanted the best care for her. In their case, they avoided the conversation of medical directives because it is such a terrible topic to talk about. Even though Karolyn wanted to intervene on behalf of her mother in law, she couldn’t because the family did not want to cause turmoil so they avoided the topic and the care facility was forced to give unnecessary treatments.
The California advance directive information is freely available on the web.
When people go to purchase a funeral plan, make sure that it is put in a trust so that it is not considered an asset by Medicare. They deduct your burial plots from your Medicare benefits if you do not put it in a trust.
The web design was very good. The colors were not distracting to seniors. However, we should have a feature to enlarge the website so that people with poorer eye site can easily adjust the size for readability purposes.
I went to the Haas Alumni Network event at Menlo Circus tonight, and talked to 5 different people about our idea – a variety of professionals and entrepreneurs across an age spectrum from about 35-55. I ended up doing a bit more ‘pitching’ than I would have liked (rather than listening) partly because of the audience and situation, but also because I had no idea whether this idea would resonate with people or not.
The first woman I spoke with had seen a similar idea presented at the SCU business plan competition, for which she was a judge a year or two ago. She had great, pointed questions about who are target customers are, and what our revenue model might look like. She seemed happy to think of this in terms of a business, and not think about herself as a potential customer….
The next woman I spoke with had recently lost her father, understood and liked the idea, but was a bit concerned that some parents will simply not want to work on this, or release control to their kids in this way – which is what she experienced…She was also very concerned about it being online only, and said there had to be a method for non-tech savvy people to use this.
The next person I spoke with I knew from a class last semester – she is very direct and outspoken, so I got some good, straight feedback from her. She understood the idea, but generally thought it was negative, and hoped I would work on something different. She had paid $500 for an estate plan through a lawyer, seemed happy with it, and said it covered almost everything we talked about offering in our site. She understood the fear of lawyers, though, and acknowledged that there are many people who won’t use an estate planner or lawyer for fear of the prices and/or just getting ripped off. She liked and understood the triggers idea, with subscriptions being based on prepped triggers and designees.
I next spoke to her colleague, who immediately understood and liked the idea – he got the ‘relieve the burden’ idea without me even needing to explain it, or the value prop. He was one of several people who asked whether I was talking about products when I told him what we were working on was ‘comprehensive end-of-life planning, online’!
He totally got that a will and formal/legal aspects of EOL planning is extremely limited, and only part of the picture. He also understood, and totally agreed with our differentiated positioning in comparison to legal zoom (he had heard of ‘zoom legal’ so their ads are working). He said he personally wasn’t interested in using the site, but certainly understood it and thought it was timely idea.
The last woman I spoke with seemed the most open to the idea – her father used something called the Neptune Society to pre-pay and pre-arrange his remains disposition and final memorial. He made incremental payments, so he was pre-paid, and merely had to share the paperwork with her so she would be aware of it. She re-iterated and understood that pricing and how we charge would be a very delicate topic for this already delicate topic. She also understood the ‘fear of lawyers’ thing – she has two children, and had spent an hour with estate planner, but didn’t click with her, so she didn’t make a plan with them.
Betsy is in her 80’s. She advises to Stanford medical school on advance directives, and she helps many people prepare directives. She also teaches and advocates all over the bay area on this topic. She was generous enough to give me over 2 hours of her time on Monday, and will be a key resource for us as we develop the advance directives area of our site. She understands many aspects of the law surrounding patients rights specific to advance directives, and is a strong advocate of having an advance directive, and having a dignified death. She also helped explain the differences between advance directive and a POLST form.
Generally speaking, she is very supportive of having better online resources, and was familiar with many of the resources currently available to start the conversation, and to document your wishes. This is her passion in life, and anything that can help more people understand and take control of how they die is valuable in her opinion. She just returned from a conference in San Diego of the Coalition for Compassionate Care of California. She said people at this conference were ‘clamoring’ for something like what we’re working on, and pointed me towards some important thinkers in this area to get input from as well. This will not be our last conversation with Betsy – she was very interested in helping us understand this problem better, and influence how it gets implemented. There’s a 2005 piece on SFGate.com where she and her husband Alan are interviewed about their advocacy work.