The collapse of Babylon Health doesn’t spell the end of digital healthcare, but it does show we need to understand our patients better, argues Dr Jay Verma
As a practising GP, I am all too aware of the intense pressure our profession is under. Data from earlier this month revealed we delivered 29.4 million appointments in June this year – a number which is equivalent to winter-level demand.
Yet, one of the biggest complaints from patients is about their problems accessing their practice. So it’s no wonder when Babylon Health offered a digital service, which allowed people to interact with healthcare professionals online, it was heralded by users as ‘the best thing ever’.
I am hugely grateful to Babylon for leading the way and making digital access a reality. The ability to contact your practice online is now ubiquitous, and personally it makes it much easier for me to triage patients and ensure that we don’t allocate appointments based on who dials in first in the morning.
But I believe there was a fundamental flaw in their business model: they increased patient access but didn’t review their patients to better understand their need or design pathways to help optimise their care. This, of course, is harder to do if your patients are spread throughout England.
Babylon went after the younger patient, who is tech savvy, busy and – on the face of it – healthier than their parents and grandparents. The spread of their registered patients shows a huge cluster around London and the South East, overwhelmingly falling into the 20-44 age bracket. But age does not mean good health – nor low demand.
An insider at Babylon Health told me that one of their biggest problems was underestimating the mental health needs of younger patients. Even a cursory glance at mental health statistics shows that younger people are more likely to contact their GP for their mental health. For example, NHS data from 2014 found 26% of young women aged between 16-24 report having a common mental health problem in any given week, and the prevalence is rising.
It is one thing improving access – as we should all be doing. But the only way we as a profession will be able to sustain this is if we understand our patients and what motivates their interactions with health providers. If you make the door wider, you need to have the right infrastructure in place once you are inside. To provide sustainable, equitable healthcare, we need to understand what drives our patients to contact us and how they can best be helped in the short and long term.
Data analysis I undertook at my practice to help me understand patient demand found that in one month, 80% of staff activity was provided to only 14% of our patient list, and 60% did not contact us at all. Some – but not all – of that was driven by older patients with more complex needs. A percentage was driven by younger patients, demonstrating that in the current environment, you cannot try to cream off the patients you feel will be ‘cheaper and easier’ based on their age and income.
It is not just about health needs, but also meeting – and managing – expectations. It is often the younger, better educated patient who will speak out to demand what they want, whether that’s a freebie in exchange for visibility on Instagram or a same-day GP appointment.
And, dare I say it, for the general practice NHS model to cope, we need to be able to prioritise patients according to their need, not their wants. That is not to say that no one under the age of 40 needs an urgent appointment – of course they do. But when you offer a service to anyone and say that they can always get a video call with a doctor ‘anytime, anywhere’, then your patients expect that service and you run the risk of demand that is unaffordable and unsustainable.
Babylon commercialised primary care by increasing their list size to increase their funding. Despite being championed by Matt Hancock when he was health secretary, founder Dr Ali Parsa complained Babylon’s NHS work failed to turn a profit. They made the mistake of not looking at lowering the cost per appointment or developing smarter ways to provide treatment. The patient journey was never central to their model. It was short-termism.
The Carr-Hill formula means that younger patients attract a lower payment. Babylon’s model as it stands would require payment per interaction. Their target patient group, being used to consuming other services through digital channels, used the service considerably more than Babylon had modelled, meaning that the revenue they got from an increased patient list size couldn’t cover the cost of providing the service as they did not change patient behaviours. It wasn’t a relationship, it was a transaction.
The lesson here is simple: in order to provide good quality care to your patients, you need to first understand, not generalise them.
Dr Jay Verma is a GP in London and president-elect of the general practice and primary care section at the Royal Society of Medicine