Jun 1, 2022 · 23m · allin

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

Tandice Urban · 14m spoken Jason Calacanis · 2m spoken Chamath Palihapitiya · 2m spoken David Sacks · 5s spoken David Friedberg · 3s spoken
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gold bands on the timeline = statements, start to end. Hover to read, click to jump. CC turns on captions

At the All-In Summit, Tandice Urban, co-founder of The Lanby, outlines the root causes of poor customer service and misaligned incentives in American healthcare while presenting hospitality-driven solutions and direct-to-consumer care models to improve patient outcomes.

How this conversation actually went

Every chapter scored 0–10 on four independent dynamics. Hover any point for the reasoning behind the score. The hosts hold 25.9% of the talking time here. How this is scored →

The hosts as informed peer 2.3 Guest teaching 4.0 Guest disagreement 1.3 The hosts pushing back 1.0
05100:0010:0020:000:21–3:41 · The hosts as informed peer 0/10 Going to the Doctor: A Healthcare Horror Story As a monologue opening, host scores are zero. Urban describes a detailed, relatable narrative of a terrible doctor visit experience and introduces the Bill Gurley quote.3:41–5:55 · The hosts as informed peer 0/10 Why Healthcare Customer Service Is So Bad Urban continues her presentation explaining structural reasons for poor healthcare service, citing WWII wage freezes and physician fee-for-service incentives. Host scores remain zero for monologue content.5:55–7:57 · The hosts as informed peer 0/10 The Impact of Bad Service on Health Outcomes Urban presents data on how bad service leads to poor health outcomes, noting afternoon versus morning antibiotic prescriptions due to doctor fatigue. Host scores are zero due to monologue structure.7:57–12:23 · The hosts as informed peer 0/10 Applying Hospitality Principles to Healthcare Urban outlines five hospitality principles applied to medical practice, quoting restaurateur Danny Meyer. Host interaction is negligible, maintaining host scores at zero.12:23–15:03 · The hosts as informed peer 5/10 Panel Discussion: Healthcare Price Transparency & DTC Models Jason initiates panel discussion by sharing a personal story about a $60,000 meniscus surgery bill without upfront pricing and citing DTC companies like HIMS and HERS. Urban explains how direct-to-consumer models and high deductibles shift patient behavior.15:03–18:03 · The hosts as informed peer 6/10 Panel Discussion: Life Expectancy, Lifestyle, and Systemic Reform Chamath pushes on why US life expectancy is declining while healthcare spending climbs as a percentage of GDP. Urban rejects the premise that international single-payer systems like Canada have solved healthcare, citing long wait times.18:03–21:03 · The hosts as informed peer 5/10 Panel Discussion: Mental Health and Nutrition Literacy Jason asks about universal subsidized mental health therapy, but Urban counters with the reality of 2,300-patient panel sizes per primary care doctor. Chamath asks about under-the-radar health issues, leading Urban to emphasize nutrition label literacy.0:21–3:41 · Guest teaching 3/10 Going to the Doctor: A Healthcare Horror Story As a monologue opening, host scores are zero. Urban describes a detailed, relatable narrative of a terrible doctor visit experience and introduces the Bill Gurley quote.3:41–5:55 · Guest teaching 4/10 Why Healthcare Customer Service Is So Bad Urban continues her presentation explaining structural reasons for poor healthcare service, citing WWII wage freezes and physician fee-for-service incentives. Host scores remain zero for monologue content.5:55–7:57 · Guest teaching 4/10 The Impact of Bad Service on Health Outcomes Urban presents data on how bad service leads to poor health outcomes, noting afternoon versus morning antibiotic prescriptions due to doctor fatigue. Host scores are zero due to monologue structure.7:57–12:23 · Guest teaching 3/10 Applying Hospitality Principles to Healthcare Urban outlines five hospitality principles applied to medical practice, quoting restaurateur Danny Meyer. Host interaction is negligible, maintaining host scores at zero.12:23–15:03 · Guest teaching 3/10 Panel Discussion: Healthcare Price Transparency & DTC Models Jason initiates panel discussion by sharing a personal story about a $60,000 meniscus surgery bill without upfront pricing and citing DTC companies like HIMS and HERS. Urban explains how direct-to-consumer models and high deductibles shift patient behavior.15:03–18:03 · Guest teaching 6/10 Panel Discussion: Life Expectancy, Lifestyle, and Systemic Reform Chamath pushes on why US life expectancy is declining while healthcare spending climbs as a percentage of GDP. Urban rejects the premise that international single-payer systems like Canada have solved healthcare, citing long wait times.18:03–21:03 · Guest teaching 5/10 Panel Discussion: Mental Health and Nutrition Literacy Jason asks about universal subsidized mental health therapy, but Urban counters with the reality of 2,300-patient panel sizes per primary care doctor. Chamath asks about under-the-radar health issues, leading Urban to emphasize nutrition label literacy.0:21–3:41 · Guest disagreement 1/10 Going to the Doctor: A Healthcare Horror Story As a monologue opening, host scores are zero. Urban describes a detailed, relatable narrative of a terrible doctor visit experience and introduces the Bill Gurley quote.3:41–5:55 · Guest disagreement 1/10 Why Healthcare Customer Service Is So Bad Urban continues her presentation explaining structural reasons for poor healthcare service, citing WWII wage freezes and physician fee-for-service incentives. Host scores remain zero for monologue content.5:55–7:57 · Guest disagreement 1/10 The Impact of Bad Service on Health Outcomes Urban presents data on how bad service leads to poor health outcomes, noting afternoon versus morning antibiotic prescriptions due to doctor fatigue. Host scores are zero due to monologue structure.7:57–12:23 · Guest disagreement 1/10 Applying Hospitality Principles to Healthcare Urban outlines five hospitality principles applied to medical practice, quoting restaurateur Danny Meyer. Host interaction is negligible, maintaining host scores at zero.12:23–15:03 · Guest disagreement 1/10 Panel Discussion: Healthcare Price Transparency & DTC Models Jason initiates panel discussion by sharing a personal story about a $60,000 meniscus surgery bill without upfront pricing and citing DTC companies like HIMS and HERS. Urban explains how direct-to-consumer models and high deductibles shift patient behavior.15:03–18:03 · Guest disagreement 2/10 Panel Discussion: Life Expectancy, Lifestyle, and Systemic Reform Chamath pushes on why US life expectancy is declining while healthcare spending climbs as a percentage of GDP. Urban rejects the premise that international single-payer systems like Canada have solved healthcare, citing long wait times.18:03–21:03 · Guest disagreement 2/10 Panel Discussion: Mental Health and Nutrition Literacy Jason asks about universal subsidized mental health therapy, but Urban counters with the reality of 2,300-patient panel sizes per primary care doctor. Chamath asks about under-the-radar health issues, leading Urban to emphasize nutrition label literacy.0:21–3:41 · The hosts pushing back 0/10 Going to the Doctor: A Healthcare Horror Story As a monologue opening, host scores are zero. Urban describes a detailed, relatable narrative of a terrible doctor visit experience and introduces the Bill Gurley quote.3:41–5:55 · The hosts pushing back 0/10 Why Healthcare Customer Service Is So Bad Urban continues her presentation explaining structural reasons for poor healthcare service, citing WWII wage freezes and physician fee-for-service incentives. Host scores remain zero for monologue content.5:55–7:57 · The hosts pushing back 0/10 The Impact of Bad Service on Health Outcomes Urban presents data on how bad service leads to poor health outcomes, noting afternoon versus morning antibiotic prescriptions due to doctor fatigue. Host scores are zero due to monologue structure.7:57–12:23 · The hosts pushing back 0/10 Applying Hospitality Principles to Healthcare Urban outlines five hospitality principles applied to medical practice, quoting restaurateur Danny Meyer. Host interaction is negligible, maintaining host scores at zero.12:23–15:03 · The hosts pushing back 2/10 Panel Discussion: Healthcare Price Transparency & DTC Models Jason initiates panel discussion by sharing a personal story about a $60,000 meniscus surgery bill without upfront pricing and citing DTC companies like HIMS and HERS. Urban explains how direct-to-consumer models and high deductibles shift patient behavior.15:03–18:03 · The hosts pushing back 3/10 Panel Discussion: Life Expectancy, Lifestyle, and Systemic Reform Chamath pushes on why US life expectancy is declining while healthcare spending climbs as a percentage of GDP. Urban rejects the premise that international single-payer systems like Canada have solved healthcare, citing long wait times.18:03–21:03 · The hosts pushing back 2/10 Panel Discussion: Mental Health and Nutrition Literacy Jason asks about universal subsidized mental health therapy, but Urban counters with the reality of 2,300-patient panel sizes per primary care doctor. Chamath asks about under-the-radar health issues, leading Urban to emphasize nutrition label literacy.

speaking balance: gold is the hosts, purple is the guest (3 minute bins)

0:00 · the hosts 0.7% · guest 99.3%0:00 · the hosts 0.7% · guest 99.3%3:00 · the hosts 0% · guest 100%3:00 · the hosts 0% · guest 100%6:00 · the hosts 0% · guest 100%6:00 · the hosts 0% · guest 100%9:00 · the hosts 0% · guest 100%9:00 · the hosts 0% · guest 100%12:00 · the hosts 52.6% · guest 47.4%12:00 · the hosts 52.6% · guest 47.4%15:00 · the hosts 51.4% · guest 48.6%15:00 · the hosts 51.4% · guest 48.6%18:00 · the hosts 63.6% · guest 36.4%18:00 · the hosts 63.6% · guest 36.4%21:00 · the hosts 48% · guest 52%21:00 · the hosts 48% · guest 52%
Sharpest disagreement ▶ 17:04 Dismissing Canadian healthcare system idealization

When Chamath asks if foreign countries have solved healthcare, Urban candidly refutes the idea that international models are better, noting Canadians face eight-week waits for basic UTI medication.

Hardest push from the hosts ▶ 15:30 Chamath challenges GDP spend vs life expectancy decline

Chamath presses hard on the paradox of US healthcare spending climbing to 20-30% of GDP while life expectancy declines across all demographic groups.

Biggest teaching moment ▶ 19:30 Explaining panel size constraints in primary care

Urban educates Jason on why a flat-rate mental health model fails in primary care by explaining that doctors manage 2,300 patients on average, making high-touch therapy economically unfeasible.

The host holds their own ▶ 12:28 Jason compares surgical pricing obscurity to menu-less restaurants

Jason demonstrates clear consumer knowledge by comparing his $60,000 meniscus surgery surprise bill to high-end Italian restaurants that conceal menu prices.

the scores for every segment, with the reasoning behind each
ChapterTopicThe hosts as informed peerGuest teachingGuest disagreementThe hosts pushing backWhy
Going to the Doctor: A Healthcare Horror Story 0310 As a monologue opening, host scores are zero. Urban describes a detailed, relatable narrative of a terrible doctor visit experience and introduces the Bill Gurley quote.
Why Healthcare Customer Service Is So Bad 0410 Urban continues her presentation explaining structural reasons for poor healthcare service, citing WWII wage freezes and physician fee-for-service incentives. Host scores remain zero for monologue content.
The Impact of Bad Service on Health Outcomes 0410 Urban presents data on how bad service leads to poor health outcomes, noting afternoon versus morning antibiotic prescriptions due to doctor fatigue. Host scores are zero due to monologue structure.
Applying Hospitality Principles to Healthcare 0310 Urban outlines five hospitality principles applied to medical practice, quoting restaurateur Danny Meyer. Host interaction is negligible, maintaining host scores at zero.
Panel Discussion: Healthcare Price Transparency & DTC Models 5312 Jason initiates panel discussion by sharing a personal story about a $60,000 meniscus surgery bill without upfront pricing and citing DTC companies like HIMS and HERS. Urban explains how direct-to-consumer models and high deductibles shift patient behavior.
Panel Discussion: Life Expectancy, Lifestyle, and Systemic Reform 6623 Chamath pushes on why US life expectancy is declining while healthcare spending climbs as a percentage of GDP. Urban rejects the premise that international single-payer systems like Canada have solved healthcare, citing long wait times.
Panel Discussion: Mental Health and Nutrition Literacy 5522 Jason asks about universal subsidized mental health therapy, but Urban counters with the reality of 2,300-patient panel sizes per primary care doctor. Chamath asks about under-the-radar health issues, leading Urban to emphasize nutrition label literacy.

Statements from this episode (12)

Opinion
Tandice Urban: US healthcare is the worst customer service industry
“The US healthcare market is the least customer centric of any customer service industry. We are so numb to the pain that we rarely object or complain.”
Tandice Urban Jun 1, 2022 ▶ 3:21
Insight
Urban: Fee-for-service healthcare incentivizes volume over patient care quality
“Physicians in the traditional fee-for-service model, which is our predominant model today, where physicians are paid per, per patient encounter they're incentivized by volume, and not by quality, and not by good health outcomes, so it's no surprise that practi…”
Tandice Urban Jun 1, 2022 ▶ 4:46
Assertion Contradicted
Primary care providers have an average Net Promoter Score of 3
“In primary care specifically, the average NPS for a provider is three.”
Tandice Urban Jun 1, 2022 ▶ 5:12
Assertion Supported
96% of patient complaints are about customer service, not medical care
“96% of patient complaints are about the service itself. Only four percent are about the care delivered.”
Tandice Urban Jun 1, 2022 ▶ 5:20
Assertion Supported
Doctors prescribe more antibiotics in the afternoon due to decision fatigue
“Doctors are far more likely to prescribe antibiotics in the afternoon than they are in the morning for the same patient with the same issues because they're just running late and they're dealing with decision fatigue.”
Tandice Urban Jun 1, 2022 ▶ 6:29
Assertion Partly supported
Urban: 40% of top US deaths are preventable with proper care
“40% of annual deaths caused by the top five causes of death in the U.S. Are preventable with good preventive care.”
Tandice Urban Jun 1, 2022 ▶ 7:28
Assertion Partly supported
Urban: Avoidable chronic disease accounts for 75% of US healthcare spend
“According to the CDC, for whatever that's worth to you, avoidable chronic disease accounts for 75% of our health care spend”
Tandice Urban Jun 1, 2022 ▶ 7:36
Assertion Partly supported
Urban: Patients with a primary care doctor spend 33% less overall
“Patients with a PCP, a primary care doctor, spend 33% less on health care overall because they're front-loading that spend toward prevention.”
Tandice Urban Jun 1, 2022 ▶ 7:42
Assertion Not checkable as stated
Jason Calacanis was charged $60,000 for a meniscus surgery in 2012
“Cleaning up my meniscus was 60,000 dollars, and that was like, how much? 60,000 dollars 10 years ago for a meniscus surgery in New York”
Jason Calacanis Jun 1, 2022 ▶ 12:48
Insight
Urban: Poor lifestyles and processed diets drive rising US healthcare costs
“We're overspending on healthcare because we're spending on things that kill us, and then our healthcare gets very expensive, Because we have terrible, terrible lifestyles, and everyone is drinking way too much across all communities. Everybody is eating totall…”
Tandice Urban Jun 1, 2022 ▶ 16:05
Disclosure
Tandice Urban: The Lanby cannot yet profitably integrate mental healthcare
“We've thought about this a lot at the Lambie, because we've tried to figure out a way to integrate mental health in a way where we would be able to make money, and we can't just yet.”
Tandice Urban Jun 1, 2022 ▶ 19:17
Assertion Supported
US primary care physicians manage an average of 2,300 patients each
“In, in the across the U S one physician has a panel of 2300 patients on average.”
Tandice Urban Jun 1, 2022 ▶ 19:44
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