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

The core customer-service failure in U.S. healthcare is an incentive problem: patients consume the care, but employers and insurers usually pay for it. In fee-for-service medicine, physicians are rewarded for patient volume rather than experience or outcomes, leaving practices little economic reason to optimize around patients.

Bad service can directly worsen medical care because rushed doctors and frustrated patients exchange less useful information. The speaker cites research that doctors prescribe antibiotics more often later in the day as decision fatigue builds, while unpleasant experiences also cause patients to postpone visits until problems become harder to prevent or treat.

The strongest financial argument for better primary care is prevention: patients with a primary-care physician reportedly spend 33% less overall. The speaker also cites estimates that preventable chronic disease drives 75% of healthcare spending and that 40% of deaths from America’s five leading causes could be prevented with better preventive care.

She sees two practical ways to realign healthcare incentives: make patients direct-paying customers or pay providers for outcomes rather than appointment volume. Direct-consumer care restores ordinary price and service pressure, while value-based reimbursement allows insurers to remain the payer but rewards quality instead of throughput.

Her proposed operating model is borrowed from hospitality rather than medicine: communicate delays, listen closely, remove unnecessary barriers and make patients feel remembered. At The Lanby, staff are explicitly trained to act as “agents, not gatekeepers,” including bending internal rules when a reasonable patient request can legally and safely be accommodated.

The Lanby was raising a seed round after initially financing itself largely through its own members, turning customers into investors. Its scaling model assigns each patient a three-person team—a physician, nutritionist and concierge manager—so administrative and lifestyle work can be distributed rather than forcing everything through one doctor.

Mental-health care remains difficult to integrate profitably into ordinary primary care because therapy requires far more clinician time per patient. The speaker said The Lanby had explored integration but could not yet make the economics work, contrasting therapy’s high-touch model with an average primary-care physician panel of roughly 2,300 patients.

The speaker argues that America’s rising healthcare spending cannot compensate for increasingly unhealthy lifestyles. She points to heavy drinking, processed food and weak preventive habits as major upstream drivers, with expensive medical treatment arriving later after those risks have already accumulated.