Trans­form­ing The Cus­tomer Ex­pe­ri­ence In Health­care

Un­der­stand­ing the driv­ers and chal­lenges in im­prov­ing the con­sumer ex­pe­ri­ence

Modern Healthcare - - News -

CON­SUMER EX­PE­RI­ENCE IS A TOP PRI­OR­ITY

for health sys­tem ex­ec­u­tives. A great ex­pe­ri­ence can im­prove loy­alty and strengthen a health sys­tem’s brand, sup­port­ing pa­tient re­ten­tion and Medi­care bonus pay­ments from pos­i­tive HCAHPS scores. A fo­cus on im­prov­ing the con­sumer ex­pe­ri­ence is be­ing driven by dis­rup­tive care al­ter­na­tives that at­tract con­sumers with con­ve­nience and lower costs, the dig­i­tal trans­for­ma­tion oc­cur­ring in other in­dus­tries that changes con­sumer ex­pec­ta­tions for health­care ser­vices, and the con­tin­ued shift of ser­vices out­side the walls of the hos­pi­tal. Stephen Mooney, pres­i­dent and CEO of Conifer Health So­lu­tions, dis­cussed this topic with four health­care ex­ec­u­tives at the Mod­ern Health­care Lead­er­ship Sym­po­sium on Oc­to­ber 11, 2018.

Stephen Mooney: The Beryl In­sti­tute de­fines the pa­tient ex­pe­ri­ence as “the sum of all in­ter­ac­tions shaped by an op­er­a­tional or­ga­ni­za­tional cul­ture that in­flu­ence pa­tient per­cep­tions across the con­tin­uum of care.” How do you de­fine the pa­tient-con­sumer ex­pe­ri­ence? What top ini­tia­tives are driv­ing your or­ga­ni­za­tion to im­prove it?

Randy Oostra: I think when­ever you use the word con­sumer, we im­me­di­ately de­fine the con­sumer as a pa­tient, but I don’t think a per­son de­fines them­selves as a pa­tient. That's prob­a­bly the big­gest prob­lem we have in health­care, it's how we look at peo­ple. Take any young per­son that works for us: they don't de­fine health and well-be­ing from a pa­tient per­spec­tive, they de­fine it from a con­sumer per­spec­tive. What I worry about is that we’re al­ready go­ing at it the wrong way: health­care lead­ers are think­ing of “con­sumer-friendly” ini­tia­tives for pa­tients, as op­posed to think­ing, what do con­sumers re­ally want?

Teri Fontenot: Agreed. We're work­ing on re­defin­ing pa­tients as guests and con­sumers. As a women's health sys­tem, most of our work is elec­tive, so our pa­tients have a choice. Pa­tients are very dis­cern­ing now, and it's not just the younger gen­er­a­tion. More of them don’t want face-to-face in­ter­ac­tion— they want to know how to stay healthy and many pre­fer not to come into the hos­pi­tal un­less it's nec­es­sary. We’re fo­cus­ing on statewide tele­health for the high-risk and sub­spe­cialty ser­vices we of­fer. Lo­cally, ac­cess is avail­able through on­line sched­ul­ing and vir­tual vis­its, but there is still an op­por­tu­nity to ex­pand through tech­nol­ogy. Our med­i­cal staff is still pri­mar­ily pri­vate prac­tice, so con­vinc­ing them that we need to be mak­ing con­sumer-friendly changes can be dif­fi­cult be­cause it forces them to do some­thing that's out of their com­fort zone, is in­con­ve­nient or has a cost. But, adop­tion typ­i­cally ac­cel­er­ates once three or four physi­cians buy in and oth­ers be­gin to see the ben­e­fit.

Pamela Abner: I think for us, it's the cul­ture. We’re in New York City, which has so many dif­fer­ent pop­u­la­tions, peo­ple and back­grounds. We’re con­stantly stress­ing the im­por­tance of bring­ing each pa­tient’s re­spec­tive cul­ture into the way you treat them. We’ve ed­u­cated our staff on un­con­scious bias — it's not just do­ing an ed­u­ca­tion ses­sion and walk­ing out of the room and think­ing ev­ery­one's mirac­u­lously bet­ter. We en­cour­age our staff to al­ways be think­ing about the bi­ases they bring into the room ev­ery time they speak to some­one. We talk to staff about how to speak to pa­tients and fam­i­lies and how to ask ope­nended ques­tions so as not to of­fend. There's too many dif­fer­ent pop­u­la­tions of peo­ple to as­sume that ev­ery­one's care is falling into the same arena.

Den­nis Dahlen: Our largest cam­pus is in Rochester, Min­nesota, where Mayo Clinic was founded more than 150 years ago and where the pop­u­la­tion is fairly ho­moge­nous and non-di­verse, so we're do­ing lots of work on un­con­scious bias, most of which has been eye-open­ing. One of the more im­pact­ful moves we made this past year at Mayo was a choice to not ac­com­mo­date pa­tient re­quests that stemmed from bias against their care­givers. This was a big deal for our lead­er­ship be­cause of Mayo Clinic’s pa­tient cen­tric­ity but was a big­ger deal for our staff, as it showed them we have their back in sup­port of di­ver­sity and in­clu­sion.

SM: How do you cul­tur­ally shift your or­ga­ni­za­tion to be con­sumer-cen­tric? How do you mea­sure progress and un­der­stand whether it’s work­ing?

DD: Many health­care lead­ers grew up as legacy hos­pi­tal providers, with ideas on the pa­tient­provider re­la­tion­ship formed solely in the con­text of the time a pa­tient spends as an in­pa­tient, an in­cred­i­bly in­ti­mate set­ting. If you think about where most health­care dol­lars are spent and with the march of tech­nol­ogy and ad­vance­ment of medicine, most of the in­ter­ac­tions are not in­ti­mate and don’t need to be. We have to get past this need for an in­ti­mate re­la­tion­ship and the ef­fort to build all of our pro­cesses around it be­cause peo­ple don't

“The strat­egy has got to be, 'How do you get the or­ga­ni­za­tion to adopt the ” mind­set of the con­sumer?' Den­nis Dahlen Chief Fi­nan­cial Of­fi­cer, Mayo Clinic

al­ways want it. I'm not sure I want it. The strat­egy has got to be, 'How do you get the or­ga­ni­za­tion to adopt the mind­set of the con­sumer which de­sires easy, fast and, well-in­formed care?'

TF: There are spe­cific tac­tics in our strate­gic plan for which the board and ex­ec­u­tive team have made a com­mit­ment. We talk about it in terms of im­prov­ing pop­u­la­tion health and com­mu­nity health. Peo­ple in these cat­e­gories are con­sumers ini­tially, but of­ten be­come pa­tients. Once we iden­tify a need that we can fo­cus on, mea­sur­able goals and time­lines are set and mon­i­tored. The goals, process and progress are shared with lead­ers and their teams.

PA: It’s about be­ing re­spect­ful and pro­vid­ing the care that pa­tients need and how they want to re­ceive it. We want to con­stantly cus­tom­ize our think­ing around the in­di­vid­ual and what the pa­tient needs, ver­sus just ap­ply­ing one kind of an ap­proach.

SM: How are the niche, spe­cial­ized play­ers in your mar­ket, like ur­gent care clin­ics and free­stand­ing EDs, ad­dress­ing the needs of your con­sumers? How do you com­pete ef­fec­tively?

RO: You see all these folks that you com­pete with, and they are quick and they are nim­ble and they don't have the ne­ces­sity to fo­cus on all that we have to. You worry that we're not chang­ing fast enough. You think

“It’s about be­ing re­spect­ful and pro­vid­ing the care that con­sumers need, how they want it. We want to con­stantly cus­tom­ize our think­ing around in­di­vid­u­als ver­sus just ap­ply­ing one kind of an ap­proach, de­pend­ing on what that pa­tient may do. ” Pam Abner VP and Chief Ad­min­is­tra­tive Of­fi­cer Mount Si­nai Health Sys­tem

about the com­plex­ity of our or­ga­ni­za­tions — all the things we're fo­cused on — and then there are ur­gent care providers who just do that all day long. And, for us, you worry that we're not able to put in the time and re­sources that oth­ers can, just be­cause of the com­plex­ity of what we do.

DD: I think one of the big­gest is­sues here is how we look at the pa­tient from our tra­di­tional view­point, and how folks that are tak­ing busi­ness away from legacy providers look at it very dif­fer­ently. They’re test­ing our abil­ity to get out of our four walls and think in­cre­men­tally. I think for health­care, these dis­rup­tive play­ers have got to be one of our big­gest con­cerns, but also op­por­tu­nity. They're mov­ing quickly, they have a much smaller foot­print and they are look­ing at things very nar­rowly in their ef­forts to cre­ate bet­ter ac­cess with more con­ve­nience. The fu­ture is more likely a se­ries of niche providers that are con­nected via data and com­mu­ni­ca­tion. What's left over are things no­body wants to do or ser­vices that are not eco­nom­i­cally at­trac­tive.

TF: What you're all say­ing is true. I've worked in gen­eral hos­pi­tals and it can be like a Whack-a-Mole game. The fo­cus of­ten shifts to what­ever’s trendy or feels like a com­pet­i­tive threat. Our hos­pi­tal will be 50 years old next month and it can be a strug­gle to re­main in our lane and not be dis­tracted by new op­por­tu­ni­ties. Ev­ery time we up­date our strate­gic plan, we start with a de­lib­er­ate con­ver­sa­tion about ex­pand­ing into ser­vices out­side of women's health or con­tin­u­ing to build depth and ge­o­graph­i­cally ex­pand within women's ser­vices. We keep com­ing back to the lat­ter. I think there's a role for spe­cialty hos­pi­tals, and the ben­e­fit for gen­eral hos­pi­tals is part­ner­ing with these or­ga­ni­za­tions that are fo­cus­ing on spe­cific pop­u­la­tions with­out try­ing to ab­sorb them.

SM: Have you had dis­cus­sions in­ter­nally about the fu­ture of pa­tient data, and pa­tients’ abil­ity to take own­er­ship over their med­i­cal data?

DD: To­day we all be­lieve the med­i­cal in­for­ma­tion that we've col­lected on pa­tients, gath­ered on pa­tients, is re­ally ours. That foun­da­tional con­cept seems to me a lim­ited du­ra­tion sce­nario. Some­time very soon, pa­tients or con­sumers will own their own data, it will be por­ta­ble, and there may even be a cost to uti­lize it in re­search. Changes on that front hold prom­ise for price and con­ve­nience, mov­ing past what is to­day mostly a bar­rier to cus­tomer ser­vice.

RO: Think about all the data though. You've got med­i­cal in­for­ma­tion, you've got per­sonal screen­ing in­for­ma­tion, you've got CRM data, you've got pre­dic­tive an­a­lyt­ics, you've got ge­netic in­for­ma­tion. As a con­sumer, you'd want that all in­te­grated into one. How that gets done is fas­ci­nat­ing. If that ever comes to­gether, I would hope that health­care or­ga­ni­za­tions are at the cen­ter of that, not some­body else. We must move fast, be­cause I think there’s a tremen­dous mar­ket around con­sumer cen­tric­ity.

SM: How about the physi­cian role in pa­tient en­gage­ment, to­day and in the fu­ture? How do you think the physi­cian plays into the emerg­ing era of health­care con­sumerism?

TF: We're ask­ing physi­cians to re­think the way they've prac­ticed for many years. They are con­stantly be­ing asked to do things that are un­com­fort­able or neg­a­tively im­pact their pro­duc­tiv­ity, but they are still ul­ti­mately re­spon­si­ble for that pa­tient’s care. But, in women’s health, physi­cians and pa­tients have a spe­cial, of­ten life-long re­la­tion­ship, so physi­cian sup­port is crit­i­cal.

PA: I think the physi­cian role in pa­tient en­gage­ment can vary so much in our en­vi­ron­ment be­cause it de­pends

What I worry about is that we’re al­ready go­ing at it the wrong way: health­care lead­ers are think­ing of “con­sumer-friendly” ini­tia­tives for pa­tients, as op­posed to think­ing, what do con­sumers re­ally want? Randy Oostra Pres­i­dent and CEO, ProMed­ica Health Sys­tem

on who we're speak­ing about. I don't be­lieve that ev­ery pa­tient has the same com­fort level and health lit­er­acy to say to their physi­cian, “you know what, this isn't work­ing for me, I'm go­ing else­where.” Some peo­ple will, but oth­ers will say, “I’ll take what I can get,” be­cause they don’t even un­der­stand how to nav­i­gate the sys­tem.

RO: Whether it is cul­ture, data, tech­nol­ogy or ser­vices, you have to ask the physi­cian again to do “one more thing.” How do we cre­ate a more com­pre­hen­sive ap­proach that says, “we're go­ing to wrap this around the clin­i­cian so that as you prac­tice, the con­sumer piece will fit in very log­i­cally and hope­fully make your life a lot eas­ier?” That’s as op­posed to just telling them, “you need to be more con­sumer-friendly.” It’s about sur­round­ing clin­i­cians with an or­ga­ni­za­tion and in­fra­struc­ture that de­liv­ers an amaz­ing ex­pe­ri­ence.

Oc­to­ber 11, 2018 MOD­ERN HEALTH­CARE LEAD­ER­SHIP SYM­PO­SIUM

PAMELA ABNER VP & Chief Ad­min­is­tra­tive Of­fi­cer - Di­ver­sity and In­clu­sion Mount Si­nai Health Sys­tem

STEPHEN MOONEY Pres­i­dent and CEO Conifer Health So­lu­tions Mod­er­a­tor

RANDY OOSTRA Pres­i­dent and CEO ProMed­ica Health Sys­tem

DEN­NIS DAHLEN Chief Fi­nan­cial Of­fi­cer Mayo Clinic

TERI FONTENOT Pres­i­dent and CEO Woman’s Hos­pi­tal

Randy Oostra, Teri Fontenot and Stephen Mooney

Stephen Mooney Pres­i­dent and CEO, Conifer Health So­lu­tions

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