By Vesna Gernot, Director, and Semhal Araya, Principal, GE Healthcare Partners
As an industry, we agree that patients are becoming increasingly attentive healthcare consumers. They shoulder more and more financial responsibility for rising healthcare costs, and will continue to drive wide-ranging demands on the healthcare ecosystem around value, access, personalization and efficiency.
Addressing the patient consumerism movement as a growth opportunity has become a key healthcare strategy. For example, providers are working aggressively to create more access channels, and integrate new technologies and methods of communication to personalize the end-to-end patient experience.
But are providers paying sufficient attention to the operational implications of patient consumerism? There is commonly a significant gap in how we understand that relationship, resulting in poor execution. When smart consumer strategies generate new demand, often the health system does not have sufficient capacity and efficient clinical operations and processes to accommodate that hard-earned volume nor deliver on the consumer-centric promise with standardization and reliability.
Operational excellence becomes more challenging with increased industry consolidation. Health systems are growing in size, level of variation, and complexity, leading to operational fragmentation that works against the consumerism agenda of standardization and personalization. Providing a reliable and consistent experience is critical to gaining consumer loyalty. Patients want to be “known“ at every access point and expect every caregiver to have access to the same up-to-date information on their medical journey.
This level of standardization requires a holistic, balanced approach to operations driven from the top down and across the organization. To do so, health system leaders will need to leverage one of the most powerful strategic assets at their disposal: data.
Healthcare organizations are rich with data, especially from electronic health records, but also from ADT, ED, and OR systems; claims databases; market demand forecasts; HCAHPS surveys; and other sources. It’s imperative that leaders get their arms around all their data to inform operational decisionmaking and support such critical patient-centric strategies as:
- Forecasting capacity
- Developing and prioritizing service lines
- Monitoring and decreasing wait times
- Redesigning clinical care and pathways
- Creating convenient and accessible points of care
- Understanding how to remove redundancies and unnecessary costs
Here are a few ways in which new methods of analyzing and harnessing data can help health systems deliver operationally on their promise of patient-centric service.
Millennial or Not, Today’s “Now” Culture
In today’s “now” culture, we can receive goods the same day we order them, and track them minute-byminute from order placement to delivery. Some call it the Amazon effect, and it’s impacting healthcare. Consumers now expect the same high level of service and personalization from healthcare organizations as they get from leading non-healthcare companies. Instead, they are often frustrated by a lack of convenience, transparency, flexibility, and respect for their time. Common complaints include lack of online appointment-scheduling; lengthy waits for an appointment slot; having to provide the same information at registration that they did during scheduling; delayed appointment starts; uncertain results availability; and lack of clarity about the cost of their care.
Organizations recognize that they need to assess these current barriers to consumer satisfaction. Applying advanced and predictive analytics to existing data can help them understand what to solve for and identify the actionable next steps, such as:
- Deploying smart technology that can seamlessly share clinical and operational data to the cloud while signaling opportunities to reduce idle time or warn for unplanned outages and notify service partners.
- Enabling disparate data aggregation and interoperability inside, across the care continuum and outside the organization via cloud technologies to improve transparency across access, service, pricing and care delivery.
- Using patient-centric technology to improve the convenience, speed, and transparency of care. Solutions include standardized pre-registration protocols, real-time insurance verification, online patient registration, self-check-in kiosks, a test-results tracker for patients, financial counseling applications, and online cost calculators and price listings.
- Providing data-driven decision capabilities to physicians to make real-time changes and clinical care decisions.
Same Diagnosis, Different Needs
Consumerism is also about personalizing patient access and engagement. Two patients with the same diagnosis do not necessarily have the same needs and preferences. Analyzing data on specific patient segments can help organizations structure operations to align clinical care services and operational processes to provide timely and on-demand patient access to the appropriate services. The goal is to enhance convenience, choice and personalization while still ensuring that core care delivery is standardized, efficient and cost effective.
- Two patients present with knee pain. One is an active student while the other is a retiree with co-morbid disease states.
- Both will have similar clinical work-ups to ultimately diagnose a torn ACL. While it is critical to align resources with the unique way in which each patient seeks information, makes decisions, and requests communication, these preferences will increasingly require providers to drive standardization of many resources and services that these patients share in common.
- In this example, the two patients may diverge in certain aspects, such as how they select a surgeon (based on online information or a neighbor’s recommendation) or when they prefer rehabilitation clinic (evening appointments or mid-day appointments with option for 3 transportation assistance). However, the lion’s share of the resources and processes they utilize across the episode of care will be the same, particularly in outpatient radiology, the operating room or ambulatory surgery center, and rehabilitation. The key is to standardize and operationalize care delivery wherever possible to offset the investments required to meet unique consumer requirements—and to do so in a way that is beneficial to patients and physicians and not cost-prohibitive to the system or the patient.
Consumer Strategy Activated Across the Network
Patient-centric organizations are focused on building care pathways that provide a seamless experience for all patients at every access point. As providers design their networks, data will key to be informing locations for care, strategies to meet supply-demand fluctuations, and opportunities to differentiate the patient experience.
For example, consider patient-centric diabetic care and the opportunities and challenges posed by new care delivery models such as wellness clinics, co-located services (labs, nutrition, wound care), innovative remote monitoring solutions, and other new market entrants. Interrogating and analyzing EHR data can help inform such strategic decisions as:
- Establishing locations that meet access and convenience needs.
- Assessing capacity to meet anticipated demand along each node in the continuum, and driving efficiencies to ensure affordability and sustainability.
- Identifying the critical pathways that create increased demand and related capacity requirements from the acute care sites.
- Integrating new care pathways with the overall system service line.
Mergers that Create New Value for Patients
As health systems consolidate and expand, it is vital to understand how to activate merger-acquisition goals to support consumerism goals. For example, many mergers have the objective of improving local community access to specialty care while increasing market reach. Meeting this goal requires a deep understanding of how patient pathways will evolve and how satellite sites will integrate with tertiary/quaternary hubs.
Data-driven service and asset rationalization is critical to achieving system integration efficiencies while ensuring appropriate, timely care to patients across the new portfolio of care sites. For example, understanding referral and transfer flows for specialty care will help organizations define the hub-andspoke model in a way that creates access and avoids transfer denials to the tertiary hub and potential patient leakage due to delays.
Key considerations include:
- Service line rationalization – Prioritize the services that the system should provide based on strong existing capabilities, patient needs, revenue generation, competitive edge and cost to patient.
- Access channels – Segment the population to determine which hospitals or ancillary care areas will best align to patient service needs, such as locating urgent care or rehab services in a retail outlets.
- Operating model – Create a standardized and efficient operating model to ensure that these services meet the organization’s cost and revenue targets, aligned with value-based care goals.
Investment in a Distinctive, Lasting Brand
Healthcare consumers are just like consumers across other industries: they expect great customer service, timely information, ease of use, and cost-to-value ROI. While most providers began incorporating foundational process re-engineering methodologies years ago, now is the time to go beyond incremental improvement efforts by leveraging data as a strategic asset to identify, prioritize and execute operational plans that support a patient-centric vision.
Providers who combine next-generation digital applications and market-based strategies with health system redesign and care coordination will create a high-performing operation—one with the potential to become a distinctive brand that not only attracts consumers but earns their loyalty through operational excellence.