For the rest of the August 2009 issue of CRM magazine, please click here.
[Editors' Note: Sidebars and related articles to this piece include "Patients Are Customers, Not Case Numbers," "The New Prescription for Pharma," and "Patience for Patients."]
“The patient is not only an illness, he has a soul.”
—RENÉ FAVALORO, MD, 1923-2000, Cleveland Clinic surgeon, who performed the world’s first published coronary-artery bypass, in 1967
Healthcare reform can’t wait, President Obama declared at a press conference in May. High on the government’s list of priorities, the issue has got the country abuzz—with both support and criticism. In a system that relies greatly on employer-provided healthcare protection, Obama’s proposed reforms will set out to provide universal healthcare for all, including an estimated 46 million uninsured Americans.
As costs continue to spiral out of control, few would deny that the healthcare system is deeply flawed. But no one seems able to agree on a solution: Reining in budgets is one goal, but so is providing more coverage to more Americans. Others simply want to reduce the bureaucracy. Overall, consumers are in an all-too-familiar state when it comes to healthcare—a state of confusion.
“This is much more of a political challenge than a technology problem,” says Rebecca Wettemann, a Nucleus Research vice president. Any plan will stimulate technology spending in the healthcare industry, but adoption remains a stumbling block if the infrastructure isn’t in place to support it.
Andy Webber, the president and chief executive officer of the National Business Coalition on Health, says that consumer-driven healthcare is a good thing—but one handicapped by a flawed delivery structure: Healthcare consumers never make direct transactions and only rarely exchange money for goods and services.
“It’s the classic middle-man syndrome,” Webber says, “with insurance being the middle man.” Perhaps an even bigger issue is that consumers don’t understand—and aren’t taught—the system’s nuances. “Physicians don’t have the time to explain the healthcare complexity in a 10-minute visit,” Webber says.
At that May press conference, President Obama listed the three essential principles of his plan: lowered healthcare costs; the ability of consumers to choose a doctor and healthcare plan; and “quality, affordable healthcare” for all Americans.
The looming empowerment of the patient may indicate something entirely new: consumer-oriented healthcare that breaks down barriers and heeds the demands of patients. The diagnosis may fit the symptoms—but do we have the cure?
According to a 2008 survey in The New England Journal of Medicine, only 17 percent of the nation’s physicians are using computerized patient records. One reason for the lack of techno-savvy? The New York Times reports that three-fourths of the nation’s doctors practice in small offices, where the cost—and burden—of technology projects is stifling. Federal stimulus money may help drive adoption of electronic medical records (EMRs), but for some healthcare providers—especially those without much tech support—it’s a tough undertaking.
President Obama has mandated that health records be digital within five years, a timeline that makes many in the information management space feel a little sick. Bob Larrivee, director and industry advisor for AIIM, a content management community, calls the goal “admirable,” but he warns that five years is simply not enough time: “It won’t actually happen.”
What’s missing, Larrivee says, is an agreed-upon set of standards. “If vendors develop to [one]…then, in theory, you could achieve this level where [silos of content] could talk to each other,” he says. “It can’t happen [by 2014].”
Consider this scenario: Your lifelong family physician has your medical records on file—and has even made them digital. After you fracture your foot in a skiing calamity, she recommends you go see an orthopedic specialist within the same medical facility. At your appointment, you’re required to fill out a lengthy health history form. You think to yourself, “My primary doctor’s in this same building—shouldn’t this be on file?” No such luck.
After the appointment, the orthopedic doctor hands you a CD-ROM with X-ray images. You bring that to your physician at your next visit to add to your medical file. Surprise—her system rejects the images. In fact, more often than you’d probably imagine, medical offices that share an elevator can’t be bothered to share technology solutions.
“Even if all of your doctors belong to one hospital, each department—radiology, orthopedics, oncology—has its own information system structure and [the systems] are not integrated,” says Leslie Ament, managing partner with Hypatia Research and Consulting.
Even worse? Larrivee says data synergy is a fiction—95 percent of business information is digital, but the content’s essentially useless if the files don’t work with one another. Valuable bits of health information often get lost along the way.
The complex predicament boils down to Digital Imaging and Communications in Medicine (DICOM) standards. Larrivee points out that there are 27 DICOM standards for distributing and viewing medical images—the trouble is getting the various factions to agree on a single one. The federal stimulus money may stimulate consensus—or it may not. “Even if they throw all kinds of money at [EMRs], if there are no interoperable standards, it’s still the same situation,” Larrivee says.
That big bag of federal cash, however—essentially government incentives to get healthcare organizations to embrace EMRs—may help explain the slew of software vendors promising a surefire remedy for the industry’s data problems.
In medical terms, the healthcare industry is riddled with metastatic silos—and it’s about to get the green light for some experimental (and expensive) treatment.
“Without incentives, [healthcare providers] will keep doing what they’re doing,” Ament says. “If someone gave me a free one-week cruise, I’d take it because it’s free. Why not? It’s the same principle here.”
What’s been holding people back? Lack of technology support, for one. Also, a fear of compromising security protocols—which Wettemann says is well founded. “We have to be concerned about security,” she says. “It’s like in the olden days when people said email wasn’t secure.” In due time, she adds, those concerns will be addressed. The biggest obstacle, it turns out, remains a cultural one: the reluctance among physicians and administrators to give up any system or process they’ve grown accustomed to.
The notion that healthcare lags in innovation might seem counterintuitive, but Ament says the industry’s complex delivery system has slowed adoption of projects such as business intelligence (BI). Insurance providers are much further along because they are more focused on trying to streamline costs. The BI that hospitals use is more financial than operational, but that may soon change.
Wettemann suggests that, though it seems like a big leap, the advent of software-as-a-service (SaaS) may make putting records online less of an insurmountable task. (See “Intelligence in the Cloud,” another of this month's features, for a look at BI delivered via SaaS.)
“Use of BI for operational reporting will provide some performance-improvement metrics,” Ament says. With those, she says, “healthcare providers can make better decisions based upon clinical outcomes and treatment efficiency.”
Using BI tools to plan a knee-replacement surgery, for example, a surgeon could apply various metrics involving demographic data to the variable costs of the procedure and prosthetic parts. Enhanced reporting could not only save the payer and payee money by determining the best procedure and parts to use, but could vastly improve the results.
Bill Haffey, director of sales engineering at SPSS, a provider of analytical software, says that goverment-sponsored health organizations have shown great interest in his firm’s solutions for evidence-based medicine. Meanwhile, he adds, predictive analytics is being used in some life-changing ways.
In Redwood City, Calif., cardiac surgeons at Sequoia Hospital use SPSS Predictive Analytics software to aid in decision making: Is this patient an appropriate candidate for surgery? What are the risk factors involved?
Predictive modeling includes patient factors such as age, weight, current state of health, previous surgeries, and number of procedures required. Based on the analytical modeling, the surgeon is able to learn more about the patient and see potential outcomes should surgery be decided upon. But Sequoia Hospital is ahead of the curve—similar technological improvements remain the exception.
LISTENING TO THE PULSE
Healthcare consumers are increasingly looking to their peers for help with decisions. They are more likely to seek second opinions and to visit facilities or practitioners that have been recommended by like-minded people—all of which makes availability of patient feedback crucial. By the same token, government agencies are demanding transparency from healthcare providers. What once occurred behind closed doors is now out in the open.
In fact, hospitals must trade accountability and transparency for public investment: If a hospital wants government funding, it must submit patient satisfaction scores using the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey. The form is given to patients anywhere between 48 hours and six weeks following their release. Made to resemble a report card, the HCAHPS results can help consumers as they shop around for healthcare.
As the industry moves toward a pay-for-performance model, providers now have to market their efficiencies and capabilities through rankings and metrics.
One source that’s gaining traction is a report produced by Press Ganey, a survey provider viewed as the Consumer Reports of healthcare. Aggregating responses from patients and physicians nationwide, Press Ganey’s annual Hospital Pulse Report provides metrics on patient satisfaction. The surveys ask patients to evaluate hospitals in the following categories:
- Response to complaints made during your stay.
- Degree to which hospital staff addressed your emotional needs.
- Staff effort to include you in decisions about your treatment.
- How well-informed you were kept by the nurses.
- Promptness in responding to the call button.
In the 2008 report, the larger the hospital, the lower the overall patient satisfaction rate. Large organizations continue to face challenges in personalizing the patient-care experience. (See “Patients Are Customers, Not Case Numbers.") Of nearly 3 million patients treated at 1,946 hospitals, less than 43 percent voiced positive comments, while 33 percent had negative feedback. The remaining results were mixed or neutral.
These surveys do have a few flaws. For one, they’re delayed, says Chris Cottle, vice president of Allegiance, a provider of enterprise feedback management (EFM) solutions. A patient might receive a survey two weeks after discharge—by which time concerns might have fizzled and the feedback is lost. And even if these surveys make a hospital aware of an issue, they do little to improve a patient’s experience in the moment. EFM, Cottle says, collects unstructured comments and complaints to address customer concerns in real time.
“If you can find out right away if there’s been an issue,” Cottle says, “someone can get on the phone and resolve and smooth out and take care of any [problems or complaints], which will directly impact how [the patient] ranks and rates post-dispatch surveys.”
Hospitals seem to be catching on. Cottle says 22 percent of the nation’s hospitals are using Allegiance products, which collect patient feedback through many different channels. Allegiance also has a data-synchronization mechanism that ties feedback data to CRM and contact center systems.
Feedback also mitigates risk. Government agencies are continually auditing hospital performance, wondering if a complaint has gone unresolved. A hospital can’t just ignore a complaint—or even be honestly ignorant that one exists—or judicious action could be taken.
HEALTH 2.0 & THE SOCIAL PATIENT
“We are now in patient-centered care,” said panelist Dr. Reed Tuckson, executive vice president and chief of medical affairs for UnitedHealth Group, at a recent conference. Online tools can now identify an individual’s risk, Tuckson said, emphasizing the themes of “empowerment and activation” to get the individual involved. “Some of that means extending care beyond the traditional arenas,” he said. “We have to talk about access.”
He wasn’t talking about access to doctor’s offices, but rather pervasive access on the Web, via mobile phone, or by any channel the consumer desires. Next-generation healthcare, Tuckson said, will be led by consumer-oriented health sites and Web-based portals. “Finally,” he said, “healthcare is entering the same world with Amazon.com and consumer sites.”
WebMD, arguably the top online health portal, may be known for the consumer education it’s provided over the years, but a presentation at Consumer Health World last winter made clear that the company also hosts more than 250 portals for health plans and employers. Phil Marshall, WebMD’s vice president of product strategy, boasted to the crowd that personal EMRs have long been the blood coursing through WebMD’s veins. Even so, he said, traction isn’t where he’d like it to be.
At the same conference, Jack Barrette, CEO of WEGO Health, an online health portal that relies on opinion leaders to drive conversation and answer questions, described his company as being 100 percent social media—which is appropriate, he added, because “social media’s higher calling is [with] health.”
EMRs, Barrette added, are “not something consumers seem to be clamoring for. They don’t understand the value of having the record. The issue is consumer motivation.”
We use Web portals and platforms to manage our banking, keep tabs on friends, and even share what books we’re reading. So why not for our health? “It’s the last great industry to be touched by the Internet revolution,” says George Scriban, the senior product manager for Microsoft HealthVault. He points out, though, that healthcare is unique: “There are few other industries that have centuries’ worth of tradition behind them and as complex of an information picture.”
To address that accumulated morass of patient information, Microsoft launched HealthVault in 2007 as a consumer-focused online health manager. “Think about your own healthcare,” Scriban says. “Your profile is split among all caregivers who have ever seen you. They know that sliver about you they were responsible for.”
So Microsoft created what Scriban calls a “digital shoebox.” The HealthVault portal is much like a social networking platform: Users can choose to add however much information about themselves as they’d like. (Scriban says HealthVault also plans to open up to selective third-party applications.)
In April, in conjunction with HealthVault, Minnesota’s Mayo Clinic launched Mayo Clinic Health Manager, a platform that allows patients to upload their medical histories and to access free information from Clinic physicians. Dr. Sidna M. Tulledge-Scheitel, a Mayo Clinic primary-care physician, says the potential benefits are huge.
In particular, Tulledge-Scheitel says, the online health program is perfect for family caregivers. “With every family, there’s a main person who keeps track of health information and when someone gets sick they try to figure out what to do,” she says. “We really target the Mayo Clinic Health Manager to this person to try to help them out.”
The more data that consumers feed into the site, the more valuable it becomes. HealthVault can connect to devices that monitor such metrics as blood pressure and fitness, and can track conditions for asthma and pregnancy. Considering the limited face-to-face time patients have with doctors, Tulledge-Scheitel says, the system’s “prepare for the doctor” wizard is especially important.
Tulledge-Scheitel says the goal is to empower patients to be more active when it comes to healthcare. That remains a struggle, she says, but she’s recently noticed an overall shift in the consumer approach to health, thanks in part to the rising number of tools, Web portals, and initiatives that support the consumer-empowered healthcare trend.
Even so, Tulledge-Scheitel’s prognosis remains somewhat guarded. “We will be adding more and more solutions,” she says. “Hopefully we will achieve [an] excellent outcome.” For those with life-impacting conditions, taking charge of wellness is essential —and tools such as HealthVault can play a role. “It has the promise of really potentially keeping them out of emergency rooms and out of the hospital,” she adds, “and help[ing] them live fuller lives.”
THE NEW HEALTHCARE PATIENTS
Consumer-oriented healthcare requires a different approach: fuss-free, flexible, and friendly. Consumers want to be involved in conversation, not dictated to.
In short, they want a few options. To make sure its patient-customers had some, insurance provider Blue Cross Blue Shield of Florida (BCBSF) turned to Brainshark, a company that allows users to upload a PowerPoint presentation to the Web and then record a voice track by toll-free phone call.
“We got Brainshark before this giant shift to consumerism and retail health care,” says Jep Larkin, BCBSF’s director of sales communication. “We saw the popularity explode.” In 2008 alone, BCBSF saved close to a half-million dollars in travel and marketing expenses by changing the delivery of its messages. Rather than sending printed materials—glossy pamphlets—to insurees, BCBSF began using electronic communications.
Brainshark’s approach aims to produce a more-meaningful experience—it plays upon the senses. Plus, Brainshark analytics show BCBSF when (and in what ways) customers view presentations.
“We had a feeling no one was reading our communication,” Larkin says. “We were concerned readership was not what it should be.” BCBSF, he adds, is always looking for innovative ways to inform customers and to get them to be more active in the relationship. Adoption and consumer engagement, however, are continual concerns. He says he’s hopeful that Brainshark’s methodology will continue to increase BCBSF’s online stickiness.
HEALTHCARE SERVICE REPS
Customer service units in healthcare organizations certainly aren’t immune to the patient-centricity pandemic. Patients are more demanding than ever before and they might—or might not—be more educated when ringing up about coverage or care. It’s also important to remember that any call to a healthcare contact center is likely to be about a fairly critical situation—more so than your typical support call.
Ireland’s Vhi Healthcare—which runs Sword Ciboodle’s contact center platform—seems fairly inoculated to what its agents encounter. “Our customers don’t experience [the need for support] until they’re emotional,” says Brendan Kelly, Vhi’s general manager for individual and corporate business. “Visiting the hospital is highly emotional. We train our agents to be sensitive around those events.”
SIDEBAR: Healthy Cities, Healthy Satisfaction
Here are the 10 metropolitan areas reporting the highest level of patient satisfaction:
1. Wichita, Kan. 87.0
2. Columbia, S.C. 86.9
(tie) Oklahoma City 86.9
4. Indianapolis 86.8
5. Miami 86.3
6. Milwaukee 86.2
7. Dallas 85.4
8. Kansas City, Mo./Kan. 85.2
(tie) New Orleans 85.2
(tie) Toledo, Ohio 85.2
Represents the experiences of 2.8 million patients treated at nearly 2,000 hospitals nationwide in 2007.
Source: 2009 Press Ganey Hospital Pulse Report, courtesy of Press Ganey.
Assistant Editor Lauren McKay can be reached at lmckay@destinationCRM.com.
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