Healthcare seems on the edge of some great transformation. People feel so much tension with the existing system – legacy technology, antiquated medical training, fragmentation of patient care via the specialist system, and the uncomfortable truth of the provider, hospital, insurer and pharma dynamic that seems to drive costs beyond reason.
There’s a lot to fix or improve upon.
And it seems to come slowly. Part of that is the sense that healthcare must work with a zero margin of error as lives are on the line. That certainly makes releasing ‘minimum viable products’ (MVP) tough. Part of it is that the interoperability of electronic medical records (EMR) across all providers in the value chain remains a linchpin capability still in the works.
Meanwhile, As Startup Health reports, investment in the next health solutions - even during COVID - was hot,
“Total health innovation funding for the first half of 2020 hit $9.1B, up nearly 19% compared to the same period in 2019.”
Transformation may come in fits and starts, but have we painted a shared vision of where we are heading? While moving towards value-based medicine is certainly preferable over fee for service, that cannot be the “vision.”
Inspiring the broad healthcare community to evolve from a focus on service-delivery to a patient-centered approach and, eventually to the distinctly different “customer-obsessed” approach is clearly part of the solution.
Still that’s not the vision.
Four Big Ideas for a Healthcare Vision
A lot of smart brains have been thinking about what should be next in healthcare. There are four themes that stand out as game-changers that might lead to a worthwhile vision.
1. Connect physical, mental and spiritual health
Recently a friend went to a primary care provider to diagnose physical symptoms that kept them from living their life. After two rounds of tests and two specialist visits, the PCP told them the condition was likely in their head. And then dismissed the patient. “Not my job,” they said in not so many words. Months later, the true physical condition was uncovered.
All doctors need to be prepared to advocate and treat the whole patient and not get stuck in the rut of their own specialism. That means they need a shared view of what the whole patient’s well being is comprised of. Being "me-centered" in whatever their trained specialism is won't fly. Each of us has a physical, mental and spiritual experience that are intertwined. People deserve health advocates who pursue every angle.
Here’s how Marc Harrison at Intermountain Health describes their system of integrating physical and mental health,
“Here’s how it works. When a patient visits a primary care clinic, she or he is asked to complete a screening questionnaire. If it suggests mental health concerns, the doctor discusses that with the patient. Mental health professionals are embedded in the clinic and can immediately interact and provide treatment, under the doctor’s guidance. There are no referrals needed or long waits to get help.
A landmark 10-year study that my Intermountain colleagues published in JAMA shows that this approach pays off in several ways: better clinical outcomes for patients; more appropriate utilization of health care services (getting the right care at the right time); and lower costs, about $667 per patient each year for those with newly diagnosed depression. Based on Intermountain Healthcare’s experience and our findings, we project that the U.S. would save at least $4 billion a year in health care costs if our model was used nationally.”
Too often mental health is seen as a lesser risk by physicians. A recent study published in Health Affairs revealed,
“The researchers used survey results from a thousand U.S. primary care facilities, taken between 2006 and 2013, to examine doctors' strategies for treating patients with depression compared to those used to treat congestive heart failure, asthma and diabetes.
While those with physical ailments were treated with the proper protocol outlined for a chronic condition -- such as doctors teaching patients about their conditions and reminding them about their specific treatment plans -- those with depression didn't receive the same level of care”
“"The bottom line is that treating mental health problems not only reduces individual pain but it actually has an impact on physical health."”
- Sagar Parikh, Associate Director of The University Of Michigan Comprehensive Depression Center.
2. Commit to wellness programs
I have heard a fair skepticism from within health insurers that wellness programs are either not attractive to people or do not provide better outcomes or insurance risks.
I don’t believe it.
More accurately, I do believe it’s hard to get people to want to adopt healthier habits. I even believe that there are short term pilots at insurers that show no immediate cost benefit. But the future of healthcare must be about helping people be well before they get sick. The challenge may be in getting the fragmented landscape of health business to commit to wellness programs. Regardless of the short-term financial impact to either a hospital system, a provider, an insurer or pharmaceutical company, helping people lead healthier, lives will have an impact.
Deloitte’s future of healthcare vision captures this, “Health care consumers typically interact with the health system only when they are sick or injured. But the future of health will be focused on well-being and prevention rather than treatment…. in response to this shifting health landscape, traditional jobs we know today will undergo change. Health will be monitored continuously so that risks can be identified early. Rather than assessing patients and treating them, the primary focus will be on sustaining well-being by providing consumers ongoing advice and support.”
3. Embrace customer obsession
Many health professionals bristle at the use of the word “customer” versus “patient.” I get it. They are improving and saving lives not selling a new and improved consumer product. Still, new-found ‘customer-centricity’ is successfully changing incumbent businesses and launching some of the most promising startups across many industries. Goldman Sachs invents Marcus to create not just a consumer brand but a customer-obsessed one. Oscar is an example of dozens of insurtech startups built on a model of customer-centricity.
Large businesses and small are overhauling their customer experience to make it simpler, more useful and comparable to our new standards of customer experience across all categories: Amazon.
The four key qualities required for customer obsession are:
Empathy – Not just the ability to understand and share the feelings of another, empathy for those we serve compels us to want to solve their most heart-felt challenges.
Humility – If we focus on the definition “freedom from pride or arrogance,” then humility causes us to be perpetually curious to learn more about our customers and open-minded that we may not always have the right answer (or even know the right question).
Listening – One lasting effect on business of the social media surge of the early 2000’s is just how important and possible it is to listen to one’s customers or stakeholders. And also, the penalty of not doing so. New research and collaboration methods typified in design thinking further institutionalize organizations’ ability to not only listen to their customer but involve them in solution-making.
Learning – Customer-centered organizations prioritize lifelong learning for the individuals in the company and the culture. Instead of placing value on ‘know-it-alls’, they reward continuous learning based upon the convictions that the “only constant is change, and humility tells us there is always more to learn.
Of all these qualities, humility is the one that causes the most trouble for large, incumbent businesses including healthcare. Lack of humility causes many “build vs. partner” choices, blindness to promising startups with disruptive, new approaches, and a deafness to the ideas of younger talent within organizations.
Smart healthcare leaders will embrace the qualities of customer-obsession even provoking their teams to think in terms of ‘customer,’ not just patient.
4. Rapidly transform the digital tools, data and operations
The promise of free-flowing (and protected) patient data between healthcare providers enabled by super-systems of electronic health records like EPIC, have been on the horizon for a while now. They are always just around the bend. Data interoperability – whether EHR or new AI-fueled predictive systems – is key to making a step-change improvement in healthcare.
Deloitte’s vision of the future hinges on data,
“Based on emerging technology, we can be reasonably certain that digital transformation—enabled by radically interoperable data, artificial intelligence (AI), and open, secure platforms—will drive much of this change… By 2040 (and perhaps beginning significantly before), streams of health data—together with data from a variety of other relevant sources—will merge to create a multifaceted and highly personalized picture of every consumer’s well-being.”
Any big health organization who has not established – and continuously revisited – their overall data strategy is not taking care of business.
Data, alone, is not the miracle. We need to understand how data fits into healthcare delivery. For example, the answer to inputting patient data cannot be putting tablets in the hands of doctors such that they tap away throughout the typical 5:00-7:00 visit. We need digital transformation that improves healthcare outcomes while improving the experience of both patient and provider.
The biggest challenge many healthcare systems have is prioritizing that digital change. There are just too many areas that need improvement. This is where the customer journey approach and decisive leadership come into play.
Customer journeys listen and analyze to find the real opportunities for incremental and disruptive improvement and innovation. They offer a logical methodology empathetic to the patient/customer. They reveal practical barriers to overcome and opportunities to swing for.
They look at the new patient onboarding process, the compliance journey, the post-op experience and so on. They take the patient’s, caregiver’s and the provider's POVs. Customer journey analysis offers the best way to uncover meaningful and pressing improvements.
This logical approach won’t change the fact that there is a lot to do. Organizations need to prioritize. They need to balance a new innovative way to improve diabetes treatment compliance with foundational improvements in their customer data capabilities. This is where leadership comes in. More than ever, today’s business leader needs to be digitally savvy enough to weigh the many options put forth by functional and business unit leaders. They need to decide where to place their bets.
Accelerating Change
The global tragedy of COVID revealed both the heroism of health professionals around the world and the need to speed up improvement and change. We did video visits because we had to, yet in many cases, this is the better way. We need to embrace and accelerate change to drive better outcomes today and tomorrow.
We need a new vision of treating the whole patient – physical, mental and spiritual. Then, of course, we need to shift to the environmental and contextual influences by rallying business and community leaders to dig into the social determinants of health. We need to embrace “wellness,” recognizing this requires as much behavioral science as medical science, not to mention a long view.
Not only do we need to move towards value-based care, we need to jump on board the customer-obsession train and affect a radically different orientation. A complete vision for health business transformation needs the customer journey lens and leadership decisiveness to place bets for the next digital and data capabilities now.
