By viewing their industry and its challenges through their patients’ eyes, organizations can put themselves on track to provide the right solutions.
Obsession is extreme by nature, often preceded by an adjective such as “unhealthy.” A healthy obsession, on the other hand, can drive excellence. Today’s healthcare organizations must become “consumer obsessed” if they are to provide a high-quality experience for a public with growing expectations, demands and options.
The healthcare market is ripe for innovation and disruption by organizations that obsess over a superior consumer experience. By viewing their industry and its challenges through their patients’ eyes, understanding the obstacles patients must contend with in their health journeys and what they really want, organizations can put themselves on track to provide the right solutions. Here is a look at three healthy obsessions that organizations must share with the people they serve.
CHALLENGE #1: Healthcare Is Fragmented
CONSUMERS DEMAND: Integration
A 2019 survey by The Commonwealth Fund found the U.S. healthcare system hampered by “key gaps in care coordination among primary care doctors, other providers and social services.” Deficits included a lack of timely notification of primary care physicians from specialists, after-hours care centers, emergency departments or hospitals regarding changes to their patients’ care or medications. This gap is but one example of what American economist Alain C. Enthoven referred to as “a misalignment of incentives, or lack of coordination, that spawns inefficient allocation of resources.” The patient ultimately pays the price.
As life expectancy in the United States continues to rise, further taxing the healthcare system, the need for improved continuity of care is heightened. That means involving the patient and the care team in cooperative healthcare management toward a mutual goal of high-quality, cost-effective care for life. But silos separating departments, disciplines, providers and organizations—and between providers and payers—often interfere with the free flow of information necessary for effective continuity. As a result, the patient experience suffers from unnecessary delays, uninformed providers, unnecessary tests and procedures, unwanted costs, and other unhealthy indignities.
Organizations must obsess over providing an integrated healthcare experience that breaks through data silos, enabling ongoing collaboration across the patient journey. Interoperability, a top priority for the U.S. Department of Health and Human Services (HHS), allows the timely sharing of data with all who need it to provide better patient care. “When we achieve interoperability and widespread exchange of information, providers will have the infrastructure to deliver patient-centered, value-driven care that improves health outcomes while reducing costs,” HHS says. In that scenario, everyone from medical, behavioral and community-based providers to individual care circles is equipped to work together to deliver informed and consistent care.
Investment in electronic health records (EHRs) and health information exchange (HIE) services is a prerequisite for interoperability across the healthcare system. Beyond that, these tools must be optimized, standardized and used. A wealth of actionable information, including automated data updates, becomes available through interoperability. A comprehensive, real-time view of a patient’s comprehensive health status can be shared, leading to the personalized and holistic care that consumers are demanding.
Personalized, holistic care takes the whole patient into consideration: physical, mental and behavioral factors as well as social determinants of health (SDoH) information that might impact the individual’s health outcomes. Having this data at one’s fingertips can guide interventions and other strategies designed to keep the patient as healthy as possible.
CHALLENGE #2: Healthcare Is Expensive
CONSUMERS DEMAND: Value
The United States spent $4.1 trillion, or $12,530 a person, on healthcare in 2020, with 9.4% of that paid out of pocket. Hospital prices are the primary driver and single largest component of increased healthcare spending, studies have found. U.S. spending and pricing far outpace those of other high-income countries.
From the patient’s perspective, while well-being is at the forefront, affordability and value are also important considerations. Surveys show that cost is a common reason for patient decisions to delay or go without medical care. Uninsured patients are more likely to put off care than those with insurance.
Insurance giant Blue Cross Blue Shield cites three key factors driving U.S. healthcare costs: prescription drug prices, chronic diseases and unhealthy lifestyle choices, which are linked to chronic conditions. While prescription prices are beyond individuals’ power to change, engaging patients to take a more active role in their own health can lead them to make healthier choices and take advantage of preventive care opportunities. Mobile apps, online patient portals and other technological tools can be invaluable in reaching out to patients without expending precious human resources.
The shift from fee-for-service models toward value-based care rewards positive outcomes and removes incentives for providers to order costly tests and scans merely as a preemptive strike against potential lawsuits. “Defensive medicine,” one of the reasons Investopedia pinpoints for the high cost of healthcare, has no place in a consumer-obsessed environment that defines waste as anything that does not add value for the patient.
The waste created by the complexity of the U.S. system is another culprit on the Investopedia list. With separate rules, rates and standards for multiple payer systems—private, employer-based, Medicare, Medicaid—about 8% of the American healthcare dollar goes toward administrative costs.
The elimination of redundancies and inefficiencies must be a key component of healthcare organizations’ efforts to better serve the patient in the cost arena. That can take many forms, including:
- Utilization management and analytics designed not only to control costs but also to ensure quality and manage risk among individuals as well as populations
- Automation of administrative and routine tasks—including data ingestion and prior authorization—that can be automated, streamlining workflows and freeing up resources for more value-added, patient-focused activities
- Virtual care, when possible, to address patients’ concerns without the inconvenience, time expenditure and cost of an in-person visit
- Education to inform patients of lower-cost options and, more important, the benefits of taking a proactive and preventive role in their own well-being
By sharing consumers’ obsession with out-of-control costs, organizations can engage them to make decisions and take actions that help make healthcare more affordable.
CHALLENGE #3: Healthcare Is Confusing
CONSUMERS DEMAND: Answers
Navigating the American healthcare system can be challenging even for providers who work within it daily. For the consumer, the complexities of deductibles, copays, out-of-network providers, prior authorizations and other details—as well as a lack of pricing transparency and uniform standards—can be intimidating and stress-inducing.
The benefits of effective consumer engagement are returned to healthcare organizations in the form of informed, proactive patients who make smarter decisions that ease the burden on providers and support staff. Omnichannel engagement can make useful information easily accessible to patients at their convenience and via their preferred channel, be it in person or remotely, through self-service patient portals, webinars or personalized digital content. Patients, and their providers, also benefit from having all their health information available digitally in one easy-to-access location. (Some patients may require instruction in the digital tools that will allow them to become better engaged.)
Community-based teams also have a role to play. Social workers, community agencies and public-private partnerships can help healthcare organizations educate the populations they serve. At the same time, they can provide the organizations with valuable insights about health trends, social determinants and other rich patient-focused data. They can also act on SDoH data, helping patients overcome barriers such as a need for transportation to a doctor appointment or a lack of healthy produce in the neighborhood.
The fragmentation, expense and confusion of healthcare are not problems that can be fixed overnight. While tools are available to address these concerns, there will be an ongoing need for new ones to advance the progress that has been made and confront issues on the horizon.
The market disrupters will be the organizations that refuse to be satisfied with the status quo, those whose consumer obsession fuels a willingness to innovate, to transform care delivery. These organizations will keep their eyes on long-term results, continually find ways to evolve, and empower team members to find new and innovative ways to deliver care.
Who will be the next disrupter? That remains to be determined. If it’s your organization, please let us know about it. Otherwise, keep obsessing about the right things: better patient outcomes, experiences and satisfaction. And stay tuned.