Blasting Out of the Past: Bringing A Consumer-Oriented Approach to Healthcare

The following article was written by Daniel A. Schulte, MBA, CHFP, Senior Vice President of Provider Healthcare.

While physicists agree that time travel to the past isn’t possible (at least based on what we know about the laws of physics today), it appears they are forgetting about the U.S. healthcare system. When it comes to our approach to patient communications, or communications with each other, a healthcare encounter is like stepping into the Wayback machine and setting it for 1985.

Consider that we live in an age where you can use your mobile phone to obtain shopping coupons or purchase tickets, then choose whether to print them directly, have them emailed or show up electronically in an app on that phone. Would you like a reminder or information about updates? Specify the method – email, text, social media, automatically added to your device’s electronic calendar or any of a half dozen other options.

Now compare that experience to a healthcare visit. It’s likely the bulk of your communications with your healthcare provider come either via phone calls or white (aka snail) mail. You may receive an email if your provider is “progressive.” There might even be a portal you signed up for at some point (although you’re not sure). But whatever is happening, it’s happening on the provider’s limited terms, with no consideration for your preferences.

If it were only a matter of inconvenience it wouldn’t be such a big deal. There is a larger issue at play, however: the need to get patients actively involved and participating in their own care. Moving the needle on patient engagement requires not only explaining what they need to do when they’re in the office, but also interacting with them on a regular basis to ensure they’re taking medications, making follow-up appointments with other healthcare professionals, checking their blood pressure/HbA1c levels, changing their eating habits, getting more exercise or doing whatever else is part of their carefully designed plan of care.

This need for patient communication and engagement is being driven by the skyrocketing cost of healthcare in the U.S. In 1980, healthcare accounted for just nine percent of the gross domestic product (GDP) according to the Council of Economic Advisers. In its National Health Expenditure Fact Sheet, the Centers for Medicare and Medicaid Services (CMS) showed that figure had risen to 17.4 percent by 2013. CMS projects that number will rise to nearly 20 percent of GDP by 2024, while CEA says by 2040 healthcare expenditures could take up roughly one-third of the total output of the U.S. economy. That is simply unsustainable.

While value-based programs such as the Medicare Shared Savings Program (MSSP) and Pioneer ACO program have the potential to slow this growth down, they won’t be enough to reverse the trend. Instead, the focus must move, and move quickly, from treating people who are sick to helping them get and stay healthy. In other words, making hospital visits a rarity for the bulk of the population.

The only way that’s going to happen is by getting patients and populations motivated to do the right things early instead of desperate things late. Through population health management we are learning more about how to create wellness strategies and to stratify patient populations based on their conditions and adjust for nuances in age, race, diagnostic groups, and the like. This type of information can inform care management and care coordination program designs that address cultural and educational issues as well as medical issues, showing patients what they need to do and dedicating resources to support them in those efforts.

Yet success in these endeavors will be limited if we are unable to motivate patients to actively involve themselves in their own care plans. To do so, healthcare providers have to get out of the time bubble they reside in and start communicating with patients when, where and how the patients prefer.

For some patients it still could mean email or phone calls. But for many others it must also include online chat, video chat, a kiosk, active patient portals, mobile apps, text, social media, etc. Providers may not always know the channel(s) patients prefer. But if they have multiple channels available, let patients know about them and have staff properly trained to use them, providers will be much more effective in driving the behaviors that lead to healthier patients and lower costs.

These same channels, incidentally, can be used to reach out to underserved communities that may not be a part of the care continuum for a particular provider. Using electronic channels removes the barriers of time and distance, helping these health consumers take advantage of wellness and chronic condition management programs rather than using the emergency department as their family physicians. Enabling communication via smartphones is particularly important since these devices are often the primary mode of Internet access for many in these communities. Given that there are 2.6 billion smartphone subscriptions worldwide today, and that by 2020 that number is expected to more than double to 6.1 billion, enabling communication via smartphone can pay multiple dividends.

If providers don’t want to dedicate their own staff to these communication activities they can bring in an outside resource to do it for them. A good partner will offer a bilingual staff of nurses adept at communicating with patients over a variety of channels. The right partner will help develop protocols segmented to ensure patients are performing the activities their insurance companies will pay for. This method allows the healthcare provider to focus on the actual care while elevating the level of patient engagement and limiting patient financial exposure – and avoiding the need to implement all of those channels internally.

Of course, this multi-channel way of thinking doesn’t just apply to provider-to- patient communication. Providers (and their staff) may also make themselves available through these same channels to answer questions from their patient community, to offer advice and even to provide encouragement when patients are faltering from their plans of care.

One good example is a 24/7 triage capability that makes a nurse available to answer questions about health concerns to determine whether a visit to the emergency department or an urgent care facility is warranted, or to determine whether the issue should wait until the primary care physician’s (PCP) office is open. This service should not only include a phone line but also the ability to perform a video chat so nurses can see what patients can’t describe.

In a true emergency, of course, nurses will recommend the patient call 911. But in many cases, following medical protocols established in advance by the provider and 24/7 Triage partner, the nurse will be able to solve issues and reassure patients that they don’t need to make an expensive, disruptive trip to the ED. If the patient doesn’t have a PCP or specialist, the nurse can recommend one within the healthcare organization’s network, and perhaps even schedule the appointment right there, helping to drive revenue as well as provide a service to the community. Triage nurses can also capture patient feedback and deliver it to providers to ensure they have all the information needed to address any issues.

Here again it might make more sense to outsource a triage function to an organization that can staff it properly, allowing the costs to be shared across multiple hospitals or healthcare organizations rather than the total cost being borne by each healthcare provider individually. A good outsourcing provider will already have the technical capabilities in place and can work with each healthcare provider organization to develop or approve protocols that meet the criteria of those providers and their payer partners.

Healthcare providers should keep in mind that the cost of technology , as well as scope of available features tend to improve as the economies of scale take effect. Larger, more experienced partners will have the resources to invest in better technology, and will have more communications options available, than those that are just getting into the market. Since one bad customer service experience can cost an organization that consumer for life, it is critical to work with an outsourcing partner that has the technical capabilities to make the experience outstanding, whether the organization is using them for inbound, outbound or both types of communication.

The mandate is clear: healthcare can no longer continue along the path it has been on. Providers must actively engage patients in their own care plans if we are to bend the out-of- control spending curve. Now is the time for providers to do a little time traveling of their own and assess consumer-oriented approaches to communicating with individuals and populations. By getting out of their own past, healthcare providers will be better-prepared for the future.

Daniel A. Schulte, MBA, CHFP, joined HGS, Inc. as Senior Vice President of Provider Healthcare, and is responsible for Operations and Client Development of all services HGS delivers to providers of healthcare, across the full spectrum of healthcare. He can be reached at daniel.schulte@teamhgs.com.