patients as consumers: how leading providers are … · digitally transforming patient consults...

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PATIENTS AS CONSUMERS: HOW LEADING PROVIDERS ARE DIGITALLY TRANSFORMING PATIENT CONSULTS

Session 122, March 7, 2018Rasu B. Shrestha, Chief Innovation Officer, UPMCSantosh Mohan, Head, More Disruption Please Labs, athenahealth

A User Experience Forum Session

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Rasu B. Shrestha MD MBAChief Innovation Officer, UPMC

Executive VP, UPMC EnterprisesChair: HIMSS Innovation Committee

@RasuShrestha

Today’s Presenters

Santosh Mohan MMCi FHIMSSHead, More Disruption Please Labs

athenahealthMember: HIMSS User Experience Committee

@santoshSmohan

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Rasu B. Shrestha, MD, MBAHas no real or apparent conflicts of interest to report.

Santosh Mohan, MMCi, CPHIMS, FHIMSSHas no real or apparent conflicts of interest to report.

Conflict of Interest

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A New Focus on Consumer Experience1UX Approaches and Techniques2

Case Studies3Discussion: What Top Actions Can Move Value Forward?4

Agenda

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• Describe how progressive organizations are optimizing their technology and workflows to support clinician objectives and enhance connection and relationships with patients

• Discuss how to create service journeys and design empathetic experiences that accommodate individual patient needs and preferences, support clinical care, and deliver personalization on both the clinical side and the consumer side

• Identify approaches to inform and influence patient preferences that influence behavior and drive quality higher and cost lower

Learning Objectives

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Acknowledgements

GE HealthcareChicago, ILDoug DietzInnovation Architect

Mad*PowBoston, MAAmy CuevaFounder and Chief Experience OfficerJen Briselli, MDes, MSManaging Director, Experience Strategy & DesignAmy Bucher, PhD, MABehavior Change Design Director

Oracle Redwood Shores, CAOracle CX – Customer Experience Solutions

Patchwise LabsAustin, TXNaveen RaoFounder and Managing Partner

PatientWisdomPalo Alto, CAGregory MakoulFounder and CEO

University of Pittsburgh Medical CenterPittsburgh, PA

WiserCare Inc.Los Angeles, CA

Advisory Board CompanyWashington, DCDoug ThompsonSenior Research Director

athenahealthWatertown, MA

Cleveland ClinicCleveland, OHAdrienne Boissy, MD, MAChief Experience OfficerJulie Rish, PhD, MADirector, Design And Best Practice , Office Of Patient Experience

Docent HealthBoston, MARoyal Tuthill, MPAChief Transformation Officer

Dignity HealthSan Francisco, CASanjay ShahDirector, Strategic InnovationRichard RothVice President of Strategic Innovation

Froedtert & the Medical College of WisconsinMilwaukee, WIMike AnderesChief Innovation and Digital Officer

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Road Map

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Concept by Sachin Jain, Art by Matthew Hayward

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Are we REALLY listening to our patients?• Technology out of step with patient

preference• Consult very focused around the episode

– 20 to 30 mins• Silent misdiagnosis: patients' preferences

are often misinterpreted or ignored in treatment decisions leading to misdiagnosis that is damaging to both doctors and patients

Old World vs. New World

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Paternalistic to Participatory


11

Source: “Right Place, Right Time: Consumer Perspectives”, Altarum, available at https://altarum.org/publications/right-place-right-time-consumer-perspectives, accessed February 28, 2018.

https://altarum.org/publications/right-place-right-time-consumer-perspectives

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Definition of health care changing• Business model and mindset shift


Source: “HEALTH: WHO'S RESPONSIBLE?”, University of Utah Health, available at https://uofuhealth.utah.edu/value/health-whos-responsible.php, accessed February 28, 2018.

https://uofuhealth.utah.edu/value/health-whos-responsible.php

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• I’m loyal to my long-time PCP• I pick specialists and hospitals

based on my PCP’s referral and my payer’s coverage

• I trust the doctor to decide the best care for me

• Medical professionals are responsible for my health

• Medicine is a mystery to me

• I change doctors based on convenience and price

• I do my own research on-line• I pick providers based on

convenience, price and service• I make my own care decisions• I am responsible for my health• I am educated about my

conditions and treatments

Source: Advisory Board research and analysis.

New ConsumerTraditional Consumer

A Tale of Two Consumers

A new type of healthcare consumer is emerging

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PwC’s “Experience Segments”

Full-Service Frank Gen X and Y (18-49), income $50 - $75K, both genders, lives in suburb of major city. Top wants: hassle-free issue resolution, good website content.

On-the-Go Gina Gen X (33-49), income >$100K, mostly female, lives in medium/ metropolitan city. Top wants: accurate claims payment.

Traditional Tom Retirees (66+), income $25 - $50K and >$150K, mostly male, lives in small city or town. Top wants: extensive provider network, accurate billing.

Brand-Aware Brenda Boomer (>50), income >$100K, mostly female, lives in suburb of medium-sized city. Top wants: accurate claims payment, extensive provider network.

Budget Brad Boomer (>50), income <$50K, both genders, lives in suburb of major city. Top wants: accurate claims payment, extensive provider network.

Source: Experience Radar 2012, PwC; art credit: Doug Thompson; The Advisory Board Company research and analysis.

Consumer Archetypes

Different types of consumers want different things from their providers

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Source: “What are you most passionate about STIRRING up in health care?”, STIR – The Experience Lab at Advisory Board, available at https://experiencelab.advisory.com/inspiration-gallery/, accessed Feb 11, 2018.

https://experiencelab.advisory.com/inspiration-gallery/

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Road Map

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“Human Centered Design is a creative approach to problem solving that starts with the people you’re designing for and ends with solutions tailor made to suit their needs.”

- from the IDEO Design Kit

Non-functional Functional Delight?

What’s Human Centered Design?

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HCD aims to cut through superfluous details to get to the user’s core needs.

Human Centered Design

Source: Results redesign credited to Mucca Design; “The Blood Test Gets a Makeover”, Steven Leckar, WIRED Magazine, Nov 2010, available at https://www.wired.com/2010/11/ff_bloodwork/, accessed February 26, 2018.

https://www.wired.com/2010/11/ff_bloodwork/

Source: Results redesign credited to David McCandless; “The Blood Test Gets a Makeover”, Steven Leckar, WIRED Magazine, Nov 2010, available at https://www.wired.com/2010/11/ff_bloodwork/, accessed February 26, 2018.


Source: Results redesign credited to Jung + Wenig; “The Blood Test Gets a Makeover”, Steven Leckar, WIRED Magazine, Nov 2010, available at https://www.wired.com/2010/11/ff_bloodwork/, accessed February 26, 2018.


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• Observing a user in context and asking structured questions to better understand why they’re doing what they’re doing.

Contextual Inquiry:

• Enhancing user satisfaction by improving usability, accessibility and efficiency in the interaction between the user and the product.UX Design:

• Evaluating design concepts with representative users. Typically, participants will try to complete tasks while observers collect data and determine the participant's satisfaction with the product.

Usability Testing:

• After testing with users, design is typically refined to align with their feedback.Refine:

Human Centered Design

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Design Thinking

Source: Brené Brown on Empathy, available at https://youtu.be/1Evwgu369Jw accessed December 5, 2016.

24EMPATHIZE

https://youtu.be/1Evwgu369Jw

The new GE Optima MR360

is well suited for a wide range

of MR scanning needs – with

the ease of operation to help

make a clinician’s staff more productive. For

streamlining routine scans, the Optima MR360

incorporates an express exam approach to MR.

It includes many intuitive and automated

functions that help increase patient comfort,

operator confidence, image consistency, and

professional satisfaction of MR staff.

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Source: Oracle . CX Strategy & Design Workshop . DesigningCX.com

Sofia

Age 6½

Source: Oracle . CX Strategy & Design Workshop . DesigningCX.com

26Develop a persona to solve forEMPATHIZE

GOES TO INITIAL DOCTOR

RIDES TO HOSPIT’L

CHECKS IN

WALKS TO MRI ROOM

SEES MRI MACHINE

CRIES & RESISTS

SEES DOCTOR ENTER

GETS DRUGGED

GOES THROUGH

MRI

………

AM I REALLY SICK?

THAT LOOKS SCARY!

WILL IT HURT ME?!

MOM CAN’T HELP?

NO! NO! PLEASE

NO!

I’M REALLY

NERVOUS

WISH I WAS AT SCHOOL

TECH. WRITER

SYSTEM ADMIN.

HOSPIT’L BLDG MGR

DOUGPATIENT SAFETY TEAM

IMAGING TECH

STAFF PAGING SYSTEM

PATIENT RECORD SYSTEM

RESERV. SYSTEM

IMAGING RECORD SYSTEM

DRUG ROOM

Behaviors

ATTITUDES

PEOPLE

THINGSON

STA

GE

EX

PE

RIE

NC

E

PEOPLE

THINGSBA

CK

STA

GE

SU

PP

OR

TSelect a specific customer persona to map

DOCTOR MOM CHECKIN NURSE

IMAGING TECH MOM DOCTOR

ANESTH.IMAGING

TECH

MRI MACHINE

DESK & COMPUT. CHARTCAR

TAKE-HOME

PACKET

MRI MACHINE

NEEDLE & DRUGS

NURSE

TISSUES

27Create an initial map: Attitudes, behaviors, and experiences


RIDES TO HOSPIT’L

CHECKS IN

WALKS TO MRI ROOM

SEES MRI MACHINE

CRIES & RESISTS

SEES DOCTOR ENTER

GETS DRUGGED

GOES THROUGH

MRI

………



ANESTH.IMAGING

TECH

MRI MACHINE


TAKE-HOME

PACKET

MRI MACHINE

NEEDLE & DRUGS

AM I REALLY SICK?

THAT LOOKS SCARY!

WILL IT HURT ME?!

MOM CAN’T HELP?

NO! NO! PLEASE

NO!

I’M REALLY

NERVOUS


TECH. WRITER

SYSTEM ADMIN.

HOSPIT’L BLDG MGR


IMAGING TECH

STAFF PAGING SYSTEM


RESERV. SYSTEM


DRUG ROOM

NURSE

TISSUES

IMPACT MORE STAFF

COST OF DRUGS

IMAGING TIME

SIDE EFFECTS

EVALUATE & PRIORITIZEIdentify moments that matter for the customer and the organization

28Evaluate and prioritize: Find moments that matter


RIDES TO HOSPIT’L

CHECKS IN

WALKS TO MRI ROOM

SEES MRI MACHINE

CRIES & RESISTS

SEES DOCTOR ENTER

GETS DRUGGED

GOES THROUGH

MRI

………



ANESTH.IMAGING

TECH

MRI MACHINE


TAKE-HOME

PACKET

MRI MACHINE

NEEDLE & DRUGS

AM I REALLY SICK?

THAT LOOKS SCARY!

WILL IT HURT ME?!

MOM CAN’T HELP?

NO! NO! PLEASE

NO!

I’M REALLY

NERVOUS


TECH. WRITER

SYSTEM ADMIN.

HOSPIT’L BLDG MGR


IMAGING TECH

STAFF PAGING SYSTEM


RESERV. SYSTEM


DRUG ROOM

TISSUES

NURSE

FEEL SAFE

HAVE SCANNEEDS

EXPLORE CUSTOMER NEEDSGain deeper understanding of functional and emotional needs

29Add detail: Deeper understanding of needs


RIDES TO HOSPIT’L

CHECKS IN

WALKS TO MRI ROOM

SEES MRI MACHINE

CRIES & RESISTS

SEES DOCTOR ENTER

GETS DRUGGED

GOES THROUGH

MRI

………



ANESTH.IMAGING

TECH

MRI MACHINE


TAKE-HOME

PACKET

MRI MACHINE

NEEDLE & DRUGS

AM I REALLY SICK?

THAT LOOKS SCARY!

WILL IT HURT ME?!

MOM CAN’T HELP?

NO! NO! PLEASE

NO!

I’M REALLY

NERVOUS


TECH. WRITER

SYSTEM ADMIN.

HOSPIT’L BLDG MGR


IMAGING TECH

STAFF PAGING SYSTEM


RESERV. SYSTEM


DRUG ROOM

NURSE

FEEL SAFE

HAVE SCAN

TISSUES

POSITION PATIENT

TAKE IMAGE

DEVELOP IMAGERoles & Processes

EVALUATE & FRAMEExamine existing capabilities to determine issues / opportunities

30DEFINE

EVALUATE & FRAMERe-examine issue / opportunity based on deep customer understanding

31IDEATE


RIDES TO HOSPIT’L

CHECKS IN

WALKS TO MRI ROOM

SEES MRI MACHINE

CRIES & RESISTS

SEES DOCTOR ENTER

GETS DRUGGED

GOES THROUGH

MRI

………



ANESTH.IMAGING

TECH

MRI MACHINE


TAKE-HOME

PACKET

MRI MACHINE

NEEDLE & DRUGS

AM I REALLY SICK?

THAT LOOKS SCARY!

WILL IT HURT ME?!

MOM CAN’T HELP?

NO! NO! PLEASE

NO!

I’M REALLY

NERVOUS


TECH. WRITER

SYSTEM ADMIN.

HOSPIT’L BLDG MGR


IMAGING TECH

STAFF PAGING SYSTEM


RESERV. SYSTEM


DRUG ROOM

DESIGN NEW EXPERIENCESInnovate to influence attitudes and change behaviors

TISSUES

NURSE

FEEL SAFE

IDEA: LET’S GO CAMPING

32IDEATE

The new GE Optima MR360

is well suited for a wide range of

MR scanning needs – with

the ease of operation to help

make a clinician’s staff more productive.

For streamlining routine scans, the

Optima MR360 incorporates an express

exam approach to MR. It includes many

intuitive and automated functions that

help increase patient comfort, operator

confidence, image consistency, and

professional satisfaction of MR staff.

Great Experience

33PROTOTYPE


RIDES TO HOSPIT’L

CHECKS IN

WALKS TO MRI ROOM

SEES MRI MACHINE

CRIES & RESISTS

SEES DOCTOR

ENTER

GOES THROUGH

MRI

………


IMAGING TECH MOM IMAGING

TECH

MRI MACHINE


TAKE-HOME

PACKET

MRI MACHINE

AM I REALLY SICK?

THAT LOOKS SCARY!

WILL IT HURT ME?!

MUM CAN’T HELP?

NO! NO! PLEASE

NO!

I’M REALLY

NERVOUS


TECH. WRITER

SYSTEM ADMIN.

HOSPIT’L BLDG MGR

DOUGIMAGING

TECH


RESERV. SYSTEM


IDEA: CAMP GUIDE

WOW, A CAMP-FIRE!

FEELS LIKE I’M CAMPING

THIS ISN’T

TOO BAD

THAT WASN’T SO BAD

THIS PLACE IS

NEAT!

TODAY COULD BE FUN

LAYS DOWN IN MACHINE

LISTENS TO

FOREST SOUNDS

…

TEST NEW EXPERIENCESNew attitudes, new behaviors….different result

NURSE

HASMRI

SCAN

IDEA: CAMPING

SITE

IDEA: CAMP

BACKPK

FEWER STAFF

NO DRUGS

IMAGING TIME ↓

↓ SIDE EFFECTS

34TEST

Photo courtesy Children's Hospital of Pittsburgh of UPMC

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Results

experiencesinfluence

Attitudes drive Behaviors deliverFEWER STAFF

NO DRUGS

IMAGING TIME ↓

↓ SIDE EFFECTS

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Design Thinking

SYNTHESIZE GENERATE FOCUSDISCOVER

EVALUATE

Source: Adapted from “Double Diamond Model of Product Definition and Design” from UK Design Council; Briselli, J. (2018, February 21). Telephone interview. Mad*Pow.

Source: athenahealth

Example: Digital Check-in – Journey Map

Example: Same Day Patient Scheduling – Service Blueprint

Source: athenahealth

M P

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How Is Experience Measured?

Source: “A better way to measure the patient experience”, Len Schlesinger, athenainsight, July 2017, available at https://www.athenahealth.com/insight/better-way-measure-patient-experience, accessed February 28, 2018.

https://www.athenahealth.com/insight/better-way-measure-patient-experience

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Net Promoter Score

Are Your Patients Promoters, Passives, or Detractors?

Source: “Patient Experience 2.0 Expanding Your Horizons”, available at http://jarrardinc.com/wp-content/uploads/2015/12/PX-Report.pdf; “NYP CEO: Telemedicine important effort as tech disrupts healthcare,” available at https://www.healthcaredive.com/news/steven-corwin-newyork-presbyterian-telehealth/512315/

NYP can set up telepsychiatry consults within an hour with an on-call psychiatrist. I thought that was going to be something patients wouldn't accept. Quite the contrary. The Net Promoter Score of the telepsychiatry consult is 95. The Net Promoter Score of Netflix is 75. We are talking about a sea change in the way that we're delivering care. I think the virtual and the physical will come together.”

Steven Corwin, President & CEO, NewYork-Presbyterian

I’m less interested in how another hospital is designing its experience... I want to know what Amazon and Chick-fil-A are doing. Those sorts of companies are the ones whose customer experience we need to emulate. Healthcare is the ultimate consumer business. We need to understand the experience patients have in other industries carries over to what they want in healthcare.”

Matt Gove, Piedmont Healthcare

http://jarrardinc.com/wp-content/uploads/2015/12/PX-Report.pdf

https://www.healthcaredive.com/news/steven-corwin-newyork-presbyterian-telehealth/512315/

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Ignite the Shift to User Centricity

Talk to your end users

• Engage patients, consumers & clinicians BEFORE starting a program or writing code• Always close the loop. Always iterate.

Action Steps

Understand the role of empathy

• Listen & understand (2 ears/ one mouth)• Always put yourself in their shoes

Action Steps

Design customer experiences that matter

• Use design thinking principles in your next challenge!• Think about behavior changes and motivators

Action Steps

Measure how your patients think and feel about your digital features

• Benchmarks are important, but customer centricity more so. Start measuring satisfaction and experience.• Corelate clinical outcomes to patient experience feedback.

Action Steps

Support the People, Not the Technology

Key Takeaways

45



Road Map

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Source: “What are you most passionate about STIRRING up in health care?”, STIR – The Experience Lab at Advisory Board, available at https://experiencelab.advisory.com/inspiration-gallery/, accessed Feb 11, 2018.

https://experiencelab.advisory.com/inspiration-gallery/

47

Ease of use may be invisible, but its absence sure isn't.

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Rethinking patients as consumers in Imaging

• As the health care industry moves towards value-based care, patient experience remains an untapped opportunity for increasing quality and value in patient care.

• Focusing on patient experience in imaging, a high volume area of health care, this we explored how a service design discipline could be well suited to find determine ways to augment patient experience.

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Journey Mapping

54Froedtert & the Medical College of WisconsinSeeking to Turn Transactions into Relationships

Every industry is striving to understand customer wants and needs, and those who do the best job of meeting them are winning. We may be late to the game, but we also have a unique opportunity to explicitly ask, listen, and customize care based on n=1. We need to do this in a standard way at scale.”

Case in Brief: PatientWisdom at F&MCW• Milwaukee, Wis. based health

care network with 3 hospitals and nearly 40 clinics

• Partnered with Connecticut based startup PatientWisdom in 2016 to co-design, develop, pilot, and scale a communication-science based digital solution that can drive more meaningful patient interactions

• Tool captures patient motivations (e.g., goals, barriers, joys, pressures, how health affects life) and integrates a 1-screen “inSIGHT summary” into Epic

• Deployment expanded to 14 sites from primary to specialty and inpatient care; continues to scale

Patients get an appointment reminder with link to sign-up and share ‘stories’ about themselves, their health, and care before an encounter

Providers view a 1-screen summary –via the EHR; admins can drill into aggregated themes and sentiments

Patient Perspectives Valuable, But Mostly Unheard

• Many patients and caregivers feeling disconnected and ‘invisible’

• Physicians, teams busier than ever but want to connect with patients

• Patient engagement not approached on patients’ terms

Pre Visit

90%Patients saying tool improves communication with doctors using it

Visits rated as going ‘extremely well’ (vs 82% baseline)

95%

Time it takes for providers to read the insight summary before seeing a patient

<20 secsProviders confirming that tool helps them know what’s important to their patients

82%

It would have taken me 45 minutes to get all of this information.”

Physician, July 2017

Early results: Doing better without taking longer

“The simple act of providing a platform for people to tell us what is important to them—and making it easy to incorporate that into care—improves their experience and informs our decisions. We look forward to bringing this tool to every person that chooses our health network.”

Mike AnderesChief Innovation and Digital Officer, Froedtert

President, Inception Health

Case in Brief: Fuller Health1

• Five-hospital health system with 155 clinics based in Los Angeles, California

• Engaged design firm to lead ethnographic research and map BPH care experience

• Patient journey included many steps, and revealed many opportunities to succeed (or fail) at patient experience

• Layering in emotional dimension revealed that patients lacked confidence to make quality choices

• Low points mainly mapped to education, decision making and expectation management.

NEG

POS+

–

Shared Decision Making

1. Pseudonym

Post-consultPre-consult

Diagnosis Confusion / fear

Unguided online

researchProcess

Research alternatives &

Revisit Decisions

Decide. Adhere?

Consult w/

‘Decision’

Explain Diagnosis

Educate on

options

Elicit patient

preferences

Refine options

list

Allow Time for Patient

Reflection and

Choice

Make treatment

plan

Orders / Rx /

referral

Clinic Visit – 22 minutes

Hours Hours

3 min 3 min 4 min 2 min 5 min 3 min 2 min

Provider Educates

on Options

Patient Educates on Preferences

22 minutes

1) Non-clinic time is unstructured and inefficient

2) Clinic visits are optimized for (mostly doctor-centered) delivery of information

3) Patient decision making is constrainedCon

clus

ions

A Patient Decision Journey

Pre-consult Post-consult

Get diagnosis

Confusion / fear

Unguided online

researchProcess

Research alternatives &

Revisit Decisions

Decide. Adhere?

Consult w/

‘Decision’

Explain Diagnosis

Provider Educates

on Options

Patient Educates on Preferences

Refine options

list

Allow Time for Patient Reflection

and Choice

Make treatment

plan

Orders / Rx /

referral

Clinic Visit – 22 minutes

Hours Hours

8 min 4 min 5 min 3 min 2 min

Structured Preference

and TreatmentEducation

Tool

Reflection

22 minutes

Focus on Adherence

1) Non-clinic time structured to promote efficiency

2) Clinic visits are optimized for two-way communication

3) Patient decision making process starts before clinic consultationImpr

ovem

ents

A Patient Decision Journey – Redesigned

Expert Consultation / Questions

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Fuller Health

Helping Consumers and Providers Make Better Choices with WiserCare

Technology in Brief: WiserCare

• Purpose built to work in clinical practice and be delivered at the right time in the patient journey• Designed to work for doctors by preparing patients to share preferences in advance • Informs decision making by abstracting relevant evidence on treatment options, modeling

probable outcomes using patient clinical data, and eliciting preferences through conjoint analysis• Currently deployed in Primary Care, Urology, Oncology, and Women’s Health; continues to scale

“Your Fuller physician would like you to complete WiserCarebefore your appointment”

Patient visit or treatment consultation and decision

Patient Report

MD Report

EMR

60

Results

79%

Net Promoter Score

Urology Top Box %

73%

45%

61%Patients endorsing that shared decision making happened in clinic

BPH Module Completion rate

74%

Improvement in knowledge of options and pros/cons

Patients who felt they discussed all options thoroughly with physician

35%

17%

26%

WiserCare experience was very helpful for understanding my treatment options. I liked that the doctor understood that I wanted a non-invasive treatment and supported my decision. It helps when a doctor includes me in the decision!”

BPH PatientFuller Urology

Source: Patchwise Labs, “What the F#%* is Wrong with Health Care? #WhatTheHealthCare”, available at https://youtu.be/0K-islqnkw8, accessed February 28, 2018.

https://youtu.be/0K-islqnkw8

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Cleveland Clinic

Struggling

I just can’t afford this.

The payments options don’t work for me –I can’t pay that much!

Skeptical

This is the fist of how many bills?

I might as well wait to receive all the bills, so I can get some clarity on all the charges.

Perplexed

I didn’t expect to owe that much! I wish you told me.

I don’t know why certain charges appear on my bill! I’m not sure what I paid for.

Searching

There’s a real problem, and I can’t get it solved.

I get a different answer each time I call.

No idea how much this will all cost.

Prioritizing

I don’t need to pay this bill just yet.

I need to get to other bills that impact my credit sooner.

Patient Challenge Archetypes

The care experience we have created for our patients is extraordinary and compassionate in every service we

provide. The billing process is…

• Patients don’t like getting a bill• The bill itself is confusing• People don’t pay it

…inconsistent, incoherent, and lacking a personal touch; it’s the

opposite of the care experience we have provided.

Patient interviews

Ethnographic research

Mapping and analysis of comments

Billing

Source: Rish, J. (2018, February 23). Telephone interview. Cleveland Clinic

Project in Brief: Billing Redesign at Cleveland Clinic• Empathy interviewing revealed

many opportunities and challenges – both with physical design of bill as well as backend processes

• 78 recommendations were aggregated from patients, patient experience and strategy teams, and design experts (Mad*Pow)

• Further synthesis was combined with iterative learning of the revenue cycle team to create new prototypes using design principles

• Ongoing work includes process changes to customer service, alignment of online portal experience, and building up the necessary backend service and technology enablers

A Bill You Can Understand: Surprisingly Important, Surprisingly Difficult

Source: Rish, J. (2018, February 23). Telephone interview. Cleveland Clinic

64

Dignity Health

Combining Personalized Care with Anticipatory Service for Expectant Mothers

Case in Brief: Dignity Health and Docent Health

• Dignity Health is fifth largest health system in the nation and largest hospital provider in California

• Partnered in with Boston based startup Docent Health that offers a data-driven and human-guided approach to manage personalized service journeys for patients

• Live in 3 hospitals, across 3 regions• “Docents” serve as patient liaisons,

capturing patient needs, helping them navigate clinical experience, and surfacing contextual data to care team

• Analytics driven platform captures patient profiles, organizes service journeys & coordinates workflowM

ATER

NIT

Y PE

RSO

NAS

• Highly engaged• High health literacy • Strong preferences

• Gestational diabetes• Wants a ‘natural’

delivery but unclear on what that entails

• Experienced mom• NPS: Neutral• Medicaid coverage

• Low engagement• Low health literacy• Passive

• Self engaged• Strong preferences• Digital preference

• Low health risks• Wants to avoid

C-section

• No identified health risks

• C-section planned

• First time mom• NPS: Neutral• Target zip code• Commercially insured

• First time mom• NPS: Neutral• Commercially

insured via parents

PERSONAL CLINICAL CUSTOMER

JOURNEY OBJECTIVE:

EFFICIENT SUPPORTEnsure expectations are set and managed; baseline customer needs management

ENGAGE LONG-TERMEnsure longitudinal engagement, while increasing education and overall level of health engagement

WIN OVEREnsure mother has a satisfying experience & returns for future care

(demographics, “readiness” factors, lifestyle & values, personality & preferences)

(disease State / diagnosishigh-risk vs. low-riskcare model: FFS or ACO)

(NPSRelative life time valuePrimary vs Sec market)

Ethnographic Research Unlocks Key Consumer Segments

Patie

nt In

terv

iew

s an

d R

esea

rch

Des

ign

Wor

ksho

ps

Dignity HealthJourney Maps Codify Ideal Touchpoints, Communication Channel, and Support Offerings

EARLY PREGNANCY LABOR POST-PARTUM POST-DISCHARGEPRE-HOSPITAL

Emotional Biorhythm

PATIENTPERSONA

Patient Segment

Needs

+

–

Qualitative Feedback

JOURNEY MAPPING

Dignity HealthChandler Regional Medical Center

Opportunity: First-time mothers are looking at this journey having never experienced before. Similarly, as this is their first birth, they’re at the apex of customer lifetime value, as they’re at their highest propensity to return for subsequent deliveries. Acknowledging their newness to the experience and tailoring the engagement is beneficial to both the mother and the healthcare provider> An early welcome can help identify areas of opportunity to assist or provide guidance to a new mother-to-be!

Pain Point: First-time mothers often articulate a thirst for information and education, but they’re often managing those on their own. A resource that can guide and encourage the right educational opportunities can help alleviate points of friction that arise later in the maternity journey.

Opportunity: Many first time mothers report a lack of knowledge on services at their disposal. Consistent delivery of key services can create moments of joy and delight that leave a lasting impression!

Pain Point: First-time mothers share a more pronounced anxiety with the postpartum experience and the transition home. Communications that establish expectations and provide assurance and comfort can improve confidence and ease transitions.

PERSONAL NEEDS CLV OPPORTUNITYCLINICAL NEEDS

HIGH HIGHLOW

Pain Point: Transitioning home highlights particular challenges for first-time mothers. Heightened rates of depression and consistent challenges with lactation are a few examples of the potential difficulties found at home. A familiar voice that can provide provide guidance on resources or local support groups can be incredibly valuable.

name: Maryage: 27segment: First -Timer

OBJECTIVE: ESTABLISH BRAND LOYALTYRATIONALE: First-time mothers in the Chandler community regularly leverage digital resources, seek connectivity with their peers, and serve as active participants in their maternity journey. And yet, for all the information at their disposal, they’re often filled with questions, anxiety, and a desire for guidance and support. When clinical risks are low, these mothers are looking for great, seemingly one-to-one experiences that help cut through the bevy of information at their disposal and make decisions and expectation management seamless. Focusing on providing great experiences longitudinally across the journey, managing known points of anxiety or stress, and exceeding service expectations can help build loyalty and social advocacy.

Future State Goals

Focus

Warm Welcome Expectation Management Deliver on the Promise Easy Transition Settling InFond FarewellRELATIONSHIP BUILDINGDETERMINE SENTIMENT

EDUCATION REINFORCEMENTSUPPORTING PERINATAL RESOURCES

PREFERENCE COORDINATION DISCHARGE EXPECTATION MANAGEMENT

“I spent a lot of time online – what foods to eat, which to avoid. I guess I talked a lot with friends too.”

“I’m a Google woman! I use Google for everything.”

“It’s interesting - I kind of judge hospitals by their internet presence. Like the website and their reviews.”

“I brought my husband to the Saturday day-long class – he did not know much at the time…so it was good to get him that education!”

“Dr. Eddy was great all along the way, but I really valued the classes. I took them at 6, 7, and 8 months – I felt it was important to be well-informed.”

“We never did a tour or classes, so we probably weren’t very well prepared when we arrived.”

“My labor and delivery nurses were like super nurses. They were so reassuring!”

“The lullaby was such a lovely surprise!”

“I felt like moving around a lot can be stressful. I probably just didn’t know what to expect.”

“Breastfeeding help in the hospital was really good. I got a lactation consultant whenever I requested it. Support was great.”

“The hospital called me a few weeks later. I was kind of shocked – that really impressed me!”

“I struggled with anxiety at home. Breastfeeding was also a struggle. I ended up joining a support group because of it.”

DETERMINE CURRENT SENTIMENTRESOURCE GUIDANCE

KEY

JOYANTICIPATION

TRUSTFEAR

ANXIETY

Optimized Experiences Leverage Technology Configured on an Individualized Basis

12-16 weeks(after 12 week OB visit)

16-24 weeks 35 weeks

VIRTUAL SUPPORT

TEXT/EMAIL

Docent makes intro call to welcome mom, explain program benefits, and learn about mom as a customer

After call, Docent sends automated text/email mom to confirm enrollment and offer additional contact OR“Love Letter”

SERVICE STAFF & NURSE ASSISTANTS

1

WARM WELCOME MANAGE EXPECTATIONS

Docent makes check-in call to gather preferences, direct to hospital resources, answer questions (hospital choice, insurance)

2

Docent sends automated links to Dignity Women and Newborn Services site and to Financial Assistance site

Docent sends reminder to find pediatrician and, if needed, offers options

Docent sends reminder to pre-register, links to virtual hospital tour, and FAQs on scheduling (e.g. C section)

(If applicable) If mom sent home after triage, Docent makes follow-up triage call to gauge sentiment and reiterate messages

~40 weeks

COORDINATE PREFERENCES

During Admissions and Labor &

Delivery24 weeks

Increase PedsretentionSYSTEM VALUE Increase pre-

registrationReduce staff burden on non-clinical questions

Reduce triage assessment times

Reduce burden of rescheduling

Increase patient engagement

CX VALUE

Docent technology pre-populated birth plan and profile; during clinical huddles mother preferences shared with L&D staff

Resource & FAQ Library

‘Next-Best-Action’ Journey Guidance & Coordination

EHR Integrated CRM Team Management & Communication

Aggregated InsightsText Engagement

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Results

Dignity Health & Docent Health March 2018 Maternity Case Study

Overall growth in net deliveries year-over-year

Improvement in likelihood to attend perinatal education classes

12%

Percentile increase in HCAHPS “Overall Rating”

Clinical team hours saved per year

+ 243%

1,000

Mothers-to-be engaging over text with docent liaisons42%

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Road Map

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• Make it familiar• Integrate design-thinking into all endeavors, not just “design”

activities• Don’t just throw technology at the problem – consider the power of

the human element• Integrate physical and digital closely • Partner with the best (external entities)• Aim to create delightful experiences

Key Takeaways

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Source: Advisory Board research and analysis.

Reimagining Consumer Experience

Develop services, capabilities that drive loyalty to the health system

71

Design for regulations Design for empowerment

Burnout Joy

Add Simplify

Bureaucracy Meritocracy

Application centric Patient centric

Interpretation centric Outcomes centric

Doing digital Being digital

Old world vs. New world

72

Exasperated ConsumerEmpowered Consumer

Shops for health plans on insurance exchanges

Clicks, calls, or uses an app to access care in an instant

Leverages information from online journals, patient forums, social media, and an array of digital tools to monitor health

Makes informed care choices based on needs and information from multiple sources

Stumbles through complex exchanges and options

Struggles to choose from wearables and telehealth options

Feels overwhelmed by too many data sources and lack of meaningful insights

Finds that options have multiplied, but decision making process has grown more confusing and challenging

Source: “Improving Customer Experience: Innovative Strategies and Solutions”, HIMSS17 Conference,available at http://www.himssconference.org/sites/himssconference/files/pdf/70_0.pdf, accessed April 2, 2017.

http://www.himssconference.org/sites/himssconference/files/pdf/70_0.pdf

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Rasu B. Shrestha, MD MBAChief Innovation Officer, UPMC

Exec VP, UPMC EnterprisesTwitter: @RasuShrestha

LinkedIn.com/in/[email protected]

Santosh Mohan, MMCi FHIMSSHead, More Disruption Please Labs

athenahealthTwitter: @santoshSmohan

LinkedIn.com/in/[email protected]

Q&A and Contact Information

http://www.linkedin.com/in/rasushrestha

http://linkedin.com/in/santoshSmohan

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