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

Session 122, March 7, 2018

Rasu B. Shrestha, Chief Innovation Officer, UPMC

Santosh Mohan, Head, More Disruption Please Labs, athenahealth

A User Experience Forum Session

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Rasu B. Shrestha MD MBA

Chief Innovation Officer, UPMC

Executive VP, UPMC Enterprises

Chair: HIMSS Innovation Committee

@RasuShrestha

Today’s Presenters

Santosh Mohan MMCi FHIMSS

Head, More Disruption Please Labs

athenahealth

Member: HIMSS User Experience Committee

@santoshSmohan

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Rasu B. Shrestha, MD, MBA

Has no real or apparent conflicts of interest to report.

Santosh Mohan, MMCi, CPHIMS, FHIMSS

Has no real or apparent conflicts of interest to report.

Conflict of Interest

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A New Focus on Consumer Expereince1

UX Approaches and Techniques2

Case Studies3

Discussion:

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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A New Focus on Consumer Expereince1

UX Approaches and Techniques2

Case Studies3

Discussion:

What Top Actions Can Move Value Forward?4

Road Map

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Concept by Sachin Jain, Art by Matthew Hayward

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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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• 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

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15Source: “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.

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A New Focus on Consumer Expereince1

UX Approaches and Techniques2

Case Studies3

Discussion:

What Top Actions Can Move Value Forward?4

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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Design Thinking

DISCOVER SYNTHESIZE GENERATE FOCUS

EVALUATE

Design Process

Adapted from “Double Diamond Model of Product Definition and Design” from UK Design Council

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Generative methods uncover latent needs.

Image: Liz Sanders

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Talk to your end users

Understand the role of empathy

Design customer experiences that matter

Measure how your end users think and feel

Igniting the Shift to User Centricity

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Net Promoter Score

3. Measuring Experience

Are Your Patients Promoters, Passives, or Detractors?

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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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A New Focus on Consumer Expereince1

UX Approaches and Techniques2

Case Studies3

Discussion:

What Top Actions Can Move Value Forward?4

Road Map

28Source: “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.

Modern medicine’s true healing potential depends on a resource that is being systematically depleted: the time and capacity to truly listen to patients, hear their stories, and learn not only what’s the matter with them but also what matters to them.

Dr. Rana L.A. Awdish & Leonard L. Berry, 10/09/2017

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Froedtert & the Medical College of Wisconsin

Seeking 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 xx

clinics from primary to specialty,

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

feeing disconnected and uncertain

• Physicians, teams busier than ever

• Patient engagement not

approached on patients’ terms

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 Anderes

Chief Innovation and Digital Health Officer, F&MCW

President, Inception Health

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The Old Reality

IMA

GE

CR

ED

IT: P

ER

WIK

IPE

DIA

TH

IS IM

AG

E I

S IN

T

HE

PU

BLIC

DO

MA

IN

Now you

listen to me!

The Times They Are A-Changing

The doctor-patient relationship has evolved since Marcus Welby, M.D.

Case in Brief: UCLA Health

• 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

+

–

Post-consultPre-consult

DiagnosisConfusion /

fear

Unguided

online

research

Process

Research

alternatives &

Revisit

Decisions

Decide.

Adhere?

Consult

w/

‘Decision’

Explain

Diagnosis

Educate

on

options

Elicit

patient

preference

s

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 constrainedCo

nclu

sio

ns

A Patient Decision Journey

Pre-consult Post-consult

Get

diagnosis

Confusion /

fear

Unguided

online

research

Process

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

Treatment

Education

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 consultationImp

rove

me

nts

A Patient Decision Journey – Redesigned

Expert Consultation / Questions

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UCLA 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

• Helps incorporate both evidence and patient preferences in treatment decisions

“Your UCLA physician

would like you to

complete WiserCare

before your appointment”

Patient visit or

treatment consultation

and decision

Patient Report

MD Report

EMR

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Results

79%

Net Promoter Score

Urology Top Box %

86%

45%

61%

17%Increase in

proportion of

patients endorsing

that shared decision

making happened in

clinic

Assessment

completion rate

74%

Decrease in

patients with “red

flag” answers

regarding decision

quality

13%

Increase in

proportion of patients

without decision

conflict

6%

Over 85% of patients

have expressed a

preference for medical

therapy, suggesting

they might prefer to be

managed by their PCP

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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

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Dignity Health

Combining Personalized Care with Anticipatory Service for Expectant Mothers

Establishing Strategic Goals for Consumer Segments A Key First StepTech in Brief: Docent Health

• Headquartered in Boston, MA

• Partnered with Dignity Health to

……………………………………

……………………………………

• Offers a data-driven and

human-guided approach to

manage personalized service

journeys for patients

• “Docents” serve as patient

liaisons, capturing individual

needs, helping patients

navigate clinical experience,

and surfacing contextual

information to care team

• Analytics driven platform

captures patient profiles,

organizes service journeys, and

coordinates workflow

MA

TE

RN

ITY

PE

RS

ON

AS

:

• 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 her

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 / diagnosis

high-risk vs. low-risk

care model: FFS or ACO)

(NPS

Relative life time value

Primary vs Sec market)

MEET AMANDA!

• Amanda lives in the North Point neighborhood and is a lifelong native of the

area.

• She and her husband Thomas have decided to start a family, and they are now

expecting their first child! If things go well, she’s always wanted three kids close

in age.

• Amanda maintains a healthy lifestyle and is an avid user of mobile technology.

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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 &

Delivery

24 weeks

Increase Peds

retentionSYSTEM VALUE

Increase pre-

registration

Reduce 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

Service Design Components

Designing the Experience

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ENGAGEMENT

Results

SCORES IMPACT

44Source: Advisory Board research and analysis.

Building a Longitudinal Relationship

Develop services, capabilities that drive loyalty to the health system

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A New Focus on Consumer Expereince1

UX Approaches and Techniques2

Case Studies3

Discussion:

What Top Actions Can Move Value Forward?4

Road Map

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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 challengingSource: “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.

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Rasu B. Shrestha, MD MBA

Chief Innovation Officer, UPMC

Exec VP, UPMC Enterprises

Twitter: @RasuShrestha

LinkedIn.com/in/rasushresthashrestharb@upmc.edu

Santosh Mohan, MMCi FHIMSS

Head, More Disruption Please Labsathenahealth

Twitter: @santoshSmohan

LinkedIn.com/in/santoshmohansantosh.mohan@fuqua.duke.edu

Q&A and Contact Information