The next BriefingsDirect healthcare insights discussion explores ways to improve the total patient experience — including financial considerations — using digital technology.
To learn more about ways that healthcare providers are seeking to leverage such concepts as customer relationship management (CRM) to improve their services we are joined by Laura Semlies, Vice President of Digital Patient Experience, at Northwell Health in metro New York; Julie Gerdeman, CEO at HealthPay24 in Mechanicsburg, Penn., and Jennifer Erler, Cash Manager in the Treasury Department at Fairview Health Services in Minneapolis. The panel is moderated by Dana Gardner, Principal Analyst at Interarbor Solutions.
Here are some excerpts:
Gardner: Laura, digital patient experiences have come a long way, but we still have a long way to go. It’s not just technology, though. What are the major components needed for improved digital patient experience?
Semlies: Digital, at the end of the day, is all about knowing who our patients are, understanding what they find valuable, and how they are going to best use tools and assets. For us the primary thing is to figure out where the points of friction are and how digital then has the capability to help solve that.
If you continuously gain knowledge and understanding of where you have an opportunity to provide value and deliberately attack each one of those functions and experiences, that’s how we are going to get the best value out of digital over time.
So for us that was around knowing the patient in every moment of interaction, and how to give them better tools to access our health system — from an appointments’ perspective, to drive down the redundant data collection, and give them the ability to both pay their bills online and to not be surprised when they get their bill and the amount. Those are the things that we focused on, because they were the highest points of friction and value as articulated by our patients.
Where we go next is up to the patients. Frankly, the providers who are struggling with the technology between them and their patients [also struggle] in the relationship itself.
Partner with IT to provide best care
Gardner: Jennie, the financial aspects of a patient’s experience are very important. We have separate systems for financial and experience. Should we increasingly be talking about both the financial and the overall care experience?
Erler: We should. Healthcare organizations have an opportunity to internally partner with IT. IT used to be an afterthought, but it’s coming to the forefront. IT resources are a huge need for us in healthcare to drive that total patient experience.
As Laura said, we have a lot of redundant data. How do we partner with IT in the best way possible where it benefits our customers’ experience? And how do they want that delivered? Looking at the industry today, I’m seeing Amazon and Walmart getting into the healthcare field.
As healthcare organizations, perhaps we didn’t invest heavily in IT, but I think we are trying to catch up now. We need to invest in the relationship with IT — and all the other operational partners — to deliver to the patients in the best way possible.
Gardner: Julie, doesn’t making technology better for the financial aspects of the patient experience also set the stage for creating an environment and the means to accomplish a total digital patient experience?
Gerdeman: It does, Dana. We see the patient at the center of all those decisions. So put the patient at the center, and then engage with that patient in the way that they want to engage. The role that technology plays is to personalize digital engagement. There is an opportunity in the financial engagement of the patient to communicate; to communicate clearly, simply, so that they know what their obligation is — and that they have options. Technology enables options, it enables communication, and that then elevates their experience. With the patient at the center, with technology enabling it, that takes it to a whole other level.
Learn to listen; listen to learn
Semlies: At the end of the day, technology is about giving us the tools to be active listeners. Historically it has been one-directional. We have a transaction to perform and we go when we perform that transaction.
In the tomorrow-state, it becomes much more of a dialogue. The more we learn about an individual, and the more we learn about a behavior, the more we learn what was a truly positive experience — or a negative experience. Then we can take those learnings and activate them in the right moments.
We just don’t have the tools yet to actively listen and understand how to get to a higher level of personalization. Most of our investment is now going to figure out what we need to be actively listening.
It’s always impressive to me when something pops up on my Amazon cart as a recommendation. They know I want something before I even know I want something. What is the analogy in healthcare? It could be a service that I need and want, or a new option that would be attractive to me, that’s inherently personalized. We just don’t have the tools yet to actively listen and understand how to get to that level of personalization.
Most of our investment is now going to figure out what do we need so that we can be actively listening — and actively talking in the right voice to both our providers and our patients to drive better experiences. Those are the things that other industries, in my opinion, have a leg up on us.
We can do the functions but connecting those functions and getting to where we can design and cultivate simple experiences that people love — and drive loyalty and relationships – that’s the magic sauce.
Gain a Detailed Look at Patient
Gardner: It’s important to know what patients want to know, when they want to know it, and maybe even anticipate that across their experience. What’s the friction in the process right now? What prevents the ultimate patient experience, where you can anticipate their needs and do it in a way that makes them feel comfortable? That also might be a benefit to the payers and providers.
Erler: Historically, when we do patient surveys, we ask about the clinical experience. But maybe we are not asking patients the right questions to get to the bottom of it all. Maybe we are not being as intuitive as we could be with all the data we have in our systems.
It’s been a struggle from a treasury perspective. I have been asking, “Can we get a billing-related question on the survey?” That’s part of their experience, too, and it’s part of their wellness. Will they be stressing about what they owe on my bill and what it is going to cost them? We have to take another look at how we serve our patients.
We need to be more in-the-moment instead of after-the-fact. How was your visit and how can we fix it? How can we get that feedback right then and there when they are having that experience?
Gardner: It’s okay to talk about the finances as part of the overall care, isn’t it?
Healthy money, healthy mind
Gerdeman: Yeah, absolutely. We recently conducted a study with more than 150 providers at HealthPay24. What we found is a negative billing-financial experience can completely negate the fabulous clinical experience from a healthcare provider. Really, it can leave such a bad impression.
To Jennie’s point, by asking questions — not just around the clinical experience, but around the financial experience, and how things can be improved – allows patients to get back to their options and the flexibility is provided in a personalized way, based on who they are and what they need.
Semlies: The other component of this is that we are very organized around transactional interactions with patients, but when it comes to experience — experience is relationship-based. Odds are you don’t have one bill coming to you, you have multiple bills coming to you, and they come to you with multiple formats, with multiple options to pay, with multiple options to help you with those bills. And that is very, very confusing, and that’s in one interaction with the healthcare system.
If you connect that to a patient who is dealing with something more chronic or more serious, they could have literally 20, 30, 40 or 100 bills coming in. That just creates such an exasperation for our patients — and frustration.
Our path to solving this needs to be far less around single transactions and far broader. It demands that the healthcare systems think differently about how they approach these problems. Patients don’t experience one bill; they experience a series of bills. If we give them different support numbers, different tools, different options for each and every one of those, it will always be confusing – no matter how sophisticated the tool that you use to pay the bill is.
Gardner: So the idea is to make things simpler for the patient. But there is an awful lot of complexity behind the scenes in order to accomplish that. It’s fundamentally about data and sharing data. So let’s address those two issues, data and complexity. How do we overcome those to provide improved simplicity?
Erler: We have all the information we need on a claim that goes to the payer. The payer knows what they are going to pay us. How do we get more married-up with the payer so that we can create that better experience for our customers? How do we partner better with the payers to deliver that information to the patients?
How do we start to individualize our relationships with patients so we know how they are going to behave and how they are going to interact? How do we partner better with the payers to deliver information to the patients?
And then how do we start to individualize our relationships with patients so we know how they are going to behave and how they are going to interact?
I don’t know that patients are aware of the relationship that we as providers have with our payers, and how much we struggle just to get paid. The data is in the claim, the payer has the data, so why is it so difficult for us to do what we need with that data on the backend? We need to make that simpler for everybody involved.
Gardner: Julie … people, process, and technology. We have seen analogs to this in other industries. It is a difficult problem. What technologically and culturally do you think needs to happen in order for these improvements to take place?
Connect to reduce complexity
Gerdeman: It’s under way and it’s happening. The generations and demographics are changing in our society and in our culture. As the younger generations become patients, they bring with them the expectation that data is at their fingertips and that technology enables their lives, wherever they are and whatever they are doing, because they have a whole other view.
Millennials, the younger generations, have a different perspective and expectations around wellness. There is a big shift happening — not just care for being sick, but actual wellness to prevent illness. The technology needs to engage with that demographic in a new way and understanding.
Laura used the word connection. Connection and interoperability are truly how we address the complexity you referenced. Through that connection, the technology enables IT to be interoperable with all the different health systems hospitals use. That’s how we are going to solve it.
Gardner: We are also seeing in other industries an interesting relationship between self-help, or self-driven processes, and automation. They complement one another, if it’s done properly.
Do you see that as an opportunity in healthcare, where the digital experience gives the patient the opportunity to drive their own questions and answers, to find their own way should they choose? Is automation a way that makes an improved experience possible?
Gain a Detailed Look at Patient
Semlies: Absolutely. Self-help is one of the first things we first went live with using HealthPay24 technology. We knew the top 20 questions that patients were calling in about. We had lots of toolkits inside the organization, but we didn’t expose that information. It lived on our website somewhere, but it didn’t live in our website in a direct, easy to read, easy to understand way. It was written in our voice, not the patient’s voice, and it wasn’t exposed at the moment that a patient was actually making that transaction.
Part of the reason why we have seen such an increase in our online payments is because we posted literally, quite simply, frequently asked questions (FAQ) around this. Patients don’t want to call and wait 22 minutes to get an agent to hear them if they can self-serve themselves. And it’s really helped us a lot, and there is an analogy in that in lots of different places in the healthcare space.
Gardner: You need to have the right tools and capabilities internally to be able to satisfy the patient requirements. But the systems internally don’t always give you that single view of the patient, like what a customer relationship management (CRM) system does in other industries.
Would you like to have a complement to a CRM system in healthcare so that you have all the information that you need to interact properly?
Healthcare CRM as a way of life
Semlies: CRM is something that we didn’t talk about in healthcare previously. I very much believe that CRM is as much about an ethos and a philosophy as it is about a system. I don’t believe it is exclusively a system. I think it’s a way of life, an understanding of what the patient needs. You can have the information at your fingertips in the moment that you need it and be able to share that.
I think we’re evolving. We want to be customer-obsessed, but there is a big difference between wanting to be customer-obsessed and actual
ly being customer-obsessed.
The other challenge is there are some inherent conflicts when you start talking about customer obsession and what other stakeholders inside the health system want to do with their patients, but it can be really hard to deliver. When a patient wants a real-time answer to something and your service level agreement (SLA) is a day, you can’t meet their expectation.
We’re evolving. We want to be customer-obsessed, but there is a big difference between wanting to be cusomter-obsessed and actually being customer-obsessed. It can be really hard to deliver.
And so how do you rethink your scope of service? How do you rethink the way you provide information to individuals? How do you rethink providing self-help opportunities so they can get what they need? Getting to that place starts with understanding the customer and understanding what their expectations are. The you can start delivering to them in the way the patients expect us to.
Erler: Within our organization, there’s an internal cultural shift to start thinking about a patient as being a customer. There was a feeling of insensitivity around calling a patient a customer or treating this more as consumerism, but that’s what it’s becoming.
As that culture shifts and we think more about consumerism and CRM, it’s going to enhance the patients’ experience. But we have to think about it differently because there’s the risk when you say “consumerism” that it’s all about the money, and that all we care about is money. That’s not what it is. It’s a component, but it’s about the full patient experience. CRM tools are going to be crucial for us in order to get to that next level.
Gardner: Again, Julie, it seems to me that if you can solve this on the financial side of things, you’ve set up the opportunity — a platform approach, and even a culture – to take on the larger digital experience of the patient. How close are we on the financial side when it comes to a single view approach?
Data to predict patient behavior, experience
Gerdeman: From a financial perspective, we are down that path. We have definitely made strides in achieving technology and digital access for financial. That is just one component of a broader technology ecosystem that will have a bigger return on investment (ROI) for providers. That ROI then impacts revenue cycles, not just the backend financials but all the way to the post-experience for a patient. I believe financial is one component, and technology is an enabler.
One of the things that we’re really passionate about at HealthPay24 is the predictive capability of understanding the patient. And what I mean by that is the predictive analytics and the data that you already have — potentially in a CRM, maybe not – can be an indicator of patient behavior and what could be provided. And that will further drive in ROI by using predictive capabilities, better results, and ultimately a much better patient experience.
Gardner: On this question of ROI, Laura, how do you at Northwell make the argument of making investments and getting recurring payoffs? How do you create a virtuous adoption cycle benefit?
Gain a Detailed Look at Patient
Semlies: We first started our digital patient experience improvements about 18 months ago, and that was probably late compared to some of our competitors, and certainly compared to other industries.
But part of the reason we did was because we knew that within the next 2 to 3 years, patients were going to bring their expectations from other industries to healthcare. We knew that that was going to happen. In a competitive market like New York, where I live and work, if we didn’t start to evolve and build sophisticated advanced experiences from a digital perspective, we would not have that differentiation and we would lose to competitors who had focused on that.
The hard part for the industry right now is that in healthcare, relationships with a provider and a patient are not enough anymore. We have to focus on the total experience. That was the first driver, but we also have to be cognizant of what we take in from a reimbursement perspective and what we put out in terms of investment and innovation.
The question of ROI is important. Where does the investment come from? It doesn’t come from digital itself. But it does come from the opportunities that digital creates for us. That can be from the access tools that create the capacity to invite patients that wouldn’t ordinarily have selected Northwell to become new patients. It can mean in-house patients who previously didn’t choose Northwell for their follow-up care and make it easy for them to do so and then we retain them.
The questions of ROI is important. Where does the investment come from? It doesn’t come from digital itself. It comes from the opportunities that digital creates for us. We have actually increased collections and decreased bad debts.
It means avoiding leakage into the payment space when we get to things like accelerating cash because it’s easy. You just click a button at the point of getting a bill and pay the bill. Now I have accelerated the cashflow. Maybe we can help pay more than one bill at a time, whereas previously they maybe didn’t even understand why there was more than one bill. So we have actually increased collections and decreased bad debts.
Those are the functions that we are going to see ROI in, not digital itself. And so, the conversation is a tricky one because I run the service line of digital and I have to partner with every one of my business associates and leaders to make sure that they are accounting for and helping give credit to the applications and the tools that we’re building so the ROI and the investment can continue. And so, it makes the conversation a little bit harder, but it certainly has to be there.
Gardner: Let’s take a look to the future. When you have set up the digital systems, have that adoption cycle, and can produce ROI appreciation, you are also setting the stage for having a lot more data to look at, to analyze, and to reapply those insights back into those earlier investments and processes.
What does the future hold and what would you like to see things like analytics provide?
Erler: From a treasury perspective, just taking out how cumbersome it is on the back end to handle all these different payment channels [would be an improvement]. If we could marry all of these systems together on the back end and deliver that to the patient to collect one payment and automate that process – then we are going to see an ROI no matter what.
When it comes to the digital experience, we can make something look really great on the front end, but the key is not burdening our resources on the back end and to make that a true digital experience.
Then we can give customer service to our patients and the tools that they need to get to that data right away. Having all that data in one place and being able to do those analytics [are key]. Right now, we have all these different merchant accounts. How do you pull all of that together and look at the span and how much you are collecting and what your revenue is? It’s virtually impossible now to pull all that together in one place on the back end.
Gardner: Julie, data and analytics are driving more of the strategic thinking about how to do IT systems. Where do you see it going? What will be some of the earlier payoffs from doing analytics properly in a healthcare payer-provider environment?
The analytics advantage
Gerdeman: We are just starting to do this with several of our customers, where we are taking data and analyzing the financials. That can be from the discount programs they are currently offering patients, or for the payment plans they’re tying to collection results. We’re looking at the demographics behind each of those, and how it could be shifted in a way that they are able to collect more while providing a better experience.
Our vision is this: The provider knows the patient so well that in anticipation they are getting the financial offer that best supports their needs. I think we are in such an interesting time right now in healthcare. What happens now when I take my children to a doctor’s appointment is going to look and feel so different when they take their children to an appointment.
We are seeing just the beginnings of the text reminders, the digital engagement, you have an appointment, have you thought about this? They will be walking around and it’s going to be so incorporated in their lives — like Instagram that they are on all the time.
I can’t wait to see when they are taking their children — or not, right? Maybe they are going to be doing things much more virtually and digitally than we are with our own children. To me there will be broad cultural changes from how more data will be enabling us. It is very exciting.
Gardner: Laura, where do you see the digital experience potential going for healthcare?
Automation assists prevention
Semlies: Automation is key to the functions that we do. We expend energy in people and resources that we could be using automation for. Data is key to helping us pick the right things to automate. The second is anticipation and being able to understand where the patient is and what the next step should be. Being able to predict and personalize is the next step. Data is obviously a critical component that’s going to help you do that.
Gain a Detailed Look at Patient
The last piece is that prevention over time is going to be the name of the game. Healthcare will look very different tomorrow than today. You will see new models pop up that are very much moving the needle in terms of how we collect information about a person, what’s going on inside of their body, and then being able to predict what is going to happen next.
We will be able to take action to avert or prevent things from happening. Our entire model of how we treat wellness is going to shift. What primary care looks like is going to be different, and analytics is at the core of all of that — whether you’re talking about it from an artificial intelligence (AI) perspective, it’s all the same thing.
Our entire model of how we treat wellness is going to shift. What primary care looks like is going to be different, and analytics is at the core of all of that. But most doctors aren’t
getting that kind of information today because we don’t have a great way of sharing patient-generated health data yet.
Did you get the data on the right thing to measure? Are you looking at it? Do you have the tools to be able to signal when something is going off? And is that signal in the right voice to the person who needs to consume that? Is it at the right time so that you can actually avert it?
When I use my Fitbit, it understands that my heart rate is up. It’s anticipating that it’s because I’m exercising. It asks me that, and it asks me in a voice that I understand and I can respond to.
But most doctors aren’t getting that same kind of information today because we don’t have a great way of sharing patient-generated health data yet. It just comes in as a lot of noise. So how do we take all of that data?
We need to package it and bring it to the right person at the right moment and in the right voice. Then it can be used to make things preventable. It can actually drive an outcome. That to me is the magic of where we can go. We are not there yet, but I think that’s where we have to go.