We finally have all this data, now what? Healthcare providers are certainly asking this, and we’re still quite early on the maturity curve. In fact, it’s fair to say that most of the industry is just getting started. Why so cautious? Put simply, if consumers think that knowing our preferred shaving or orange juice brands is creepy (even if it improves your shopping experience), we can’t feel good about having it “out there” that we’re diabetic or allergic to latex. In other words, healthcare is really personal. Or at least it should be.
Modern healthcare, even before the much publicized Affordable Care Act reforms, is decidedly not personal. And with the ACA, many fear that the impersonalizing of healthcare could get worse before it gets better. But, despite sounding impersonal, “Population health management,” which seeks to manage all aspects of health from general wellness activities to complex care, will force many to reassess where they fit in a highly dispersed care coordination paradigm. It is no longer about a single episode of care; it must be holistic, perpetual.
In this new paradigm, the patient is the only constant. Comprised of electronic health records (EHRs), health information exchanges (HIEs) and so forth, the system now generates a swirling cloud of data (increasingly in “the cloud”) that must be harnessed. The key isn’t just more data, however, it's using what's already there, and that's going to take new approaches, training and thinking. A shift from fee-for-service reimbursement to pay-for-performance demands this now.
The healthcare industry is moving along a “care maturity curve,” but such a massive undertaking requires time. To better understand where we're heading, it helps to consider the necessary stages of progression along this curve: digitization, unification, attention, optimization, coordination and personalization (individualization), which is the pinnacle.
- Digitization – at this point we're getting the clinical data organized and making it accessible (EHRs); the effort at this stage is provider-centric, not consumer centric (that happens later)
- Unification – integrate and reconcile multiple data platforms that are often disparate and don't look like or talk to one another; begin to unify both Provider and Consumer access
- Attention – begin paying attention to what Consumers and Providers have to say; social listening, and opening channels for real-time feedback on care experiences and perceptions
- Connection – start to demonstrate action on the things we're listening to; make changes visible to Consumers and Patients; manage the mass customization of Consumer and Patient communication and feedback
- Optimization – now that we’re unified, listening, and connecting, let's begin to take the friction out of individual care processes; processes as simple as scheduling can be dramatically simplified for the Consumer; let's provide useful self-service tools and proactive alerts that simplify Consumer interaction with our organization
- Coordination – at this stage we're investing energy in managing experiences and outcomes across the continuum of care for individuals. We may, for example, proactively identify those at risk for type-2 diabetes and/or hypertension and create and coordinate personalized care plans for those individuals.
- Personalization/Individualization – now our care can be informed by much more than just the clinical data we have on any individual. When care is fully coordinated and personalized, the patient feels a shared sense of wellness ownership with the care team and will leverage personal resources to drive collaborative outcomes. Rich, easy, convenient access (portal, mobile, wearable) to health system resources supports this ongoing collaboration.
One early adopter riding this maturity curve is N.J.-based Virtua, the largest healthcare provider in southern New Jersey. Virtua is using the Microsoft Dynamics CRM platform for its transition, preparing for the challenges of becoming an accountable care organization (ACO) under the ACA. Today, Virtua is in the “coordination” phase on the maturity curve.
What organizations like Virtua are trying to accomplish is nothing short of massive transformation. The Retailing of Healthcare will be largely consumer-driven, and providers will increasingly be challenged to attract and manage profitable consumer relationships in the same way that Nordstrom or Target or Walmart must (and they’ve got to decide if they want to make the investment to be Nordstrom-like provider or make a lesser investment and become a discount retailer).
A consumer-driven healthcare system will require dramatically different approaches to care and is far more challenging than simply retrofitting CRM technologies to work in this new paradigm. Providers must develop creative solutions – and keep creating them – that drive consumer engagement, from GPS wayfinding that help patients locate the new specialist in an offsite facility to mobile device applications that help patients actively manage their diet and exercise regimens.
What providers are attempting to deliver is “quality consumer engagement,” and this goes beyond managing episodes of illness to instead building engagement processes that are meaningful to healthy individuals too. In fact, providers must create solutions that are at the epicenter of a consumer’s life, delivering a “perpetual wellness relationship” that creates much tighter alignment between patients and providers through big data and channels consumers use.
Consumer-driven healthcare won’t be easy on providers – they’ll need to be more agile. And they’ll require new platforms that digitize, unify and coordinate processes in ways that leverage “big data,” but do so in a way that delivers an experience that truly feels – and is – personalized to each patient.