Top retail, hospitality and even finance companies employ customer experience as a brand differentiator, but superior experience as strategy is just starting to take hold in health care. Rising out-of-pocket costs and more transparent data on price, quality and experience have prompted patients to begin to scrutinize health care purchasing decisions in a way not previously experienced by the field.
As a result of this rising consumer interest in health care, provider organizations are adjusting their strategies to ensure consumers recognize value from their services. But, perceived value is a tricky thing: it’s often driven more by wait times, ease of access and patient-centered care than it is by true clinical quality. And, whether or not patients perceives the care they receive as centered around them is determined by a number of factors. Some — like workflows — are fairly obvious, while others — like the language used by caregivers — is more subtle.
At the AHA Health Care Systems’ Constituency Section Annual Retreat in Phoenix in October, a group of health system CEOs gathered to discuss their role in moving their organizations toward value-based, consumer-friendly practices. The discussion was moderated by Lindsey Dunn Burgstahler, director, Health Forum, the publisher parent of Hospitals & Health Networks, and sponsored by Siemens Healthineers.
Betting the Brand on Patient-Centeredness
While health care organizations have traditionally differentiated their brands by touting technical competencies, Hartford (Conn.) HealthCare is betting big on a strategy of patient-centered, coordinated care. Elliot Joseph, CEO of the health system, believes this approach will differentiate the organization from other health care providers in the region.
As a result, the system’s leaders are shifting capital investments toward care coordination and related activities, rather than continuing the predominant focus on buildings and technology.
“We’re building a very tightly integrated operating company around the full continuum of care,” said Elliot Joseph, CEO of the system. “All the investments we’re making on new people and new technologies are to manage care more effectively.”
Bart Hove, president and CEO of Wellmont Health System, based in Kingsport, Tenn., said his system’s strategy is also shifting away from investments to drive volume. “I think the old model, where you were driven by volume and by having the latest and greatest technology, I think that is in process of changing,” he said.
These same trends are pushing Siemens to rethink its longstanding business model as a manufacturer of diagnostic imaging equipment, said David Pacitti, president, Siemens Medical Solutions.
“We are exploring how we can get closer to the delivery of therapy and help — especially with regards to imaging —improve outcomes,” he explained. “Is there is a way we can help you manage your patients better? We have been very focused on making the latest, greatest technology, and we are still going to work on that. But we know it’s not the most important thing: outcomes are.”
No Longer Counting ‘Hospitals’
As health systems shift strategy away from hospital-based, Joseph believes it’s important leaders change their language to reflect the movement toward a continuum of services. “I've gotten into some new habits, and one is I don’t talk about how many hospitals we have,” he explained. “We’re moving away from thinking of ourselves that way, and the way I speak about it is important.”
Nancy Howell Agee, president and CEO of Carilion Clinic, in Roanoke, Va., agrees the words leaders use are important in setting a tone and establishing the culture of an organization. “We’re not eliminating the word ‘hospitals,’ but it’s secondary to us.”
Patients Don’t Seek a ‘Continuum’
With more care based outside of the hospital, health systems must help the consumer navigate that care. If consumers are forced into an uncoordinated journey that’s challenging to make sense of, they’ll become disillusioned, and they may seek other providers with better coordinated care.
Many hospital leaders recognize this and have made establishing a continuum of care — either through ownership or partnership — a strategic pillar. However, Agee warns against actually using the term ‘continuum.’
“I’ve eliminated the word continuum,” she said. “I don’t think patients come to us to be put in a continuum. I prefer calling it a ‘constellation’ of services.”
As part of offering a continuum, or constellation, of coordinated care, many provider organizations have realized the need for increasing patient outreach. “Bundled payments have caused hospitals to increase the touchpoints they have with patients, which increased personnel,” said Tom Kearney, vice president of business development, Siemens Healthineers. “Some systems have had to add two new touchpoints to ensure that from the diagnosis, to the admission, to the discharge, the patient was getting all the care that they needed.”
Michael Slubowski, president and CEO of Denver-based SCL Health System, said his system has hired care navigators to help coordinate care. “With bundles, or anything you do in a managed program, you have to connect things in a way you didn’t connect before,” he said. “You have to build a very conscious connection across the continuum to support the patient.”
Coordination and access is top of mind for Rich Gilfillan, M.D., president and CEO of Trinity Health, based in Livonia, Mich. “Easy access, good communication. It’s all those basics that are important to the consumer,” he said. “We are optimizing how we communicate with patients and get them what they need. With [our patient portal] we can let people self-schedule their appointments, and it allows for rapid communication between the patient and primary care physicians and specialists.”
Discontinuing the Use of ‘Discharge’
Many hospitals are also rethinking their approach to discharging patients. Discharging a patient used to mean the hospital’s connection to the patient was done; that’s no longer the case.
“I’m trying to eliminate the word discharge from our vernacular,” said Joseph of Hartford HealthCare. “We’re using transition, which is modestly better.”
In addition to hiring navigators to coordinate care, SCL Health has also been using them to help patients manage chronic conditions while at home — a site of care that will become more and more common as payment shifts to bundled arrangements. “Often, the only way you can deliver quality care below the bundled payment rates is to discharge to home,” said Slubowski. “For example, in orthopedic bundles, we’ve focused on linking our home care company to our orthopods so those doctors, and their patients, can access our home care services and manage their rehab at home.”
Care navigators, and similar resources, start to move the field toward a response to consumerism already exhibited daily by other industries: predicting and acting on consumer needs — even before the consumer goes looking for a service.
“If our response to consumerism is only patient portals, self-scheduling, and allowing patients to more easily communicate with their doctors, the emphasis is still very much on the consumer, instead of us making navigating health care easy for them,” said Agee of Carilion Clinic.