Healthcare is one of the few industries that has not embraced customer relationship management (CRM) - yet. But as revenue streams dry up, no potential stone can be left unturned. Today, some hospitals are beginning to look at the business world for financial answers, and adopt CRM models. Though, as with everything in the healthcare vertical, the model of CRM is a little different in the hospital setting.
“When you talk about CRM, in general there is a tendency to have some misunderstandings. Often, people in the same organization and even the same meetings don't have the same idea of what CRM means,” says Tom Foley, a principal with New York-based Deloitte Consulting LLP's Healthcare Provider practice. “For us, CRM means managing the patient's relationship, enhancing the experience, helping improve the bottom line - and the strategy, operations and the technology to support that.”
Foley adds that though many hospitals have initiatives that could be considered CRM, most shy away from using that label.
And though marketing initiatives can also fall under the CRM umbrella, most CIOs, naturally, defer that function to the hospital's marketing or public affairs department. For example, at Sharp HealthCare, a four-hospital system in San Diego, CIO Bill Spooner directs questions in that space to his vice president of customer strategy, Sonia Rhodes, who runs the Sharp Experience program. Under the program, CRM initiatives are handled as customer loyalty activities, which is seen as a more appropriate approach in the healthcare setting. “We've got to listen to our customers and we've got to engage our employees in a way that makes it meaningful for them too, and that is what we've had our success with,” Rhodes says.
CRM and PHI
“When you think about it, healthcare is not a free market,” says Chad Mulvany, technical manager at the Westchester, Ill.-based Healthcare Financial Management Association. “There are a lot of prohibitions on what you can and can't do with patient information.” He's referring, of course, to the Health Insurance Portability and Accountability Act (HIPAA) privacy regulations, explaining that integrating a CRM application into a medical record would require some very tight restraints. Mulvany adds that he would be hesitant to even inform patients about new products and services. “If I was going to embark on any CRM initiative,” he says, “I would have my compliance and legal folks look at it to make sure we aren't in any kind of gray area; get it thoroughly vetted.”
Foley agrees that HIPAA privacy and regulatory issues necessitate sensitivity in the space, but says it is still possible to adopt some CRM principles in a hospital. “There are two integration points - the EMR and patient accounting,” he says. “You're not going to see too many providers willing to share the episode and diagnostic items, but there would be some integration in terms of when the episode took place, tracking dates and number of encounters.” What that means is patients who haven't been seen for a while may wind up getting a call from the hospital.
Hospital payment structures have also had an impact on the slow adoption of CRM, but as healthcare reform gains steam, and transparency becomes more pervasive, that may change. “The whole culture around how we deal with healthcare is set around things that are old school,” says Scott MacLean, CIO at Newton-Wellesley Hospital, a 289-bed community hospital in Newton, Mass., part of Boston-based Partners Healthcare. “People are used to the physician being all powerful and the physician charts being sacred,” but, he says, this may soon change. He also points out another key differentiator: “It's not approached as a business because people don't pay for their healthcare, so they're not the interested party.”
MacLean says another dichotomy between traditional CRM business models and healthcare is the driver. “The goal of CRM in business is to increase spending, but in healthcare, we want to decrease spending.” He says that to be effective in the hospital setting, CRM should be viewed as helping patients make better choices, for example, in things like health maintenance.
Some hospitals are leveraging software from vendors like New York-based Thomson-Reuters Solucient, a database subscription service. Under the auspices of the marketing department and Rhodes, Sharp HealthCare uses Solucient's databases for a target marketing analysis.
“In the old days, we used to be able to say, ‘Let's cull the database for people with a propensity for this and this and this,’” says Rhodes. “That became illegal, and we aren't allowed to target based on any utilization information.” (Under HIPAA, patient identifiable information cannot be used to send marketing materials - see sidebar). She says that now a small part of Sharp's CRM program involves generating lists of patients based on lifestyle attributes that databases like Solucient provide. “It does help us from a direct marketing perspective,” says Rhodes. “But if you want to know what's having a bottom line impact for us, that's not the driving force - it's to create the healthcare experience customers have been telling us they want.”