As healthcare providers, health plans, and new entrants into the healthcare competitive marketplace, such as retail pharmacies and non-healthcare-based technology companies, all rush in to try to capture healthcare consumer mindspace at a time of great tumult and change in U.S. healthcare, what strategies must traditional providers—hospitals, medical groups, and integrated health systems—employ in order to thrive in the emerging healthcare landscape?
According to Mark Werner, M.D., national director of clinical consulting, and Raphe Schwartz, national practice leader for strategy practice, at The Chartis Group, the Chicago-based consulting firm, the answer is going to lie in systems of engagement with healthcare consumers. The Minneapolis-based Werner and the Denver-based Schwartz spoke recently with HCI Editor-in-Chief Mark Hagland regarding the current moment in healthcare, the race to engage healthcare consumers/patients, and the implications of that race for healthcare IT leaders. Below are excerpts from that interview.
You gentlemen have been involved in broader discussions recently around patient and consumer engagement in healthcare, correct?
Raphe Schwartz: Yes. We have a perspective that really, the battlefield for consumers is moving upstream, and it’s the confluence of improved access to information through technology and improved access to quality and cost data, and together, those things are moving towards consumers. And consumers are increasingly responsible for some of their costs, so health systems need to advance a coordinated set of activities to address consumer needs in the emerging healthcare. And we call that coordinated set of activities, systems of engagement.
Would you agree that such considerations are particularly coming to the fore in the context of risk-based contracting, such as in the development of accountable care organizations and other contracting, and moves towards population health management-based care delivery?
Schwartz: You’re right, this move towards population health management and value-based contracts really provides an opportunity for providers to take responsibility for patients’ needs. At the same time, there are benefits to systems of engagement even in traditional fee-for-service contracting. And health plans and health systems are creating what I call close-the-loop systems, and even in FFS contracts, they’re creating narrow network-based contracts, so even there, this is happening.
Mark Werner, M.D.: Raphe said it very well: one of the core competencies in population health or accountable care will be the ability to engage patients. At the same time, it’s no longer possible for me as an individual provider to have a relationship only with the plan or employer I’m contracting with; I need to have a relationship with the patient/consumer. For healthcare consumers and patients, as they move into needing specialty-level care, they need more information about their health and their care. But the playing field between the patient and doctor is increasingly being leveled in favor of patients, in terms of the information available to patients from a variety of sources, and the points of access to care becoming available to them [such as via minute clinics, retail pharmacy-based clinics, etc.]. So providers need to realize that that dynamic is evolving forward. And now as a consumer, I could actually stay with the same provider through a variety of different health plan and other arrangements, so there is opportunity in that.
Mark Werner, M.D.
So we’re talking about providers moving to engage patients or consumers in relationships that can maintain continuity across health plan arrangements and care settings, then?
Schwartz: There are ways health plans need to engage with consumers when they make their health plan selections, but also when consumers are choosing providers, managing their care, and so on. Today, when consumers are making insurance product decisions, often those insurance products will include or exclude one of the health systems they may want to access, so it’s important for health systems to be communicating with and engaging consumers at that point of the process, as well as at other points in their interactions with consumers.
Werner: What Raphe’s alluding to is that providers have often stood behind the payer as the payer goes about engaging in engagement activities, but that’s changing now. Because there could be some tremendous implications for the provider if they don’t step up and move to [strengthen their relationships with consumers].
What does that mean in practical terms, with regard to providing healthcare consumers/patients with a different set of experiences?
Schwartz: When we talk about a coordinated set of activities, we mean engagement with technology, but also creating exceptional access to care services, providing care management across the continuum of care, providing a very broad geographic network for care delivery, and providing engagement across the whole healthcare system. The entire healthcare system has to create this coordinated system of engagement.