Health systems across the country are focused on digital transformation with an eye toward lowering costs and improving access to and quality of care. At Seattle-based Providence St. Joseph Health, technology leaders are making significant advances in the health system’s digital journey, offering robust capabilities that empower patients to become more active participants in their own health.
Aaron Martin, executive vice president and chief digital officer of Providence St. Joseph Health (PSJH), is a key player in driving digital innovation across the health system. Martin is responsible for the digital, web, mobile and online marketing channels for PSJH, and he also serves as managing general partner of Providence Ventures, a $150-million-dollar healthcare IT venture fund. A former Amazon executive for 10 years, Martin also previously worked at McKinsey & Company, and he was an executive/founder of two early-stage technology companies funded by New Enterprise Associates and Mayfield.
PSJH is a health system that includes Providence Health & Services and St. Joseph Health, with facilities in Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. PSJH has 119,000 caregivers who serve 50 hospitals, 829 clinics, and hundreds of programs and services.
Martin joined PSJH four years ago, and since that time, the health system’s digital team has been keenly focused on leveraging technology to provide patients and consumers better access, convenience and personalization. Martin brings his unique experience and expertise in consumer-facing digital technology to healthcare. “Traditionally healthcare, on the provider side, has been a B2B (business-to-business) industry, so traditionally not focused on consumers. For 10 years I worked at Amazon and now I’m bringing in that focus on the consumer and looking at it from the perspective of, how do we engage with patients, especially in a digital context? It’s about setting a high bar for customer service to our patients and to our consumers who are working with us,” he says.
One of the significant hurdles facing patient care organizations in this ongoing digital transformation journey is meeting consumers’ expectations, and at a time when the healthcare industry is generally behind the digital curve.
“Consumer expectations are such that consumers, and particularly Millennials, are not going to put up with this notion that I have to make a phone call to do anything. They want self-service wherever they can possibly get it; the expectation of the consumer is that you should be able to find and schedule a physician or a clinician appointment just as easily as you can make a restaurant reservation on OpenTable. There’s just a higher bar of expectations out there, which I think is great,” Martin says.
Technology leaders at PSJH are addressing these challenges, with a focus on building digital capabilities that ensure the health system continues to own and drive patient experiences and relationships, while also addressing the broader set of strategic problems for different patient populations.
Driving Digital Engagement
Foundational to PSJH’s digital strategy, Martin says, is delivering a ‘10x better experience’ online to entice healthcare consumers to work with the health system online, as opposed to offline. Once the health system has interacted with patients online, the second aim is to engage on an ongoing basis through a personalized health platform.
“Your digital experience has to be 10 times better than your offline experience to cause consumers to change behavior. Think about technologies such as Netflix, Amazon and Lyft, those are an order magnitude better experiences than what they replaced, and that’s what is needed to cause consumers to change their behavior.”
With this in mind, the health system’s digital team built PSJH’s Express Care suite of services for non-emergency, low-acuity care. As part of this suite of services, PSJH offers 33 Express Care Retail clinics to provide same-day visits as well as the Express Care Virtual platform enabling patients to see a nurse practitioner from their smartphone, tablet or desktop computer. Also, the health system launched Express Care at Home, a service that enables patients in the Seattle market to summon a provider, through an online platform, to come to their home or office to provide healthcare services.
According to PSJH, Express Care is projected to have well over a hundred thousand visits in 2017 with over 10,000 coming in digitally through Virtual Visits and At Home Visits. Net promoter scores, an indicator of customer satisfaction, for Express Care range from ~65 to ~85, on par with major technology companies like Apple and Amazon, Martin says.
The next challenge that Martin and the digital team tackled was finding ways to engage consumers an ongoing basis. “Healthcare is challenging because unlike other industries and services we use as consumers, there isn’t a natural engagement model that is frequent. Healthcare consumers and patients often only interact with the system episodically if ‘something is wrong’. How do you create that engagement between episodes of care?”
Martin continues, “Some industries and some companies have naturally occurring engagement models that are better than healthcare. We’re based in Seattle, so just down the street is Starbucks, and I use their product every single day. So, when they are transitioning me to an online state, by using their app, they have an engagement model that is just naturally occurring, because it’s daily for me.
PSJH has developed two digital platforms—Circle and Xealth—to promote more frequent consumer engagement. Circle by Providence is a personalized platform which delivers content, products, and services for women to help them manage their health and the health of their families. The Circle app is targeted to the female head of household, who Martin refers to as the “chief medical officer of the home.” “She controls about 90 percent of the healthcare spend, not only for her family but also extended family,” Martin says.
The key to this platform is personalization, he notes. Personalization is driven either through a connection to the patient’s electronic medical record (EMR) or by the woman providing information about herself and her family. The resources Circle offers continue to grow with new, relevant information continually being added. The platform drives digital engagement in much the same way as the Amazon Prime platform.
“If you look at Netflix, Amazon and all these other e-commerce platforms, they have a personalized engine riding on top of them that basically says, ‘We’ve noticed you like this product, this movie, can we be helpful to suggest this other content for you?’ That’s exactly what this platform does.”
Another way PSJH is driving digital engagement is through Xealth, a digital prescribing service. One challenge facing clinicians is they can’t prescribe digital apps, services or products to their patients in the same way that they prescribe medications right from the EMR. “How do offer your patients the vast array of different applications, content, products and services that are out there, without having to build it all yourself? We can’t out-innovate the marketplace,” Martin says. As an example, a clinician may want to prescribe a digital diabetes prevention program, such as Omada, to a patient. In most cases, clinicians must do this outside of the EMR and outside of their existing workflow.
Using the Xealth platform, clinicians can prescribe digital care just as they would a pharmaceutical, directly from their EMR, Martin says. The platform provides a simple, continuous connection back to the health system ecosystem and existing portal. The clinician also can see if the patient has taken action on what was prescribed right in the EMR workflow. “The patient is going to the virtual drug store to pick up whatever it is their physician has recommended, and then we have an opportunity as they are ‘walking’ through that virtual drug store through our portal app to show them other products and services that we just launched that may help them in their next episode of care,” he says.
Martin notes that foundational to this digital journey is establishing an accurate catalog of providers, or a “source of truth” for physician directories. To address this challenge, the health system implemented solutions from Boston-based startup Kyruus, which uses analytics to help hospitals match and schedule patients with appropriate providers.
“Having an accurate physician directory sounds like a small problem to solve, but it’s not, it’s a massively complicated problem. We have 20,000-something clinicians on the Kyruus platform, and I think, 10,000 or so of those we employ, and the balance of them are affiliated, so they might just have credentials in our hospitals. So, it’s about making sure the clinicians still work there, have credentials, and then what’s their scope of practice,” Martin says.
Kyruus offers an enterprise-wide platform that integrates patient access applications and the provider data management platform, which enables health systems to optimize patient access across points of entry, with the same provider data appearing in each channel. The result is consistent information across the enterprise, more precise patient-provider matches, and a better patient experience.
Improving Healthcare Access, Convenience
For patient care organizations, building better digital platforms can help to address larger healthcare challenges around patient access to care and convenience. While some healthcare leaders worry that increasing access will drive up utilization, Martin says he holds a contrary view.
“I think if you can lower the cost of care and make it more prevalent, you’re going to lower the overall cost to healthcare. I think there’s a lot of disfunction that happens due to lack of access,” he says. “A lot of the work that we’re now doing is around taking that convenience platform, with Express Care, and we’re starting to retool it and refocus it toward the Medicaid population.”
Martin notes that it’s common for Medicaid patients, due to issues with access to primary care, to utilize the ED for low-acuity, primary care visits. In some of its hospital emergency departments, the health system is experimenting with offering visitors to the ED the option of a video visit to address low-acuity health issues.
“We’re looking at these other technologies to improve access and drive down the economics of delivering care. We’re starting off with low acuity, and you’ll see us work more in primary care and parts of specialty care as well,” he says. “Our mission, fundamentally, is to serve the poor and vulnerable; inconvenience hurts lower income patients much worse than middle and upper income. If you’re asking someone who works an hourly job to take a day off work to go to a primary care clinic, that’s a day’s wages. If we can create an offering where he or she can pick up phone and allow us to triage whatever complaints he or she may have over a telehealth visit, then that helps those patients.”
More broadly, driving digital engagement also enhances population health efforts as well, Martin contends. “If you have great digital engagement with patients across different patient populations your ability to deliver population health is enhanced dramatically. Today, how population health happens is, typically, you have people intervening by calling people during dinner and doing case management. If you’re constantly engaged with them digitally, you can be a lot subtler in terms of encouraging them to try healthier habits and to access care in a different way,” he says.