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Behind Providence St. Joseph’s Daring Push Into Digital Consumer Engagement

November 5, 2018
by Mark Hagland, Editor-in-Chief
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Providence St. Joseph’s Aaron Martin shared insights on the success of his organization’s digital consumer engagement strategy

On October 23 at the Health IT Summit in Seattle, sponsored by Healthcare Informatics, Aaron Martin of the Renton, Washington-based Providence St. Joseph Health, shared with attendees his organization’s vision of a digitally connected consumer population—and what he and his colleagues have done to achieve that vision.

Martin joined Providence St. Joseph Health—which encompasses 51 hospital facilities across seven western states—Washington, Oregon, Alaska, Montana, California, New Mexico, and Texas—as chief digital officer in January 2014, and has been helping to lead a team of 200-plus Seattle-based software engineers and programmers and marketing professionals, in the health system’s push to engage patients, families, and communities.

Speaking to the audience gathered at the Grand Hyatt Seattle, Martin, who spent several years at the Seattle-based Amazon, spoke to attendees on the subject “Disruption from the Inside: Why Digital Matters: Lessons I Learned from My Time at Amazon.”

“I get asked, what lessons did you learn at Amazon over ten years that you can apply to healthcare?” Martin said. “First, healthcare has got many, many, many, many, many, many problems—so you have to decide where to start. There’s limited bandwidth to solve all the problems. It sounds a little weird to say that we have to go top-down, but that’s what we’ve been doing at Providence. U.S. healthcare is so big, that it’s the fifth largest economy on the planet,” he noted, pointing to a slide that showed the size of the U.S. economy at $19 trillion annually, the economy of China at $12 trillion, the economy of Japan at $4.3 trillion, the economy of Germany at $3.1 trillion—and the size of the U.S. healthcare system larger than that of the German economy, at $3.2 trillion per year.

Aaron Martin

As a result, Martin said, “You have to pick and choose” which issues to tackle. What’s more, he told his audience, “You’ve got to innovate at the end of the value chain. Amazon started with books.” Historically, the value chain around book publishing involved the following stakeholder groups: authors, publishers, distributors, bookstores, and readers. “And we learned that only two members of that value chain matter; everybody else is expendable,” Martin said. “And if someone can figure out how to disrupt that value chain, you can reduce friction and create value. People think that Amazon disrupted bookstores; they didn’t; they disrupted the value chain.”

As a result, he noted, “Amazon literally carries tens of millions of titles now, because of Kindle. Distributors quickly went away because Amazon became its own distributor. The second thing that happened was self-publishing, and then, e-commerce. The value proposition in the past was that you’d work hard on a book and submit your manuscript to a publisher. And if you were lucky enough to get published, you’d get 5 to 10 percent of the net. And the publisher really couldn’t provide a worse marketing experience,” he noted. “So at Amazon, we created a situation where you could publish a book in print and digitally, on demand, globally. And we only charge you if you sell a book? And guess what? You get 30 percent of net. So Amazon totally disrupted that. And Kindle got rid of the last-mile problem. I can be sitting on a tarmac and get a book on my Kindle in 30 seconds. Amazon methodically went through the value chain and got rid of the middlemen.”

Importantly, Martin told his audience, “We’re in the same situation in healthcare. Physicians and nurses are necessary, and patients are necessary. Everyone else is expendable. How do we collapse and create a frictionless environment, at scale, to allow physicians and nurses to give care to patients?” That, he said, is the key question for the healthcare delivery system going forward—the transformation of the delivery system towards a truly customer-centric model.

“So how are we going to that at Providence St. Joe’s?” Martin asked. “Most of the healthcare system is beginning to move past the hospital-centric mindset. We realize that patients are at the center, and that we have to push care closer to the patient. Health 2.0—specifically, we’ve eliminated the word ‘care’—it’s about health. So at Providence St. Joe’s, we’ve got to eliminate the healthcare system and be a health system. If you look at any e-commerce company like Google, Apple, they created a daily habit of connecting with consumers. My job is to take an offline consumer experience and make it an online experience. And we’ve got a huge lift on my team, because we see patients an average of two-and-a-half times a year. Look at Starbucks: they’ve got an ongoing engaged experience online” that often involves daily interactions between consumers and Starbucks. “So we’ve got two big lifts: we have to both get patients online, and engage them.”

Martin cited six key “digital journeys” involved in moving to “health 2.0”:

> Caregiver-facing interactions: “How do I turn technology from a buy into a feature for caregivers?
> “How do I simply care for consumers
> “How do I enable revenue streams?”
> “How do I grow commercial share?”
> “How do I better serve Medicaid patients?”
>“How do I better enable behavioral health?”

When it comes to developing a digital innovation model, Martin told his audience, “We take those six journeys and we mine them for opportunities. Our digital team works with our customers, the owners of our businesses, and we define problems. It sounds easy, but is hard to do. Here’s where you know you’re not defining a problem—when you call a project by the vendor’s name,” he said. “Then,” he said, “we size and prioritize these problems—again, that’s something easy to say, hard to do.”

The next step? It’s “what we call the tech cascade,” Martin said. If an existing vendor solution already in place can be used, it is simply used. If the organization doesn’t own a solution, “We’ll go out and search for a solution. That’s where we use a company called Avia, that helps us solve problems. And then what happens is, Providence Ventures, the venture team I run, gets involved. So they’ll determine whether we want to invest in a company, because we’ll add a ton of value b being an early investor. That’s where we’ve ended up with a portfolio of ten companies we’ve invested in.”

Next step in the “tech cascade”? “If we don’t already have something in place, and can’t find it in the market, we’ll build it,” Martin told his audience. “I’ve got about 120 people, 85 of whom are software engineers, down the street in downtown Seattle, some from Amazon and Microsoft, and we build solutions. We’re going to scale something up and prove value; get it in front of as many customers as possible. Secondly, we’ll actually sell that solution to another health system, and once we’ve done that, we’ll spin it out to another company. The first was Xealth, we spun them out a year ago June. That allows you to prescribe anything not a pharmaceutical, from the EMR. I can prescribe a lift ride, a digital app, content such as a knee brace, anything that can be sold retail. We also spun out a company called Circle.”

Putting it all together

“We’re a mission-based non-profit,” Martin emphasized to his audience. “And why do we care about our commercial business so much? When I say ‘commercial business,’ I mean private insurers and employers, everything that’s not Medicare or Medicaid. In the U.S. healthcare system, we make money off commercial contracts, and subsidize Medicare and Medicaid. So the commercial insurance business is oxygen to our system.” One key element there, he said, is thinking strategically about how to use technology to connect with patients as healthcare consumers. Disruptors like the new CVS-Aetna organization that is merging a nationwide retail pharmacy company and a nationwide health insurer, promise to challenge traditional patient care organizations, he insisted. Speaking of those organizations and others, he said, “All these disruptors are going after the best part of your business; it’s called cream-skimming. Jeff Bezos used to say, ‘Your margin is my opportunity.’” Meanwhile, he noted, “There are technology companies with literally millions of existing, strong relationships” with consumers—consumers who are using their smartphones on average about three-and-a-half hours a day.

Per that, Martin said, “When we’re talking about digital, we’re really talking about changing the business model. The issue with new technologies like telehealth, artificial intelligence, etc., is that version 1 is taking new technology and applying it to existing models, and it doesn’t work well. So for us, it’s not just the technology, it’s how you acquire patients, how you engage with them, how you make the platform efficient on the back end, and how you engage them in the continuum.”

And so much of success, Martin told his audience, will depend on engagement. “How do you engage patients on Google?” he asked. “We built a platform that’s optimized for web search. The key takeaway? We’ve achieved a nine-times increase in appointments and starts, just by applying this platform, attuned to how Google works. The other thing we’ve done,” he added, “is that we’ve stepped this up as if it were an Expedia experience. We don’t make you fill out a huge form, we delay the acquisition of data until the last minute, until you’re ready to book. You go into the physician detail page after search (SEO/SEM, primary care/specialist), we take you through that process, land you on a detail page, have you book online, schedule a visit, and then have you download the IOS/android app.”

And, Martin added, “We’ve also started to experiment with AI, to launch an express care assistant virtual assistant, we call Grace. We’re looking to make her smarter and smarter and smarter.” And the results have been quite noteworthy. “Thirty percent of our consumers are new in-clinic, and 40 percent are new virtual customers, he noted. Meanwhile, with regard to customer retention, he said, “With regard to returning consumers, 20 percent of our in-clinic consumers are returning customers, and 17 percent are new virtual consumers.” What’s more, 55 percent of clinic patients booked online, a 10-fold growth in online engagement since the program began, while 80 percent of those patients coming through digital channels are commercial insureds.

Wildflower: A Focus On Women Consumers

One of the key areas of success at Providence St. Joseph has been with it Wildflower program. “Wildflower focuses on the female head of household,” Martin explained. “She controls 90 percent of household healthcare spend. She is basically our customer. We need to understand how she thinks, and to engage her.” Wildflower was initially designed to engage women from preconception through fertility, through the first 100 days after childbirth; and has since been expanded to engage women across their adult lifetimes. That program, he noted, has been wildly successful.

A week after his presentation at the Health IT Summit in Seattle, Martin spoke on the phone with Healthcare Informatics Editor-in-Chief Mark Hagland, to share additional information and insights. Below are excerpts from that interview.

Can you tell me more about the Wildflower program?

So Wildflower, what they do—this is the second spin-out I mentioned. We go through rank lists, where we prioritize six different digital or technology journeys where we could move the needle. And we work with the business owners to prioritize what they want to accomplish. And we do problem definition, and get a team focus on the problem we’re solving, and we walk it through a tech cascade. Do we already have a license with Microsoft or some other company, for example? If not, we’ll go out and look for best-of-breed, and if we can find a best-of-breed existing solution, we’ll use that. And then if we don’t have it and can’t find it, we’ll actually build it. My team is based in Seattle, and we’ve built a fairly large team of 200 people, software engineers, marketers, etc. And we build these as businesses. And the reason why is because we want to spin them out to finance their own road maps. So it’s sort of like an incubator, but we tend to “cook” them a little bit longer. We’ll implement and scale, and to test the market, we’ll test them with one or two health system.

So the first spinout was Xealth, a year ago in June. And then the second spinout was Circle, which we merged with Wildflower. What it is is, we had built a women’s health platform that basically curates content, products and services that an expectant mother might need from the health system, and allows her to book prenatal visits, then well-baby visits, and then it follows her throughout her life. The Wildflower thing does the same thing for payers and employers. We had three customers: ourselves, Sutter, and OSF (in the Midwest). So we merged these two businesses together. And it made total sense. And Leah (Sparks), the CEO of Wildflower, and I got very excited about the idea that an expectant mother and the female head of household is by far the most powerful person in a household. She controls her own spending, as well as that of her kids, her partner, her adult parents. So we built the platform to build a relationship with her, and that’s why we started Wildflower. But what we got really excited about was the intersection of those worlds, to help Mom get things done for her family. She could get curated content from our experts; she could be getting information about her charges and benefits from the health plan; and about what programs the employer was providing to support her. It’s a three-way intersection. So that’s exciting.

We’ve been working on this for five years. I always like to tell people, this is not magical.

For CIOs, CMIOs, marketing, web development, patient engagement leaders, what have been key lessons learned?

I think the first thing is that I would tell them, use the fact that healthcare is very regional, to your advantage. So a lot of the progress we made was simply by collaborating with a ton of other health systems, and learning from their learnings. We’ve met with 80 health systems in Seattle over the past several months (out of about 400). And we’ve really leveraged the fact that we’re a big health system that covers seven states, but that we don’t compete with the 80 we’ve been meeting with. And that’s different from a consumer-facing company in the outside world. I worked with Amazon, and would have been fired instantly had I reached out to Google, right? So that’s an advantage in healthcare.

Second, don’t build anything when something already exists. If somebody else has figured something out, just use it.

And then the last thing is, follow from other industries. How we’re structured—the division of responsibility between me and the CIO, how marketing reports to me as chief digital officer, is kind of settled law in other industries. You’ve got tons of industries dealing with disruption for over a decade, and they’ve had plenty of time to think through the chief digital officer role, and the CDO reports to the chief marketing officer, or vice-versa. And there’s a very close interaction and relation between the two roles, and they’re all very customer-focused; whereas our CIO is very focused on the B2B relationships, and relationships with plans and enterprise systems. And if I can be judged by a single metric, and it would be the NPS score for the consumer, whereas the CIO might be judged on the metric the NPS score of the caregiver. Net promoter score, the degree to which somebody would recommend your service over somebody else’s. A typical score of whether you’re doing a good job for consumers. A standard outside healthcare for determining preference or satisfaction.

Should everyone do what you’re doing?

No. We’re in a “Goldilocks zone” for HIT innovation: we’re not in Silicon Valley, and we’re not in a place where there are no software engineers at all. So we’re in this great middle ground where it’s possible for us to get really, really great product and software engineering folks in Seattle, because we’ve got these two great software companies. And we say, code what matters. I think that summarizes what we’re trying to do, which is to be a place where your efforts are going to work for the greater good. And if you’re in Silicon Valley, you’re really trying to learn—that’s where I learned how to lead and manage at Amazon. And when you’re there, and you’re thinking, wow, do I want to do the next feature on a new product like Kindle at a big company, or do something more focused and meaningful to me personally? In Silicon Valley, the way that manifests is that you go create a startup. In our area in Seattle, we don’t have nearly as robust a startup community here, so we have a lot of people looking to do something meaningful in their lives. And Seattle’s a nice, reasonable place to live, and it’s relatively cheap compared to SV; or do I stay in Seattle and do something like this? So that’s our value proposition. And we have an unusual context here, and situational dynamics. Not everyone can do this.


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Consumer Health Tech Startup Ciitizen Raises $17M

January 16, 2019
by David Raths, Contributing Editor
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Building a platform to help patients collect, organize and share their medical records digitally

Ciitizen, a California-based company working to build a platform to help patients collect, organize and share their medical records digitally, has closed $17 million in new funding in a round led by Andreessen Horowitz and that included Section 32 and Verily.

The Redwood City, Calif.-based company said it would use the proceeds to accelerate platform development and expand commercial operations. The company received a Series A financing round of $3 million led by Andreessen Horowitz in July 2018. As part of the new financing, Vijay Pande, general partner of Andreessen Horowitz's Bio fund, will join the Ciitizen board of directors. Michael Pellini, managing partner at Section 32, and Andy Harrison, head of business and corporate development at Verily, will join the board as observers.

Ciitizen’s co-founders are Anil Sethi, Premal Shah, and Brian Carlsen. CEO Anil Sethi’s last company, Gliimpse, was acquired by Apple. Carlsen was formerly special projects lead at Apple, and serves as director of clinical informatics at Ciitizen. Deven McGraw, who has deep experience in HIPAA and medical data sharing, and was formerly the head of privacy at the U.S. Department of Health and Human Services, also works for Ciitizen.

"We are aggressively hiring to support release of products in partnership with select healthcare stakeholders that will immediately benefit patients—all driven by obtaining and organizing a patient's health data," said Premal Shah, COO, in a prepared statement. "Contrary to what is happening today, we want to facilitate patients gaining maximum direct benefit from what is rightfully theirs: their personal healthcare data."

"We are aggressively hiring to support release of products in partnership with select healthcare stakeholders that will immediately benefit patients—all driven by obtaining and organizing a patient's health data," said Premal Shah, COO and Co-Founder of Ciitizen. "Contrary to what is happening today, we want to facilitate patients gaining maximum direct benefit from what is rightfully theirs: their personal healthcare data."

Ciitizen also has initiated a weekly blog, The Voice of Ciitizens, that offers opinions from healthcare thought leaders on ways to address some of healthcare's most pressing challenges, including patient empowerment with their data.



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Survey: Consumers Want to Manage Healthcare Benefits, Costs via Smartphone

January 15, 2019
by Heather Landi, Associate Editor
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There is a growing “mobile first” trend, as consumers increasingly want to preform everyday tasks and utilize services on their smartphones, and this trend is moving into healthcare. A recent consumer survey indicates that consumers want more transparency, convenience and control of their own healthcare, particularly through mobile access, and, this demand could be influencing their healthcare decisions.

A survey by Metova, a provider of mobile, connected care, connected home and Internet of Things (IoT) solutions, found that 80 percent of consumers would be more likely to visit a doctor or seek treatment if they could see the exact out-of-pocket cost on their smartphone. And, three-quarters of consumers are interested in viewing and managing their health care benefits using a smartphone.

Metova surveyed 1,000 consumers who have healthcare to gauge their understanding of their health benefits, and to find if technology can improve their experience.

Nearly half of consumers have avoided going to the doctor or seeking treatment due to uncertainty around their benefits, according to the survey. Looking at the role of technology, nine out of 10 consumers said they would like an app that provides notification when a doctor sends a prescription along with pharmacy location and pickup time. In addition, 60 percent would like to purchase eyeglasses or contact lenses using their smartphone.

“It’s impressive to see how having a clear understanding of out-of-pocket cost on a smartphone would have a powerful positive effect on consumers’ deciding to seek treatment or even visit a doctor,” Jonathan Sasse, CMO at Metova, said in a statement. “Our sentiment surveys overwhelmingly demonstrate that the new connected consumer is ready and wanting to manage a wide range of facets of everyday services all via their smartphone, and that a person will choose one business, or even a doctor or insurance providers over another based on this mobile experience.”

Ken Erickson, CEO at Bridge Purchasing Solutions, said in a statement, “The healthcare industry is overdue for disruption. Consumers want more transparency, convenience, and control of their own healthcare.”

Related Insights For: Patient Engagement


One Thought-Leader’s Look at the New Social Contract in Medicine and Healthcare

January 7, 2019
by Mark Hagland, Editor-in-Chief
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Healthcare thought-leader Michael Millenson shares his perspectives on the emerging new social contract around medical care and healthcare—in a time of accelerating technology disruption

Last week, Michael Millenson, president of Health Quality Advisors LLC, and an associate professor of medicine at Northwestern University’s Feinberg School of Medicine, authored a thought-piece in the online publication STAT, entitled, “Google is quietly infiltrating medicine—but what rules will it play by?” Millenson looked at the emerging landscape in healthcare around the accelerating participation of healthcare consumers in using web search, consumer-facing apps, and other tools, to help them educate themselves about personal health and healthcare delivery issues, as well as the emergence of a number of corporations, including Google, Amazon, and Apple, as disruptors in the healthcare world—both as innovators in technology, as well as, increasingly, players in the care management and care delivery arenas.

“If ‘data is the new oil,’ as the internet meme has it, Google and its Big Tech brethren could become the new OPEC,” Millenson wrote on January 3. “Search is only the start for Google and its parent company, Alphabet. Their involvement in health care can continue through a doctor’s diagnosis and even into monitoring a patient’s chronic condition for, essentially, forever.”

Meanwhile, Millenson wrote, “Suppose you’re worried that you might have diabetes. Googling ‘diabetes’ brings up not just links but also a boxed summary of relevant information curated by the Mayo Clinic and other Google partners. Google recently deployed an app enabled with artificial intelligence for remote professionals to use that can all but confirm diabetes-related retinopathy, a leading cause of blindness. Diabetes is also a diagnosis your doctor might have predicted using more Google AI applied to the electronic health record. Meanwhile, a Google joint venture called Onduo recently announced a partnership to allow a major pharmacy chain to use its “virtual diabetes clinic” to coach patients on managing their disease. And, of course, at home you can get daily diabetes reminders from your Google Assistant.”

And, in some cases, he added, “[Y]our doctor could actually be Dr. Google. The brick-and-mortar Cityblock clinic, whose first site opened in Brooklyn, N.Y., earlier this year, is an Alphabet spinoff. It promises a ‘personalized health system’ experience for low-income patients.”

And with Google hiring the former chief executives of both the Geisinger Health system and the Cleveland Clinic, more and more interesting developments are certain to be at hand.

Michael Millenson

And all of this, Millenson noted, is prompting some in the industry to ask what the implications are of these developments for the social contracts that have long anchored physician-patient/clinician-patient, and patient care organization-patient relationships and interactions. In that context, he spoke with Healthcare Innovation Editor-in-Chief Mark Hagland, following the publication of his STAT commentary, to discuss the implications of some of those current trends, for the future of patient care delivery. Below are excerpts from that interview.

There are so many developments taking place right now involving what might be called “interspecies” business combinations—payers and providers, payers and retail pharmacy companies, employers and providers, and on and on. Do you see some potential dangers in the uncharted territory that’s emerging in healthcare, because of such combinations?

What I was trying to sound as a cautionary note, not an alarm, but a cautionary note, was that, when barriers are breached in terms of definitions, there are new challenges to long-established ways that we do things. We all like to talk about disruption, but there are downsides. And those downsides need to be confronted squarely. And what I was trying to propose in my commentary was a practical ethical framework for dealing with downsides—not a mission statement, or whatever, but practical thoughts. If you have a commitment to accountability and shared responsibility, it brings up issues. Just because you believe you’re committed to patient engagement or lowering healthcare costs, or whatever noble goals you espouse, particularly if you’re working for a not-for-profit entity, or even a for-profit, personal and corporate interests can conflict with noble goals.

And even as all these kinds of partnerships can be wonderful, we also realize we need new ways of dealing with potential negative side effects. No hospitals that merge ever say, thank God we can get rid of the price pressure from insurance companies! And it’s not that individuals making statements about mergers are deliberately telling untruths, but they sometimes make statements that may not be in the best interests of patients.

Healthcare informatics arose from people who were in the HC field, who wanted to apply the benefits of informatics knowledge to improving care, lowering costs, and other problems. That’s a different set of assumptions from when you take people whose expertise is in manipulating data and information, and put them into healthcare. There are cultural issues there. People from within HC tend to say, there are certain problems, and let’s look for solutions.

But people outside healthcare sometimes have the tendency to say, we have this wonderful tool; look at all the ways we can solve your problems.

Looking at the entry into the healthcare delivery process of disruptors like Google, simply because of the near-universality now of web search as a consumer activity in healthcare—will consumers simply start self-diagnosing off the web now?

It’s one thing to look at Google as a search engine. It’s another to look at the issue of Google as an element in care delivery. The issue of “Dr. Google” is a significant one. I wrote an article recently called, “Beyond Dr. Google.” What happens if you’re using the Babylon Symptom Checker with AI? What happens if you’re looking at a mole? Because they’ll have a legal disclaimer. But we’re looking at an entire paradigm shift around how we interact with doctors. Years ago, I said the Information Age is to medicine as the Protestant Reformation was to the Catholic Church. It changed the people’s relationships to the priests; the Church didn’t go out of business, but it had to change. Once the laity could read the Bible, the role of the priests had to change. And I think that the role of physicians as holders of knowledge, has to change. They still have specialized knowledge; but the conversation has to change, and the tone has to change.

What I’m concerned about is when an organization like Google, Amazon, or Apple, starts partnering with physicians, what happens? When Google, Amazon or Apple, starts being a partner to help you with your diabetes, are they helping you have a better conversation? Or are they starting to use gathered information to try to cause behavior change, to manipulate you? And there’s a fine line between doing this for your own good, or because I want you to change?

And then there’s the accountable care issue—when you have attributed patients, and it’s in your financial interest now to collect and use social-determinants-of-health data and other forms of data, as well as apps and tools, to try to motivate your patients towards participating in the enhancement of their health status.

Exactly—now, there’s also a profit motive. I wrote an article about the secret use of the social determinants of health, for care management—and for profit, on the part of vendors that are putting data into algorithms and selling those solutions. LexisNexis found a correlation between someone in the household having completed some kind of professional certification, anything from a plumber’s license to a PhD—with medication compliance and adherence. The point is, you get companies that use information about my life, as raw data for analytics, that are meant to influence my behavior. We need a different kind of safeguard doesn’t go awry. And I’m not saying that what they’re doing might not be wonderful and disruptive in a good way, but nothing turns out as promised, whether Brexit or Google.

The social contract in healthcare, particularly between providers and patients, especially that between physicians and patients—what might that look like, or need to look like, in the coming years?

I see collaborative health as the new social contract. I’m not sure that that patriarchal, hierarchical relationship has changed as much as we might be thinking. I remember writing things 30 years ago that everything would change, and the hierarchies would be totally gone. They haven’t disappeared, though. Your grandmother was probably just grateful to see a doctor. And there are still a lot of people in the country who are still grateful just to see a doctor.

So part of that issue involves socioeconomic class, of course?

Yes, absolutely. That said, I also absolutely agree that a new social contract is going to center around collaborative health. And an explicit one is needed. There’s a lot of talk about that, around Google, Facebook, Alexa. But the medical element is different. When organizations that have tremendous data analytics capabilities, are applying those to the problems of individual patients, that gives us both the potential for unprecedented breakthroughs in patient care, and for the unprecedented ability to manipulate people. The fact that I know everything about your Google searches, your purchasing and eating patterns, and I’m tracing your driving patterns—that can help me improve your health, but also control your life, and manipulate people. And even if the decisions are to your benefit, a social contract demands shared engagement and shared accountability, because that’s the social contract that medicine needs, to retain its soul—even if that doesn’t help increase the value of the IPO or the price-earnings ratio, or the amount of money you get back from meeting your obligations under an ACO contract.

How do you see physicians and other clinicians adapting to this new world?

I think the social contract is even more important, because the power of the individual doctor is often decreasing now. If more and more doctors will be employed, and operating under stricter rules of accountability, that’s good for patients, but the balance between accountability and autonomy is a balance we’ve got to find. And we should welcome Amazon, Apple, and Google—they have an incredible potential to disrupt HC for the better; but the individual doctor, just like the individual patient, is going to be powerless to set a new social contract on their own. That’s why we need a social contract that encompasses clinicians, patients, patient care organizations, payers, pharmaceuticals, and everyone. It may be to my benefit that my doctor is using an app to track population health issues, but with the blurring of lines between different types of organizations, things get complex. Information is power, and the information we’re gathering is extraordinarily powerful, and good things can go awry. So frankly, I see this new social contract as a protection for physicians, and as something that will ensure that the “therapeutic alliance” that doctors like to talk about, will remain strong, even as other boundaries dissolve. And whether my doctor is employed by an insurance company, a hospital, or is a solo practitioner, it should make no difference to certain kinds of relationships.



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