Even as the term “patient engagement” has become hotter than ever, the reality is that the leaders of most U.S. patient care organizations haven’t yet figured out how to execute on the concept. But Debe Gash, senior vice president and chief digital officer at the Kansas City, Mo.-based Saint Luke’s Health System, offered attendees a lot to consider, as she shared the innovations taking place in her organization, on Thursday morning, at the Health IT Summit in Denver, sponsored by Healthcare Informatics.
Speaking on the topic “Using Mobile Apps to Increase Patient Engagement,” Gash told the audience gathered at the Grand Hyatt in downtown Denver that patient engagement has to be a strategy, not just a wish. That’s especially true at any large integrated health system such as St. Luke’s she noted. St. Luke’s encompasses 10 hospitals with a total of 1,100 beds, with 1,500 providers, 750 of them employed, and 1.5 million clinic visits. It also encompasses 17 retail clinics, and four micro hospitals, with eight beds each.
Indeed, Gash told her audience, St. Luke’s Health Systems’ overall strategy encompasses mobile apps, patient engagement, and various strategies around patient/consumer convenience and service, all of them interrelated.
Debe Gash speaks at the HIT Summit-Denver
“Our growth has primarily been in the ambulatory space; we heard from our customers that they wanted more access to care in their neighborhood.,” Gash said. “So we’ve been deploying our clinics, our big boxes, and have embarked on this initiative to build micro-hospitals in our area. A micro-hospital,” she explained, is a small facility of eight beds, anchored by an ED. And if we need to perform a procedure or they need more complicated care, we transfer them to larger facilities. We’ve opened four of seven so far. In fact, our fourth micro-hospital opened just this week. These are exciting times for us.” Further, she reported, “We’ve gotten into the retail space. So far, we’ve created 17 clinics, and they’ve served us well.”
Among the guiding principles in this journey has been the articulation on the part of patients of what they want in terms of service, convenience, and interactions with providers.
Gash cited a recent survey that found that millennials’ demands for digitally facilitated healthcare are accelerating. Among other survey results: 71 percent of millennials want to book appointments with mobile apps; 74 percent would prefer to see a doctor virtually; and 75 percent look at online reviews before selecting a physician. What’s more, one-third downloaded a health app in the last 30 days; and 42 percent have used synchronous video telemedicine.
But the idea that interest in the digital facilitation of healthcare delivery and service is limited to younger people is deeply mistaken, Gash told her audience. “It’s a myth that older people don’t use technology,” she said. “My mother is 76, and she had problems using a flip phone; but I got her a smart phone, and she uses her smart phone more than I do. I see that with the elderly community; it’s an interesting dynamic. But even more interestingly, the millennial generation really want to use digital features in their use of healthcare.”
A new world—of consumer demands
The reality, Gash told her audience, is that the old, provider-centric world is falling away quickly now, and is rapidly being replaced by a world in which provider organizations will have to compete strongly with one another for patient loyalty and engagement. Indeed, she said, “For a growing number of people we serve as providers, companies that fail to offer a friction-free digital connection are just not going to be acceptable anymore. And when consumers have a choice, and more do now, it’s going to be critical that we provide friction-free digital services. Kaufman Hall found in a recent report,” she said, “that only 14 percent of hospitals offer digital tools for consumer engagement, and only 23 percent offer some form of telemedicine—and that is primarily inpatient consults, but not direct-to-consumer-type solutions. Only 20 percent of healthcare consumers have digital access to pricing. It’s not something that you can go out and search on your own. And only 43 percent provide messaging between patients and providers. And I personally believe that that figure is that high only because of the meaningful use program.”
And those deficiencies are a problem. “The lack of contemporary digital experience, I believe, is a major vulnerability for hospitals and health systems today,” Gash told her audience. “And that’s because we’re seeing [disruptive new] entrants into the healthcare industry that can pose a threat to our not-for-profit systems. Look at the merger of United Healthcare and Optum, and of CVS and Aetna,” she said. “What are they doing? They’re employing physicians and practices, acquiring practices, employing health management programs; and their goal is to basically do that primary care service. So they’re pulling assets out of the healthcare system, and they’re highly capitalized companies. So that’s the threat. And what are Apple and Amazon doing? Apple says, we can go directly to the consumer; they’re good at that. And what could Amazon do? They’re investigating healthcare, and they, too, are highly capitalized companies.”
So what should provider leaders do? “We need to think about that threat, and how we can continue to compete and differentiate ourselves and work with that potential down the road,” Gash told her audience. “So those are things that could disrupt our industry, and the real reasons why St. Luke’s is trying to deliver a better experience, so that we’ll be the choice of our consumers, and create that friction-free service, and make sure that we’re better at delivering that last mile of care. We’re known in the market as being the least convenient type of service provider. So we need to change that paradigm, and that’s critical.”
Among other actions, Gash and her colleagues “have been pursuing digital solutions for a while,” she noted. “We’ve deployed MyChart”—the personal health record embedded in the electronic health record product from the Verona, Wis.-based Epic Systems Corporation—“and we’ve mobile-enabled our website, https://www.saintlukeskc.org/. Still,” she said, “there was a lot of friction in our service delivery model, which still relied on traditional forms of communication, including phone, letters, and face to face encounters. And yet we still had really good customer satisfaction scores. Our HCAHPS [Hospital Consumer Assessment of Providers and Systems] scores are great,” she noted.
“So our thought is that we need to continue pursuing the removal of friction in that last mile of delivery of care. How many of you have trouble scheduling an appointment with your doctor? I do. It takes two or three interactions to get one scheduled. That’s friction. Or I get discharged from my provider, and he says, I want you to go get a diagnostic test, and I have to call, and it can only be done between 7 and 4 on weekdays or whatever, and I have to take off work or whatever, and that’s friction. And we want to remove it.”
Pacing those efforts has been one strategic element involved. After deploying MyChart, Gash and her colleagues enabled “Saint Luke’s 24/7 Virtual Health visits, through our app. You can schedule an appointment, you can do it via video,” she explained. “That was deployed, and people were very excited about it. We pushed it with our employee health plan. But we were only getting about three visits a week. We partnered with ZocDoc to offer online scheduling. It was hard to convince doctors to allow us to do this,” she reported. “So I went back and did a lot of research, wanted to know if we were doing what our consumers wanted. Through focus groups and reading research papers,” she said, “I found that it’s really generational, what people want.”
Research shows that millennials—18 to 29—are “very digitally fluent, are the most socially connected, and are the most likely to read reviews, find prices, and seek for value,” Gash noted. “They are the most likely to shop for providers and write reviews online.” Meanwhile, “The 30-49-year-olds are often directing not only their care but their family members’. And they want care to fit into their busy lives, through non-traditional hours, etc., and virtual care delivery. The 50-64-year-olds are active, managing personal wellness, and managing multiple chronic illnesses, and they want timely access to care. Over 65s are traditionals. They don’t mind seeing the doctor, but traveling is hard for them. And they’re probably the most resistant to virtual care options.”
Doing that research was eye-opening for herself and her colleagues, Gash told her audience. “It helped us to understand what consumers were looking for, including access to after-hours care, weekend availability, etc. Value was a key factor; and what we heard was that convenience and service trump what is free. In other words, people are willing to pay for extra service. People are looking for cutting-edge technology and convenience of service,” she said. “We wanted something we could brand our own and could leverage that brand in our market, the perception of St. Luke’s, as a way to publish some of these capabilities. And we wanted to bring those digital features together as part of that brand, and simplify that access. So we started looking for features our customers asked for. They thought wayfinding would be great in these big facilities. Also, food service, and e-check-in. Those were all things we heard from our population. So we changed our approach, and expected we’d see increased utilization of e-services.”
And all of that was based on building a mobile application first. In that regard, Gash reported, “I did a lot of research in the market to see what’s out there and available. We do not have mobile application developers in our shop. We wanted something that we could purchase as a service. There really wasn’t anything in the HIT space that could meet our needs. So I have a friend, Andrew Burns, who works in our space and he said, ‘Hey, Debbie, I have a product.’ They primarily work in the entertainment industry, but what he explained was exactly what I needed—a mobile platform that would enable me to bring all these products together and drive engagement. So we partnered with them to develop the SaintLukesKC mobile app. It provides access to the medical record, and to online scheduling. It also facilitates virtual visits; and it provides directories of locations, as well as wayfinding information within facilities.”
In terms of results, Gash reported, “We have been promoting our app. We started with a soft launch, using it primarily without our own employee population, to get feedback, then… Our adoption is growing rapidly… 97,188 visits… we’re retaining our users. We have about 7,500 users using our mobile app right now, and that is growing exponentially. Our MyChart utilization is increasing as a result of the mobile app. We’re seeing many users leveraging the product, doing more messaging; and we’re seeing more patients participating in online payments.”
In terms of lessons learned, Gash said, “You really need to find out what your customers want, because what you think may not be right. I really encourage you to do focus groups and talk to your customers and discover what they’re looking for. And our demographic is very different from children’s hospitals, ambulatory spaces, etc. You do need to check with the consumer. I think you need to define a strategy and execute it. And also talk to your business units about what would work for them. Also, don’t be afraid to try something new. Just because another system hasn’t done it, doesn’t mean you shouldn’t. Look outside our industry—we are way behind! Look outside the healthcare space for solutions. We are so far behind in digital—look outside healthcare and figure out how to apply what they’re doing, to healthcare.”
Two other key pieces of advice: “Make sure that people know what you have to offer. And that means, when it comes to patient engagement solutions, that you’ve got to include your marketing team” in the development process. The other key piece of advice: “Measure results. It’s so important to go back to the organization and say, here’s the success, here’s what we’re seeing. I encourage you to figure out what those measures of success might be. When I meet with the board, I’m sharing those kinds of results.”