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.
Werner: We’re beginning to have some very thoughtful conversations with clients around making access and engagement work together—how to make access more based on how patients would prefer to access care services and information, across a continuum including through retail care locations, based on their preferences. And how does access relate to clinical models of care? How do you want to optimize your clinical care, and how does that interface with how your patients prefer to access care and information?
In creating these systems, you really build a stronger relationship between payer and provider, which will now influence the payer community. When patients have that higher level of engagement and stronger relationship, that will influence payers as well. At the same time, providers need to work more closely with payers around the creation of narrow networks, contracts, etc. So as a provider, I need to be going much more deeply into my community and patient population, in creating an access strategy that allows me to be more effectively engaged with my patients/consumers. And all of this transcends a technology platform, and transcends simply optimizing scheduling. This is all taking this to a much more thoughtful and strategic level.
Industry observers have long noted the escalating “arms race” between providers and payers in markets across the U.S., with providers consolidating to obtain more power against payers in contract negotiations, and vice-versa. How do these theories of systems of engagement interface with the reality of the contracting “arms race”-based consolidation currently taking place across the U.S.?
Schwartz: I think you’re right about the increased consolidation on both sides. In fact, when providers span the whole continuum of care, they also become very large organizations. So what’s at stake here isn’t a single visit; it’s the lifetime of care for the consumer who engages with a particular health system. Providers are trying to win the loyalty of a consumer forever. I’ve read a lot of articles on engagement, and nearly all of them have a bias that it will be either payers or new non-traditional providers that will lead consumer engagement; and that's a possibility, such as through these new retail and technology service providers—and they may have a role. But really, who is better-positioned to have a lifetime relationship with consumers, than providers? Providers should do it in concert with payers, and they should become health information technology organizations, themselves, but they’re the best-positioned of entities to create those kinds of relationships.
Werner: There are still vestiges of the price fight, with payers and providers still involved in that fight, but we’re getting to the end of that strategy, and benefit hasn’t been show to have been created. So we’re facing a tipping point fairly soon where the marketplace will no longer tolerate price fights. So this form of engagement will rapidly become a critical competency. Back to the population health discussion, you’ve got to have this level of engagement with your members. So we’re beginning to see the foreshadowing of the next phase of healthcare development, and the end of the phase of healthcare industry evolution focusing on the price fight.
Are providers going to be nimble enough to fend off these new retail pharmacy and technology entrants in the emerging competitive landscape?
Raphe: There has been a gap [in access to convenient care], and CVS and other retailers have begun to fill it. Consumers are doing self-service in all other industries, so they’re starting to do it now in healthcare. At the same time, another factor here is that a lot of consumers have signed up for high-deductible plans, and are more responsible for their costs now. And we believe consumers are more aware and convenience-and price-aware now. But if you look at the ability to create a continuum of care and tie it together with care management across the continuum, and also with technology and information technology, CVS can’t do that. But in some markets, retailers are partnering already with traditional providers on this.
Werner: Yes, that’s happening in some markets already. And focusing on this form of engagement may cause some providers to ignore retailers, but they shouldn’t do so Instead they should consider the possibility of partnering with retail pharmacies in some cases.
What should healthcare IT leaders be doing to help prepare their organizations for this emerging landscape?
Schwartz: I think that it’s really important that they do this in a coordinated way. A lot of organizations think that engagement is about building a better patient portal, or building applications for connecting wearables so patients with certain conditions can be continuously uploading data to their doctor. Our view is that those efforts, which are important, have to be a part of a continuum of coordinated activities. It has to be done as part of creating a continuous system of engagement that touches and engages with patients and consumers at every point in the engagement cycle.
Werner: Raphe said it well. Al of these activities are forcing the CIO to start with the end in mind, to clearly articulate what the end looks like for these efforts. It’s just not just saying, we need a patient portal. Well, why? How should we create a portal as part of a strategy? We have to tightly map that portal to our strategic plan. And that is a challenge for many health systems. And the CIO is particularly at risk for a lot of chaotic activity when that strategy isn’t present.
Schwartz: One other point around this topic that CIOs can play can really important role around is that Mark and I believe that to be successful, these systems of engagement will really need focus. Health systems must identify a few specific segments of the population where they can build out these systems of engagement. They won’t have the money and time to do this for every segment of the population. And that’s where CIOs can bring something to the table, because building out systems of engagement for populations will not be easy, and it will be expensive, so CIOs can help articulate what is possible.
And then you can build out the medical, the health information, etc., aspects of these systems. One key is to figure out which populations you want to create these systems of engagement around. For example, people in high-deductible plans we’ve been talked about who recently got diagnosed with a chronic condition, that target segment will have very different needs from, for example, elderly Medicare patients with multiple organ system issues. A health system can focus on two or three of those populations, but not every population.
And you’ll need to engage in analytics to parse that out and segment those populations, correct?
Schwartz: Absolutely. And here’s one last thought: we believe there’s a great opportunity for first movers—that health systems that do build out these systems of engagement have an opportunity now in their markets—that winning that loyalty of that consumer could really help to build that relationship for life. So building that engagement with that consumer is becomes that much more important.