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Personalized Medicine: The Process

March 31, 2009
by Dale Sanders
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Who are the patients visiting us the most often and should we treat them differently?

I have this theory that we (healthcare) could learn from retail in terms of customer relationship management, in a variety of ways. For example, in retail, almost every store has a “Top Customers” report that lists their top customers over the past year, month, and week. They calculate “top” by total purchases and by the number of customer visits to the store or web site. In theory, retail companies treat these “Top Customers” differently, either through targeted marketing or in some cases, “red carpet” treatment and gratis benefits. I sense that the leaders in the hospitality industry engage in this type of personalized process behavior, too.

We could easily produce a report in most ambulatory healthcare settings which lists our “Top Patients.” It’s not exactly the best name for the report, but it gives us insight to the same concept as retail, i.e., Who are the patients visiting us the most often? Which patients are spending the most money on their healthcare? My theory is, these are our sickest patients and potentially the most financially challenged. Their families feel a heavy burden, too. We should keep a close eye on these patients… treat them differently… be more aware of their appointments and encounters… make life easier for them in terms of their encounters… maybe offer preferred scheduling and parking… maybe proactively reach out to them and their families to manage their experience better… process their claims differently…work with their employers and insurance companies more closely… and proactively target them for financial assistance if needed. Of course, I’m not so sure it would be a good idea to tell these patients that, “Congratulations! You are one of our Top 50 Patients!” The awareness on our part should be subtle and in the background, but patient treatment in the foreground should be noticeably different and more personalized.

I’m not exactly sure what this looks like operationally, but I do think that we should be more aware of and adaptive to these patients and their families, and do something different with their treatment and experience. There might be opportunities for research, too, assuming that these patients represent a significantly different, outlying health experience than other patients.
It’s a step towards Personalized Medicine, but from a process perspective, not from a genomics perspective.

Maybe some organizations are already doing this?



Dale, if you offer special treatment to high-volume patients, how would you prevent encouraging the, "I'm just here because you're nice to me and I'm lonely" patients that, I'm sure, are a part of every general physician's practice?

Hi Dale, you are right on track with this: I spoke to a CIO recently whoi absolutely had this as part of his IT strategic plan. As a matter of fact, there's a sidebar on it in the profile I did of Lindsey Jarrell and BayCare Health that is online right now in our April issue where he talks about knowing everything about a patient and greeting them appropriately when they check in--the sidebar on personalizing the patient encounter is down at the bottom.

Thanks, Daphne... I'll take a look at that!

Anthony, that's a good question. In retail, the business wouldn't care because the customer was spending money in the store, which is the whole point of personalized service. If the "lonely patient" in healthcare were self-pay at 100% of charges, we would probably be very tolerant, too. Unfortunately, in our hybrid capitalist/socialist economic model of healthcare, the lonely patient typically pays a nominal co-pay, which is no disincentive, and the provider is reimbursed at 35-45% of charges. In summary, there's no clear answer to this scenario, but we shouldn't let that deter us from experimenting with new models. As someone recently reminded me, in the old USSR, the saying among workers was: "You pretend to pay us, and we pretend to work." In our US healthcare model, patients can say, "We pretend to be sick" and the physicians say, "And you pretend to pay us."

Great points. There's definitely a problem when going to the doctor is cheaper (out of pocket) than going to the movies.