Using Data to Drive Down Cost and Support Consumer-Centric Care: A Thought Leadership Roundtable

Introduction

After a turbulent 2020, health systems are looking for ways to quickly drive process transformation, with cost saving efforts high on the agenda. For many, the ability to connect and defragment the patient care journey is a top priority, not only to find efficiency gains, but also to improve customer service as the patient experience is the new battleground for attracting and retaining patients. How will digital healthcare leaders cope with multiple priorities for 2021, balancing tight budgets and high expectations of consumer-centric services? How can they scale new, integrated workflows fit for a hybrid world of virtual and in-person care?

Lumeon hosted a virtual thought leadership roundtable including six members of the College of Healthcare Information Management Executives (CHIME) to talk about strategies to reduce costs while retaining and growing their organizations’ customer bases. CHIME President and CEO Russell Branzell moderated the discussion. Participants included:

• Jerry Henderson, MD, CMIO, JPS Health Network
• William Hudson, Senior Vice President and CIO, John Muir Health
• Robbie Hughes, CEO, Lumeon
• John Kravitz, Corporate CIO, Geisinger
• Sarah Richardson, Vice President, Change Leadership IT, Optum
• Mike Ward, Senior Vice President and CIO, Covenant Health
• Alan Weiss, MD, Vice President and CMIO, BayCare Health System

Playing the Long Game

Walgreens, CVS, Walmart, Amazon, and even the grocery titan Kroger have ventured into the healthcare marketplace in recent years, using their brand recognition to draw customers to their walk-in clinics, pharmacies and other services. Deals like CVS’s acquisition of Aetna and Walgreens Boots Alliance’s joint venture with Humana have helped them expand their footprint in healthcare markets, and by offering convenience, easy access and price transparency they are successfully converting consumers. According to a study by J.D. Powers, consumers’ usage of health and wellness services at retail pharmacy chains, and their satisfaction with the experience, both rose in 2020.

This new competition could be an ominous trend for existing healthcare systems, especially as they already are dealing with the financial strains from the COVID-19 pandemic. Healthcare organizations are being challenged to find ways to lower cost and increase efficiency without losing patients to traditional and now nontraditional players, too. That strategy may be akin to holding the opposing team at the scrimmage line; it is not a loss, but it also is not a gain. To move their business forward, some organizations are maximizing data to create a consumer-centered healthcare experience.  

The first step for many digital health executives is identifying opportunities to eliminate waste and streamline processes, both administratively and clinically. “As in any organization, over time you grow thick in administrative layers,” Kravitz observed. He and others at Geisinger are reviewing personnel and processes to bring them in line with current needs. On the clinical side, BayCare Health System instituted a “whole pathways” project for congestive heart failure, pneumonia and chronic obstructive pulmonary disease admissions “to remove some of the fat from the organization (such as) excess tests and excess procedures,” Weiss said. “We have some good outcomes, so we’re going through the organization and trying to figure out, how do we remove costs, but do it in a way that actually enhances the quality of care we provide?”

Richardson layers current efforts to drive efficiency at Optum on top of a business model projecting rapid growth over the next decade. As the digital executive responsible for change management and IT team development, she needs to quickly align the processes and cultures of several onboarding healthcare organizations, knowing that many more are on the horizon. She may use methodologies like Six Sigma in decision making, with an eye on the resources they have or will need. “If we were able to reduce people because we have better processes or workflows, where do we reallocate or retrain those necessary to continue to bring us into the next level of what we want to be able to achieve and deliver to our patients and our caregivers?” she asked. “There is so much tribal knowledge in our system, and our level of how we deliver care is so complex. … How do we really look to be transformative and innovative – two big buzzwords we hear – by really looking at what we already have? What’s going to be the best option for us?”

After several years of trimming and using data analytics to finetune their decisions, John Muir Health is evaluating existing resources to find more value, Hudson said. “We have a lot of data, and the question is, how do we start using that data to help to drive not just outcomes, but relationships? How do we use it to make our system sticky for our patients and the community? And how do we use that to take cost out of the equation? … How do we leverage systems we have in place to help us to answer the key questions about how we can perform better than we are today?”

Value will come when solutions are applied systemwide, Henderson said. Covenant Health is a community-owned system that serves 23 counties in East Tennessee, an area whose historically low ranking on the Medicare Wage Index made it one of the lowest paid markets in the nation. Systemwide efficiency was “a matter of survival for us,” Ward said. “We had to get to that point of efficiency from a system perspective through economies of scale attained through centralized services. IT was one of the first departments across the health system to mature through consolidation and standardization, something we call ‘systemness.’”

Growing a Consumer Base

Increasing efficiencies will help position their healthcare organizations to challenge competitors, but who wins consumers’ loyalty will be measured by market share. Telehealth and outreach programs, which have been successful at JPS Health Network, allow providers to reach more patients while freeing up bricks-and-mortar space. “Those tools are going to enable organizations to grow, expand and get more patients in the system,” Henderson said.

Targeted marketing based on data analytics is another tool that has worked for John Muir Health. “Part of it is making sure we retain the patients who are there, but also tying it with very specific marketing campaigns or trying to drive service levels into very specific areas within our geography,” Hudson said. “We’ve done a combination of both,” with early results favoring targeted marketing over previous unstructured methods.

Joint ventures and partnerships offer another way to reach new customers. At Geisinger, the IT team’s experience and success using advanced analytics and digital innovations to support clinical services has made them an asset in joint ventures. “We can offer a lot to other health systems that don’t have the resources or the wherewithal to be able to do it,” Kravitz said. “That’s been the carrot, if you will, an enticement to move forward with IT services through new joint ventures.” Covenant Health collaborates with local businesses to promote health and care in their communities. “If we can work with them proactively for better care in the workplace, then the strategy is to maintain the long-term relationship if they become patients who feel connected to the hospital system,” Ward said.

Taking a page from retailers’ playbook, BayCare Health System has partnered with local Publix stores to offer interactive walk-in telehealth kiosks for shoppers seeking non-urgent care. “We are also trying to add on new service lines and organize those service lines so that we’re improving the quality of care that we deliver,” Weiss said. “We are exploring genetics as a way of helping bring in more patients, treat them at a younger age, and hopefully keep them healthier longer. We’re trying to pursue this from a combination of both technology and just good clinical care.”

New entrants like Walmart and CVS use their brand recognition to build their customer base, Lumeon’s Hughes observed. By applying automation, decision support and other advanced technologies, retailers can provide consistent, convenient and low-cost care that aligns with their brand. “The patients who go to the Walgreens, the CVS’s, the Walmarts, etc., are not coming to see a named physician,” he noted. “They are coming there because they’re getting a guarantee of quality from that brand.”

Making Radical Change

The game changer – for patients, physicians and businesses serving them – is the provision of a user-friendly experience that seamlessly links every part of a patient’s healthcare journey. Some healthcare organizations have a vast amount of data and the analytical expertise to display information that is useful, accessible and presented in a way that clinicians and patients can understand. “We are better on our clinician’s ability to see the total view of the patient than we are on the patient being able to see the total view of themselves at this point,” Richardson said. “But we have the information. It’s a matter of being able to elegantly get it into their hands.”

With the spate of mergers and acquisitions in healthcare, many organizations are trying to align practices and procedures to one standard. Until that alignment occurs, patients may experience hiccups in their interactions. “Not only is the patient experience different across the whole healthcare system, but the provider experience is different,” Weiss noted. “Until we embed a true system within our healthcare system, we will make it difficult to achieve what we want from a patient care point of view.”

Organizations are bringing patients and clinicians to the table to learn first-hand from consumers about their preferences and the barriers they encounter. BayCare Health System and John Muir Health assembled patient panels and community boards to help shape consumer-centered programs. Knowing the consumers’ needs and limits can avoid costly assumptions, Henderson added. “We’re really trying to get patients engaged because we have an at-risk population,” he said. “We are starting to understand that a lot of our patients don’t have access to data plans, so we have to take a lot of things into account when we’re trying to drive that electronic engagement.”

Hearing the consumer’s voice is critical within the healthcare system, too. Richardson emphasized the importance of validating a process and revisiting it to ensure it delivers what was expected. “When you get people involved from the very beginning and you start to think about ways to do things differently, that does create a flywheel effect that’s really, really important,” she said.

Achieving that flywheel effect, where reiteratively data-informed decisions spur engagement within and outside the organization in support of systemwide change, will accelerate transformation and leapfrog an organization to the next level of innovation in healthcare. Other strategies also are driving change, like Geisinger’s hospital-at-home program using telehealth and other technologies to remotely care for patients where they live; or John Muir Health’s partnerships with disruptors to facilitate transitions and scale operations; or offloading physicians’ tasks using a centralized team to handle logistics like testing and consults to allow doctors to concentrate solely on their patients.

“They (healthcare organizations) take care of a patient in a much more holistic fashion,” Weiss said. “But because they make it seem like it is being done by the primary care provider, they enhance the relationship with that provider. That’s the kind of approach that I think we need to start thinking about as we move forward in what is becoming a more challenging healthcare arena.”

That is the direction healthcare organizations need to go if they want to innovate and compete with retailers, Hughes said. By building a brand that in patients’ minds equates to convenient, high-quality, low-cost care, hospitals and healthcare systems can shift patients’ allegiance from individual physicians to the organization. “If you can make that transition so the patient is loyal to the brand rather than the physician or the specialist, then you have an opportunity to create hybrid virtual care models and use your resources more efficiently,” he said. “How do you move to that model where it’s about the brand, about control, about predictability and not about the individual? Because while it’s still about the individual, innovation won’t take place.”

Conclusion

Digital health executives are being tasked to contend with the growing demand for a consumer-centric model of patient care driven by newly competitive retail brands while also balancing financial challenges from the COVID-19 pandemic. Some healthcare organizations are adapting to this environment by implementing data-based strategies to retain and grow their consumer base while reducing waste in their hospitals and health systems. Engaging consumers in the development and use of a seamless, transparent experience for patients and clinicians, as well as other innovative strategies, will put organizations on a trajectory to successfully overcome retailer competition and lead in the transformation of health and care. To innovate and compete with retailers, healthcare organizations will need to build loyalty to their brand rather individual physicians.