Learning from the Financial Industry: A Roadmap for Healthcare Practices

Turn Services into Products

The financial industry enables their clients to easily invest for their retirement and reach milestones with the client’s financial goals and objectives at specific dates prior to retirement. Clients simply go to the firm’s website and select the year they plan to retire, buy the recommended mutual fund, and enjoy the benefits of dynamic, lifetime asset allocation. In the past, before target date funds existed, people had to meet with their financial advisors to change the asset allocation in their financial portfolios as they aged toward retirement. The development of target date funds turned asset allocation from a service that typically required in-person annual discussions into a “set it and forget it” product that lowered costs and increased convenience.

In healthcare, Omada (www.omadahealth.com) similarly has turned services into a product. Omada packages complementary healthcare devices, services, and support into a turnkey offering that it sells to employers and health insurance plans to help people lose weight and reduce their risk of type 2 diabetes or heart disease. When people sign up for Omada’s offering, they receive a wireless, digital bathroom scale, pedometer, resistance band, and tape measure. Customers also use a smartphone app to pair them with health coaches, who help guide them through health and wellness decisions throughout their day. By integrating devices and services with a well-designed digital platform and service experience, Omada has created an effective product that links participants’ engagement to their clinical outcomes.

For example, Omada provides patients with highly trained coaches who are empowered with data to deliver guidance and healthcare advice from professional caregivers. Patients are given wireless scale to keep and offer smart device integration for seamless tracking. Those who decide to participate in the program are matched with a small group of peers for motivation, encouragement, and empathy. From meditation to medication, the program tailors the content to have an immediate and lasting impact. Omada empower participants to reach their unique goals through a customized to-do list. The result is that Omada has become the largest CDC-recognized digital diabetes prevention program and has inspired hundreds of thousands of participants to take their health into their own hands.

Another example is Pillpack (www.pillpack.com), a digital pharmacy “designed around your life,” which turned the complex business of managing multiple prescriptions into an easy-to-use product. It sends subscribers customized packs of pills labeled with the date and time they’re to be taken, and its mobile app pushes reminders and provides access to 24/7 customer service. Pillpack turned prescription management from a clunky, disconnected series of services into an elegant product that decreases trips to the pharmacy, eliminates sorting and counting medications, and reduces the chance of missed or incorrect doses.

Increase Convenience and Reduce Cost

Historically, if you wanted to meet with a stockbroker or your insurance agent you had to make an appointment and get to the broker’s office during his or her office hours. Today, of course, online brokers enable customers to manage their portfolio from home, at any time, on a 24/7 basis, at a fraction of the cost of a traditional broker, and with the added advantage of being much more convenient. However, you might have a problem trying to reach the online broker on the telephone!

More than 10 million consumers benefited from telehealth use in 2017, and insurance carriers are increasingly covering these visits.

Just as online brokerages pioneered virtual financial services, telehealth, which connects patients and clinicians by video and other digital technologies, enables patients to get a diagnosis, healthcare advice, and education, day or night, from the comfort of home.(1-3) More than 10 million consumers benefited from telehealth use in 2017, and insurance carriers are increasingly covering these visits, because they’re both more convenient for their members and less expensive than office visits.(4)

Telehealth applies to patients with conditions requiring frequent follow-up visits and infrequent physical exams, and who have difficulty coming into the office. As with the financial industry, security is of paramount importance. Telehealth uses a secure video platform to connect with patients remotely, which is especially helpful if a patient is at a great distance from the hospital or the medical office. This technology is certainly applicable for patients who would not need to come into the office for in-person care and, therefore, avoids increasing overall utilization and reduces the cost of care. There is a movement for doctors to open up their schedules to see patients virtually, which makes the doctor more efficient and more productive.

Few recent trends in healthcare delivery have more power to improve population health, patient and provider experience, and hospital business models than virtual care. But for an industry reliant on, and in many ways limited by, brick-and-mortar facilities, this movement will mean significant disruption for providers. As more commercial and state payers offer telehealth coverage, and patients come to expect virtual care as standard practice, meeting the demand is quickly becoming clinically and financially imperative.

Virtual care at most practices and hospitals remains a future vision.

Like many hospitals, Brigham and Women’s Hospital (BWH) in Boston is actively preparing for the era of virtual care in order to best meet patients’ needs. The Director for Telehealth at BWH regularly hears about practices interested in offering virtual care services or receives patient inquiries about the telehealth programs. In spite of this growing buzz, however, virtual care at most practices and hospitals, including other academic medical centers, remains a future vision. For smaller or community-based providers, there is a greater need for virtual care but less interest in implementing the technology.

For virtual care to move from a pilot project to a standard service, the interested provider must answer five questions:

• Which clinical services should be offered virtually and why?

• Which technology tools will meet the demographic, clinical, and business needs for these services?

• Should telehealth programs be offered directly to patients or only offered through providers?

• How does virtual care create value for my practice or organization?

• How can this value be assessed from the patients’ perspective as well as that of the organization?

Once these questions are answered, then the decision can be made to proceed with the implementation process.

Improving Access to Healthcare as Well as Improving Chronic Disease Management

The virtual care strategy can easily be started with video-based visits for outpatients with chronic diseases. Providers who see patients with conditions requiring frequent follow-up visits but infrequent physical exams, and who have difficulty coming into the office, are most likely to benefit. Patients who meet these criteria include patients with inflammatory bowel disease, diabetes, mood disorders, hypertension, ischemic heart disease, prostate disease, and airway disorders. The exam rooms and provider offices contain cameras that have a secure platform to remotely connect with patients. Providers must be willing to open up their schedules to see patients virtually, either during their clinical hours or during their nonclinical time.

The results of the pilot study at BWH consisted of approximately 600 visits that were conducted virtually, requiring about 200 additional hours for participating providers to see patients. Among patients surveyed after their initial encounter, 97% were satisfied with the experience and would recommend the program, and 74% felt that the interaction actually improved their relationship with their provider, allaying some of our concerns. The study found that 87% of patients said they would have had to physically come to the office to see a provider face-to-face if it weren’t for their virtual visit.(4)

The program director believes that no-show rates will be decreased by offering virtual care, given the dramatic improvement in patient convenience. Increasing the time patients are able to spend at home or at work, instead of traveling to see providers, will be a major advantage for the patients. Moreover, reducing no-shows and increasing the number of patients who engage with their doctor will lead to improvement in quality and help reduce cost of care, such as hospital readmissions or visits to emergency departments. Finally, virtual care should result in a reduction of provider burnout, which currently affects nearly 50% of all physicians.(5)

E-Visits: Providing On-Demand, Virtual Urgent Care for Simple Symptoms

At the other end of the clinical complexity spectrum, a virtual care program is applicable for patients with common, acute symptoms requiring rapid triage and management who have trouble achieving access to their providers. For certain common and irritating symptoms, seeing one’s provider in the office is often less important than obtaining quick access to care.

Broadening the Reach of Specialty Care

In addition to telehealth services offered directly to patients, virtual tools are available to improve care and communication among providers. Virtual visits solve daily problems in ambulatory care. For example, after reviewing the patient questionnaire and having a brief discussion with the patient, the physician makes the decision if a referral is necessary or if the patient should be advised to make an appointment to visit the brick-and-mortar facility. At BWH, virtual visits can be directed to a dedicated and responsive communication channel that can be ordered like any medication or test. Providers formulate a question and synthesize relevant information, and then route these requests to established specialists. The most common specialist teams were cardiology, endocrinology, gastroenterology, hematology, infectious disease, orthopedics, and urology.

The BWH virtual care program has two strategic aims, targeted at improving access and supporting primary care providers so that more primary care can be managed without actual face-to-face referrals, and to ensure that when referrals do take place, the specialty consultation is more effective and more timely for the patient. The results demonstrated that when a patient first virtually consulted with a specialist in that field, about 50% of the time, a face-to-face office visit was avoided. From a cost perspective, this means fewer unnecessary specialist visits, thus reducing healthcare costs.(4)

There will soon be a day when providers will be deciding not “whether” to offer telehealth, but “when” and “how much.” Virtual care holds the promise of revolutionizing healthcare delivery, but it must be carefully guided through complex clinical, financial, and technologic decisions. The challenge has not been in finding opportunities for virtual care, but, rather, on focusing on those with the highest value and the greatest cost savings.

Leverage Big Data

In the financial world, Mint (www.mint.com) aggregates financial information from disparate sources including banks, brokerages, and credit card companies to provide users with a comprehensive view of their finances. Based on these data, it provides targeted money management recommendations and advertisements for other financial products and services such as auto insurance, credit cards, and IRAs. By applying insights drawn from analysis of data from its 20 million users, Mint can recommend highly targeted financial products to individual customers that align with their financial goals and with their level of risk.

Similarly, Memorial Sloan Kettering Cancer Center partnered with IBM Watson and Quest Diagnostics to apply big-data analytics to cancer diagnosis and treatment.(5) After the genomic makeup of a patient’s tumor is determined, Watson examines a vast and growing clinical trial and medical literature database and, applying rules created by leading oncologists, finds targeted treatment options for individual patients.

IBM Watson has harnessed artificial intelligence–based screening processes to automate data-driven clinical trial identification steps and increase the speed at which matches can be made between patient, tumor, diagnosis, and treatment. Using the analysis of unstructured and structured data to analyze both patient records and trial inclusion/exclusion criteria, Watson for Clinical Trial Matching enables oncologists to quickly review a list of potential trials for every patient, while supporting the clinical trial office in reaching enrollment numbers. Watson for Clinical Trial Matching enables clinicians to more easily and quickly find a list of clinical trials for an eligible patient. Similarly, it enhances the ability of clinical trial coordinators to find patients who are potentially eligible for any of the site’s trials. The improvement in screening efficiency and more effective patient recruitment can help increase clinical trial enrollment targets and offer patients the option of a clinical trial for treatment. IBM Watson proactively identifies eligible trial participants to help maximize placement into suitable clinical trials, improve enrollment target success, and enhance treatments with relevant trial options.

Process Improvement

In aviation, in the 1970s pilots were the king of the cockpit. (They were like the surgeons of decades ago, who were like gods in their operating rooms.) These surgeons and those airline pilots did things the way they felt was best, which meant each did things in a different way. For plane crews, that variation resulted in unclear expectations and in accidents. The result of this behavior was a crash every five days, with over 2300 worldwide deaths in plane accidents in 1973. Standardizing work, clarifying roles, using checklists, and system design has dramatically improved safety and reliability. Major crashes are now rare.(6)

Atul Gawande made an eloquent argument to apply these principles to patient safety in The Checklist Manifesto.(7) Standardized processes (with allowances for patient-driven, individual variation where needed) have been regarded as anathema to medicine. Fortunately, this is changing. Today every surgery in the United States begins with the surgeon identifying the name of the patient, the name of the intended surgery, the side or organ that is going to be operated, the estimated time of the surgery, and the estimated blood loss. This has reduced wrong-side surgery from one in 115,000 operations (the average large hospital may be involved in one event every five to ten years) to a negligible level (CMS has not reimbursed hospitals for additional costs associated from wrong-side surgery since 2007). As a result, process improvement has become commonplace in most healthcare organizations.(8)

Bottom Line: Over the past 20 years, financial services have become much more consumer-oriented, and today healthcare is following suit by becoming patient-centric. But simply handing investors the yoke, alternatively known as a control wheel or joystick, and having them fly the plane solo wasn’t the right idea. Having patients drive their own healthcare decisions without professional support isn’t right either. As in financial services, effective consumerization in healthcare requires a collaborative partnership. The other take-home message is that the methods that we used in the past to provide care of patients will not be effective today. We don’t use the same techniques for diagnosis and treatment of diseases and conditions that were effective 20 years ago because in many cases they are antiquated today. We have to make changes and put patients first and use the same technology that has improved the financial service industry to improve the care that we can provide our patients.

References:

1. How to Successfully Adopt Telemedicine into Your Practice. eVisit. http://pages.healthcareitnews.com/rs/922-ZLW-292/images/How%20To%20Successfully%20Adopt%20Telemedicine%20Into%20Your%20Practice_0.pdf?aliId=913083420.

2. Herendeen NE, Schaefer GB. Practical applications of telemedicine for pediatricians. Pediatr Ann. 2009;38:567-569.

3. Adamson SC, Bachman JW. Pilot study of providing online care in a primary care setting. Mayo Clin Proc. 2010;85:704-710.

4. Licurse A. One hospital’s experience in virtual healthcare. Harvard Business Review. December 9, 2016.

5. Bresnick J. IBM Watson, Quest launch genomic cognitive computing partnership. Health IT Analytics. https://healthitanalytics.com/news/ibm-watson-quest-launch-genomic-cognitive-computing-partnership .

6. Mate K, Compton-Phillips A. The antidote to fragmented health care. Harvard Business Review. December 15, 2014.

7. Gawande A. The Checklist Manifesto: How to Get Things Right. New York: Henry Holt; 2011.

8. Kwaan MR, Studdert DM, Zinner MJ, Gawande AA. Incidence, patterns, and prevention of wrong-site surgery. Arch Surg. 2006;141:353-358.