W. Roy Smythe, MD

Editor's note: This is the third piece in Dr. Smythe’s four-part series on fostering healthcare innovation to face some of the biggest challenges fronting healthcare today: Chronic and Behavioral Care, Operations 2.0, Patient as Consumer and Post-Acute Care. This post discusses treating Patients as Consumers, while the previous two addressed Operations 2.0 and Chronic and Behavioral Care. Smarter. Faster. More connected. On demand. These are the global trends that are redefining and revolutionizing every industry – and healthcare is just getting started. Today, consumers can choose to comparison shop, read reviews, crowd source recommendations for just about everything, instantly. And as consumers increasingly bear the burden of their healthcare costs, patients are starting to approach their healthcare decisions in the same way. Hence, it is critical for healthcare systems to proactively manage both the patient experience and their expectations, to increase patient loyalty, sustain the provider’s brand reputation and prevent new entrants into healthcare from siphoning patients away. Technology can play a key role in meeting the needs of both patients/consumers and healthcare system organizations. Here are a few vital areas. 1. Transparency Consumer expectations are on the rise and patients are paying more attention to their healthcare costs. As of January 2015, 19.7 million Americans had high-deductible health plans making them responsible for the first $2,000 to $5,000 of their healthcare spending. Even for those not participating in high-deductible plans, out-of-pocket costs rose substantially. From 2009 to 2015, on average, deductibles rose from $680 to $1,200. It is important to note that the business of healthcare is not exactly like other markets. While financial responsibility may encourage individuals to be more discerning about services that are optional or variably priced, it may also provide an impediment to care when needed. Regardless, it is a reality, and one of the current strategies to provide some level of health insurance coverage to everyone. Moreover, transparent marketplaces in other industries— from Airbnb to Uber—are changing consumer expectations, at a time when health systems are under increasing competition for patient loyalty. CMS, along with consumer and employer demands are elevating the need for pricing that is clear, complete and accessible. Some health systems are responding by playing offense; many are investing to meet expectations. One common patient pain point is the bill paying experience. According to a Consumer Reports National Research Center survey, in the last two years, nearly one third of Americans with private health insurance were surprised when their insurer paid less than expected, leaving a larger-than-expected bill for the patient. As described by one family, “We just wish that a doctor's office would give us a reliable statement at the time of service; we would rather be told to bring $1,000 or know up front that we can't afford this procedure. End of story.”  In fact, as reported by PricewaterhouseCoopers (PwC), 66% of consumers have never had a conversation with their physician about the cost of a visit, 57% have never discussed the cost of a prescription, and 66% have never discussed the cost of a procedure. Technology can improve this experience by making it easier for patients to understand their cost for healthcare and pay their bills. 2. Real-time insights In nearly every industry, there is a common challenge: “big data” is not enough to sort through the swirl of uncertainty and complexity in today’s modern society. To quote the Harvard sociologist, E. O. Wilson: “We are drowning in information, while starving for wisdom. The world henceforth will be run by synthesizers, people able to put together the right information at the right time, think critically about it, and make important choices wisely.” In healthcare, the deployment of technology and willingness of patients to engage in their care has led to a proliferation of data. The challenge; however, is in the synthesis – how do you glean actionable insights? In addition, are there ways to harness data previously unavailable from “non-clinical” sources? In response, many health systems are revamping their online presence, as consumer-facing physician search and rating websites proliferate. Technology can also drive powerful results to improve patient experience and satisfaction. With real-time insights, providers can know how patients feel about their experience before they leave the hospital or doctor’s office. Patients can also offer perspective into health systems’ strengths and opportunity areas that can help provider organizations build patient loyalty and acquisition strategies. One example where technology is offering new insights to improve patient experience is Binary Fountain. Binary Fountain offers a “social listening” tool that continuously monitors reviews, feedback, and mentions from the web and social media and integrates these insights with CAHPS data, point of care surveys, and other sources of patient feedback.  The solution offers a single platform where health systems can distill actionable insights to inform their operational decisions and patient experience strategies. The solution both enables health systems to address patients' needs and to take control of managing their brand. 3. Virtual access Healthcare consumers increasingly seek out convenient and immediate access to care for common conditions. A 2014 survey of 3,873 patients conducted by the Advisory Board showed the number one priority for patients, when selecting a primary care clinic, was convenience. Over 70% rated “I can walk in without an appointment and I’m guaranteed to be seen within 30 minutes” as the attribute they sought most when seeking care. In 2013, Cisco performed an international study of attitudes regarding virtual care and found that 76% of individuals would prefer virtual care over a visit to an in-person provider, and showed while 19% of respondents preferred to visit a provider in-person, 23% preferred a consultation or visit by phone. Seeking convenient access to care, patients have turned to non-traditional healthcare providers such as retail clinics and direct-to-consumer telehealth providers. As a result, health systems are losing both loyal patients and downstream referrals. However, offering convenient access requires a significant change in provider organization scheduling, workflow, clinic hours and staffing without disrupting clinic workflows or leading to physician burnout. One company addressing this challenge head on is Bright.md. Bright.md's "SmartExam" is a virtual physician assistant that helps primary care groups automate up to 90% of provider time spent on low-acuity conditions. Using online exams that are easily accessible by both providers and patients, patients are able to interact with their own health system and trusted providers more efficiently. Learn more about the patient as consumer provider challenge and emerging technology solutions at HX360 during HIMSS16. Don’t miss the HX360 Innovation Pavilion plus cutting-edge programming led by world-class healthcare executives, investors, innovators and leaders like you.  

Editor's note: This is the second segment of Roy Smythe’s four-part series that takes a deeper look at healthcare innovation from the perspective of four Contemporary Provider Challenges: Chronic and Behavior Care, Operations 2.0, Patient as Consumer and Post-Acute Care. This post focuses on Operations 2.0 while the first focused on responding to the Chronic and Behavioral Care challenge. Today, healthcare systems and providers face the challenging headwinds of new regulations, increased competition, the need to understand and implement value-based payment models, an overwhelmed workforce, and more. At the same time, healthcare is transforming at an increasing rate - in part due to the impact of emerging technologies. All of these factors are converging to create a “perfect storm”. Making care delivery operations maximally efficient is an imperative, considering all of the above. We call this Operations 2.0. Value = Cost / Quality, and maximally efficient care means removing all non-value added components of work. We feel that there are exciting opportunities to use innovative technologies to these ends in an increasingly value-based healthcare enterprise. HX360, co-developed by HIMSS and AVIA, is focusing on the way forward by more effectively leveraging technology, along with process and structure, to improve health care. The good news is that providers actually now do have better tools and insights at their disposal – tools that can transform their operations and potentially revolutionize the delivery of care to patients. So, how is technology impacting health system operations today? Here are just a few exciting examples: Referral management One key opportunity where technology is improving operations is in the area of referral management.  Referral management enables providers to more effectively and efficiently refer to specialists that are aligned with them, or their organizations on the same EHR platform, and can provide referral guidelines based on clinical condition or need.  Innovative technologies that fit into providers’ workflow and channel patients within the desired network benefit both administrators and physicians, particularly in highly competitive markets, and this is especially true for delivery systems that have recently expanded, and/or are taking on more risk. Supply chain Another area ripe for innovation is supply chain. Across the country, health system leaders list financial stewardship as a top strategic goal and foresee increasing participation in value-based models. In this environment, understanding end-to-end cost is an imperative and as a result, purchasing is a tremendous opportunity.  Building supply chain capabilities—to understand pricing, renegotiate, and bring discipline to supply purchasing and use—grows in importance in this context. Traditionally, most decisions are based on cost, physician preference, or lack of information on inventory availability or price. Technology now allows for better information tracking and easier information retrieval of supply chain data points in real time for better decision-making and greater price/cost transparency, and can provide physicians with better data to make better collective decisions. Automation Automation or delegation is another area that will benefit from innovative technology. In this case, leveraging technology helps clinicians practice at the top of their license. With algorithm support, technology empowers clinicians to better understand which tasks should be delegated, to whom, how, when, etc., for best results. When considering technology in this area, it is important to be sure that solutions help streamline rather than become additive to the provider’s workflow. These are just a few examples of areas being transformed by technology and innovation in the era of Operations 2.0. In the months and years ahead, there will be much more to come. HX360 exists to advance the new model of care. Learn more about Operations 2.0 and emerging technology solutions at HX360 during HIMSS16. Don’t miss the HX360 Innovation Pavilion plus cutting-edge programming led by world-class healthcare executives, investors, innovators and leaders like you.

Editor's note: This is the first segment of Roy Smythe’s four-part series that takes a deeper look at healthcare innovation from the perspective of four Contemporary Provider Challenges: Chronic and Behavior Care, Operations 2.0, Patient as Consumer and Post-Acute Care. HX360, co-developed by HIMSS and AVIA, was established to advance innovation in these four areas through the thoughtful use of emerging technologies. Though not exhaustive, this series is designed to advance the dialogue among healthcare stakeholders and begin clearing the way for innovation in care delivery. Part one focuses on Chronic and Behavioral Care. The opportunities to improve the delivery of health care are evident, but how do we more effectively engage patients in their health and wellness? A recent study by the RAND Corporation demonstrates the massive challenge that chronic diseases pose to healthcare. It reports about 141 million U.S. citizens lived with one or more chronic conditions in 2010. Citing another study, the RAND Corporation projects this number to increase to 171 million by 2030, with diabetes and cardiovascular disease as two leading drivers: By 2034, the number of people with diabetes in the United States will double to 42 million with a healthcare price tag of $336 billion. The American Heart Association projects that by 2030, 40 percent of the U.S. population will have some type of cardiovascular disease. Healthcare costs will triple to $818 billion. In the face of such a large, industry-wide challenge, as might be expected, there is a wide spectrum of interests motivating healthcare systems and providers to respond to the chronic care challenge. RAND’s 2011 Health Plan Survey shows the top reasons health plans implement chronic care management programs include: Contain Cost – 96% Respond to market demands – 92% Improve patient health – 76% Improve clinical care – 64% Empower patients – 44% Respond to demographic changes – 32% Increase patient satisfaction – 20% So, what can be done, in the words of the World Health Organization, to face this “invisible epidemic”?  Pitfalls to Avoid in Chronic Care One established approach to chronic care uses individual risk identification and population risk stratification to drive care management program content and intensity that is matched to patients’ risk profiles.  Many health systems are using this approach, but two potential pitfalls can derail these efforts: Pitfall 1: Underutilizing emerging technologies to enhance and scale current services. Many care management programs use phone calls and home visits to monitor patient progress. This high-touch, low-tech option can be highly effective but difficult to scale to support a broader population. Pitfall 2: Bypassing the first two steps of risk stratification and care management infrastructure and jumping directly to patient engagement. Technology doesn’t solve internal workflow challenges; it amplifies what is already set up. It is important to ensure patients are stratified with the right focus; to clarify the role of care providers and how they interact with patients; and to define the information flow from provider to care manager to patient and vice versa before incorporating technology to engage patients. Promising Areas for Innovative Technology Emerging technologies have enormous promise in the care management and patient engagement stages, especially in relation to the EMR. Care Management Strategy and Programming Developing strong chronic patient care leaders, teams and programs is top priority. For health systems and hospitals with resources, this is straight-forward. Specific challenges for hospitals in this category, center on taking an existing workforce and building in efficiency and scale. Care management platforms such as CipherHealth's View, allow providers to streamline care coordination, improve patient engagement with automated touch points and assign evidence-based care plans. For smaller hospitals with more modest budgets or healthcare organizations with limited resources and internal staffing, creating a care management program may be out of reach. Turnkey solutions that include outsourced care management resources, in addition to patient engagement applications, such as MD Revolution, may be the best option to consider. Patient Engagement The good news is that there is a cornucopia of technologies that can be used for increasing patient engagement and satisfaction, but each takes a different approach. For example, all communicate with the patient but do so through different channels, like mobile, web, text, email, chat or EMR patient portals. Engagement solutions are also enabling a customized patient experience by translating patient data into more tailored insights and messaging, which can lead to better self-care management and patient satisfaction. Learn more about the chronic and behavioral provider challenge and emerging technology solutions at HX360 during HIMSS16. Don’t miss the HX360 Innovation Pavilion plus cutting-edge programming led by world-class healthcare thought leaders, investors, innovators and leaders.

Editor's note: This is the second segment in Roy Smythe’s two-part interview with Dr. George Day on the nature and application of science-based innovation to advance the new model of healthcare. A world class thought leader speaking at HX360’s Executive Program during HIMSS16, Dr. George Day is the Geoffrey T. Boisi Professor Emeritus and co-Director of the Mack Institute for Innovation Management at the Wharton School of the University of Pennsylvania. He is one of the leading global experts on the science of innovation. Dr. Day has studied many aspects of change and competitive advantage in businesses, including such topics as understanding how to leverage emerging technology, the importance of utilizing interdisciplinary partners to anticipate market needs, and most recently what differentiates non-healthcare corporate innovation leaders from “laggards” in his most recent book, “Innovation Prowess”. This interview has to parts. Part 1 focused on organizational structure around innovation. Part 2 below centers on innovation execution. (This interview was edited for clarity, readability or length.) Question [Smythe]: Healthcare organizations have a large number of areas where improvement could be beneficial – financial, technological, clinical and others. How do organizations that have an abundance of choice in this regard focus on the vital few initiatives that will create the biggest outside impact? Answer [Dr. Day]: I’ve never met any organization that didn’t have more opportunities than they can ever possibly pursue. The worst case is where you try to do a lot of different things, but do none of them well - hence the role of discipline in narrowing the set down. In any organization, having a clear strategic approach to looking at the possibilities ahead of you is critical. Everyone in your organization has to be aligned around the qualitative and financial objectives that will be accomplished (e.g. cost reduction, improving the patient experience). What is critical to the execution and discipline part is the (1) resource allocation and (2) the choice among innovation alternatives. Counter-intuitively it works better if you start in a divergent way and ask – what are all the things we could do? Start looking aggressively for ideas – not just the ones that come across your desk - but go out and canvas for ideas within the organization as well as peer hospitals, and spend time studying the patient experience. The idea is you diverge first and then converge –you are at risk of missing the best ideas if you don’t ask. This is something the Chief Innovation Officer or Chief Strategy Officer could orchestrate. Once you have your portfolio of possibilities, the discipline part comes in. Narrow down to the ones that are aligned with your strategy, technically feasible, and can deliver results in a realistic timeframe. Some techniques you can use to screen your portfolio include innovation tournaments, discovery-driven planning, and patient experience mapping. Question: Could you please explain further the importance of real options reasoning and how it could apply to efforts to generalize innovation in healthcare? Answer: The idea around real-options reasoning is akin to the experience in buying a house. You are not sure you want to buy that house, but you don’t want to lose it. So you put down $10,000 to get another month to consider it while continuing to look further. If at the end of the month, you don’t like the house, all you have lost is the $10,000. If you do like the house, you can exercise the option and apply the $10,000 to the purchase price. Buying a real option gives you the opportunity to learn but doesn’t commit you to big action. Think of it as a stepping-stone or a way to step into a major change. Some examples of this in the healthcare space would be doing a pilot or initial implementation, or taking a small stake in a start-up company – both actions do not require big commitments. Question: In an industry that is shifting towards a focus on measuring outcomes, some of which could take months or even years to show clinical benefit, how can an organization measure innovation progress and effectiveness? Should there be more focus initially on input, engagement and process measures? Answer: About six years ago, I did a project with McKinsey where we looked at all the innovation metrics. We found an upwards of 45 metrics that could be grouped into 3 buckets: Inputs – e.g. # of ideas (expanding before contracting), # of investment dollars, employee time, # of employees involved in innovation, balance of the portfolio Throughputs or intermediate steps – e.g. # of quality ideas, time to move idea from concept to prototype, satisfaction with prototype, # of pilots completed Outputs – e.g. how many reached the market, % of revenue derived from new solutions Outputs turn out to be of little to no value in situations where you are fixing a system that is broken. For example, failure rates on innovation are found to be really high, but you have no diagnostic insight into what to change. The challenge is to push back into the innovation funnel towards the intermediate stages and focus on inputs and throughputs. By tracking inputs you are able to uncover issues such as – are inputs being protected? Throughputs and intermediate stages of innovation is often where you see problems propping up. Here you can uncover issues such as: significant approval delays and people moving in and out of teams. Monitoring these earlier process problems can help tell you what to fix when issues arise. Discover more of Dr. Day’s critical healthcare innovation insights and applications at HX360’s Executive Program during HIMSS16, February 29 – March 3, 2016 in Las Vegas, Nevada.      

Roy Smythe, MD, interviewed Dr. George Day to drill down into the science of innovation and give readers some flavor of the need to understand innovation at this level.