Creating a “Radical Convenience” Healthcare Delivery ...

Please note that the views expressed by the conference speakers do not necessarily reflect the views of the American Hospital Association or AHA Health Forum.

Creating a “Radical Convenience” Healthcare Delivery Strategy –

Fundamentals of Access Transformation and Lessons from Other Industries

Craig Ahrens

David Fairchild

Pamela McClain

Welcome & Facilitator Introductions

• 20+ years as a healthcare executive, practicing clinician, researcher, &consultant

• Expert in physician organization and engagement, clinical quality improvement, and shared-risk contracting

• Former SVP, Clinical Integration, UMass Memorial Health Care, and former CMO, Tufts Medical Center

• Professor of Medicine, University of Massachusetts

DAVID FAIRCHILD, MDDIRECTOR – BDC [email protected]

• 20+ years as healthcare executive and leader• Chief Operating Officer for one of the largest,

independent faculty groups in the country serving Washington DC

• Affiliate of The George Washington University School of Medicine & Health Sciences

• GW MFA is comprised of more than 950 physicians who deliver care in 51 medical and surgical specialties, all of which are supported by academic medicine and clinical research

PAMELA MCCLAIN COO – GW MEDICAL FACULTY [email protected]

• 20+ years as a healthcare executive & consultant

• Expert in Healthcare Strategy, Operations, Physician Enterprise, and Healthcare Delivery Transformation

• Former Senior Director, Health Solutions, at FTI Consulting ; as well as, former consultant with Tiber Group and ECG

• Former healthcare leader at Ascension Indianapolis and BJC Healthcare

CRAIG ALLAN AHRENS, MHA MBAMANAGING DIRECTOR – [email protected]://www.linkedin.com/in/craigahrens/

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Agenda

Session Objectives

Concepts – Market Trends & Radical Convenience

Review of 3 Key Radical Convenience Activities

Case Study and Q/A – GW Medical Faculty AssociatesOutside Industry Learnings

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Session Objectives

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Three Objectives

1. Review and learn fundamental convenience concepts related to health system performance and market position

2. Consider 3 key radical convenience actions when establishing healthcare delivery strategy goals

3. Discuss advanced ambulatory health system “front door” convenience approaches that improve performance and access

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Concepts - Market Trends & Radical Convenience

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Disruption = Patients Expect Convenience

Performance and reliability ….need to be met first, but once care is met that is more than adequate in those regards, consumers do and should make their healthcare decisions on the basis of speed,convenience, and affordability.

Clayton ChristensenHarvard Professor

Founder of Disruptive Innovation TheoryAuthor of The Innovator’s Prescription

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Consolidation, Profitability, & Employment

1: American Hospital Association (AHA) Hospital Statistics, 2017; Merritt Hawkins

3.2

3.8

4.5

5.0

42%

76%

20%

42%

3.0

3.5

4.0

4.5

5.0

5.5

0%

10%

20%

30%

40%

50%

60%

70%

80%

Highlyunprofitable

Unprofitable Profitable Highly profitable

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Hospitals

US hospitals’ Markup, System Affiliation, Regional Power, and Profitability

Markup System affiliation Regional power

Ge Bai, and Gerard F. Anderson Health Aff 2016;35:889-897©2016 by Project HOPE - The People-to-People Health Foundation, Inc.

Physician Employment by Health Systems1

16%

2007

33%

2017

Full or partial hospital/health system employment

Non-hospital/health system employment model

Increase in the number of physicians employed by hospitals between 2012 and 2017350%

health systems are often under-appreciated as the first point of patients’ perception of system convenience

As healthcare systems have consolidated, so have physicians into groups (aligned or employed)

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Commoditized Markets at Risk for “Disruption”

Commoditization increases the risk to lose share to disruptive new entrants1 who offer convenience

As markets consolidate = similar services and profiles = commoditized to consumers

Health System A Health System B

Employed health systems

Broad Services

Many Commoditized Cities, Any State USA

Split Market Share Margin/Cost Issues

Limited Patient Access

Employer/Payor Shifts

1: Adapted from Clayton Christensen, “The Innovator’s Prescription: A Disruptive Solution for Healthcare”, 2009, McGraw Hill9

Convenience over Credentials or Continuity1,2

1: Advisory Board, https://www.advisory.com/-/media/Advisory-com/Research/MPLC/Research-Study/2014/What-Do-Consumers-Want-from-Primary-Care/28878_Research_Brief_PDF061614%20(2).pdf, 20142: Deloitte, https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-lshc-cx-survey-pov-provider-paper.pdf, 2016

Recent research all supports that consumers would rather visit virtually than come into the office

Multiple surveys have shown that convenience linked to access is a primary driver

0 1 2 3 4 5

Walk In Guaranteed 30 mins

Diagnostics onsite

Expanded Office Hours

Appointment that day

Same Provider

Onsite Rx

Near home

Dr. vs NP/PA

Provider Credentials

Provider Contuity

Convenience

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Access Bridges Volume and Value Based Worlds

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Curve One – Fee-for-Service Curve Two – Value-Based Care

• Volume-driven• Maximize unit price / volume• Little reward for quality• Patient preference

• Reward lower cost / higher quality• Engaged consumer; price sensitivity• Coordination of care; incentives to

reduce utilization• Lines blurred between payers and

providers

Although there is uncertainty about the future of ACA and the political landscape, the basic business model for healthcare delivery will continue to face unprecedented change where a focus on access is key to meeting patient needs

Access

$$$

“Disrupting” Forces Driving Convenience Trend

Evolving Patients

Adopting Technology

IncreasingCompetition

Healthcare Industry1

1. Payer/Provider2. Employers3. Retailers

1. Brand Disloyalty2. Alternative Care

Pathways3. $ Sensitivity while

Expecting More

1. Virtual Healthcare2. Customer Data3. Logistics (Scheduling/Transport)

Disruptions often center around patient convenience with the health system being the front line

New entrants often in alliance with traditional players apply simplicity

1: Adapted from Deloitte, “The Digital Transformation of Customer Services”, 2013, https://www2.deloitte.com/content/dam/Deloitte/nl/Documents/consumer-business/deloitte-nl-the-digital-transformation-of-customer-services.pdf

Fee to Value/$/Costs

Provider Supply/Culture

Government

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“I’ve Heard this Before and It Didn’t Happen”

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An evaluation of where your market is versus the adoption cycle1 is critical to plan a convenience strategy

It may not…yet…most have almost cleared the chasm and/or are beyond tipping point2

1: Adapted from https://www.researchgate.net/figure/5-Diffusion-of-Innovation-The-Chasm-and-The-Tipping-Point-Once-the-The-Tipping_fig5_3017899912: NEJM Catalyst, https://catalyst.nejm.org/care-redesign-report-push-convenient-care-protect-patient-doctor-relationship/

What is Radical Convenience? Simplicity

Consider the four laws when implementing radical convenience across the following three key activities

Radical defined adj.1 Arising from or going to a root or source; basicConvenience defined2 Any element that simplifies for a better patient experience

How can we reduce steps to better organize?

1 How can we save effort (time/$)?

2

How do we promote transparency?3 4How do we offer

choice?

4 of MIT’s Laws of Simplicity3 to Apply to Radical Convenience “RECT”

1,2: Adapted from Merriam Webster online dictionary3: Adapted from John Maeda, “The Laws of Simplicity – Design, Technology, Business, Life”, 2006, MIT Press

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Framework for a Radical Convenience Effort A Radical Convenience Effort is tied to a Healthcare Delivery Strategy

health systems are the venues where consumers (patients) can benefit from convenience strategies

Communication, Choice, &

Coordination

Governance and Leadership Measurement

Scheduling & Capacity

Channels(Virtual, Telephony,

Web)

Care Team Design

Ease of Access (Scheduling, Retail,

Transportation)

Consumer Data and Profiling

Alignment

3 Key Activities to Implement Radical Convenience “CIA”

Incentives and Compensation

health system Performance

Consumerism

Infrastructure

Partnerships & Payers

Price Transparency1

2

3

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5 Key Concepts Takeaways and (Q&A) Poll One

Consumerism - How long does it take to see a physician for a new appointment?

1

Alignment - Are leaders measured and incented on patient convenience (not satisfaction)?

3

2

4 Infrastructure - Do patients have a choice to schedule virtual versus in person visits?

Disruption - Is disruption starting to impact your market? If so, what kind?

Convenience = Simplicity - Do you believe your health system is convenient/simple?

5

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1 Consumerism

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Paternalistic versus Patient Centric

One of my observations has been that healthcare has been pretty paternalistic, but we are working to change that….the primary care physician is a quarterback and can see all the care you’ve gotten through different venues that you choose –retail clinics at drugstores, virtual visits, home visits – in other words convenience1.

Aaron Martin Executive Vice President and Chief Digital Officer

1: Aaron Martin, “A Patient Centered Culture Focuses on Convenience”, NEJM Catalyst, 19 January 2017, https://catalyst.nejm.org/videos/patient-centered-culture-convenience/ 18

Return/Effort


Coordination

Ease of Access (Scheduling, Location,

Transportation)

Consumer Data and ProfilingConsumerism Price

Transparency1

A Chief Marketing/Digital Officer in combination with skilled partners is often key to rapidly implement

Communication, choice, & coordination foster consumer rapport & collaboration

Inhibitors

Actions

Enablers

□ Communication engagement plans for “stickiness”□ Develop “multi- channel” care choices, retail strategy2

□ Analyze care journey and coordination points

□ Social media, text platform, auto calendar, Spotify □ Technology, alternative care pathway, retail alliances□ Streamlined specialty referrals/diagnostics□ Translate approach to consumer for providers too

□ health system marketing/communications□ Consumer brand disloyalty, infrastructure investment□ Physicians, siloed nature, coordination infrastructure□ Splitting providers time between virtual & clinic

$$$/++

Action in Practice1

1: Ara Telbelian, “Innovating Retail Health Care Solutions for an Evolving City & Customer”, 2016, AMGA Annual Conference.2: Chad Pinnell, “Healthcare Is the New Retail™: How to Think Through Your Consumer Strategy with a Retail Approach”, 2015, JLL.

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1: Sanne Magnan, https://nam.edu/social-determinants-of-health-101-for-health-care-five-plus-five/, 9 October 2017, National Academy of Science2: https://www.acxiom.com/wp-content/uploads/2017/06/AC-0114-17-BRO-Acxiom-Healthcare-brochure_0617.pdf


Coordination


Transportation)


Transparency1

Return/Effort

Partnering on data and creating (IA) teams are critical to realize gains quickly by turning data into action.

Segment consumers to learn needs and what to measure to make a difference

Inhibitors

Actions

Enablers

□ Develop a data science plan (consumer+claims+EMR)1

□ Partner or invest in very hard to find data people □ Create profiles and segment (social determinants)

□ Partner with data firms and technology players□ Create cross functional teams provide info assist (IA)□ Identify measures that move the needle□ Employ the same profiling process on providers□ Share information platforms with consumers□ Technology investment and health system resources□ Lack of trust regarding data in health system settings□ Inexperienced data professionals and support

$$$$ (> in value)/+++

Practice2

40% of health factors are due to social/economic profiles1

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21


Coordination


Transportation)


Transparency1

Ease of Scheduling

Ease of Location

Ease of Transportation

1: Geisinger Zoc Doc/Uber Announcements


Coordination


Transportation)


Transparency1

Return/Effort

Ease of Access is the baseline experience for consumers and area of greatest opportunity for most systems

Ease of scheduling, the location experience, & getting to an appointment are top of mind

Inhibitors

Actions

Enablers

□ Develop health system access plan/standards□ Create an ambulatory strategy & facility plan□ Determine transportation/parking barriers

□ Create access governance (hours, channels)□ Partner with retail and scheduling experts□ Dedicate meaningful capital to health system □ Gather missed appointment/transportation data

□ Physicians desire to “control” schedules □ Predilection to underinvest in MOBs□ Misunderstanding of gender or socio economic needs

$$$$/+++

Practice1

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1: https://www.healthcarebluebook.com/


Coordination


Transportation)


Transparency1

Return/Effort

Marketing with experience in strategic pricing and consumer behavior is essential (learn from other industries)

As employers shift, pricing is increasingly becoming a determiner of place of service

Inhibitors

Actions

Enablers

□ Analyze professional revenue cycle & patient impact□ Gather intelligence on competitor service pricing□ Develop simple, tiered pricing, and billing plans

□ Develop team to focus on professional revenue cycle□ Periodically, survey pricing in the market□ Focus groups on bills and understanding bills□ Ensure CFO and marketing officer meet to discuss

□ Hospital revenue cycle traditionally more focus□ Pricing information can be difficult to obtain□ Aversion to addressing low balance AR

$$ /+++

Practice1

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5 Key Consumerism Takeaways and (Q&A) Poll

Segmentation – Do you understand your consumer enough to know care preferences?

1

Price – Do you know the price of an office visit in your system versus your competitors?

3

2

4 Access/Location – Do you feel that the ambulatory facilities are a place you’d want to visit?

Consumer Trust – Does your health system engage consumers and offer choice of care?

Coordination – When a consumer goes to an alternative care site, do you know?

524


2 Infrastructure Activities

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Infrastructure Performance = Convenience

Patients are demanding immediate access to care, convenient hours, and multiple ways to communicate with their physicians. They want to be able to navigate the system to find the right care at the right time. Health systems need to assess the patient experience from the patient’s perspective: …..How does the health system support the process? How does technology, such as patient portals and online options, support patients to ensure they receive the right care at the right time?

Care delivery is changing. Consumers are seeking convenience and are increasing their use of technology; depending on the situation, care can be provided virtually.

Lucy Zielinski Vice President

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Performance Supports Convenience

“Optum Envy” – Payer physician/provider investments are escalating thinking that they can do it at lower costs

Operating loss/MD increased from 10% of net revenue to 17.5% of net revenue in 20171

1: AMGA annual report on practice performance, 20172: Modified from AHA Guide to Health Care Partnerships for Population Health Management and Value Based Care July 2016; AMGA High Performing Health System Definition

Barriers to Convenience Correlate with Performance2

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Return/Effort

An Ambulatory Mindset needs to replace our Hospital Mindsets to succeed going forward (Ascension Health).

Fundamentally, health system performance is interrelated to consumer convenience

Inhibitors

Actions

Enablers

□ Develop a philosophy beyond productivity□ Create a care team, consumer engaged culture□ Standardize outpatient like inpatient w/revenue focus

□ Dyad leadership □ Over communication of convenience standards□ Performance measurement system □ Tying convenience performance to pay

□ health system leadership experience□ Ambulatory versus hospital cultural focus□ Physician burnout and engagement□ Physician employment and “new” expectations

$$$$/++

Practice1

1: https://www.stltoday.com/business/local/ascension-ceo-outlines-new-strategic-direction-for-nation-s-largest/article_becde0ee-b795-50fc-bf3f-5b3bc8cd1eb8.html



Web)

Care Team Design

health system PerformanceInfrastructure 2

Ascension, the nation’s largest nonprofit health system, is pivoting away from its hospital-centric thinking as it forges a new strategic direction

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Supporting Convenience Requires the Team

“Rise of Urgent Care” – urgent care and other retail options leverage alternative care team models (e.g NPs, PAs, etc)

Physician centric versus care team centric lends to lack of focus on convenience

Care Model Barriers to Convenience

ClericalClerical

MAsMAs

LPNsLPNs

APsAPs

MDsMDs

RNsRNs

Roles are being fully leveraged to operate at top of license (e.g. Advanced Practitioners)

Appropriate mix of roles ensure effective team for convenience

Optimal skill mix to deliver quality care, cost efficiency, and convenience

Role responsibilities are defined based on best practice

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Return/Effort

Urgent care and retail locations grow in markets where consumer convenience is not met (especially access)

Beyond the physician, effective care team design supports consumer convenience2

Inhibitors

Actions

Enablers

□ Develop a care model beyond productivity mentality□ Create care team staff incentives □ Human capital plan (FTEs and experience) to support

□ Staff for convenience not just productivity□ Invest in flexible outpatient/alternative staffing□ Centralize where appropriate (e.g. access centers)□ Retail and consumer focused training

□ Misunderstanding and misuse of NPs/PAs□ Ambulatory versus hospital cultural focus□ Physician burnout and engagement□ Physician employment and “new” expectations□ Caring for value/volume based patients same setting

$$$$/+++

Practice1

1: VA Mission Act of 2018, https://www.jdsupra.com/legalnews/the-va-mission-act-of-2018-and-77097/2: NEJM Catalyst, https://catalyst.nejm.org/care-redesign-report-push-convenient-care-protect-patient-doctor-relationship/



Web)

Care Team Design


Since the Veterans’ Health access crisis, they have employed their alternative care models

more aggressively mirroring commercial retail and urgent care players use of NPs/PAs

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Access=Convenience=Tied to Performance

31

20-30% capacity exists in health system practices due to no shows, cancellations, transportation issues, etc.1

Productivity Plateaus driven by supply, burnout, life/work balance, & expectationsProvider Performance Barriers to Convenience

1: Patient Access Symposium, “http://www.patientaccesssymposium.com/”

Return/Effort

32As provider supply/costs and other issues increasingly inhibit convenience, virtual care models rise

Access is intimately tied to consumer convenience & often it is immediate access

Inhibitors

Actions

Enablers

□ Promote an access scheduling philosophy (immediacy)

□ Establish scheduling/care pathways by specialty area□ Plan physician/ambulatory capacity (supply, burnout, etc)

□ Immediate scheduling is new expectation□ Ensure staffing, facility, & EMR systems are aligned□ Create access teams that rapidly implement□ Physician and care team leadership standards□ Physician burnout, engagement, expectations□ EMR implementations and support□ Facility limitations (# of exam rooms)□ Cultural resistance to templates and standards□ Academic non-clinical commitments

$$$$/++

Practice1

1: Kaiser Permanente Business, https://business.kaiserpermanente.org/insights/passport-to-kp, 2018



Web)

Care Team Design


Consumers Prefer Virtual over In-Person

Growth in services has been dramatic with some systems seeing triple digit growth in virtual care volume1

Systems who dedicate resources to a virtual channel are driving loyalty through convenience

Virtual Care Model Example Enhances Convenience1

1: Shauna Coyle, “NYP OnDemand”, 6 March 2018, HIMSS 2018 Annual Conference Las Vegas33

Return/Effort

34Reimbursement is low, but the virtual model can immediately improve high demand/negative margin areas + convenience

First Adopters in markets are starting to see a convenience and cost advantage

Inhibitors

Actions

Enablers

□ Develop a virtual health system within system plan□ Target low reimbursement, high cost/demand services □ Create leadership over digital with dedicated focus

□ Virtual providers with limited split time□ Include provider to provider connections coordination□ Target first areas loss leaders w/ “stickiness” (psych)□ Develop multi channel options w/plan (telephony)

□ Health system leadership experience□ Reimbursement challenges and understanding□ Legal/liability understanding□ Technology understanding and investment

$$$/++++

Practice1



Web)

Care Team Design


1: Shauna Coyle, “NYP OnDemand”, 6 March 2018, HIMSS 2018 Annual Conference Las Vegas

5 Key Infrastructure Takeaways and (Q&A) Poll

Access = Convenience – What is your biggest barrier to access for your consumers?

1

Start with Low Margin/High Demand Areas – What areas do you think would be

good candidates for piloting virtual services? (e.g psych, primary care, etc.)

3

2

4 Virtual Healthcare Delivery Plan– Do you currently have a virtual plan?

Performance Tied to Convenience – Is your health system high performing?

Care Team Focus – How is your health system supporting convenience through care teams?

5

35


3 Alignment

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Aligning to Enhance Consumer Convenience

Depending on how providers and payers align their communications with healthcare consumers, the experience may still be disjointed. Today's consumers expect care to be coordinated across providers, payers, pharmacists, and other third-party entities. ….When payer-partnerships align, it can have immense benefits for everyone involved. This is the case with Sentara Healthcare, a provider, and Optima Health, a payer1……examples are changing the health consumer experience by improving the coordination of communications, quality care, competitive pricing, and convenient access.

Dr. Tom LundquistSVP and CMO Optima Health

1: https://www.beckershospitalreview.com/quality/leveraging-payer-provider-partnerships-to-enhance-the-health-consumer-experience-focusing-on-quality-and-safety-to-accelerate-healthcare-transformation.html, November 2017

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Organize Teams for Focus on Convenience

Health system Leadership and Governance systems should enable resources for convenience teams

health systems should organize to focus and address convenience and value

Virtual Care Model Example Enhances Convenience1

Rapid Value and Convenience Team Operationalizing performance set forth by leadership Reviewing monthly KPIs with direct reports and identifying imbalances in

supply/demand of staff, providers and patients Making recommendations to Executive and Provider leadership of ways to

model/improve convenience

Provider Leadership Team Defining and communicating convenience standards Developing analytics, productivity, leverage and actions Developing policies and holding care teams accountable for

following approved policies and procedures, while maintaining focus on consumer engagement

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Return/Effort

39Governance and leadership align more effectively in convenience goals through measurement systems

Governance and Leadership support at System level is critical to support convenience

Inhibitors

Actions

Enablers

□ Align with healthcare system delivery strategy□ Establish convenience/access board subcommittee□ Create leadership over digital with dedicated focus□ Organize team that are aligned around convenience□ Experienced facilitators and training support□ CEO and Board support□ Organizational focus and bandwidth□ Partnerships to facilitate and implement

□ Health system leadership experience□ System support of health system convenience□ Limited health system resources

$$$/+

Practice1

1: https://nortonchildrens.com/news/cox-named-presidentceo/

Governance and Leadership MeasurementAlignment Incentives and

CompensationPartnerships &

Payers3

“We are completely committed to being a consumer-driven health care provider. We will find ways to make the increasingly complex health care system easier to use…we will provide the best care while always putting the convenience of our patients and families first.”

Russell Cox CEO Norton Healthcare

Measure Performance Tied to Convenience

Access metrics are the starting place for convenience measures & visualizations

Health systems need to develop measurements/visualization platforms that tie resources to convenience

health system Dashboards to Enhance Convenience1

1: Change Healthcare, “The Engagement Gap: Healthcare Consumer Engagement”, 2017 and BDC Advisors40

Return/Effort

Measurement, communication and meeting alignment are key, but ultimately tying to compensation = results

Health Systems should begin with Access Metrics (same day, time to next available, wait times, capacity)

Inhibitors

Actions

Enablers

□ Determine core metrics for measurement□ Identify a measurement system and platform□ Communicate measurements in meeting cadence

□ Technology partners/dedicated IT support to sustain□ Communication plan in concert with leader meetings□ Identification of best practice measures□ Provider educators

□ health system leadership experience□ Limited interaction with consumers □ Survey capabilities and measurement systems□ Limited industry benchmarks for virtual/convenience

$$$/+

Practice1

1: Dimensional Insight and dashboardMD company websites



Payers3

41

Incentive Models Shifting to Access/Value

Value Based reimbursement and payer collaboration is driving the trend to support convenience incentives

Health systems are beginning to incent providers on convenience related measures

Provider Compensation to Enhance Convenience1

1: Ankura Healthcare consulting client example 42

Return/Effort

Compensation is a lightening rod for providers, but starting with leadership/staff is often the best pilot to align

Health Systems are struggling with how fast to transition mix of wRVU versus convenience related incentives

Inhibitors

Actions

Enablers

□ Evaluate current compensation plan efficacy□ Identify convenience measures to tie to incentives□ Align incentives across administration, clinicians, staff

□ Physician leadership support□ Aligned value based contracts□ Communication plan□ Large percentage to align behavior models

□ health system leadership experience/contracts□ Survey capabilities and measurement systems□ Virtual system measures□ Initial distrust of data

$$$$/++++

Practice1

1: HFMA, “http://www.hfma.org/Leadership/Archives/2017/May/Toward_a_Common_Vision_for_Value_Based_Care_Metrics/”



Payers3

43

Payer/Provider Collaboration Drives Convenience

Payor Collaboration and Alignment will reinforce consumer convenience with success in first adopter markets

Health Systems should encourage payer collaboration at the system level to align/profit convenience

Payer/Provider Collaboration Key to Profit Resources to Enhance & Align Convenience1,2

1: Change Healthcare, “The Engagement Gap: Healthcare Consumer Engagement”, 2017 and BDC Advisors2: McKinsey Healthcare Services Practice

Per member Per Year Profit

44

Return/Effort

68% of payer partnerships launched in 2017 are joint venture or fully co-branded2

Health Systems are shifting to partnerships as a method to enhance convenience and margin

Inhibitors

Actions

Enablers

□ Identify payer/employers partners for convenience/$□ Recruit leaders that understand payer & provider□ Align health system dedicated resources for model□ Preferably in market payer/employer collaboration□ Learn from other markets and industry experts□ Create a plan to pilot relationships□ Steer new model consumers to dedicated sites

□ Health System leadership experience□ Limited interaction with payers/employers□ Finding the “right” people to engage

$$$$/++++

Practice1

1: Aetna, “http://lp.aetna.com/index.html”2: Oliver Wyman, “Payer Provider Partnerships Continue to Deepen”, November 2017



Payers3

Aetna Whole HealthSM products with provider partners

45

5 Key Alignment Takeaways and (Q&A) Poll

Measure – Does your health system have a dashboard that incorporates access convenience?

1

Payer/Provider – Are you currently exploring payer/provider collaboration?

3

2

4 Incentives – Is there a plan to create incentive models around access and value?

Organize and Focus – Do you have dedicated teams for access convenience?

CEO and Board – Does your governing leadership understand convenience as priority?

5

46

3 Key Overall Convenience Takeaways

Partner/Collaborate to More Rapidly Realize Gains

1

3

2

Consumer Engagement through Performance/Provider Excellence

Invest in New Models of Care Supported by Virtual Enhancement

47

Case Study and Q/A – GW Medical Faculty Associates

Application Convenience = Access/Payer Alignment

48

Case Study – GW Medical Faculty Associates

Situation Division of General Internal Medicine

o 30 physicianso 6 Advanced Practice Clinicianso Direct Contribution Margin –

Break Even

Closed panel to new patients for over a decade

Specialists were not receiving referrals and/or were not referring to Internal Medicine

Culture of academic excellence uncoupled from clinical performance

Divisional leadership resistant to change and not educated in current clinical management practices

Physician Practice Support

Lack of clinical performance management metrics

Incentive system not aligned with clinical productivity

Caps on Number of Patients scheduled and Physicians “controlling” schedules

Physicians, APCs, and Nurses not practicing at top of license

Very low staffing ratios left physicians to complete almost all clinical tasks

Imbalance of clinical and non-clinical time related to didactic teaching and admin duties

Performance Below Peers

Physician panel size at AMGMA 25th

percentile

Average number of visits/clinic session for MDs = 7.6 vs. 12 benchmark

APCs averaging 1.8 visits/session vs. 12 benchmark

Care model not leveraging provider time/efficiency to increase patient throughput

APCs were focused on managing specialty clinics and nursing duties

RNs were performing supervisory tasks vs. clinical care to facilitate care process

49

Case Study – GW Medical Faculty AssociatesChallenge - Design a strategy to:

Guide DGIM to industry standard clinical performance while honoring the academic mission

Reach consensus on current clinical performance and specific goals

Mentor division leadership on rapid cycle change in an academic environment and best practices

Open panels to new patients to meet patient needs and to grow overall financial business

Pilot care team models and revised schedules to engage physicians/care teams in learning to meet increased patient volume targets

Approach Goals:

Establish dataset defining the baseline clinical performance within the Division

Understand perspectives and attitudes within DGIM from MD to MA

Design a new care model that would achieve industry standard clinical performanceo Pilot test within the Division

Provide a road-map for implementing the new care model

Transformation Process:

Conducted in-person interviews across the Division that provided insights to Division and Practice Plan Leadership

Rigorous data authentication and validation process resulting in consensus on baseline performance

Designed and facilitated pilot testing of new clinical care model

Modeled financial implications of clinical performance achieved during care model pilot

Formed Governance oversight

50


Outcomes

Happy Patients Served with More Convenient, Timely Access

Happy Specialists and Patients with Service in Network

Happy Providers with More Resource Support for Patients

Happy Payer Service Needs of Members

Happy COO Increase in Revenue

Increase in New Patients

Increase in Patients Served

51


Q & A

Outside Industry Learnings

52

Ease of Scheduling and Managing Capacity

• Millions of people routinely self-schedule everything from flights with Southwest Airlines; restaurant reservations with OpenTable; hotel reservations through hotels.com, etc.

• While self-scheduling has already revolutionized many industries, health care has been late to the party.

• Use data and algorithms - airlines and hotels book and double book to manage capacity

• https://www.forbes.com/sites/forbesbusinessdevelopmentcouncil/2017/07/25/five-lessons-on-relationship-building-for-sales-professionals-in-health-care/#18366d767692

Transportation and Convenience

• Uber and Lyft revolutionized transportation

• Now, they want to revolutionize non-urgent care transportation

• Many no-shows are due to lack of transportation

Source: Geisinger Zoc Doc/Uber Announcements

Case Study - Geisinger

Focus on the Customer Experience

• Customer experience management has been critical for retailers to survive Amazon.

• Nordstrom has been known for empowering employees to use good judgment, building personalized relationships with customers and providing a welcoming atmosphere from the moment someone enters the store.

• Nordstrom shifted from a transaction to a personal experience.

• https://www.forbes.com/sites/forbesbusinessdevelopmentcouncil/2017/07/25/five-lessons-on-relationship-building-for-sales-professionals-in-health-care/#18366d767692

Predictive Analytics Using Big Data

• Spotify maintains giant datasets of users, their listening habits, and clusters of micro-genres that define the types of songs listened to.

• Spotify’s approach mainly includes collaborative filtering (similar to Amazon and Netflix), convolutional neural networks, natural language processing (to both scan music blogs to build micro-genres and analyze the contents of playlists), and outlier detection.

Source: https://blog.markgrowth.com/6-models-for-engineering-personalized-digital-experiences-part-2-spotify-and-pinterest-3bb974252bbd

Leverage AI to Understand How to Improve

• Artificial Intelligence is being employed now and it is amazing.

• Use it to measure and improve—analyzing CRM and Access Data.

IBM Watson and Applying AI in Healthcare Sector

Source: https://www.weforum.org/agenda/2017/01/what-did-we-learn-from-the-first-wave-of-ai

Chatbots - Lower Costs and Enhance Service

• Half a million people professed their love for Siri

• Remember the movie entitled Her? The main protagonist, Joaquin Phoenix falls completely in love with the voice of a digital assistant capable of learning at astonishing pace as well as fulfilling his every need

• According to a recent report in the New Scientist, hundreds of thousands of people say ‘Good morning’ to Alexa every day, half a million people have professed their love for it, and more than 250,000 have proposed marriage to it.

Source: http://medicalfuturist.com/chatbots-health-assistants/