Q&A: As Nontraditional Competition Grows, Providers Should Prioritize Patient Loyalty in 2023
Though the descriptor most assigned to healthcare in 2023 is "challenging," the word that may prove most consequential is "choice." After all, everything from telehealth to nontraditional entrants to the industry like Amazon and Walmart mean more options for patients — leaving health systems to navigate a brave new world of consumerism.
"It used to be you either went to your local hospital or your local doctor," said David Levine, Vizient Group SVP, advanced analytics and data science. "Now, there are more popups from within Walgreens or CVS, you have more ambulatory surgical centers — there are just more choices that are more convenience driven."
Levine — along with John Becker, Vizient Group SVP, Sg2 and intelligence, and Simrit Sandhu, Vizient EVP, Strategic Transformation and Clinical Supply Solutions — came together this year to offer insights into what providers should focus on to achieve sustainable growth, including spend management beyond the supply chain; operational effectiveness and patient care; short-, mid- and long-term growth strategies; and workforce strategy and adaption.
No. 1 on their list of priority areas? Patient loyalty in a more competitive environment.
"Loyalty really comes down to understanding and creating the best healthcare experience for the patients you want and need to serve," Becker said. "The question is: How do you do that?"
The trio contributed their expertise to answer that question and more in Vizient's recently released "The growth mindset 2023." Here, they further discuss considerations surrounding patient loyalty, including the four major disruptor segments and the challenges and opportunities that exist for health systems to build, buy or partner.
How is consumerism changing the face of healthcare and what innovative tactics are other industries using that healthcare can likewise model?
Sandhu: Embracing patients as consumers is a big first step. This may sound like a basic change in language, but in our experience it's anything but. Narrating the rationale of this change within your leadership team and organization is critical to success. Patients receive care. Consumers make purchasing decisions. Treating a patient is a clinical endeavor. Serving a consumer involves patient care, but it's so much more. It's how your team answers phone calls. It's how your organization offers online channels of connectivity. It's how your team provides translation or transcription services. It's how you communicate with patients' loved ones. It's how you help people navigate your physical and virtual spaces, and the broader experience outside of the actual care delivery that happens within those spaces like scheduling, billing, ongoing provider communication and wellness support. Building loyalty means the patient is at the center of everything you do.
Levine: It's exciting that consumerism is finally becoming more front and center, and it provides a challenge for our traditional providers to embrace convenience and access. You see some of that with health systems expanding and also with telehealth, which was obviously accelerated by the pandemic. There are going to be some challenges still in reimbursement for providers to offer that service, but consumers love telehealth, and it's not nearly as robust as it should be. Other industries have done a much better job of focusing on their digital front doors.
Becker: Patients are taking more control of decision making — it's the what of care, the where of care, and the why of care delivery. That's driven both by the pandemic introducing patients to new ways of accessing care and by the rise in high-deductible health plans, which now account for more than half of U.S. employee enrollment. When consumers see all the costs, that's when they become shoppers. Consumerism also means seamless integration. Look at banks where you have a kiosk, an app, the ATM. It's rare that you have to call someone. The winners in the future of healthcare are the systems that can wrap their arms around these capabilities and make the data accessible and the experience integrated.
Levine: To John's point about automation, the use of technologies like MyChart is so important, especially in that ability to send a message for a refill request or ask a non-urgent clinical question.
Becker: The use of MyChart and so many more technologies will be critical to creating a seamless experience that consumers really want and need. There's a real opportunity to bring together traditionally siloed data, fueled by new universal data standards and new regulations improving data interoperability. Combining a broader set of healthcare data within the right technologies will help personalize the healthcare journey for the consumer, at their convenience. The goal here is to help consumers participate more fully in their care experience, to promote proactive health decision making, and to create the kind of navigation experience that garners loyalty and produces meaningful outcomes. It's about creating a more unified consumer experience in healthcare. Interoperability and technology will be core to truly connected health.
Looking at the four major disruptor segments – venture capital-backed medical groups, payers as providers, digital/telehealth, and retail and big tech – is there one that you think has the greatest growth potential moving forward?
Becker: The perfect consultant answer is that it depends on the market. What I am most interested in are the "payviders" and VC-backed medical groups because of the collision there with value-based care — the opportunity is great to bend the cost curve. These disruptive collisions are creating integrated services that are purposefully consumer centric. Think payer-first virtual care, consumer-focused primary care models like Oak Street, VillageMD and One Medical combined with integrated pharmacy services, and expanding care at home options. It's a two-fold threat to hospitals and health systems: It ramps up strategic steerage of patients within a "payvider" network, while driving consumer loyalty by offering a more integrated and convenient set of experiences. These kinds of disruptors are building integrated models that produce more compliant patient populations who are more likely to use their services when they suggest they need them and they get a satisfied customer base that strengthens their Medicare Advantage (MA) and risk-based attribution retention.
On top of all of this, the Medicare risk adjustment changes coming into MA are going to force a new level of cost control. So, they're going to need to manage down excess cost like unnecessary ED visits and hospitalizations with new urgency. Who's going to lose money? The hospital or healthcare system. But, this kind of disruption isn't just competing for the next office visit, MRI scan or admission — it's about taking the risk of not competing for it, successfully exerting more and more control of utilization within new incentive structures and building a consumer experience expectation that may be difficult to match. Hospitals and health systems need to understand what's going on around them. The question is how can healthcare systems compete – or do they partner? And here, I'm back to my perfect consultant answer… it's going to depend on the market.
In many ways, the customer loyalty piece still proves difficult to measure. But are there some specific ways hospitals and healthcare systems can build greater loyalty with consumers?
Levine: Great customer service goes a long way, which is what we've seen in studying our top provider performers at Vizient year over year. From the way you're greeted at the door to even how you're treated if you happen to visit the cafeteria – those things are huge. So, that's the simplest piece. Then you really have to optimize access, look at what's growing in the market and consider the quality of service. What's your wait time for new patients and for established patients to come in? Generally, people start shopping for alternatives because of a bad experience or an inconvenience.
Sandhu: To David's point on service, providers need to adopt customer experience strategies from hospitality and retail markets. These industries have learned the hard way that consumers make decisions based on the perceived value of their experience. Increasingly, consumers are applying these standards to their experience with healthcare. It's not enough to provide quality care, it's also about ease of access. Young families, for example, want options for after-hours urgent care. These families also expect clean and kid-friendly spaces, thoughtful post-visit follow-up care and billing transparency.
Becker: You also have to dive into the data. Understanding the leakage and "keepage" will help you pinpoint areas of opportunity. Why are you getting leakage? It could be time to next appointment, it could be wait time within the appointment, it could be staffing issues. With loyalty, there's two ways to grow: It's get new patients or the best-fit patients, and it's keeping those right-fit patients you have — and what are you doing to keep them? Are you building services for a generic cardiovascular patient? Or are you building services for a cardiovascular patient that has ortho comorbidities? The more segment-specific you get and the more you hone your strategy, the more likely you are to meet those segment needs — and the more loyal your patients will be.
Can you talk about the importance of the build, buy or partner framework to enable health systems to move quickly, win loyalty and regain market share – and what are some of the barriers that may exist as they try to implement that approach, including related to workforce constraints?
Levine: So traditionally healthcare has been more focused on the build. It's really important to consider partner or buy in areas that are outside of their expertise, especially around some of these new technologies. No one is going to build an electronic health record on their own. But I think the biggest challenge around any of the partner or buy is interconnectivity. Even with things that health systems have built on their own, there's a lot of disconnectedness. I think one of the bigger partnership or buying opportunities is around services to help with creating that unified operational experience from the inside and on the patient side. As margins have decreased significantly in healthcare, it's going to be a question of where do you spend your limited funds? Where does it make sense to outsource your cafeteria or your environmental services? In this tough hiring environment, it's a balance of what you pay to outsource versus insourcing.
Becker: At Sg2, we've talked about the system of care for roughly 15 years now and how providers don't have to own it all. The idea is that the line connecting all the care sites is data moving back and forth, and having information arrive at the next site of care before the patient does is critical to creating that connected health experience that consumer crave. You often need partnerships to do that. When Amazon and One Medical came together, there were 15 to 20 healthcare systems that partnered with them. They're have the potential to be a great disruptor, but they don't have hospitals, they don't have higher acuity care sites. They're going to need to integrate with and connect to the local providers of care, which are the healthcare systems. Through partnerships, you get the ability to gain patients from the One Medical and Amazons and others while also learning what they do well that will help you better compete in the future. But I would add that before you do anything, fix what you already have — then think about how to build, buy, or partner.
Are there specific clinical innovations that you consider the biggest gamechangers for health systems moving forward, particularly when it comes to more equitable access for consumers?
Becker: It's not a clinical innovation per se, but better data that's visualized in a more complete, responsible way is a huge accelerator of strategic decision making both to purely grow but also to meet the needs of your local market in addressing health disparities, health inequities and just better access for all patients.
Levine: I'm with John — you start with the data. And by the way, when you have social determinant of health issues with your patients, guess what? A lot of your staff have those same challenges because they come from the same community. By looking at the data and addressing those social inequities, that will help with employee recruitment and retention.
Sandhu: And with any innovation, you must balance opportunity for growth and efficiency with cost and quality. Take, for example, robotic surgery. More and more, our providers are beginning to understand that it is a mixed bag, and they have to go deeper into procedural-level choices and then manage the mix with their traditional practice.
Clearly, there are always many forces at work when it comes to access, price and convenience in the healthcare ecosystem, including payer preference. Do you think patients now have a more influential voice in the healthcare environment, and are there ways that health systems can better tap into and implement consumer feedback?
Becker: YES. There's no question. We have more of a say because we're at least partially spending our own money and that's what it comes down to. David can debate me here, but I don't see how the winners of the future in providing care aren't going to be those that are more responsive to us. Some of it is extended office hours so that people who work can come in late or on the weekends or allowing patients to do a virtual visit. The winners are going to give me access, it's going to be convenient and it's going to be at a cost that makes sense, right? The second part of that question is to ask the patients and look at the data. For a given disease state or care path, you should understand what's sticky and what's not. If patients are leaving, they're leaving for a reason — start asking questions. And you're probably going to see it has to do with access, cost, convenience or quality.
Levine: Follow up with the patients. If they haven't been there for a while, call and let them know they're due for a physical. If a primary care doctor refers a patient to a specialist, ideally one within their system, is someone checking to make sure they went to that specialist? Maybe they did, or maybe they went outside of the system because they couldn't get an appointment. But that follow up needs to happen to understand why your patients are staying with your system — or why they're leaving.
Sandhu: Echoing John and David – ask your patients what they expect and then implement satisfaction metrics to gauge your success in delivering on their expectations. It helps immensely when you tie these metrics to incentive programs.