In Analytics & Data Management, Artificial Intelligence, Engagement Strategy, Healthcare Transformation, Patient Experience

We are approaching a golden age in medicine, powered by hard-won advances in science and technology that enable treatments and outcomes that once were the stuff of science fiction. And yet for most patients, their healthcare experience remains firmly, and frustratingly, stuck in the past.

With all of its associated paperwork, insurance authorizations and administration, even a commonplace doctor’s office visit can be confusing—and far more so if a hospital procedure is required. The result is a distrust of the overall healthcare system for many, and a considerable population that is woefully underserved. This, despite Americans paying more for their care than patients do virtually anywhere else in the world.

Neil Jordan, general manager of Microsoft Health, says that the healthcare system has historically focused on the experience and satisfaction of patients last, rather than making it a priority. “We’ve grown up in a world where the expectation of the health system is that it takes action on patients, versus patients making their own choices,” he says. “While that is changing, there’s much yet to be done.”

In conjunction with adopting value-based care practices, which incentivize outcomes and efficiency, healthcare providers and payers are reimagining their practices to put patients and their experiences first. “They want to understand their patients more deeply so they can provide better service, but they also want to understand the demographics that enable them to manage and develop their own services,” Jordan notes. Providers should grasp what the patient is interested in from the minute they hit the hospital website, he says, echoing a practice of today’s successful retailers.

In fact, by adopting successful practices pioneered in sectors like financial services and the hospitality or retail industries, tomorrow’s healthcare journey will get a lot more streamlined, more understandable, and transparent.



Radical Transparency

For most Americans, the U.S. healthcare system is defined above all else by a fundamental lack of transparency. For instance, as a consumer, it’s fairly easy to research the particulars of something when considering a purchase, whether it’s electronics, a car, or a house. However, attempting to do the same for a healthcare procedure—especially one that is complex—is far more difficult if not impossible.

Keith Roberts, vice president of engagement for Change Healthcare, says this disconnect at the last mile is the main point of friction for the prevailing patient experience. “Imagine if you went to a restaurant and received an exquisite meal. Then after months of back and forth with paper artifacts, the final bill arrives. Over several pages, the meal components are laid out: the farmer, the rancher, the distributor, the dishwasher—it is all itemized, with pricing for each. That meal is no longer as delightful in your memory as it was,” he says. “That is a ridiculous notion, yet for patients today it’s the status quo of their care.”

Roberts says radical transparency, not only in pricing but also in the choice of care itself, is fundamental to a new approach to healthcare. “That is where the friction occurs in the U.S. healthcare system, because we have patients seeking hope, health and healing, and they are instead confronted with a transaction or a customer experience that’s confusing,” he says. “It erodes trust in the entire system—including the provider who is giving a world-class clinical experience.”

The solution lies in engaging the patient directly and openly with all of the available choices—including quality ratings and pricing, and working with them to make the best possible decisions for their outcome. It’s also about communicating before, during, and after care in a way that is timely, orchestrated, and personalized. While that may not sound like rocket science, compared with most of today’s experiences, it’s positively revolutionary.

Customer Service Industry

Roberts says that the healthcare community could take guidance from successes in the retail industry, itself emerging from an epic transformation to create more personalized shopping connections with consumers. By taking a holistic approach to the patient relationship, providers will foster a dynamic that is complementary rather than adversarial, as it often feels today.

“The world’s best healthcare providers are not only world-class in the clinical experience, they are making great strides at becoming world-class in the customer experience itself,” Roberts says. “For patients, the goal is: Help me trust you, simplify things for me, and personalize my interactions for me.” To do that, it’s necessary to simplify healthcare interactions and present patients with highly relevant information when and where they need it, whether that’s before, during, or after care.

Today it’s common for patients to be involved in a plethora of administrative activities, from upfront securing medical authorization for procedures to providing financial and insurance information. “It can be a research project to understand your benefits, determine your financial responsibility, and negotiate with providers and payers to land on an acceptable outcome,” notes Roberts.

Following even basic services, there are multiple levels of communication between provider and payer, manual clerical processes, coding, verification, billing and more, all requiring multiple people, hours of work and perhaps weeks to complete. It’s a cumbersome, mostly manual, friction-filled process, and the output is still largely confusing for patients, breeding distrust rather than confidence in the system. But introduce technology, and the process can be transformed.

Data-Driven Improvements

As financial services and retailers have learned, translating data into actionable information is the fuel for customer relationship management. Healthcare providers and payers are focused on rapidly doing the same. In the clinical realm, data interpreted using artificial intelligence (AI) and machine learning processes can allow for faster, cheaper and better patient outcomes when used with diagnostic imaging tools and an expert clinician. But Roberts and Jordan say data and AI are also key for creating a vastly better patient experience overall.

From identifying and reaching out to patients with chronic conditions to simplifying patient statements, payers and providers are already using information and technology to create stronger ties with the patients they serve. “By applying AI and analytics, organizations can reason across different types of data to help people make better decisions,” Jordan notes.

But more can and is being done, particularly when it comes to reducing friction in the healthcare system. “Imagine knowing the price of a procedure, your financial responsibility, and the quality rating of your doctor—without 10 phone calls to piece it together yourself or secure the medical authorization,” says Roberts. “Further, imagine that afterward you receive one itemized, accurate bill that reflects all the services you received for that care. That’s how you simplify the patient experience while building confidence and loyalty.”

A New Patient Experience

It is inevitable that, as with retail consumers, patients will elevate their expectations of service as they experience what’s possible when powerful data techniques are put to work. While everyone involved in the healthcare journey—patients, providers and payers—will benefit from better outcomes at lower costs, it is the patient who stands to gain the most.

“The expectation of the patient, the consumer, is that the interaction they have with the healthcare system is going to be so much more digital than it is today. And not only will that help them navigate their way around a very complex and fragmented system, but also stay much more engaged pre-, during-, and post-care with their treatment and their payments,” says Jordan. “Patients, really for the first time, will have the ability to understand and chart their own course.”

Change Healthcare is inspiring a better healthcare system. Learn more about our practical healthcare technology innovation strategies.

Developed in collaboration with CNBC Brand Studio.

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