Who Really Cares About Patient Journey?

By John League, Managing Director, Digital Health Research, Advisory Board

I’m part of a webinar series on the patient journey where we dig into how to find the potholes in the patient journey and how to fix them once you’ve found them. The experience your patients have with your organization is just one of many in the broader patient ecosystem. Without a thorough understanding of the road a patient travels with your organization, it’s tough to know where the potholes are and how to fix them. It’s even tougher to know what other “roadwork” may benefit your patients’ journey with your organization. Click here to register for this patient journey fireside chat style webinar series.

In addition to sharing insights with webinar audiences, my team at Advisory Board did a lot of work this year to understand which healthcare stakeholders prioritize the quality and experience of the patient journey in its entirety. We wondered if there were organizations that thought about patient journeys from the patient’s perspective. Healthcare organizations only see the patient journey as what happens when the patient interacts with them, but patients experience their journey across organizations and time.

What we found is that healthcare stakeholders seem to care about the totality of an individual’s healthcare journey in direct proportion to how much of it they are responsible for. This means that patients care the most, followed distantly by plans, employers, and the rest of the industry. Providers in population-based models seem to care more than others, followed by those whose work is primarily transacted in bundles (TAVR, joint replacement, etc.), primary care, and specialties with long patient journeys (like oncology).

Some provider organizations may be upset to read that they seem to lag behind other parts of the industry, and some have made heroic efforts to improve. But in most cases, providers have imposed the structural frictions that exist both within their organizations and across the industry as a whole on patients instead of doing anything to meet the minimum requirements of the consumer experience they all claim to want to offer.

Many provider organizations, specialists, and programs try to elevate service and customize interactions to individual needs and preferences consistently by simply throwing clinicians at the problem. This has several different manifestations:

• Primary care with physicians as the “quarterbacks” of care, who are required to build individual relationships across enormous patient panels
• Oncology programs, which effectively invented care navigation, rely on a corps of clinicians to guide patients’ care, financial, and survivorship needs
• Chronic care management for conditions like COPD and CHF, which depend on teams of physicians, nurses, and allied health professionals.

The problem is that these kinds of headcount-based solutions simply aren’t scalable as solutions to experience or care delivery. Even if an organization could find all of the qualified clinicians they need, and find them in their own market, could they afford to hire them?

Most organizations feel little genuine competitive or consumer pressure to reverse this trend through investment in patient journey redesign and/or digital experience. There is no real opportunity among patients to behave like consumers of health care, despite a desire to interact in the same ways that consumers do with other industries.

Patients simply cannot behave like consumers. They have, in most markets, many choices for where they can get care—maybe so many that it makes decisions harder. But they have no accessible way to make comparisons between health care offerings based on quality or price, they have limited understanding of their out-of-pocket obligation before receiving care, and they usually lack any confidence in their own ability to make decisions and self-refer.

Besides, people don’t think of themselves as patients when they aren’t sick. No one really even wants to use health care—at least not the way we’ve taught them to. Health care in the U.S. is almost entirely reactive, and its purpose is to heal, treat, or correct, not to prevent. People who need health care services are much more likely to act like consumers when they are seeking the proactive, preventive interactions that the industry occasionally tries to scold them into having, but not when they are seeking treatment for an emergent need.

Our research shows that patients want to interact with health care in the ways that they do in other industries.

• They want a single platform where they can coordinate and manage all of their personal health interactions and records.
• They want to find care and pay for it in the same way that they locate and pay for all of the other services they consume. That could be on their phone, or it could be with a call to a single point of contact (Kaiser Permanente).
• They are open to ecosystems where choices are limited but customized/curated to their needs and/or preferences. Think Netflix, Amazon, virtual-first plans, and Centers of Excellence.

The reason that this should matter so much to healthcare organizations is that experience can drive results on genuine business objectives like access, retention, and risk management.

• Access: The patient journey begins here, and if patients can’t access an organization’s services, none of the other investments made in patient experience will matter.
• Retention: If healthcare organizations can influence that first access point, they have a much better chance of steering the rest of the patient journey. If they can also make that journey one that requires less effort on the patient’s part, they’re more likely to capture a larger share of wallet.
• Risk management: Better outcomes and lower costs are possible with a better patient experience. This is the ROI most associated with chronic care and discharge management. Most patients don’t adhere to discharge instructions. Even hospitals’ discharge best practices have limited effectiveness once patients go home (probably because they aren’t thinking of themselves as patients anymore at that point). Any improvement here could have a huge impact on the total cost of care.

Below, we offer questions that healthcare organizations have to answer—and may need to be answered with some urgency. Out-of-industry players like Amazon aren’t entering the industry because they think health care is so easy; they’re entering because they think the experience of receiving care is so bad. The questions are:

• To what extent are provider and patient experiences linked?
• How can effective patient digital self-service reduce the administrative burden on clinicians?
• To what extent does a relationship-centered approach to care improve outcomes and provider burnout?
• How should health systems think about patient experience, satisfaction, and engagement beyond HCAHPS and Press Ganey?