Amazon hovers over nearly every aspect of the healthcare industry, and it was easy to see (and hear) that permeation at the U.S. News & World Report Health of Tomorrow (USNHoT) conference.
Chatter on the e-commerce giant popped up in panels — a whisper here, a name drop there — and predictions about Amazon's next move were seemingly around every corner.
Industry execs have said they fear Amazon more than other tech entrants into their space, especially during a year when the company has made multipronged forays into the pharmaceutical chain, employee healthcare and home health devices.
American healthcare is currently in the same spot as the publishing industry was in 1997, when Amazon disrupted the book value chain, said Providence St. Joseph Health EVP and chief digital officer Aaron Martin, speaking at the recent event.
"The only people that matter are [clinicians] and patients," Martin said at a panel on consumerism. But there's some serious room for disruption in how those two interact, to take friction out of that "sacred encounter."
But that disruption doesn't have to come from external giants. "If we can all agree about one thing with our future consumer, their expectation with having their needs met will be higher than the consumer of the past," Larry Hollier, Texas Children's Hospitals surgeon-in-chief, said.
Luckily, there are some things healthcare organizations can do to get a little more in front of the roiling tide of consumerism — before it swamps them.
Engagement, immediacy and convenience
The healthcare industry is really no different from the airline industry, said Manny Rodriguez, chief marketing and experience officer at provider network UCHealth at a patient experience panel at USNHoT. The whole idea is to get from point A (your location: unhealthy) to point B (your destination: healthy) as safely and pain-free as possible.
"You can still have an amazing experience with the worst possible outcome," Rodriguez said. "At the same time you can have a horrible experience, and the best possible outcome."
The hard part is making both of those great. "What our patients really want is this notion of immediacy," he said — like Netflix. What people are looking for in consumerism is convenience and, though this may be unrealistic, "that's what they want."
An engaged workforce is key to this appearance of immediacy, Hollier said. Today's patients are so used to doing things quickly and remotely, so when they show up to a physical point of care they expect providers to be focused and "empathic" with them.
Texas Children's started at the physician-patient relationship with a doctor training program on pediatric engagement. The 20 physicians initially trained went on to train more than 1,000 doctors themselves, resulting in stronger patient relationships and lower burnout scores for those providers, Hollier said.
It's also important to make care access easy, especially for lower income demographics, Hollier said. Texas Children's has centers open seven days a week, some until 11 p.m., that provide care for patients usually covered by Medicaid.
Engaging with all patients allows providers to understand what their gaps are and be directional moving forward. Adventist Health System director of patient experience Marcela Reyes called it an "aha moment."
A focus on the consumer starts with a focus on data and IT
As healthcare attempts to become more patient-centric, it's key that health systems meet consumers in their comfort zone: online.
"People like to review an interaction before they have it," Hollier said. Texas Children's used to find misleading information about its practices on Google provider sites. Now, it manages roughly 750 websites, standardizing content and inserting widgets to bring customers straight into the hospital's online scheduling process, he said.
Texas Children's also puts clinical outcomes on external-facing websites, which "instills a sense of trust," Hollier said.
However, patients also need to bear more responsibility for their care and the elements that impact their care, like their own data.
HIMSS president Harold Wolf III said patients should be bringing their doctors their relevant health and lifestyle data rather than force health systems to seek that data elsewhere. "This is about lifestyle management, looking at the whole person across their entire ecosystem," Wolf said at a panel on investing in IT.
To knowingly block that information from your physician, he said, is a questionable decision for a patient to make. But it "doesn't matter" who owns patient health data as much as who has access to it, who currently has it and how they're allowed to use it, Wolf added. If you restrict access to an individual, patient or provider, in need of that data, you're "fundamentally tying the hands" of the healthcare system.
"It's almost like saying, you can do any operation you want, but you can't use electricity and you can't do it in the operating room," he said. "Access is different than usage."
And artificial intelligence can help to streamline data usage, Ochsner Health System senior vice president and CIO Laura Wilt said on a panel on AI.
AI can do a lot to assist consumerism. Like personalized medicine, it helps providers and other healthcare actors to take specific action based on the individual they're talking about, Wilt said.
Providence-St. Joseph Health recently deployed technology called Kyruus to fix the issue of matching patients with the correct provider, given that roughly 30-40% of appointment slots are empty or poorly used, said PSJH CDO Martin.
Kyruus, which raised $10 million in its most recent round of fundraising, uses a provider data management program to identify, match and book appointments with providers directly suited for their specific suite of needs.
The system got a lot of pushback from PSJH's doctors, Martin said, because limiting the scope of a specialist's practice limits their profits. But Kyruus brings a bit more value-oriented architecture to PSJH — along with helping patients get trusted data to shop.
Branding and ongoing relationships are a must
Adventist Health System is changing its name to AdventHealth in January as it works on internally aligning its system around the patient, Reyes said. "We're here to build relationships for a patient's whole life cycle" — a motivation that spurred the hospital chain's ongoing rebrand.
(Adventist saw its patient payment volume more than double between the second quarter of 2017 and the same quarter this year by revamping its billing process to be more consumer-friendly and price transparent).
Providers should change their relationship with their customers from two to three times a year to "continuous," urged Martin. If a provider is too expensive or doesn't have a good relationship with patients, they will lose those patients, he said.
But health systems shouldn't think of it in terms of loyalty, said UCHealth's Rodriguez, because loyalty means "I want you to come back."
"If we do our job correctly, it means you won't come back," Rodriguez said. "We don’t subscribe to the notion of loyalty. Loyalty is very transactional. We subscribe to the notion of relationships."
That ethos is why online behemoths like Amazon or Google, seemingly omnipotent entities that can address almost every aspect of the modern consumer's needs, are so scary to healthcare executives.
But the two are unlikely to jump directly into care provision, according to experts at the conference. "They'll dabble in it, but it's a crappy business," Rodriguez said. "They're going to get into the direction and the guidance of where these volumes are coming from" — which is already happening today.
"Self-service is the best service," concluded Martin, who used to work at Amazon. Though the care provision can't be online itself, "everything up to that point can be."
Tony Abraham contributed reporting.