Over the past few months, the topic of Patient Experience has come up more and more in my client meetings. Everyone seems to know that there are huge issues when it comes to providing people with a great healthcare experience, but no one seems to be able to put their finger on exactly what the problem is.
All the players in the experience are taking their lumps. Pharmaceutical companies are accused of inserting themselves into a process in which they don’t belong in; Payers are accused of only caring about what will save them the most money; Physicians are scolded for not taking a more proactive role in improving the experience;Pharmacies…well, no one really seems to know exactly what to do with pharmacies these days as they actively search for the right way to redefine their role. In my experience as both a consumer of healthcare products and services and as an experience design professional who has done a great deal of research on various interactions among these players, the root cause doesn’t fall on any one, rather on all of them collectively.
Today’s patient (or healthy person) experience is a complex web of touch points and information sources that don’t have any one connecting point. There is no central role ensuring that information exchanged in discussions or interactions between the patient or caregiver and any one product/service provider is captured and available to all players in a coordinated “team” strategy that leverages collaboration. Furthermore, equating “self-managed” healthcare to “patient-centered” healthcare is muddying the waters even more. Care must be centered on the patient without requiring the patient to manage the system of delivery.
Healthcare is a team experience. As healthy people seeking to stay well or as patients seeking to address our various conditions, we have a vested interest and responsibility for our healthcare. But that responsibility is shared. We are key stakeholders and decision makers, but we can’t manage our care alone. And the more complicated our conditions, the more help we need.
This perspective has been brought into sharp relief for me by my personal story and by a recent article in New Yorker magazine.
My Story: The Abridged Version (For the detailed telling, go here.)
I am a pregnant woman who also has a preexisting health condition. I troubled over whom to call when my preexisting condition flared up – my GI specialist or my OB? I called my OB and her response was eye-opening: “This is the one time in your medical health where you get to have a strategist. In the same way that I coordinate lab/hospital visits and all of your insurance interactions related to your pregnancy, I also coordinate any specialist visits you may require. You will always start with me.” What a novel idea.
With my OB as my personal healthcare strategist, these are some of the differences I have experienced…
Role of the Pharmacist was Clearly Defined: The pharmacist immediately acknowledged not only the current reason for the visit, but also the fact that I was pregnant. While she did have an alternative suggestion for me around my medications, she made it clear she would be filling the current prescription and simply writing down the suggestion for me to take back to my doctors for a follow-up discussion if I so choose.
Complete Access to a Collaborating “Team” of Doctors: For the first time ever, I do believe there is one person who has a complete view of my health. More importantly, I also believe that there is a “team” of doctors working to ensure my continued good health. Both doctors work together (without me playing go-between) to collaborate on a course of treatment that helps me get better and keeps my baby’s health needs in mind. They are also managing the health insurance interactions.
Proactive Team Ownership of My Wellbeing: My doctors are checking-in to see how things are going with the medications, my pharmacy is making some good recommendations for additional steps I can take that support my doctor’s treatment; my insurance company is providing additional live resources for me to leverage as I go through my pregnancy.
No one person’s experience can be generalized across the healthcare experience spectrum. But my experience does reinforce a recurring theme in healthcare: The need for better and more open collaboration and communication among all of the players involved in managing any patient’s health. A good patient experience isn’t about a solitary owner; it is about a good point person who is knowledgeable in all touch points and objective enough about the emotional part of health management to take the lead, grab the pen, and “own” the coordination, leading all players toward the same mutually agreed upon desired outcome. In other words, a personal “healthcare strategist.”
The New Yorker Article
While formulating this position, I came upon a fascinating article by surgeon and journalist Atul Gawande in New Yorker magazine called The Hot Spotters. The article is about how some pioneering doctors are rethinking how those who use the healthcare system the most are treated. One of his subjects is Jeffrey Brenner, a physician in Camden, New Jersey, who decided to combat excessive medical costs by treating the “super-utilizers.” (In Camden, one per cent of patients are responsible for thirty per cent of medical costs.)
Brenner formulated his own team concept. It includes a nurse practitioner and a social worker. They make regular home visits and phone calls to check in about new and existing complaints, unfilled prescriptions, and other complications that could land these patients back in the hospital. They help apply for disability insurance and fill out paperwork for state-run housing where their medication can be overseen. They encourage these super-utilizers to improve their lives with steps like quitting smoking, cooking more, and joining Alcoholics Anonymous. And the results are striking, both in cost reduction and in better outcomes for the patient.
This is exciting stuff and something I and others at MISI XD are paying close attention to. This team concept with a lead “strategist” is very compelling on many levels. The reason this strategist cannot be the patient is that with rare exception we are the least knowledgeable about how the healthcare system really works and what options are available to us, and because we are too emotionally involved with the experience of our health. The role must be filled by someone who understands the entire healthcare system and is tasked with achieving the best outcome for the as dictated by the patient.
In my experience, with few exceptions coordinated team care seems to be limited to 1) the very wealthy; 2) people in crisis; 3) pregnant women. The $64B question is, “How do we institutionalize the team healthcare concept for everyone?”