The 15 Ways to Improve Patient Access & Engagement

I have developed a certain affection for the television shows SurvivorNaked and Afraid, and Life Below Zero.  If you are not familiar with the shows, their premise is to determine who among the contestants has the inventiveness and mental toughness to exist on a diet of insects or to live when the average temperature is forty below zero.

Having slept on the glacial face of a volcano at seventeen thousand feet, I fancy the notion of competing on those shows.  Give me a piece of twine and a pull-tab from a can of soda and I will build the iPhone 12.

So, last summer our power was out for four days because of a thunderstorm.  Instead of having to hunt narwhals while wearing nothing other than my skivvies—don’t try to picture that in your mind, I was ensconced in my home; no air conditioning, no television, and having to fight my way around obstacles at night with nothing to guide me other than my wits and the light from me cell phone.  The showers were cold, my soft drinks were warm.  I survived the first two days with nary a scratch.

By day three the lettuce was wilting and so was I.  I reflected on my not too distant halcyon days, days when I could sit in my air conditioned home and watch television shows about people trying to survive in a Brazilian rainforest eating grubs.  It was then I decided that were I able to survive my own odyssey I would put aside my dreams of living a wilderness adventure and make due with mowing my lawn.

I have no segue for this post, so here we go.

Chances are your health system’s website is a clunky old thing designed by the elderly (people over the age of thirty.)  The time to rethink what you want out of your website has come and gone; that train already left the station.  The only way to play catch-up is to dump the sclerotic vision that defines your online presence, and figure out what your stakeholders expect from it.

People who visit your website have an experience, they just have a good one.

The best way to not have to measure patient experience is to design such a good, interactive online experience that measuring it would be redundant. Design these things into your website and you will have the most progressive health system on the planet.

  • If half of your callers would rather have their needs met online, figure out how to let them do that. If you don’t know what they want to do online, ask them.
  • If half of your patients will seek a second opinion, give them a link telling them why they should stick with you
  • If half of your competitors’ patients are seeking a second opinion, give them a link telling them why they should pick you
  • If twenty percent of your callers have questions about their bills, use co-browsing and online videos to explain your bills
  • You know your patients are going to dispute their reimbursement, show them how to do that on your website; make videos explaining payer by payer how to do it
  • If a percentage of your patients want to speak with a clinician, make sure they can. Heck, make sure they can do it at a time convenient to them, which probably will not fit the hours of your call center.
  • If every single person who visits your website is either a patient or a potential patient, tailor all of its functionality to them—get rid of the other eighty links; links about the gift shop and posting baby photos online
  • If you have a scheduling center instead of a real call center—80% of your calls are not about scheduling—create a real call center.
  • Put a chat function on your website—how may I help you—and delete that silly contact us box that promises a response before the next full solar eclipse
  • Let callers on hold enter their phone numbers instead of having to wait, and have the next available agent call them back
  • Let call center agents email callers
  • If someone contacts you through your website, respond to them within an hour
  • Let people schedule appointments online
  • Since a lot of people who are considering buying healthcare from your system visit your website, give them something to do when they get their—how about a customer portal where nonpatients can store and track their health data like they do with apps on their smartphone, a portal whose data you can monitor.
  • Since only a fraction of your callers and website visitors are in your EMR, make sure you can meet the needs of everyone who isn’t—those people are called customers.

Prevent people from leaking at the start of their experience.  Design an experience focused on keepage, not leakage.  None of these features are difficult to accomplish using current technology.

If you do all of these things you will never have to worry about measuring patient experience.  You will already know it is great.  And maybe then we can ask why everyone in Washington is so concerned about building a wall to keep out the Canadians.

Is Your Lawn Healthier Than You?

Last week I received an email from my dentist letting me know that I was due for a checkup and that I could schedule it on their website by clicking the inserted link.

Yesterday I received a postcard from my eye doctor asking me to schedule my annual eye exam, and letting me know that if I scheduled it in the next two weeks I would receive a twenty percent discount on either contacts or a pair of glasses.

Today I received an email from Chem-Lawn reminding me to schedule my fall fertilizer treatment, and an offer to receive a thirty discount on next year’s service if I prepaid for it this year. I received a similar email regarding the health of my car.

Everyone wants my business.

Well, almost everyone.

And they are not only making it easy for me to buy from them, they are unabashedly flaunting me with rewards for buying their services. Why are they doing this? They want to prevent me from having bad teeth and bad eyesight, a lawn full of weeds, and an unhealthy car.

Healthcare isn’t able to communicate on a personal enough level that it is interested in my weeds or teeth. While healthcare has many proactive initiatives, healthcare has not figured out how to connect those initiatives to you and me at a level that causes us to act. We act when we are ill.

Healthcare’s strategy is straight out of the 1970s; mailers, billboards, Stepford Wives-like commercials, and outbound telemarketing calls. If you do not understand history you are destined to repeat it. How well is that working?

And that about sums up everything you need to know about why, under its present course, healthcare is at least a decade away from being able to do anything more than just talking about population health, accountable care, and wellness.

Just saying you are a digital healthcare company or a population health company does not make it true.

Healthcare marketing needs a do-over.

There are probably tens of millions of people who would pay a healthcare provider or payer or national retail pharmacy to manage their wellness. But there is not a single firm selling wellness.

Until then, healthy people will keep getting sick. The only good news out of all of this is that when we get sick we will have good teeth, great vision, weed-free lawns, and cars that work well enough to allow us to drive to the doctor.

23 Reasons Healthcare Needs A Makeover

Since nobody wants to sit through having to read twenty-three of anything, I’m going to try to make this easy for each of us.

These are a few of Roemer’s Healthcare Axioms:

  • Axiom 1: Nobody knows what it costs to acquire a patient
  • Axiom 2: Nobody knows what it costs to retain a patient
  • Axiom 3: Nobody knows what it costs to prevent leakage—heck, nobody even knows if someone leaked; before treatment, after treatment. Leakage is one of life’s great mysteries
  • Axiom 4: Patients and members, both new and existing, will tell you that healthcare marketing has zero impact on who they choose as their provider and payer
  • Axiom 5: Providers and payers will continue to play a zero-sum game, spending money on marketing campaigns that do not resonate with anyone outside of marketing

So, here’s how I got to the number ’23.’ (You can come up with your own number using this same approach.)

I started thumbing through this month’s issue of Philadelphia Magazine, and I was gobsmacked by the number of full-page healthcare ads, so much so that I felt the need to count them. By the time I reached page sixty-six I had counted twenty-three ads.

Four providers and two payers paid for those twenty-three ads. Doing the math—four plus two, divided into twenty-three—indicates that each organization marketed to the magazine’s readers about four times in the first sixty-six pages.

I took some time to reach each ad, and to ask myself if there was anything in any of those ads that would compel me to take action. There wasn’t.

It is worth noting that all of the ads had the same look and feel. It was almost as though all of the marketing departments, independent of their firm, operated from the same marketing omnibus—it means compilation—of acceptable healthcare marketing strategies.

The only difference among the ads was the name of the institution doing the advertising. The ads each pictured one or two animated and healthy people having the time of their lives. The people were frolicking, picnicking, biking and jogging. They were carefree.

I suppose the ideas behind the ads were that even if you had cancer, that if you brought your cancer to one of these organizations, you could be frolicking by the time you finished reading the magazine. The ads do not show someone with any hair connected to an IV dispensing cisplatin. Perhaps the thinking is that ads about frolicking are preferable to ads about cisplatin.

The same kinds of ads are on billboards and on television. They are in your mailboxes and mine. If every healthcare organization is pitching the same message, is the effect on consumers the same as if they had pitched no message? I think it is. I think consumers think the same thing.

I am willing to bet my neighbor’s BMW that not a single reader of the October issue of Philadelphia Magazine will be influenced one iota about who to choose as their provider or payer based on a magazine ad, a billboard, or a television commercial.

If you want to get my attention, tell me that you designed a tool that will help me manage my care and wellness. Don’t give me frolicking. Give me care and then I will care.

Why Is Healthcare Like Watching Black & White TV?

I am amazed at the speed at which most of the world changes.

When I was young, drinking-water was free, and our rotary phone was attached to the kitchen wall.

We used to get two newspapers a day; the Baltimore Morning Sun and the Baltimore Evening Sun. As a result, we knew everything that had happened in the world before ABC, CBS, and NBC televised the evening news at 7 p.m.

Our television set was a piece of furniture the size of a dishwasher. To watch the television we had to adjust the rabbit ears to try to get the picture to stabilize. During storms, sometimes we had to attach a piece of aluminum foil to the antenna to stop the picture from fading. If we wanted to watch one of the other two channels, someone had to walk to the television and turn the selector knob. To be fair, rumor had it that there was also a UHF channel. That channel came with its own non-functioning antenna, but I never met anyone who was able to get the picture clear enough to watch.

Even so, we also watched the news, and when Walter Cronkite went from black and white to color, I knew technology had just about peaked. And then came portable television—television on wheels. Instead of something the size and weight of a chifforobe, televisions were so miniaturized that they could fit on a wheeled cart and could be moved from room to room. Naturally, we did not have to worry about connecting it to the cable outlet because there was no cable.

Next to the portable television, on the end table, was a spiral-bound, paper AAA map with the directions to get me from Baltimore to Vanderbilt in Nashville—stone age GPS.

As an aside, it occurred to me that the practice of healthcare and the practice of law have a lot of similarities—however, people don’t call having a thousand doctors on the bottom of the ocean a good step. The greatest commonality is that nobody wants to engage either a doctor or a lawyer until it’s already too late. I guess though that telling a lawyer that you were thinking of robbing a bank would garner about the same reaction as telling a doctor that you were thinking of taking up smoking.

So, back to the fact that many years ago what we thought of innovation as consisting of tap water, a morning and evening newspaper, color television, and a TV on wheels.

Almost everything has changed since then because of the rate of change of technology.

Almost everything.

I went to the hospital to get an MRI on my knee.  The clerk inserted a three-part carbon firm into her IBM Selectric typewriter and typed my admissions data.  I was instructed to go to the waiting room. A woman dressed like June Cleaver rolled a black and white television into the room and turned on the Get Smart. She told me there was bottled water in the avocado-colored refrigerator and that if I wanted to make a call, the phone was on the wall next to it.

The song from the Archies, “My Heart Went Bang-Shang-A-Lang” was playing on my transistor radio. I reached down and retied my Converse Jack Purcell sneakers. And folded neatly next to me, on the end table, was a copy of this morning’s newspaper and a spiral-bound map from AAA.

The business model of healthcare never left the 70’s.

Are Healthcare Consumers The New Payers?

McKinsey wrote in—Enabling Healthcare Consumerism—that consumers now control more than $330 billion of annual out-of-pocket healthcare spending and “the choices they make have the potential to affect 61% of all healthcare spending”.

That single statement is all one needs to understand to know why

This is a direct result of the large increases in the average deductible.

What does this mean for providers?  It means I decide what services I purchase and from whom I purchase them.

In the same paper, McKinsey found that over eighty percent of the people they surveyed believed digital solutions are the most effective way to perform healthcare activities.

Kaufman Hall’s “2017 State of Consumerism in Healthcare” reported that ninety percent of providers replied that improving the consumer/patient experience is a high priority, yet only eight percent of health systems stated that they have implemented some digital consumerism solutions with some demonstrated success.

The report went on to say, “Building digital capabilities should be integral to organizations’ efforts to improve the end-to-end consumer experience, yet many are taking a more siloed approach that is disconnected from a broader consumer engagement strategy”.

So, what do we know?

  • Consumers control 61% of healthcare spending
  • Over 80% of consumers want to manage all aspects of their healthcare digitally
  • 90% of providers call consumerism a high priority
  • Only 8% of providers are actively trying to implement digital consumerism solutions

Why is digital consumerism a business imperative? An article listed many internal provider business drivers of consumerism.  And there is the underlying failure point.  Consumerism is being driven by only one thing—consumers.  By the +80% of the people who want to access and engage digitally.

The underlying unmet business driver is the need for providers and payers to understand and meet consumer expectations.

There is a great disconnect between the discussion of patient experience and the discussion of consumerism.  Patient experience initiatives do one thing.  They measure, “How did we do when the patient was receiving care?”

Patient experience initiatives do not include any of the experiences patients have pre- and post-treatment.  They do not include any of the experiences of consumers—prospective patients.  And they do not account for anyone’s expectations.

There are more than 165,000 health-related apps on iTunes that do 165,000 different things.  iTunes is where people go to manage their health.  Get an app.  Get several.  And they go to the web.  The one place they do not go to meet their health needs is to your health system’s consumer portal and the reason they don’t go there is that your system doesn’t have a consumer portal.

Consumers, patients, and prospective patients are the new payers.  They are your customers and prospective customers.  Consumerism is the same thing as customer experience.  People who understand this know that consumers are not happy with what they are experiencing.

Abandon Hope All Yee Who Enter Here


I thought those words would make a better announcement for a provider’s call center, or at least, it would add a bit of whimsy for the callers.

I hung a new sign outside of my office; Senior Hallway Monitor, and I added a parenthetical note; “Do you need me to build the watch, or do you just need to know the time?”

Too many providers are trying to build watches to understand consumerism. Unfortunately, none of them have any experience building watches.

The neo-watch-builders have reset their call center IVR to the following:

  1. If you want a single payer system, press ‘1’ and your call will be transferred to Bernie Sanders
  2. If you want to single payer system today, press ‘2’ to be transferred to Canada’s immigration system
  3. If you believe in global warming, press ‘3’ to be transferred to Barbara Streisand
  4. If you want to do something other than schedule an appointment, press ‘4’, click your heels together three times, and chant, there’s no place like home
  5. If you went to our website to do anything other than finding out what hours our gift shop is open, press whatever you wish because we can’t help you
  6. If you went to our website to donate, press ‘5’ and we will send someone to your home to pick up your check
  7. If you want to speak with a clinician, press ‘6’ to listen to the recording that says someone will get back to you within 2-3 days
  8. If you do not want to press ‘6’, hang up and go to the Minute Clinic
  9. If you clicked ‘contact us’ on our website, repeat step 7
  10. If you want to solve this problem, press ‘7’ and you will be connected to the Senior Hallway Monitor

Did I mention that I am the Senior Hallway Monitor?

There are solutions that are better than trying to learn to build watches.  If you are interested in learning what time it is, call me.


Consumerism Nuance: You Did Not Say There Would Be A Math Quiz!

To me, one sentence sums up healthcare consumerism—We don’t know where we’re going, but we’re making really good time.

I can order anything I want online except a healthcare appointment. Why?

There are plenty of healthcare white papers available from the firms who are known for writing plenty of white papers.  They all read the same; lots of facts, plenty of graphs, user-friendly fonts.

These papers should be read and then filed away until the next time you feel compelled to read about consumerism.  Me, I’m going to wait for the consumerism IMAX movie.

There is a significant difference between a white paper and a WHAT paper. A white paper is a collection of facts.  A WHAT paper tells you what to do with those facts.  Most of the facts teeter on the nuances of nuisance; 79% of this versus 81% of that.  Most of those nuances come from data collected from providers, not from their patients.

An example of a key misunderstood nuance is scheduling.  All providers agree that patients want to schedule. Most providers have an 80% or higher level of confidence that their scheduling process works fine.  Patients want to schedule appointments.  Providers schedule those appointments.  Problem solved.  Providers define the scheduling nuance as a slight difference between how patients want to schedule appointments, and how providers schedule appointments. Patients describe that difference as a nuisance.

Providers’ metrics reflect how well providers perceive they are doing on a range of consumerism KPIs.  KPIs for which they collected data and calculated the scores.  Those KPIs are calculated in patient-free vacuums.  A nuance—a subtle difference of meaning.  A smidge.  A skosh.  Provider consumerism nuances are simple to understand—how they do something versus how patients want them to do something.  Providers do not focus on the difference between the how’s, they simply check the box and move on.  Providers are indifferent to the difference between the two scores.

To patients, the consumerism nuance is the numerical difference between the two scores.  If the difference is just a rounding error, we have “much ado about nothing”.  Shakespeare and math all in one blog—I hope there’s not a quiz at the end of this.  If the calculation of the difference between the two scores requires fractal geometry we are no longer dealing with a nuance.  To patients who want to engage their provider digitally, a digital engagement score of 15% is not a nuance, not a smidge, not a skosh.

It is a reason to spend our $310 billion of discretionary healthcare dollars elsewhere.  Providers think about consumerism as access to care—retail care, urgent care, care from a pharmacy.

To patients, access is about doing what they need to do when they want to do it, and on whatever device they want to do it.  Patients want easy access to their provider as they have to their banks and eBay.  Providers give themselves a high score because they are opening urgent care centers.  They think that the difference between having their patients access an urgent care center by phone versus accessing it digitally is a nuance.  Patients think of it as a nuisance.

For those who like to score level of patient dissatisfaction using math, a Nuisance is much greater than a nuance:  Nuisance > Nuance.

And the survey said…the content of white papers, even the white papers of preeminent firms, are written around their own survey data. For example, “97% of providers rely on post treatment surveys.” “More than 80% of patients want electronic access.” “One in three providers get real time information during the patient visit.”  Data is good. How we get it is a nuance.

Borders, the bricks and mortar book store knew people liked to read Tom Clancy.  Amazon knew the same thing.  Borders thought how people purchased a Tom Clancy novel was a nuance.  In a store; versus online.  Borders’ inability to understand the term nuance drove them out of business.  So did US WEST’s understanding of the nuance of which firm people purchased long distance phone services.  And eBay versus Macy’s.  A Netflix versus Blockbuster.

The real nuance, the one to which providers pay lip service, is not the nuance.  Nuance implies scale. A small change yields a small and different outcome.  Nuance, in today’s vernacular, means that firms that were created out of thin air knocked all the air out of industry stalwarts.

Nonsense > Nuisance > Nuance.

And the driving force of all this change was the customers and patients.

Patient surveys tell you nothing about what patients want.  Patients tell you what they want.  And there is nothing nuanced about what they say.

The average patient does not care about your 37 KPIs.  They care about whether they can do what they want when they want, and on whatever device they want.  Give them those three things and the other 37 will take care of themselves.