Why Are Prospective Patients (Consumers) Worth More Dead Than Alive?

When it comes to numbers, numbers don’t lie. At least most of them don’t

According to what I read online, the chemical makeup of a human body is worth about $4.50—about the price of a Happy Meal.

According to my research, the value of a patient over twenty-five years ranges between $180,000 and $250,000. Now I know many of you will want to argue that number, but whether or no you like my number, a patient is worth something, for if it wasn’t, your doors would not be open for business.

That said, it stands to reason that the more services provided to that patient over time will cause that person’s value to a health system to increase.

Now, here’s where I think things get curiouser and curiouser. How much value does the person on the phone have to your health system? Or, the person on your website trying to book their first appointment?

There are a number of different variables you can use and complex formulas you can develop to try to answer that question. But here is a much simpler way to understand what is at stake.

If you do not answer the phone, or if you do not provide a way for a visitor to meet their needs online, the value of that person is precisely zero.

With regard to your health system, they are worth $4.50 more dead than alive.

And yet your marketing department is still buying billboards and advertising on NPR trying to get people to call.

While most health systems know the term leakage, none of them knows, to any degree of certainty, what it means.  People leave the health system after they receive care.  We don’t know who, or when, or why.  We just know that some do.

But here is the scary part if you happen to be the CFO or Chief Marketing Officer.  I think that the leakage factor on the front-end of customer experience, or patient access–whatever you like to call it, may be 50 to 100 hundred times greater than at the back end.  Someone is calling to make their first appointment.  Someone else is calling to make their second appointment.  

Because the experience of making multiple calls and being placed on hold they do the only logical thing.  They hang up, and their value drops to zero.

Why Must Your Health System App Link To Frogger?

A friend of mine told me to come over and check out his new healthcare mobile app. “Look,” he said, “It plays Frogger.” (Those of you who were still at the zygote stage in the 1970’s may have to Google Frogger.)
“What else does it do?” I asked. “Does it provide real time updates for inventory of appointments? Does it have click-to-call functionality? Notify you when you have a refill about to expire, or that your lab results are in? Does it tell you if your doctor is running thirty minutes late and waive half of your copay for inconveniencing you?”
“No, it is just a healthcare mobile app,” he replied. “The last healthcare app I had only displayed a phone number for their call center. But dude, this has Frogger!”

I’ve seen many of your mobile healthcare apps, and the best advice I can provide you is that you should consider adding Frogger to your app. That way at least your users will have something they can do when they use it. You may want to think about adding a Frogger link to your homepage as well.

Healthcare IT is growing by leaps and bound with or without you. The race to employ it effectively is somewhat like the arms race—another 1970’s reference. Second place, in whatever market you serve, is first loser. Most of you probably know the business adage; lead, follow, or get out of the way. Who would have thought so many healthcare organizations would choose ‘get out of the way’ as their healthcare IT strategy?

I was going to write about the importance of adding the need for your technology to be cognitive, but I thought that would seem like I was rubbing salt in the wound I just created.

Today there are wearables for employees to interact real time with patients. Seventy percent of health runs less than 20 percent of its enterprise apps in the cloud. This handcuffs their ability to manage effectively with connected systems, devices, and APIs from other businesses and mobile workers.

I just read that Fitbit and Amazon’s Alexa are learning how to play together.

Then there is DeepMind from Google for clinicians. While I have not seen confirmation yet, I believe that there must be a way to deploy blockchain technology to tie together more effectively consumers and patients to their healthcare food chain.

The time has come for healthcare to go big, or go home. Or play Frogger.

What is Patient Experience’s Wow-Factor?

I spent way too much time this morning drafting a creative piece on where innovation exists in healthcare. To my chagrin I was stumped with regard to developing a cute analogy that segued into anything that would be worthy of your time and mine.

Maybe what follows will pass the test. If it does not, I apologize.

If asked, most of your employees would probably describe your organization as highly innovative.  Would those same people be able to describe the most impactful innovation in the last two years? Would they be able to describe a single innovation? Do they know who is in charge of innovation? If the answer to those three questions is not a universal and resounding ‘yes,’ then perhaps the term innovation does not really apply to your organization.

When I look at healthcare from one perspective, the perspective of the services it delivers, I see an industry that is the poster child for innovation.  Our system of healthcare delivers healthcare services that others have yet to think of.  As an example, a few months ago I watched a video of a skin cell be transformed into a beating heart muscle cell. If you Google “healthcare innovations” all of the hits have to do with the healthcare services we are able to deliver.

However, when I look at the industry from the perspective of how providers and payers operate their businesses, the term innovation does not jump out at me.  If the healthcare services delivered are reflective of a 2.0 business model, how then can the way the businesses operate continue to function under a 0.2 business model?  Because of this, is it reasonable to assume that the industry actually operates in a 1.1 model (2.0 + 0.2)/2 = 1.1?

Does the 0.2 portion of healthcare water down or dilute the value of the 2.0 services it delivers?

I think it does, or at least it makes the acquisition of those services by patients (customers) much more tedious for those doing the acquiring.

The purpose of innovation is to bring something new to the market that is so compelling that it will make customers in any industry leave one provider for the other. It is so compelling that it will make those leaving choose to stay with their new provider. It will compel those who changed providers to advocate to others that they join them.

We have just described an innovation strategy that brings about:

  • Patient Acquisition
  • Patient Retention
  • Patient Referrals

And since nobody seems to know what it costs to acquire a patient, innovation should be a strategic focus. Given a lifetime value of a patient of between $180,000 and $250,000, one should argue that innovating to acquire patients, retain them, and earn their referrals offers a substantial ROI for a very reasonable investment.

Can it also be argued that innovation can be applied to reducing readmissions by twenty percent or more, and to dramatically enhance the revenue cycle by being innovative?

It can indeed.

People need two things from their provider; they need to get well and stay well, and they need to be able to interact well with the institution.  The notion is so simple it is silly—if people cannot easily do something as basic as scheduling an appointment, they will not buy services. Or they will not buy them more than once. And they will not refer others.

So, just what is this innovation that can do all of these wonderful things?  Sometimes it is easier to first make the point of what it isn’t.  Adding valet parking, free Wi-Fi in the lobby, or a Starbucks coffee cart are not examples of innovation. Neither is implementing a new ERP system or enhancing the organization’s website.

Innovation should have heft. It should foment change.

Innovation is not only about doing things that other organizations are not doing, but discovering and doing those things that offer compelling reasons for your customers and theirs to switch their business to you, to stay with you, and to compel others to join you.

Some examples of firms that have innovated how people do business with them include:

  • Netflix: eliminated what their customers did not see as convenient or valuable processes; two trips to get and return the video, eliminated the rewinding, late fees, and offered unlimited rentals for a single fee
  • CVS: eliminated calling the PCP, scheduling the visit, and having to drive to the pharmacy for medications. CVS just added the ability for people to refill their prescriptions by taking a photo of their prescription bottle
  • Banking: instead of having to deposit a check at a bank or ATM, people can deposit the check electronically by photographing the check.

And here is the part that most of their customers overlook. The innovation wasn’t just a win for the customers, it has been a huge win for the institutions who innovated.

So, how does knowing what Netflix and CVS did help my organization understand what we should do to innovate?

Being by looking at what your organization would have to look like from the perspective of your customers to create a remarkable user experience each time someone interacts with it—in-person, on the phone, and online.  Start by asking your organization’s stakeholders; customers and patients. Then define the wow-factor, define remarkable—not better, not new and improved. And then design that remarkable experience at each touch point.  You will know it when you see it because people will tell you when they see it.

What Happens When Patient Experience Encounters Spiderman?

I had some questions for my provider.  That is not accurate, I had a bunch of things I needed to accomplish, and questions I had been saving up for the simple reason that I did not want to put myself through the process of interacting with the hospital multiple times. I thought it might hurt less if I did them all at once.

Some of the things and questions on my provider to-do list included:

  • Scheduling a follow up appointment
  • Refilling two prescriptions
  • Setting up a payment plan for myself
  • Learning how to file a dispute with my payer
  • Getting additional information regarding my discharge orders
  • Learning if there was a way for me to add personal health data to my health record
  • Get a copy of my personal health record
  • Learning if I could track my vital signs, diet, exercise, and medications on their system.

I thought I would try get some of these sorted on the phone and others online.

As I was reveling that I was able to do all of these with a single call and a single visit to the hospital’s customer portal my wife woke me.

“You were having that crazy nightmare again, weren’t you?” She asked.

“What nightmare?” I wondered.

“The one where you suspend disbelief, and you go to that hospital’s website and do all of those things . You have that dream every time you wear your Spiderman pajamas. Tonight you wear your Flintstones pajamas so I can get some sleep.”

Patient Experience Meets Roemer’s Laws of Evolution

There are people who believe that to improve the effectiveness of a business you must belong to one of two camps; the business process camp where you get the same result every time—a structure for predictability, or the creative process camp where you get a different result every time—a structure for possibility.

Let’s look at the here-and-now.

Most businesses, including hospitals, have, according to Roemer’s Laws of Evolution—think Darwin without the bit about fish walking from the sea—processes in place that have evolved over time.  Individual processes have evolved from multiple ways of performing a task to a single way of doing a task.  Inefficient ways were eliminated, and we settled on one efficient—fast—way of executing a process. If we still do not like the process, we hire and expensive firm and squeeze out a few more seconds by using some form of twelve-sigma approach.

When we are done, what we have left is a process that is as fast as we know how to make it, a process by which we get the same result every time. We have created a structure of predictability.

The process may not even be necessary, and the results from the process may not be correct—think effective, but we have figured out how to make that ineffective process very fast. And after all, fast is good. Right?

Having arrived at this point in the process evolution process, we have arrived at a point of stagnation.  There is very little left to tweak, and the last person who uttered the words ‘change’ or ‘innovate’ in a meeting is now working as a barista at Starbucks.

That is why patient experience improvement efforts have stagnated. What inertia there was to improve it has become the inertia of passivity.

I am not arguing that having patient experience processes and patient access processes that yield the same result every time is a bad thing. In fact, I believe that result to be the goal; processes that do the same thing every time.  However, what would happen if a priori to this singular way of doing things we added a structure for possibility?  What if we allowed creativity into the mix?

For example, what if?

What if instead of asking how do we improve the process people experience when they call the hospital we asked—what if people did not have to call the hospital? Do you know why people call the hospital? They call because they have no other alternative to meeting their needs.  What if—and I know this borders on the edge of credulity—people did not need to call? What would that entail? What would the business look like?

What if instead of asking how do we improve the process people experience when they are admitted to the hospital we asked—what if people did not have to be admitted?  But what would we do with the waiting area, the admissions desks, and all of those outdated copies of Highlights Magazine, you ask. 

There is not rule that requires you to keep a process just because the process is efficient.

Eliminating a process yields the ultimate in efficiency.

Instead of shaving thirty-two seconds off of the time it takes to admit someone, why no eliminate admissions? What would that look like?

One of my consulting clients had seventeen call centers.  They asked me to help them create a call center strategy. At the kickoff meeting I announced we were going to operate under the assumption that we were going to close all of the call centers. One executives argued, “You cannot close all of the call centers because we receive over four-hundred-thousand calls each month about our bills.”

I replied, “At thirty dollars a call, you are spending $144,000,000 a year, each year, talking to your customers about your bills. Can’t you fix your bills for less than $144,000,000, or eliminate your bills?”

Once you get that process fixed make it repeatable, make it yield the same result every time.

What is the Patient Experience Gumball Postulate?

This is my gumball machine. There are many like it but this one is mine. Without me my gumball machine is useless—a paraphrase from Full Metal Jacket.

The gumball postulate states: Most times you will have a gumball experience that gives you a gumball that is not the color you wanted.

The only problem I have with gumball machines is that although you know you will get a piece of gum for a penny, you never know what color the gum will be until you have spent the penny.  There are eight colors of gum in my machine. I like the greens, yellow, and purples.  Hence, for any given turn of the dial I have a thirty-seven and a half percent chance of being satisfied.

At the outset, assuming there is an even distribution of the gumball colors in the glass jar, the chance that I will be dissatisfied with each expenditure of a penny is greater than sixty-percent.  Not great odds.

From the perspective of a customer, they know from their prior experiences that their experience of having to interact with any organization, with your organization, will be a whole lot worse for them than getting the wrong color of gumball.

But the principle is the same.  The experience doesn’t depend on anything that was planned. It does not depend on anything that was designed.  The quality of their experience, and their satisfaction with that experience depends on one thing—random selection.  Green gumball; red, white, or purple.

The healthcare postulate states: Most times you will have an experience that is not the one you wanted.

Now some of you will argue that your organization is committed to improving patient experience, and you will cite actions like employing a parking valet service, and improving the food in the cafeteria. It may be worth noting that the management team parks their cars and eats in the cafeteria, but maybe that had nothing to do with why those services were improved.

One thing the management team does not do is call the hospital. They do not know how many times someone has to call to schedule an appointment, to speak with a nurse, or to get someone to help them understand their bill.

A person’s (patient, customer) satisfaction when they call your organization depends on a combination of some or all of the following:

  • Was the phone busy
  • Were you placed on hold
  • Did the person you spoke with know the answer to your question
  • Was your call transferred to someone else who they hoped might know the answer
  • Did the person speaking with you know anything about you before they spoke to you
  • Did it seem as though the person had access to the right information to answer your question
  • Did you have to call multiple times to get the right answer
  • Did you have to speak with multiple people to get the right answer
  • Did you ever receive the right answer
  • Has this happened to you more than once

Suppose you were bold enough to call more than once, and that you asked the same question to each person with whom you spoke.  Would you get the same answer from each person?

Of course not. Don’t believe me; try it.

Do you know why people call your institution?  Try to write a list about why you believe people call. Hint: if your list contains fewer than twenty items, you probably do not know why they call.  And, if you do not know why they call, how can you possibly expect to answer their questions when they call?

So where are we?  We do not know what type of experience people have when they call, and we do not know why they call.  That said, can there be any doubt that what they experience when they interact with your organization is poor?

The solution to this problem is not a software package. Software is a tool.  The solution comes from knowing why people contact your organization, and knowing what they expect from your organization when they make contact. Without knowing the answers inside-and-out to those two items means the experiences will continue to be poor.  Once you know those answers you must design an experience that provides each person exactly what they want every time they call you or go to your website.

If you think that is impossible, go to the websites of Amazon or eBay. Look for a phone number to call that will allow you to speak with someone about anything; customer service, accounts receivable, customer returns, and shipping.

Is that because they do not want to talk to you? Is it because they do not want you to talk to them? Of course not. It is because they inventoried all of their business processes, and then they designed a way, one way, to ensure that each interaction was tailored to solve that business process the very first time the person needed it solved. They designed it so that it works for every business process and so that it works for every person every time and on every device.

Here’s a freebie for playing along.  Chances are good that the people who answer the phones at your organization do so only between the hours of 8 A.M. and 6 P.M. Monday through Friday.  Why not at least offer your patients and customers the same opportunity to reach you as Comcast and Verizon offer their customers?  That is a low threshold, but certainly not one your organization should be below.

Now if you have made it this far, you might suspect that I am a huge advocate of call centers. I am not. I am a huge advocate of the notion that says if you are going to interact with your patients and customers by phone that that interaction should be remarkable.

It is a lot easier to improve the gumball machine customer experience. All I have to do is use the key, open the top, and select the best experience.

The future for patient/customer interaction lies with self-service on the web. If you are interested, this link takes you to a PowerPoint deck that addresses that point.


Arrogant Socks and Emergency Department Wait Times

socksWriting a blog is the only affectation I know where sarcasm passes for intelligence.  Sometimes I find it helpful to leave a trail of breadcrumbs to help you see where the story may be headed; today I have decided to leave a trail of croissants.  That said, here we go.

Packing for my trip today I was interrupted by the obscure phrase, “Those socks are arrogant. There is a reason why most men wear plain, dark socks.”

“I don’t want to look like most men,” I said as I tossed them into my suitcase.

“If you wear that pair, you won’t look like any men.”

“Besides, socks cannot be arrogant,” I replied, ignoring her sarcasm, “any more than they can be disappointed. Socks can be cotton and Italian, as these are, and they can be colorful for the same reason, but they cannot be arrogant. Show me someone who has a bad thing to say about my socks and I’ll show you someone challenged by color.”

Every time we get into one of these conversations I feel like I am trapped in a veritable Tennessee Williams play, or like I am having a battle of words with Sigourney Weaver in Alien minus her automatic weapon.

“You know what I mean,” she said. For those of you who have your own sock monitor, you should be able to infer who she is. “Wearing those socks makes you come across as arrogant. The type of person who would wear those socks is the type of person who would walk into a Seven-Eleven and kill everyone because the Slurpee machine wasn’t working.” Sigourney get your gun. Wasn’t that a musical?

“I have a mind of my own.”

“I know,” my Sock Monitor replied. “It’s how you use it that keeps me up nights.”

“The socks make me a nattily dressed, confident and sartorial gentleman.” I felt like I was trying to explain cholesterol to a Big Mac. Maybe I needed to spend some time in a reeducation camp.

“Yeah, whatever you think they make you, do not wear them to your meeting tomorrow unless you want to be remembered as the guy with the leprechaun feet.”

I looked at her with the trepidation of a student teacher in a geography class trying to point out Burma on a dated map, and I decided to call this a draw before Ms. Weaver went for her weapon.

The IDN’s website displayed the waiting times for its five hospital emergency departments. Two of hospitals displayed wait times of “+60 minutes.”

Now I am not sure why I think the way I do about things. Maybe it means I don’t play well with others. Or, perhaps it reflects the fact that my thinking is so far off from being main-stream that my little billabong dried up a long time ago.

So, let’s look at the idea of posting wait times for a hospital’s emergency department. I imagine hospitals post them because someone suggested that doing so would improve customer experience. My question is, Cui Bono—who benefits?

Emergency: a serious, unexpected, and often dangerous situation requiring immediate attention. The definition, to my way of reading it, is unambiguous. Dangerous situation requiring immediate attention. Need we define immediate? Suppose you have one of those situations.  Which of these do you do?

  1. Dial 911
  2. Drive yourself to the hospital
  3. Log in to the hospital’s website to check the wait times at the emergency department, and then drive yourself to a hospital.
  4. Phone a friend and ask him to come over to watch the Eagles game with you.

Let’s take a minute to review your options.

If you dial 911, you do not have to trouble yourself with wait times because the ambulance driver will decide which hospital will treat you.  The EMT will not ask you about your insurance, and the driver will not consult you about your preference based on current wait times. In fact, you may not even be taken to one of the hospitals in your payer network.

If you drive yourself to the hospital, and your situation is really a dangerous situation requiring immediate attention, do you go to the closest hospital regardless of whatever the wait time may be? Or, do you start messing around with higher maths. Please play along.

Our Lady of Rapid Service is seventeen miles away and has a posted wait time of ten minutes. The hospital of We’ll Get To You When We Can is five miles away and has a wait time of forty-two minutes.

The real question becomes, “Which hospital has the lowest gross time before I can be seen?” (The lowest wait time does not guarantee that you will be seen sooner. Gross time equals the sum of drive time plus parking time plus wait time.) To answer this correctly requires that you include numerous other factors; traffic, road repairs, weather, time of day, curvature of the earth, and so forth. It also requires a bit of clairvoyance on your part.  The posted wait times are the current estimated wait times, not the estimated future wait times. The posted wait time would be helpful if you were at the hospital now, as in right now. But the wait time may be different by the time you arrive.

So chances are good that if you have the time to look up and evaluate wait times, and have time to select a provider based on those wait times, and have the additional time required to drive yourself to said hospital, the one thing you do not have is…say it with me… A dangerous situation requiring immediate attention. The concept of wait time flies in the face of the concept of immediacy. In other words, someone with all of this extra time on their hands probably does not have an emergency. 

Which, as it turns out, is what a lot of people who go to the emergency department do not have—an emergency. In which case those people should not be going to the emergency department, and if they do, perhaps they should be made to wait. Getting rid of those who do not have emergencies, or just making the non-emergency group of people wait in their own little queue, will make the wait times for those who have real emergencies so low that the hospital will not need to post wait times.

Which not only solves the problem, it makes the option of watching the Eagles game make a lot more sense.

Back the question I raised at the outset, Cui Bono from posting wait times?  The only answer I can come up with is that the people who benefit the most are the ones who do not have an emergency. An example might be the person who called their doctor on a Friday afternoon because they ran out of their prescription and they were told that they would have to wait until Monday for a new script.  This person calculates the drive-time/wait-time math and picks the hospital that will get them home with the least amount of interruption to the Eagles game.

Bonus round. Now, for extra credit, how would having a triage nurse available at the hospital’s call center impact ED wait times? It would bring them down because many of the people whose needs were basic, those people who did not have an actual emergency, but who needed a new script or medical advice, could be served by speaking with the nurse. This would bring down wait times, reduce costs, improve patient experience, and allow more people to watch the game or do whatever it is they would have done had they not been waiting in the emergency department.