In our other articles, we’ve discussed driving innovation at scale by going digital with our customers, which first means having healthcare consumers transact and engage with us online. We do this by enticing our customers to work with us online by delivering a 10 times better online experience as compared to offline. It is necessary to have a significantly better (10X) experience to entice customers to change their behavior and adopt something new. If the online experience is only marginally better, inertia in human behavior will usually win. For the Providence St. Joseph Health (PSJH) Digital team, an example of the 10 times better online experience is delivered through the Express Care suite of services which delivers care when, where, and how patients want it for non-emergency, low-acuity care, combining three different types of care:
- Express Care Retail clinics provide same-day visits treating common conditions. Providence St. Joseph Health has built 33 retail clinics, 25 of which were built in partnership with Walgreens and 8 standalone retail clinics.
- Express Care Virtual gives patients the opportunity to see a nurse practitioner from their smartphone, tablet, or desktop. The service is accepted by most insurance plans.
- Express Care at Home enables patients to summon a provider to their home or office via smartphone, tablet, or desktop. The service operates within the Seattle metropolitan area.
Express Care is projected to have well over a hundred thousand visits this year with over ten thousand coming in digitally through Virtual Visits and At Home Visits. Most of these clinics have just reached their one year anniversary. Of these appointments, 50% are scheduled online, 75% are commercially insured patients, and 30% are new patients to the system. Net promoter scores, an indicator of customer satisfaction, for Express Care range from ~65 to ~85, on par with major technology companies like Apple and Amazon.
To achieve the 10X better experience, we followed some key tenets in building Express Care:
- Make Digital Services Easy to Find via Search: Most healthcare interactions begin with a Google search, as we’ve talked about in previous pieces, with nearly 50 million searches occurring daily. Ultimately, in order for searches to result in value to consumers, they need to find what they’re looking for. Search Engine Optimization (SEO) and Search Engine Marketing (SEM) enable content to be found in the digital universe. The Digital Marketing team at PSJH has optimized SEO/SEM to accomplish a cost per acquisition (CPA) for the segment seeking care to a fraction of what is typically seen in the industry.
- Create Familiar Customer Experiences: Large consumer technology companies have trained consumers to interact with them in a specific way at a massive scale. We aim to make healthcare experiences similar to the experiences that customers have with these other familiar digital brands. The Swedish mobile app, a PSJH affiliate whose portal app is powered by Express Care technology, has a similar user experience to the OpenTable app and other consumer scheduling apps. We don’t want consumers to bear an unnecessary cognitive load when scheduling in health care. We want them to schedule online the same basic way they have learned to do so on OpenTable, Expedia, etc. Virtual visits provide an experience similar to FaceTime or Skype. The Express Care At Home service is reminiscent of an Uber or Lyft-like experience. It’s important not to re-train customers to learn a new system and capitalize on their existing experiences with consumer-oriented companies.
- Deliver Care Everywhere: Bricks and mortar clinics have a typical catchment area of approximately 5 miles. Patients are less-willing to wait or to travel long distances for low-acuity or common conditions. Covering the entire geographic footprint of all of PSJH’s ministries would require hundreds of clinics and would not be sustainable. Densely populated, major metropolitan areas such as downtown Seattle can be covered by a home visit service. Rural and more remote areas can be covered by virtual visits. The combination allows a sustainable and patient-centered approach to covering entire states with reliable healthcare service wherever a reliable internet connection can be had.
- Integrate Online and Offline: The combination of retail, virtual, and home visits creates an opportunity to create a unified experience across all the methods of care. The singular experience creates continuity for patients who experience the same thing regardless of how they interact with the system, helps strengthen the brand of the system, and improves the effectiveness of marketing and branding efforts.
- Create a Continuum of Care: The beauty of a truly integrated experience is that information about the patient flows back into a single electronic health record. The benefit of having integrated information is that is creates continuity across patient care. Diagnoses, medications, problem lists, and other critical patient information is readily accessible to providers across any setting in Express Care or within the broader health system enabling the delivery of higher quality, safer, and more personalized care. This allows a patient to have their primary care physician manage the patient’s care, while maintaining visibility into even low-acuity episodic visits at Express Care. The app also enables the patient to work with their primary care physician online as well: booking appointments, messaging, prescription refills, etc.
- Create a Frictionless Patient Experience: Last but not least, Express Care represents a technology-enabled frictionless patient experience that takes the place of many onerous, offline processes that patients encounter today when they interact with a health system.
What Is the Frictionless Patient Experience?
Navigate: Once patients decide they need care, the question then becomes “Who can help me? What does this cost? What is most convenient?” That’s where Express Care first comes in. We call the first step in the experience “Get Care Now” where patients are provided content and support to direct them to the right venue of care for their condition, needs, and preferences. The goal is to direct patients to receive the right, clinically appropriate care on the first try.
Register: Most of us are familiar with the process of filling out a variety of forms when we show up to doctor’s office. The registration process can detract from the amount of time we have face-to-face with our providers, and is especially bothersome when patients are asked to fill out the same form over multiple visits. Pre-registration is the start of a fully paperless experience that enables patients to fill out forms online, in advance of their visit, maximizing the amount of face-to-face time with their provider.
Insurance: One of the greatest points of friction for the patient experience is tied to payment complexities. Our vision for the frictionless patient experience is that patients would know their out-of-pocket payment before they get a service. Insurance would be verified in real-time and patients can make rational economic decisions tied to care rather than being faced with a black box, or worse yet, getting service they may not be able to afford.
Express Care, in addition to being a way of delivering convenience to our patients, is also economically efficient way of introducing new commercially insured patients to PSJH. These patients are predominantly online and seeking convenience. In 2018, we will also tailor the Express Care offering to the needs of Medicaid patients. Medicaid patients have a high need for convenient access to primary care and will sometimes visit higher-acuity sites such as EDs because of the lack of convenient hours. This is because many of Medicaid patients work hourly and a visit to a primary care physician during the day is not only less convenient, it costs them a considerable amount of money in lost wages. Inconvenience harms lower income patients economically way more than it does mid and upper-income consumers. We will be significantly expanding the Express Care footprint in the coming years and tailoring it to different populations.
We are also discussing partnerships with other health systems around how to deliver Express Care technology in their markets. These health systems are intrigued with the impact Express Care has had on our consumer perception in the market and the corresponding economics and want a solution that has been demonstrated to work in a large, complex health system.
The frictionless patient experience can be replicated in any care setting; such as primary care or even in the acute care setting. Taking primary care scheduling as an example, approximately 95% of primary care appointments today are currently made via phone making for a less convenient patient experience. PSJH is currently enabling its primary care locations to online scheduling leveraging what we have learned from Express Care. There are significant opportunities to rethink current services that we provide to consumers, while also building capabilities that will make health systems financially sustainable in either fee-for-service or value-based payment models.
After delivering the 10 times better experience, systems earn the right to engage with their patients on an ongoing experience. More on this in our next piece…
Aaron Martin is Executive Vice President and Chief Digital Officer for Providence St. Joseph Health (PSJH), and Managing General Partner for Providence Ventures (PV). Aaron is responsible for the digital, web, mobile, and online marketing channel for PSJH.
Sara Vaezy is the Chief Digital Strategy Officer for PSJH. Sara leads the development of the digital strategy and roadmap, digital partnerships and business development, and technology evaluation and pilots.
Dr. Mishra is the Vice President of Express Care services and Consumer Innovation in the division of population health. Dr. Mishra works closely with the Providence Digital Innovation Team to ideate on and then operationalize technology solutions across our enterprise. Dr. Mishra came to Providence by way of Swedish where she was an internist and primary care physician, as well working on primary care re-design.