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“Denial is not an option.” Contrary to the typical (and here, oversimplified) pre-certification, “approve” or “deny” approach to utilization of services in health care, HealthHelp launched a new model of utilization review based on the premise of non-denial procedures, and that utilization management is about collaboration and education. HealthHelp taps into its evidence-based database and network of physicians and academics to review and approve or to recommend alternatives to procedure requests. In tandem, HealthHelp drives studies and education opportunities to lead to better medical and financial outcomes when providing or using health care services. In short, the company that WNS just acquired is building out a patient- and healthcare provider-centric approach to utilization management designed to match procedure and treatment to the patient’s needs and network.
HealthHelp took roots in the founder’s own pain
The HealthHelp approach is tied to the experience of its founder, Cherrill Farnsworth, who found the number of denials and appeals she managed for radiology procedures discouraging and painful. Thinking about “how to do this differently… why do we have to deny”? Cherrill tapped into her network of people at medical centers and universities, creating a collaborative model on the premise of using data, insights, and education. Instead of a review, approve/deny, the approach is review, approve and/or educate and/or recommend. The approach uses an increasingly sophisticated system of data, digital technology, and relationships. HealthHelp is taking product development further into the realm of machine learning and artificial intelligence, as well.
What gives HealthHelp the “right” to make recommendations to healthcare providers and patients?
An approach like this one—essentially, a break from the norm—depends on the credibility of the data, technology, and people involved. HealthHelp faced the challenge in the early days of people not being sure that a “non-denial” approach would be effective for containing costs. With 15 years of data, though, the company has been able to ingrain a lot of experience and knowledge into the approach and platform, to the extent that now 75% of prior authorization requests get approved for providers or are responded to with recommended changes that are approved by providers, without any human intervention. In about 25% of the cases, it goes to nurses for review; 6-7% of which are forwarded to doctors, and after that, the provider has the option to and can still disagree and go with treatment, which happens in under 0.5% of cases.
Results to date show improvement in the quality of care, which impacts Star and HEDIS ratings and reduces the cost of care by making sure the right kind of care is provided versus the lowest transaction cost at a point in time. Also, in a fee-for-service model, a healthcare provider gets paid for the procedure regardless of the result. As the industry shifts to value based care with payments tied to outcomes, approval based on evidence or alternatives becomes more strategic to positively impacting outcomes (and payments). This approach, therefore, seems to have further credibility in the value-based care model and can help healthcare providers move into the new world of healthcare. HealthHelp worked with CMS to get approval to qualify this program under provider education/quality improvement initiative and thus be included in the 85% Medical Loss Ratio for health plans.
The acquisition by WNS brings a complement of resources to both organizations and its client base
The healthcare industry is so ingrained in a yes/no approach that it took a few years before the model got adoption, primarily with mid-tier healthcare organizations. Joining with WNS gives HealthHelp the opportunity to scale and support a broader range of payers and providers. WNS also has a wealth of analytics capability, talent development and industrialization expertise that is complementary to HealthHelp, with resources that can help expand and develop the services and technology platforms to impact healthcare outcomes more broadly.
The acquisition of HealthHelp is part of the WNS strategy to shift attention from the cost of transactions to the cost of quality care and support—towards patient centricity. To date, WNS’ work in healthcare has been mostly analytical and transactional services: billing, collections, provider network services, and claims processing. HealthHelp brings in clinical and operational expertise to impact medical, as well as administrative outcomes, thus closing the loop. It also brings a human-centered (aka design thinking) approach to solving problems and developing a new business capability that the healthcare industry needs.
While we wait for the new Obamacare “replacement” bill to sink or swim, we can’t help but ponder the implications of whatever outcome on the healthcare industry and the services ecosystem that supports it (especially since we get asked!). Amid all this uncertainty, one thing that is sure not to change is the consumerism that has taken a strong hold within the healthcare industry, which would be the case with or without the ACA. As consumers, we are wondering, if I can order merchandise from many different suppliers on amazon and pay in one place, why can’t I see all my clinical data and lab images and send them from one doctor or clinic to another? If I can send the record of my dog’s shots to a boarding kennel electronically, why not send my children’s immunization record to schools and summer camps just as easily? Yes, we know about interoperability and security issues. However, we have come to expect the same access and convenience in our healthcare experiences as we do in all the other aspects of our lives.
Healthcare providers and payers are challenged to meet these increasing expectations—and are investing accordingly in digital enablement. HfS’ recent state of business operations survey indicated that 42% of healthcare companies are planning a significant investment in analytics to better understand what are the issues for whom, what are the opportunities to interact and impact members and patients and administrative support; and 36% are investing in social/mobile/interactive enablement to redefine, “modernize,” or create the customer experience. Despite all this planning and rhetoric, dealing with the healthcare system often feels like the dark ages rather than a modern customer experience. Our recent research found several examples of service providers and buyers working together that are hopeful of experiences to come:
- Creating the digital customer experience by connecting front and back office: Due to ACA regulations, healthcare payers have needed to adjust to dealing with consumers (versus employers’ HR departments.) Many have set up retail storefronts including mobile centers where people can come in for enrollment (majority), questions and paying bills. Teleperformance uses a proprietary software, TLSContact, to manage the process and workflow of the customer retail journey. Representatives are able to access the initial app that the customer started online, and the workflow software helps identify the bottlenecks and how to better staff these centers. For example, they can look at and analyze the processes to find out why there are long wait times—enabling clients to improve the process and better staff to meet demand.
- Developing customer journeys that look “outside the hospital walls” and building solutions that support the journey: Approaching healthcare in a consumer-centric economy drives healthcare organizations to look at how to initiate and keep the customer relationship over an extended period of time, not a point in time. Emergency rooms are designed to address a “point in time,” but we know that a health incident starts before a person arrives at the ER. VCU Health neurologist Dr. Sherita Chapman Smith is championing an effort to use telemedicine as a way to do assessments on stroke patients while they are in the ambulance, on their way to the hospital. (link). In pilot simulations underway, the hospital is using trained actors to simulate stroke symptoms to test out the platform during ambulance rides to the hospital. “Patients” are picked up in an ambulance and connected via teleconference to the neurologist in the hospital, who conducts a remote assessment; and when they get to the hospital, they are quickly advanced to the next stage of treatment. The approach creates faster interactions between the points of care and speeds the time to treatment.
- Using digital technology to make the users life easier and more real-time interactive with support systems: A healthcare organization that has partnered with NTT DATA Services described a consulting-led project which was aimed at the total redesign of the patient’s journey in various medical use cases (i.e. bariatric surgery, knee or hip replacement) in order to personalize that patient’s journey whenever he/she logs into the mobile app or accesses the website. This means drawing together an understanding of that patient’s journey from start to finish, and knowing what stages they are in throughout their course of treatment, and what their needs might be. This hospital relied on the provider’s experience mapping expertise.
It’s clear that healthcare isn’t getting less complicated any time soon. Whatever the fate of the ACA, the current political tone is foreshadowing more complexity and anxiety. Whether people are going to be uninsured or underinsured as critics of the current bill claim, or need to switch plans or providers, we can be sure that activity in the healthcare systems will increase. We can also be sure that that emotion will be at an all-time high, with the anxiety and fear that comes with people uncertain about what the changes mean for their lives and their loved ones: all the more reason that healthcare organizations need to be more nimble, intuitive and empathetic to that customer experience. Unfortunately, examples like the ones we highlighted above are the exception rather than the norm.
Bottom line: It’s time to think of and treat patients and members as customers you want to attract and retain, whether you are a health care provider or payer or a third party service provider partnering with a healthcare organization. Now we need to roll up our sleeves and partner in the effort to create a healthcare experience that puts the customer at its center.
How Design Thinking plays an integral role in increasing the value of outsourcing, service design, and delivery
In business operations, global shared services, and outsourcing, the mantra has been: centralize, standardize, industrialize, globalize. Traditional shared services and outsourcing contracts have been developed to focus on “lift and shift” and how to make processes increasingly more efficient and effective, measured by service level agreements. But what happens when the SLAs are green but customer or stakeholder satisfaction is level, stale, or down? When you feel that “innovation” is lacking? That the world is shifting to become faster, more flexible, and in-touch—but your business delivery isn’t and you just don’t have the time to think about it?
The answers to those questions are more and more often to use Design Thinking as a catalyst for innovation and continuous change. And it is the reason we explored the integration of Design Thinking into business operations and outsourcing design and delivery. Insights on how Design Thinking plays a role in creating a different experience—a different way of working and new insights for operational excellence and expansion—and 11 service providers are profiled in the recently published HfS Blueprint: Design Thinking in the As-a-Service Economy.
All of the service providers in the blueprint we’ve just published, Design Thinking in the As-a-Service Economy, are increasingly incorporating the principles of Design Thinking—human-centered, collaborative, action-oriented—into the way they work. Just like the increasing attention to robotic process automation and cognitive computing, experimentation has been going on for a while now… and so it is no longer “new” to many of them.
Design Thinking is a complement to, not a replacement for, operational excellence and solutioning for service design and delivery
You can use Design Thinking to understand what’s really causing problems or issues or expenses, by better understanding what people are actually doing –or not—and feeling. What is their experience? And then working through ideas that may revise, or replace, or eliminate process; that may change what people are doing and how; and could use current technology better, or new technology. As one shared services executive told us, “we already know how to make something efficient [with Lean Six Sigma] and we required a new way of thinking in some specific areas.” Along these lines, we are not anticipating an end or replacement to Lean Six Sigma or “operational excellence” but adding a way of stepping outside the process to identify trouble spots and new solutions.
With Design Thinking you focus on understanding who is involved in whatever process or problem you are looking to address, and what are their expectations and needs (the “human” side)? And what is the industry and corporate context, the business outcomes to impact (the “business” side)? And what are the technology enablers? Then bringing it all together in a solution through a series of prototypes and tests. (See Exhibit 1: Incorporating Design Thinking Into Business Context for Shared Services and Outsourcing) Sometimes the solution is a quick fix, like changing the day of the week or where a request from a consumer is directed in a system; and sometimes it will help you identify a new way of working or a new service or solution.
Bottom line: By using Design Thinking, we are moving a more human-centered, business-outcome oriented, and questioning approach to defining and delivering services in consulting and outsourcing, just the way the world is doing in general.
Using Design Thinking “was helpful because we make assumptions about people,” said an insurance executive interviewed in our study. Taking the time to empathize with the end user through interviews and observations “helped us to make sure we understand not just what we do for the consumer but how it makes them feel.” In other words, it’s not just about what you’re doing but the relevance of it to your end user. If you want your customers and your stakeholders to work with you to reach your business outcomes, then look for ways to make it easier for them to do it – and that means understanding them better, and that’s a role that Design Thinking can play.
Where is the outsourcing services industry on the path to integrate Design Thinking?
We want to help you, through our blueprints, to make the right match for a services engagement – short or long term. While that effort used to be about “we as a buyer post a list of requirements and look for cost reduction” and “we as a service provider will tap into our best practices, tell you about our features and functions, and hire or assign people who can process transactions” … times are changing.
Now, engaging a service provider or providing services to a business means understanding the context, the challenges, the outcomes desired, and how to broker and define a solution that can be flexible and change as the market changes. We’ve been calling this movement the “As-a-Service Economy.” Design Thinking can play a role in this movement towards a new way of working as partners. But because it is a new way of working, it does take time – trial and error and willingness to work in a new way. It impacts roles, governance, budgets, and contracts. And equally important, you need to have alignment in the expectations and cultures of the partners involved in order to feel as though this way of working can work – to deliver results.
In the Design Thinking in the As-a-Service Economy Blueprint, we look at the relevance, use and impact of Design Thinking in services engagements as it takes shape as an integral part of business operations and outsourcing solution and service design and delivery. It includes coverage of the following service providers in terms of Design Thinking integration into the way service buyers and service providers are working together: Accenture, Capgemini, Cognizant, Concentrix, EXL, Genpact, Infosys, Sutherland, Tech Mahindra/BIO Agency, Wipro
A Different Take on HIMSS 2017 and Health IT
Technology was first and foremost on the minds of the over 42,000 people who gathered in Orlando for HIMSS2017 last week – or was it? And should it be? There is a groundswell rising at HIMSS for not just talking but acting when it comes to putting the individual—the person—at the center of healthcare. In a word: empathy. How does what you do with IT, or as an IT professional impact the way a person experiences healthcare throughout their lives? There is a lot of attention on security, cognitive computing, analytics, and so forth – the enablers of how healthcare can better serve its constituents. But at the end of the day, it’s about the people for whom you are designing these systems because if they can’t or won’t use them, it won’t impact health, medical, and financial outcomes. So an undercurrent of themes is swelling around social, behavioral, and environmental aspects of healthcare.
Effective healthcare IT systems need alignment and collaboration inside the hospital system—but need to also include what is outside of it
After the conference, on the way back from the airport, I sat next to an IT project manager. She told me how she had coordinated across five hospitals in a system to prioritize a list of IT projects that would enable these hospitals to create an interoperable network to exchange data more effectively and enable communications. After the agreement, one hospital came back and said, no, we have a different priority this year. This is the real challenge in healthcare—not whether the technology will work because it can and it will—it’s about whether the people will work together to define and achieve common goals.
Community collaboration as shown by the Value Care Alliance (VCA) in Connecticut
Earlier in the week, I attended a session about a group of hospitals in an ACO called the Value Care Alliance. They share a goal to increase quality and to build capabilities to assume and manage risk in a move to value-based care, with efforts to improve the health of the local community, reduce ER instances, and to reduce the number of attributed ACO members who go outside their community and their provider network for healthcare services.
To be successful, the alliance knew they needed to have a shared view of the community members – in technical terms, a population health platform with a data repository that would bring in data from disparate systems. However, each member of the alliance had a different platform; and they didn’t know each other’s platforms. They had started the alliance with a governing body that over time had saved money through shared services and group purchasing, thereby funding the investment in infrastructure needed for the population health initiative.
How has VCA approached it?
The VCA aggregated claims and electronic health record data, the hospital and physician practice medical records. The group then cross-referenced medical data with geographic data, looking at maps in the neighborhood: what is the health of the community when looking at, for example, a group of people with high HbA1Cs… is there local access to clinical care; what are the community activities offered; where are the grocery stores; can they see physical elements and conditions of buildings. They started reaching out to other community organizations such as the YMCA and a local parish nurse program to conduct health education, screenings, and other outreach activity. They also applied to CMS for a community health grant that will help them fund activities for further identifying high-risk individuals and connecting them to resources.
Back to the IT: the local hospitals all had legacy population health IT and didn’t know each others’ systems, and getting them to abandon what was already in place was complex. They brought in a facilitator to assist with defining shared goals and IT decisions; and every organization had one vote, regardless of size, to show commitment to the collective. The group also defined the value of the data to each and to the collective, to come to an agreement on multi-stakeholder data sharing. The underlying theme throughout, is how to get to a community health program – where the hospitals are enabling greater health in the community, where people locally come to their hospitals for treatment as needed, and have local support for being healthier, staying healthier, and receiving the right care at the right time and right (local) place.
To strategically use Health IT to drive health, medical, and financial outcomes, you need to balance internal and external efforts in coordinating care with shared community goals.
While walking the halls at HIMSS, I saw an endless variety of technology offerings—and among them, people—physicians, EMTs, nurses, patients, caregivers—all of whom want a healthier society. We need to not only connect the systems for interoperability, we need to connect the individuals. IT professionals need to be just as excited as doctors, nurses, and caregivers about truly changing people’s lives through healthcare, in order to really have an impact. We need to get our security experts, IT project managers, coders, consultants, and data scientists all thinking about the impact they can have on helping the people in their community live healthier, and therefore less expensive, lives. Because when we care, we make a difference.
“I’m putting more money behind women-run businesses because of return of capital and performance; this is what matters,” said self-made millionaire Kevin O’Leary, in the closing keynote at HIMSS2017 last week. When it comes to growing a business, Kevin has a proven track record you can easily find online if you don’t already know it from the U.S. hit show, Shark Tank. He has invested millions in startups over eight seasons of the show that hosts entrepreneurs pitching businesses and requesting support.
When taking a look at the returns in his portfolio, Kevin O’Leary noticed the ones with the greatest returns are owned or run by women. And what he called out about their management style is universally applicable in business.
It may also be a reason why we’ve seen in our research at HfS that the #1 thing that executives would change about the outsourcing services industry – per 25% of respondents – “more women in executive roles.” What we can learn from women-run businesses that are realizing higher results:
- Allocation of Time: “If you want something done, give it to a busy mother.” This is about focusing on what you know needs to get done first to impact the outcomes that matter; and about delegation, not trying to “do it all.” As an example, Kevin pointed to Honeyfund, which is approaching ~$500 million. He describes CEO and co-founder Sara Margulis’ approach with her team as: you have goals to achieve on a monthly or quarterly basis, period. It’s not about “how” or watching to see it done. It is closely linked, however to #2…
- Achievable Targets: In the companies run by women, the teams achieve revenue targets over 90% of the time, in Kevin’s experience with his portfolio. He claims this is because women tend to set realistic goals and motivate productivity. When individuals and teams achieve goals, there is a feeling of satisfaction, turnover is lower, and productivity is higher. In some circles, it’s called employee engagement. The opposite approach is to set goals that are too high to be achieved ... leading more often to higher staff turnover, lower morale, and lower return on capital.
Along with the management style, Kevin also pointed out that successful business (and project) pitches have three characteristics: (1) Articulation: Ability to articulate an opportunity in 90 seconds or less; (2) Uniqueness: Why you are the right person or the right team to execute; (3) Numbers: Know the numbers on the size of the market/opportunity, margin, etc. Altogether, these three, with the passion of a leader for her cause, can take a pitch from a spark to a sizzle to an explosion.
While Kevin’s observation comes from a review of his portfolio of start-ups that survive the explosion to move into operations, these two “T” characteristics can be universally applied to management in current business as well.
Bottom line: Today’s businesses need this type of outcomes-focused performance management with meaningful and achievable targets in this day and age when so many businesses that have been in existence for years are having to undergo transformation to become more customer-focused, interactive, and flexible.
A smart business operation uses the right combination of talent and technology to drive desired business outcomes. Third party suppliers are crucial for that combination, and our new research shows an increasing focus on the relationships with suppliers to standardize contract management and governance, centralize management of strategic suppliers, recruit and engage talent that has relationship building and critical thinking skills, and better leverage self-service platforms and automation in procurement and supplier management.
The big emerging trends in SRM:
Based on our new research, including discussions at the HfS Summit, our annual Shared Services and Outsourcing survey with KPMG, and interviews with executives from financial services, healthcare, logistics, high tech and other industries, we’ve put together this picture of the “state of supplier and partner management” in the IT and business process services industry:
- Ambitious procurement / sourcing leaders are positioning themselves as advisors to plug capability gaps – partnering with the business units to define strategy; coordinating across business units, IT, and legal; defining standards for governance (reinforced through templates and automation); using training to ensure the more distributed relationship management is active and following a framework.
- Organizations are increasingly standardizing and centralizing business operations functions - often incorporating outsourcing in hybrid / global business services models. IT has been the first mover here, with business functions following – F&A, Procurement, and HR as well as industry specific support. We expect centralization and shared services to continue, with selective and targeted use of outsourcing (on and offshore) and RPA in a model many are calling “no-shore.”
- There is a similar move to centralize supplier/partner governance and contract management, often separate from the relationship management. Relationship management is more difficult to centralize, and typically happens when the suppliers are providing IT or BPO through a shared services unit. Once centralized, governance and contract management is increasingly automated; and relationship management gets more focus.
Exhibit 1: Top 3 Desired – and Hardest to Find – Capabilties for Business Operations
Source: HfS Research in Conjunction with KPMG, State of Business Operations 2017 N=454 Enterprise Buyers
- Supplier management talent is increasingly oriented toward relationship building, decision-making, and analytical skills. Subject matter knowledge of the function is a basic capability that’s needed; negotiation and contract management “can be taught.” Executives are also increasingly interested in candidates with technical skills (or interest) in determining the right mix of talent and technology for managing optimal business results.
- Procurement is setting the pace for evaluating and implementing robotic process automation and cloud-enabled platforms for more self-service. In our state of industry study, 57% of enterprises are in the process of evaluating/implementing RPA for procurement processes.
- Across the board, we have found a move to consolidate and prioritize/tier suppliers for better negotiation capability, more effective and compliant oversight, and a more collaborative and engaged approach to partnering versus managing “off the side of the desk.”
- It doesn’t matter what your operating model is if you don’t have the right talent. The right talent will make the relationship with the supplier effective for the business.
The bottom line: There are three critical components to effective supplier management that stand out in our research
- Alignment and tiering of suppliers with business objectives
- Standardized and coordinated supplier relationship management and contract management and governance
- The “right” talent to broker and manage relationships and results
In general, companies are on a journey to have a more strategic approach to supplier management and believe it will take a matter of years to get there because of the cultural shifts required. We explore these themes further in our recently published POV, “The Rise of Supplier Relationship Management,” available for download (free with site registration).
We’ve seen a number of consulting and outsourcing firms making investments in design thinking over the last couple years. The most visible approach recently has been the roll of acquisitions of design-thinking boutiques. A few representative ones that are being covered in our current research for the Design Thinking in the As-a-Service Economy Blueprint include:
- Capgemini – Fahrehenit 212 (2016)
- Cognizant – Idea Couture (2016)
- Tech Mahindra –BIO Agency (2016)
- Wipro – Designit (2015)
- Accenture – Chaotic Moon (2015), Fjord (2013)
And while other outsourcing companies are not making acquisitions, they are partnering with design thinking firms (e.g., Sutherland with UXAlliance, Genpact with Elixir Design) and academic institutions that offer design-thinking curriculum (e.g., Infosys with Stanford d.school). Do their clients feel like it really makes a difference? From what I’m hearing in my interviews with operations executives, product managers, and finance transformation leaders to name a few… Yes, it does.
From designing to doing: Design thinking offers an approach for a diverse group of people to work together to identify and articulate a common problem, brainstorm ideas for addressing it, quickly prototype/wireframe/storyboard and test it, and continue to iterate on the idea as it takes shape into a proposed solution. While designers often operate within a “non-constrained world,” Consultants bring a healthy dose of reality check into the process, shared one interviewee. For example, a market-based and analytical approach adds context to the process of testing the ideas and prototypes for how well they could work in the business and how relevant they are to the market. Another executive described it as an “innovation agency” partnering with a “solution provider.”
Industrialization of methods and tools: Consulting and outsourcing firms have a rich history of standardizing what they have seen work in multiple instances. Many of them have been known to go to the extreme of “this way or the highway.” Most design thinking firms take a more creative, empathetic, and flexible approach, but are typically not as strong in analyzing, identifying, and setting standards. There are design-thinking agencies that are known for strictly adhering to standardized approaches and toolsets – IDEO comes to mind – but it is not the norm in the industry. Likewise, there are pockets of creativity in consulting and outsourcing, but, again, not typical. These two groups are starting to find complements in one another. Clients are appreciating this emerging combination of creative, engaging, and simple (thanks designers) and standardized, contextualized (thanks consultants) approaches.
Research depth: Design thinking can be a richer experience through thoughtful diversity – bringing together people at different levels (hierarchy) in a company, from different business units and functions, and from different professional backgrounds (e.g., ethnographers, CPAs, and programmers). Design thinking firms are rich in creative professionals; and consulting and outsourcing firms can tap into industry subject matter experts, technology gurus, and change management leaders, as well, because of the breadth and depth of their organizations. They can help address needs from market sizing to industry expertise to rapid prototype development with new, emerging technologies because of internal experts or their own ecosystems.
A key theme we hear over and over in the outsourcing industry is the drive toward “recalibration.” Outsourcing firms that have been in business for years were built on the premise of providing lower cost, higher efficient processes using best practices: Lean six sigma, and ERP or now, increasingly, cloud-based/SaaS platforms. But to keep doing something basically the same way and expecting different results is insanity (a refrain often accredited to Einstein) – design thinking offers an approach to finding those new results.
Bottom line: A design thinking led approach moves the focus of the operations executive and service provider partner off the process itself, off the internal, “what’s wrong inside of what we do” to “what do we actually want to achieve” (the business outcome), and what do we want people to feel and do naturally that will lead to further engagement and new—and different—results.
After seeing the impact of the human-centered, flexible, creative, fast approach within “innovation centers,” “labs,” or “digital” business units, consulting and outsourcing firms are realizing that design thinking can help a company and its clients reimagine something that desperately needs a new way of working. Outsourcing and service delivery is an industry suffering from hitting thresholds on cost reduction, failing to meet expectations of innovation, and wondering how to use digital technology and overcome barriers in communication set up within and between clients and service providers. At the same time, though, there are key aspects of rigor, process orientation, and service inherent in the services industry that fit well into enabling design thinking to move into solutions and results such as increased customer and employee loyalty and new revenue streams.
About 18 months ago, we thought – wow, what an interesting idea, using design thinking in the services industry. And we launched the first Design Thinking in the As-a-Service Economy Blueprint to explore whether it not it was feasible – if there were any examples of how design thinking was changing the way consulting and outsourcing firms work, internally with or for their clients. There were a few. As we go through the current refresh, we are finding that design thinking is actually changing the way many clients and service providers work, that there is a real complement between designers, consultants, engineers, and service delivery; and we will continue to share examples over the next few months.
We hear a lot about how retailers are trying hard to bridge the online and in-store experience for customers, but have you thought about how this concept can help patients in healthcare? VCU Health, for example, is a forward thinking hospital that is looking outside the hospital walls for how to create a better experience and outcome for stroke patients before they even reach the ER. Partnering with the ambulance authority and technology providers, VCU Health is testing remote assessment of the patient during their ambulance journey to shorten their time to treatment. Led by neurologist Dr. Sherita Chapman Smith, this hospital’s story involves a passion for modern and mobile patient care, a lot of collaboration, and some real outside the box thinking in order to fine-tune and bring the idea to life.
At the heart of the effort is empathy – making an effort to “get inside” the experience of each person involved, understand their needs, and how to address those needs both simply and effectively.
The group that Dr. Chapman Smith gathered to the table included individuals from the local ambulance authority, the VCU Health Telemedicine Center, and technology provider swyMed, to determine what was needed to have a secure and stable system that would work and work well for all users. To get a patient perspective, the hospital reached out to specialty actors who have been trained to act in patient scenarios with medical students and residents, to give feedback on how they should interact with patients. The team trained these patient “stand-ins” on how to act out symptoms for a stroke.
These “patients” were picked up in an ambulance and connected via teleconference to the vascular neurologist in the hospital, who conducted a remote assessment; and when they got to the hospital, the scenario had them quickly advanced to the next stage of treatment. Afterwards, each one shared feedback via survey and interview, such as, did they feel safe, did they feel connected with the neurologist, were they comfortable, what did they think of the audio/visual quality? Participants ranged in age and ability to take into consideration comfort with technology and levels of hearing. The hospital also compared the responses with bedside evaluations. The feedback, combined with the experience from the physicians and EMT has led to proposals for changes to protocol and to the solution.
As the project moves along, they keep zeroing in on what will make the patient comfortable, and whether that works for the physician and EMT in the ambulance.
What makes it work?
Internal and External Network of Active Participation: “It’s a small group of vascular neurologists at VCU,” said Dr. Chapman Smith, “so I just asked my colleagues – can we give this a try?” She talked to her department chair, who connected her to the Chief of Emergency Services Operations and Medical Director of a local EMS agency, and then reached out to the communication office, and then to the ambulatory authority, bringing in representation from groups that all have a stake in how it would work, and how easily, and how smoothly. A small community banded together to test—what will work for the hospital, the patient and the EMT, and provide feedback. They have roles in working through implications to protocol, simulations, and dry runs.
Steady Visual Connection: “We wondered if the patient really needs to see the physician or EMT from within the ambulance,” said Dr. Chapman Smith, “but a main comment from the patient simulators was that it put them at ease to see a face versus just hear a voice… just a voice can add to the anxiety.” So the ambulance clearly needs a steady and secure connection with high enough bandwidth as it makes its way to the hospital. A modem, antennae, and single carrier connection did not do the trick; in test runs, the ambulance encountered multiple dead zones. “We want to be sure wherever we go, we can do the assessment/exam without a drop.” So, as part of the solution under development, swyMed software monitors for connections and can switch cell towers and antennas to get the best quality signal at the lowest bandwidth. It’s part of a portable solution the team developed to keep a live-video connection to a doctor all the way to the medical center.
Ease of Use and Access: During the assessment, the neurologist wants to be able to see the patient, but not have to click arrow keys to move around a camera. Taking this into consideration, the team designed a set of predefined commands such that a command would move the camera to a certain spot to look at an arm or a hand with as few arrow clicks and mouse moves as possible. Also, the physicians and EMTs want a mobile solution: physicians don’t want to be limited by being at a desktop computer; and the EMTs want something that is portable between vehicles, something not every ambulance has to have, since they are not all in service all the time. These insights all came from interviews, observations and dry runs.
There are a number of healthcare providers working inside the walls to create a better and more effective experience for health and care, but what happens before and after that care can have significant impact on outcomes as well. The work that VCU Health is doing is an example of a human-centered, not hospital-centered or technology/telehealth-centered care. The hospital is on a journey—still to finalize the protocols and rollout the remote assessment with real patients—but it’s a worthy example of forward thinking that shows how healthcare providers can step outside the storefront and provide real remote services that can really impact the quality of care.
“It is a truth universally acknowledged” that the healthcare experience needs to change – for consumers and clinicians. Part of this change is to make access to data, services, and transactions easier – more “at the fingertips,” if you will—and more relevant to their healthcare experience. In a word, mobility. Mobile is about the platform; mobility is about the journey, the movement of the person, and the experience while in motion. There are a number of mobile platforms on the market today, but who is using them to bring mobility to healthcare?
“…mobility is about understanding where I am, where I am going and what I want to accomplish, and helping to make that journey exponentially better,” said David Sable, CEO of communications firm Y&R in a Huffington Post blog.
Well said. There are a number of mobile platforms on the market today to help make this happen, from well-established technology providers like IBM, PegaSystems, and SAP as well as up-and-comers like Kinvey, Kony, and MobileSmith. And I recently had an opportunity to get to know one offering suite a little better – Skava, which was acquired by Infosys in 2015.
How can mobile platform technology providers bring mobility to healthcare?
Skava is well established as a mobile development platform in retail, powering mobile apps, kiosks, and mobile devices for Gap, Staples, ToyRUs, and others. Now Infosys is bringing this consumer engagement and e-commerce enablement platform to healthcare. It is developing a set of independent, modular, discrete functional units packaged as “Build Your Own Digital Platform” for healthcare providers and payers. (see Exhibit 1) Imagine consumers, patients, caregivers, pharmacists, and clinicians – among others in the healthcare community – being able to enroll, complete transactions like paying bills, scheduling, care management plans and alerts, etc. Then imagine having it integrated into the core healthcare management systems already in place.
Exhibit 1: The “Build Your Own Digital Platform” Play for Mobility in Healthcare
Infosys isn’t the only one with this capability, so if you are looking at walking down this path, take a look around for what best fits your needs. What I found with Infosys is that even though this solution set is not well established in healthcare, it does have a strong client base and proof points from retail, an industry that is heavily dependent on engaging consumers in transaction oriented interactions. The platform supported $1.5 billion in e-commerce revenues in 2015. Infosys also has depth in IT services across industries, including healthcare, so it has the capability to work with clients to integrated and customize apps and services as needed. The Skava platform does plug into current IT infrastructure. And, the service provider is also better integrating its business services and IT capability so that if you want on-going support that includes data management and analysis, you can tap into extended services and have a single provider.
One “miss” in the story line so far, though, is my earlier point about mobility and creating an experience versus offering a mobile platform. Infosys as a company is investing heavily in design thinking capability – an innovative approach to identifying and solving problems. Yet, when we engage in briefings and look at the materials associated with this solution set, there is no mention of starting first with – what problem are you trying to solve? What opportunity are you looking to address? How are you defining and testing out the proposed solution prototypes with the stakeholders – consumers and business? And that’s a critical first step to ensure that the use of the IT-based solution is truly to address the consumer experience and how that impacts the business outcomes.
Bottom line: If you want people to do something, make it as easy as possible for them to do it. Healthcare providers and payers need to make healthcare services easier for consumers to access, use, and pay for, and mobility plays an inevitable role.
Infosys can tap into its design thinking approach and IT services, and leverage the Skava platform in a flexible way to help clients get there. There are already a number of healthcare management apps and mobile capabilities on the market, so it isn’t new. It is something that if you want to truly be a healthcare consumer oriented organization, you’ll have to incorporate into your business, and partnering with a service provider with IT, business process, and analytics skills is a viable option.
Much as I’d like to, I can’t foresee the actual future of the U.S. Affordable Care Act (ACA) or healthcare policies under President-elect Donald Trump… anymore than anyone could predict the true outcome of the recent U.S. presidential election. What I do foresee, however, is the increased need for partnerships to focus on what the ACA is designed to accomplish (regardless of its existence) – affordable, accessible, quality health care.
Getting to the heart of the problem –the cost.
There are many people who are upset at having to pay for “other people’s” healthcare costs – which they believe is because of the ACA. And there are many people who are receiving care who didn’t before and wouldn’t otherwise, because of pre-existing conditions or age, for example. And these are often people who when they did get sick, would go straight to an emergency room – an expensive treatment which by the way somehow had its cost passed in some way at some time to, likely, people who today do “not want to pay for other people’s healthcare.” Any way you look at it, costs get spread around.
So let’s look at this issue – cost – from a different angle... how about the angle of reducing or eliminating some of these costs? Reducing the cost of ER visits or readmissions because we can identify and intervene in someone’s pattern of such use or events before they happen because of triggers? Or, increasing the possibilities of people being healthy because of proactive education around nutrition, exercise, and lifestyle?
Partnerships are critical to truly changing the nature and outcome of health care
Just as it “takes a village to raise a child,” it takes a community of partners to create a high quality, lower cost environment for healthy consumers. Those partners include people on the front lines of care everyday—the obvious, like doctors, nurses, pharmacists, social workers – and also professionals who work behind the scenes but have an impact on care and cost – such as billing coordinators, claims processors, and coders. If everyone is thinking about their work, and how changes to the way they work, can impact the healthcare consumer, we have a