There is a land grab going on right now, the likes of which the health care industry hasn’t seen before—at least in our generation. Spoiler alert: There’s a whole episode of Relentless Health Value coming up on the impact of the Teladoc-Livongo hookup. And that is totally relevant to the point I’m about to make.
But let me just start with a little bit of background: American patients—let’s get real here—have no more money to spend on health care every year. Really. I mean, you look to employers. The government? Who knows? But let’s just say for the purposes of this discussion that what’s going on right now is a zero-sum game—that the dollars in the system every year are the dollars in the system, and if you want to increase your revenue as any given health care stakeholder, you’ve got to take those dollars from somebody else.
Alright … now consider this: Previously, if a health system, say, were going to make a list of their competitors, they’d probably list the health system down the street, maybe the one in the next town over if there seems to be a lot of commuting. Oh, my, how we no longer live in that simple world!
Enter the pandemic and patients not only accepting but kind of digging virtual care and its convenience and its accessibility. Now consider what happened to brick-and-mortar stores who didn’t add online retailers to their list of competitive threats. Virtual entities doing chronic care management, diabetes, musculoskeletal, other population health endeavors … these are now or will soon enough be head-to-head competitors to in-person care settings.
My local health system, they may also decide to stand up to telehealth—and many of them did. But if the playing field is now in the Cloud, how’s the patient experience on their systems? Everybody accepted that, in the beginning, they were kind of buggy and calls dropped and all you could see was the doctor’s ear in a weirdly dark room or something. But six months later or a year later? Not exactly sure when patients’ patience will run out, especially when there are companies out there who built amazing virtual experiences from the ground up and who, by the way, are often hired by health plans, who, by the way, make it financially, let’s just say, attractive for patients to use those services that the plan is providing instead of the big expensive consolidated health plan that raised their rates 30-fold over the past couple of years like one of them anecdotally did.
So, you start to see why, if I were a health system or a provider executive, I’d kind of shuffle the patient centricity, design thinking, patient experience—that whole bunch—to the first tab of my spreadsheet. Patients have, at this moment, unprecedented choice; and so do their employers, nothing for nothing. As Dr. Matt Anderson told me the other day, if a health system thinks that it’s going to make the difference by doing more specialty services and expensive procedures, that might be a risky bet.
Other battlegrounds in the land grab include home health or hospital at home. Humana, for one, is trying to dominate the whole home health space. Again, it’s a turf war, because these patients are now not going to the local hospital—you know, not paying the local hospital, which might be the more operative statement.
So, anyway, I thought it might be a good idea to replay my conversation with Dr. Joe Selby from early last year. Dr. Selby is the [now-retired] executive director of PCORI, otherwise known as the Patient-Centered Outcomes Research Institute. PCORI is an independent nonprofit organization in Washington, DC. Since December 2012, PCORI has funded hundreds of studies that compare health care options to learn which work best given patient circumstances and preference. So, it’s definitely good background information. Anyone driving for the best patient experience might want to have it at their fingertips.
If you want even more advice about what to contemplate when contemplating patient experience, I’d refer you to episode 236, which is my conversation with Liliana Petrova, the CEO and founder over at The Petrova Experience. In that episode, Liliana translates her experience as director of customer experience at JetBlue to the health care industry. You could also check out episode 228, “How to Figure Out What Patients Really Want,” when I spoke with Julie Rish, PhD, from the Cleveland Clinic. And I’d round out the mix with episode 252, “The Not-So-Obvious Thing That Musculoskeletal Care and a 4-Minute Mile Have in Common”; and that’s when I talked to Chad Gray, CEO over at Integrated Musculoskeletal Care. I mention this last one because Chad’s company is pretty much a direct competitor to local orthopedic practices across the nation that his group is not aligned with. When you listen to the show, you can start to get a bead on how high the bar is starting to raise.
You can learn more at PCORI.org.
Joe V. Selby, MD, MPH, retired as the executive director of the Patient-Centered Outcomes Research Institute (PCORI) in December 2019. A family physician, clinical epidemiologist, and health services researcher, Dr. Selby has more than 35 years of experience in patient care, research, and administration. He was responsible for identifying strategic issues and opportunities for PCORI and implementing and administering programs authorized by the PCORI Board of Governors.
Dr. Selby joined PCORI from Kaiser Permanente Northern California, where he was director of the division of research for 13 years and oversaw a department of more than 50 investigators and 500 research staff members working on more than 250 ongoing studies. He was with Kaiser Permanente for 27 years. An accomplished researcher, Dr. Selby has authored more than 200 peer-reviewed articles, with his most recent research primarily in the areas of diabetes outcomes and quality improvement. His publications cover a spectrum of topics, including effectiveness studies of colorectal cancer screening strategies; treatment effectiveness, population management, and disparities in diabetes mellitus; primary care delivery; and quality measurement. Dr. Selby was elected to membership in the Institute of Medicine in 2009 and was a member of the Agency for Healthcare Research and Quality study section for Health Care Quality and Effectiveness from 1999 to 2003.
A native of Fulton, Missouri, Dr. Selby received his MD from Northwestern University and his MPH from the University of California-Berkeley. He was a commissioned officer in the Public Health Service Corps from 1976 to 1983 and received the Commissioned Officer’s Award in 1981.
05:36 Can payers afford to make health care patient-centric?
05:59 “If you make care more patient-centric … you actually see decreases in utilization.”
06:32 Shared decision making.
09:59 “What gets in the way of implementing good evidence?”
10:08 A study involving community health workers.
11:26 Default care and back surgery.
13:45 “There’s just a lot of habits like that in clinical care that aren’t backed up by evidence and can be undone with good evidence.”
14:23 How Dr. Selby figures out what the patients want and what outcomes to focus on.
14:48 Looking for evidence gaps.
16:26 What PCORnet is and what they’re doing.
18:15 “To do really good quality research, you have to be able to link the data from health systems … to data from claims.”
19:32 “We’re asking questions that matter to them, to their bottom line, and to their patients.”
19:37 What the main goal of PCORnet is—what or where?
21:26 Giving and getting data as a health system.
22:12 Studies that have come from PCORI’s queries.
25:31 “It’s very important that the systems … appreciate that PCORnet is active in their midst.”
26:09 “It’s hopefully a culture-changer, driving toward more collaboration and toward … finding common ground between people who are asking purely clinical questions and people who are asking the more practical questions.”
26:28 What frustrates Dr. Selby the most.
28:39 Turn the Ship Around!—a book about short-term evaluation and short-term results vs long-term change.