Dan Prince

Hospitals may be one of the last hold-outs in adopting social media. And understandably so.  Hospitals deliver complex products and manage highly sensitive information about their “customers”.  Engaging in social networks, online bulletin boards and blogging seems daunting – both in the sheer management of it and the privacy and legal implications.

But where do you think decision makers 25+ are getting much of their information about doctors, discussing health issues and blogging about their hospital experiences? Shouldn’t the hospital be a major part of that conversation?  Isn’t the online patient experience almost as important today as the face-to-face experience?

Social Media at Mayo Clinic

Mayo Clinic thinks so. At a recent AHIP conference, my colleague Karen Stone and others attending the Social Media workshop — led by Lee Aase, manager of syndication and social media for Mayo Clinic – were wowed by Mayo’s social media strategy. They jumped in when brand research revealed that “word of mouth” was a key influencer in directing patients to Mayo Clinic. And when they jumped into social media, they really jumped in!

Mayo Clinic launched its expert blog in April 2008, and entered the Twitter and YouTube worlds around the same time. In 2009, they launched a video blog where patients tell their own stories. They send out videos of doctors introducing themselves to patients prior to the first appointment, which saves around 10 minutes of time for meaningful conversation during the appointment. And they test and retest to see if social media influences the patient experience.

Medical Professionals Must Use Social Carefully

But as they follow their patients online, medical professionals have to tread carefully. Health care providers see “all see the potential and promise, but they’re still trying to find their footing,” said Bob Brown, in an online interview. Brown, a partner of BryantBROWN Healthcare, a L.A.-based marketing firm, put it this way: “They think they can and should play a role in social media, but there’s a lot of confusion over using it.”

In risk-averse organizations, it’s easier to manage the online conversation when you have your own place to encourage comments and feedback – rather than having it happen on other sites. Mayo Clinic does monitor for negative feedback:  10% of staff time is spent on monitoring activities. And they’ve developed guidelines for employees who access and post to social media sites.

Managing the Social Media Workload

How does Mayo have the staff to manage all this?  They make social a part of every strategy. How does social media staff convince the C-suite it’s important?  They must track and show impact constantly.  Mayo Clinic conducts brand research every two years and guess what they’ve discovered? Social media can also be a vital piece of the research process!

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Dan Prince

We’ve all posted questions or opinions on online discussion or bulletin boards – to research a problem we’re having with a product, find out more about a health issue, comment on a restaurant, or join in the conversation about a favorite TV show (The Closer, anyone?). In the last several years, online bulletin boards have become a tool of choice for evaluating customer satisfaction, because they often provide a “truer” look at the brand experience – both from a functional and an emotional perspective.

Online Bulletin Boards vs. Traditional Online Surveys

Bulletin board discussions offer a cheaper, faster and better way to survey difficult-to-reach populations. Participants can respond when they wish and can take more time to think through and type out their answers. The conversational approach encourages them to “bounce off” other participants’ comments, which lends its own set of insights. But perhaps most critical to the research process – bulletin boards offer a familiar, non-threatening place for people to talk about issues and topics that are meaningful to them.

The Sandwich Generation: How Are They Coping?

Case in point: A health plan wished to determine the attitudes and behaviors of the “Sandwich Generation” – people who are caring for themselves and their own families, while also caring for older loved ones. If you know anyone in this role, you know they are often caught between the demands of these younger and older family members for their time, energy and finances. The research was designed to explore and understand more about the following:

• What challenges and obstacles do Caregivers face in managing the health and healthcare of the older person(s) they provide care to?
• What feelings do they have about their situation; i.e., being a Sandwich Generation Caregiver?
• How much do they know about Medicare and Medicare Advantage plans, and what are their attitudes toward both?
• What things are Sandwich Generation Caregivers doing ONLINE to manage the care of their older loved one(s) and how well are these things working for them?
• What online activities/tools/information could a health insurance company provide or promote to help Caregivers be more effective and feel less stressed?

The Takeaway: Strategies for Positioning with Caregivers

The bulletin board discussion revealed strong feelings about the Caregiver role that may have been more restrained in a focus group. Participants felt uninhibited in voicing their frustrations and fears about Medicare. And the health plan took away concrete strategies for positioning itself favorably with Caregivers: 1) more two-way online communication; 2) online tools for tracking health information; 3) easy-to-use content; and 4) access to “real” people at the plan to help them manage their Caregiver roles.

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Dan Prince

Back in July, I repeated the predictions of many health plan executives that customer experience will soon be a key driver in healthcare decision-making. With state health insurance exchange (HIX) implementation mandated by 2014, health plans in particular face intense market pressure to find their points of differentiation and use this knowledge to engage customers and compete effectively.

Level One Grants Provide Needed Funds

In December, the healthcare media reported that over half of U.S. states are dragging their feet on building exchanges — attributed to lack of funds and the uncertainty surrounding the Patient Protection and Affordable Care Act. To keep things moving, the Department of Health and Human Services has awarded more than $220 million in exchange-related grants to 13 states to help them move closer to the January 2014 deadline.

Twelve of the states in this new announcement are receiving Level One grants. According to HHS, these funds are available for one year to support the activities of states that exhibit progress. Level One grants may be used to pay for consulting with stakeholders, analyzing data, developing business operations and systems, and integrating existing Medicaid eligibility systems with those of the exchange.

More Time to Improve the Customer Experience

While a total of 29 states have received Level One grants to establish exchanges and a handful of states have received Level Two grants for multi-year support, many state exchanges have been delayed by internal politics and operational dynamics. Now, there’s a real question if most states will be ready by 2014, and HHS has extended the deadline six months for states to apply for establishment grants.

What will a delay mean for health plans? Plans will still need to focus first on the technology upgrades needed to enroll members quickly and easily. But more time means health plans have an extended window to track and analyze current attitudes about their brands, understand their target customers’ wants and needs, and create a more positive online experience through Web site retooling and social media strategies. In other words, improve the customer experience!

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Dan Prince

Ever since I first heard the phrase ‘medical home,’ I have been entranced with the concept.

Since I haven’t lived in an era where doctors make house calls, I hope I live to see the era where care teams, healthcare technology and the right reimbursement models will come together to create a primary care system that will enfold me in a little cocoon . . .

• where my records will be coordinated and accessible to every provider I see
• where every provider on my team will care enough about me to actually read those records, and will consult and collaborate with others on my care team
• where everyone will apply evidence-based guidelines as they make decisions about my care

. . . and, as a result, get me safely out of the woods whenever I need acute care or go the distance with me if I need care for a chronic condition.

What is a patient-centered medical home?

The ‘patient-centered medical home’ is defined in the white paper “NCQA Patient-Centered Medical Home 2011” (available at http://www.ncqa.org/tabid/631/default.aspx). It’s a companion to the Patient-Centered Medical Home (PCMH) standards NCQA issued in January.

“A patient-centered medical home is a model of care that strengthens the clinician-patient relationship by replacing episodic care with coordinated care and a long-term healing relationship. Each patient has a relationship with a primary care clinician who leads a team that takes collective responsibility for patient care, providing for the patient’s health care needs and arranging for appropriate care with other qualified clinicians. The medical home is intended to result in more personalized, coordinated, effective and efficient care.

“A medical home achieves these goals through a high level of accessibility, providing excellent communication among patients, clinicians and staff and taking full advantage of the latest information technology to prescribe, communicate, track test results, obtain clinical support information and monitor performance.”

The concept is, according to one of the organizations that has promoted ‘medical homes’ for years as a model for primary care, the American Association of Family Practice (AAFP), “An Idea Whose Time Has Come . . . Again.”

“The medical home . . . is both old-fashioned and thoroughly modern – a blend of the personalized, comprehensive care that family physicians have been offering for decades and coordinated care that capitalizes on new technology and helps patients make sense of the increasingly complex health care system.”

One of the hurdles: teamwork

There are so many hurdles, though. Making primary care staffs gel as care teams is one. I have a vision of a care team like a band of ministering angels, solely focused on me and on how best to integrate their disparate skills to provide me with the best care, the best experience possible. (This band of angels is pictured on the cover of the NCQA white paper, shown here.)

From the cover of the white paper "NCQA Patient-Centered Medical Home 2011"

There are over 1,500 NCQA Recognized Patient-Centered Medical Home sites in the US, but I’ll bet that even in these distinguished practices, teamwork is still something they have to work on.

Thinking about the future of healthcare professionals’ cooperation and collaboration, I ran across a paper about how some institutions that educate healthcare professionals are trying to make inter-disciplinary cooperation part of the curriculum. The article is “Educating the Care Team,” by Brian Schuetz, Erin Mann and Wendy Everett, published in Health Affairs in 2010.

The authors write, “Team-based primary care offers the potential to dramatically improve the quality and efficiency of care, but its broader adoption is hindered by an education system that trains health professions in silos. Collaborative models that educate multiple practitioners together are needed [as are] changes in professional cultures, organizational structures, clinical partnerships, admissions, accreditation, and funding models . . .”

Interest in collaborative education in healthcare first blossomed in the 1970s, and some major institutions, including Ohio State University, Indiana University, and the Universities of Minnesota and Miami started programs. But as grant funding dried up in the 1990s and 2000s, so did the programs. Today, most doctors, nurses, NPs, PAs, and therapists graduate from programs that reinforce “the traditional hierarchical structure that considers physicians to be the primary decision makers and relegates others to a secondary status,” according to Schuetz, Mann and Everett.

The cultural divide that starts in college has to be bridged in the physician practice or it’s not going to be a very happy ‘medical home.’

The changes required to live up to the care team standard in the NCQA PCMH guidelines are just as foundation-rattling as the ones needed for integrating technology in the practice workflow, tracking and reporting patient results, population health management and instituting appropriate payment systems.

Hard as it’s going to be to create the new medical home, most of what the NCQA guidelines call for will be table stakes for practices that expect to survive into the 2020s and 2030s when the baby boom generation is truly the “old old” and the principal consumers of healthcare services. It will be great if the healthcare system really makes us feel at ‘home’ when we get there. But following the NCQA guidelines will at least make the system functional.

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Dan Prince

I haven’t had much personal experience as a patient lately (Knock on wood!), but I have spoken several times to a friend whose 85-year-old father has been in and out of hospitals a lot in the past four months. Her experience of staying with him in the hospital for a week in early August was the subject of one of my blog posts a few months ago, Fear as Part of the Patient Experience.

Recently, her father has been making a very slow recovery after another seven-day hospital stay followed by a 14-day nursing home stay. He was in the hospital because his primary care physician attributed his 102-degree fever to an infection resulting from a catheter procedure his urologist had recently done. So, rather than treat him with antibiotics at the local hospital, she sent him to a hospital in Cincinnati, 60 miles away, where his urologist is based and, according to my friend, “washed her hands of the situation.”

My friend’s father was in the hospital for seven days – even though his fever came down almost immediately. He saw the urologist once in those seven days, for about 5 minutes.

My friend’s father has very weak legs, and he uses a walker. Seven days flat on his back in the hospital made him even weaker and made a two-week ‘layover’ at the nursing home necessary before he could go home. He’s been home for a week and a half now, but he fell last week and was back in the ER briefly. My friend told me he was pale and glum and didn’t eat much at the Thanksgiving dinner table last week – and hasn’t eaten much since.

All this, in my friend’s mind, is because his primary care physician wouldn’t take the trouble – or the responsibility – to confer with the urologist and work with him to figure out what was causing the 102-degree fever and what would most effectively bring it down. If my friend’s dad had to be hospitalized, she thought the primary care physician should have realized that the local hospital would have been a better venue. His PCP could have kept an eye on him and maybe gotten him released when his fever went down after a couple of days. His wife and family could visit more often and for longer periods, if the trip to the hospital was three miles instead of 60.

My friend is probably judging her father’s doctors too harshly. I mentioned the story to a doctor friend of mine, and he said he would have done just what the primary care physician did. People with catheters are prone to infection; infections can get out of control in a patient whose immune system is not strong to begin with; the urologist is the best one to assess the situation and deal with it.

But I think there is still a problem with the PCP’s choices in handling this patient. Whether she was in the right or not clinically, she didn’t – at least in the view of the family – show the proper consideration for the patient’s recent health history and his weakened condition. She didn’t take the time to explain their father’s risk or her decision to the family, so it felt to them like the brush-off – shuttling Dad off to the big city just because he had a little fever.

To me, the whole story underscored one of the central points we’ve been trying to make in this blog: A healthcare professional can make the right calls from a clinical standpoint, but to really be a healer, you have to take into account the patient’s experience and the experience of the family network of which the patient is a part.

What do you think? Comment on this post or send me a message at dan.prince@catalysthcr.com.

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