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!

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.

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!

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.

Dan Prince

A lot of my reading lately is taking me back to the theme of how the healthcare system needs to move out of hospitals, doctors’ offices and insurance company headquarters and into the community if it’s going to make a real dent in society’s biggest health problems.

The problem of obesity is a good example. We reported in our Living in Denial white paper a few months ago on Americans’ strong sense that the country is in the grips of an obesity crisis – and their adamant denial that their own personal obesity is contributing to it.

A recent National Public Radio (NPR) series on obesity included a piece about new research on how our hormones fight us when we try to lose weight.

It reported some emerging insights into why losing weight slows metabolism – which makes it hard to keep losing, and very hard to keep the weight from creeping back on.

NPR’s Patti Neighmond wrote, “For example, if you weigh 230 pounds and lose 30 pounds, you cannot eat as much as an individual who has always weighed 200 pounds. You basically have a ‘caloric handicap.’ And depending on how much weight people lose, they may face a 300-, 400- or even 500-calorie a day handicap, meaning you have to consume that many fewer calories a day in order to maintain your weight loss.”

One of the interesting links in the NPR piece was to a study by the American Journal of Clinical Nutrition of 784 people (629 women and 155 men) who had succeeded in losing weight and keeping it off. These folks were, years after losing weight, still eating less than other people who had never had to lose. In particular, they were eating less fat.

The other secret to their success was exercise. The group exercised in a variety of ways, but the researchers calculated their average caloric burn and said it was the equivalent of walking 28 miles a week – four miles or about an hour a day.

I mentioned these statistics to a friend of mine who is a weight loss success. She found them interesting because they matched her experience, but she had always thought she was unusually cursed – especially by the way she still has to curb her caloric intake – 10 years after losing the weight.

Just how hard it is to lose weight and keep it off is not a news flash, but I don’t think it’s something our society and our healthcare system have fully internalized. Obesity is tied to the most dangerous chronic conditions and a root cause of much of the cost of American healthcare.

If healthcare reform and the ACO movement succeeded in its mission to shift more of the healthcare system’s focus to wellness and prevention, doctors and hospitals would have a new motivation to look beyond the acute conditions that bring people into their facilities, to help them work on making better day-to-day choices as to how they eat, drink, sleep, move – live.

Taking better health out to the community

Taking better health to the streets was the theme of another piece in the NPR obesity series: ‘Secret to a Long, Healthy Life: Bike to the Store.’

Physician Jonathan Patz and a team of researchers at the University of Wisconsin-Madison studied the health impact of making short trips by bike rather than car. They gathered up data sets for 11 Midwestern cities on obesity, automobile pollution and pollution’s health effects. They estimated that, in those 11 cities, with 31 million people, 1,100 deaths influenced by overweight and pollution (heart attack, strokes, asthma) could be avoided every year, and $7 billion a year in healthcare costs could be saved.

I found particularly thought-provoking a short comment by Dr. Patz at the end of the piece. He’s a dedicated bike commuter in Madison, and he can do that because Madison is a bike friendly city with 87 miles of bike lanes, 116 miles of bike routes and features like ‘bike boxes’ on the streets – painted rectangles at intersections where bikes can move in front of cars, to protect bikers from drivers making right turns.

Dr. Jonathan Patz. Photo by Jean Patz.

Dr. Patz commented that when he lived in Baltimore, a city not set up for biking, he didn’t bike-commute. “I tried it about three times, and realized this could be very hazardous to my health.”

If he still lived in Baltimore, Dr. Patz might not be the picture of health he appears in the NPR blog.

One of the thrusts behind the government push for Accountable Care Organizations is the desire to make healthcare professionals and hospitals broadly responsible for the health of their community – not just treating its illnesses, keeping it healthy.

I think a healthcare professional like Dr. Patz, looking beyond the clinical setting, at where patients live day to day, sets a positive example for the healthcare system and suggests some of the ways that healthcare could be truly “accountable” to its community.

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