Perfecting Healthcare’s 360° Consumer-Centric Strategy

To ably compete in today’s healthcare environment while meeting their mission of quality patient care, health systems must make patient access and the consumer experience a core value across their entire organization. That means placing a relentless focus on reducing friction to meet customer expectations and aligning people and tech resources with standardization and scale.

This advice from healthcare industry leaders took center stage at the 2024 Guidehouse Medicare Advantage Summit during its “Developing a Customer-Centric Strategy” panel, which featured discussions with:

• Peter Chang, MD, senior vice president and chief transformation officer for Tampa General Hospital, a private not-for-profit hospital and one of the most comprehensive medical facilities in West Central Florida.
• Margaret McGovern, MD, executive vice president and chief physician executive, physician services, for Yale New Haven Health and CEO of Yale Medicine, which regularly ranks among the best hospitals in the U.S. and is accredited by The Joint Commission.
• Conrad Vial, MD, senior vice president of Sutter Health and president of Sutter Health Network, an integrated network providing coordinated care to more than 3 million Californians.

Summit participants also engaged in discussions with U.S. Rep. Buddy Carter (R-GA) and U.S. Rep. Claudia Tenney (R-NY), who stressed that price transparency is a key part of the healthcare experience, and it must benefit consumers and healthcare providers alike.

Key Quality Indicators

In Dr. Vial’s view, patient access and the consumer experience are inextricably interwoven as quality indicators.

“Both themes depend on relationship centricity and need active redefinition for disruption,” he said. “Some of the most patient-centric things you can do are also good for the people doing the work. Enriching the quality, durability, and resilience of the relationships that caregiving multidisciplinary teams have with patients, their families, and the broader community will promote access and a better consumer experience.”

“We all want the same thing: accessible, affordable, quality healthcare,” said Carter, a pharmacist who sponsored The Drug Price Transparency in Medicaid Act and co-sponsored the Pharmacy Benefits Manager Accountability Act. “I was the one who had to tell a mother how much the antibiotics her child needed cost. Patients depend on you, and so do we as a citizen legislature. It’s important to build relationships with your members of Congress, because we need you to educate us.”

Tenney said that pharmacy consolidation resulting from the increased power of pharmacy benefit managers is not good for consumers or health systems. “We’re looking at the anti-competitive issue and whether they continue to price set,” she noted. “We need to preserve rural and locally owned pharmacies and reduce the consolidation that’s affecting pricing.”

Dr. McGovern acknowledged that the typical healthcare customer experience has failed to match the simplicity and appeal of that offered in recent years by commercial companies that people have come to expect across industries.

“The consumer experience journey is foundational and critically important,” said Dr. McGovern. “If you were traveling and got assigned to a hotel room with someone else, you wouldn’t be happy—but we do that every day in a hospital.”

Reducing friction so that people aren’t interacting with multiple systems is another important part of facilitating simpler access to care, she added.

“Our patients have had to deal with different organizations and jump through different hoops—and things were difficult to navigate even if you worked here,” she said. “We’re now streamlining and harmonizing those operational pieces to get rid of that friction to benefit patients and clinicians.”

One successful innovation she pointed to in that regard was the care connection centers that Yale Medicine has been creating for its clinical programs. Leaning heavily on technology, the centers bring together health advisor triage, scheduling, and care navigation all tied back to the clinical programs they’re supporting. And creating a line of sight across Yale’s two physician groups to increase access has been a huge culture shift, resulting in more appointment slots now that patients can easily discover the soonest appointment available with a specialist in different locations.

“Before, if a patient called Cardiology and was told there’s no appointment for a month, you couldn’t say, ‘But if you want to drive 10 minutes away, you could get one tomorrow,’” she shared. “The processes weren’t there, so we’re making investments to fix them. It’s not easy to tell doctors to change their templates, but we’re being disciplined, methodical, and supportive to give them the tools they need to be successful.”

From Dr. Chang’s perspective, access is not just about patients trying to get care; it’s about health systems trying to engage them. He discussed Tampa General’s creation of its Experience Center to effect centralizing scheduling and referral management across primary care and more than 20 specialties. The center makes it easier for patients to navigate the system, ask questions, and make appointments with the help of a registered nurse instead of a non-clinical scheduler. He noted that Tampa General has been working with Guidehouse on scaling up access across its hub and spoke model (in which the medical center is the hub, and the spokes are the regions where patients can get convenient follow-up care close to home). Implementing relationship management software to better connect with patients, standardizing appointment types, and reconstructing their Epic templates to provide “OpenTable-like” appointment scheduling has resulted in a 75% increase in available appointment slots and a 50% increase in patient self-scheduling.

“We’ve had a pretty amazing journey,” said Dr. Chang. “Our no-show rates are down by 20% because patients find it easier with self-service to cancel or modify an appointment. We’re creating digital pathways to push things like directions out to patients and make call center representatives’ jobs easier. It’s the connective tissue inside of an organization needed to link all these things together in a meaningful way.”

Who’s the “Customer”?

According to Dr. McGovern, fulfilling “customer” needs means making the care journey as easy as possible—not just for patients but also for caregivers, staff, clinicians, referring physicians, and specialists. Instead of making operational changes and telling providers about them after the fact, Yale Medicine has arrived at decisions collaboratively and obtained buy-in first.

“We take a very broad view of who we consider customers,” said Dr. McGovern. “We are asking our people to change what they do and how they do it, and to get that buy-in and enthusiasm is a lot to ask. We keep the focus on all of our constituents to push this forward.”

Both she and Dr. Vial also agreed it’s essential to ensure that advanced practice clinicians—from pharmacists and licensed clinical social workers to dietitians, life coaches, and nutritionists—can work at the top of their licenses to reduce physician burnout and increase efficiency and access.

“We’re shining a light on access and the underutilization of our advanced practice provider workforce,” said Dr. McGovern. “A full third of our clinicians are advanced practice providers, and in the ambulatory environment, almost 40% of those are mostly handling functions that are not top of license. Our calculation on this is that it’s a huge number—hundreds of thousands of additional appointment slots that we can free up by getting our APPs top of license.”

Dr. Vial said that Sutter Health has been improving disease burden capture by creating a centralized problem list for advanced practice clinicians to prepopulate and pre-prompt so that primary care physicians can assess and validate problems in 20 minutes instead of 60 minutes—freeing up two more 20-minute appointment slots and achieving closer to 100% disease burden capture at the same time.

“We’re doing the right thing around disease burden capture, which is certainly a quality indicator because you can’t close gaps if you can’t see them in the first place,” he noted. “But we’re also opening up access with workflows, technology, tools, and human support for primary care physicians that allow them to work at the top of their licenses and not redline their engines doing things they don’t actually have to do.”

Specialty Care Access Improvements

When it comes to specialty care, panelists pointed to the need for improvements to specialist access and referrals.

“We’re all working on access and affordability, especially poor access to specialty care because so few specialists take Medicaid,” said Dr. Chang.

As an organization comprised of 95% specialty and subspecialty care, he added, Tampa General depends on referrals but doesn’t have a workable referral management system to effectively track patients from the time of entering their system to scheduled appointment to diagnosis to treatment or surgery.

“How do we track patients and not have them show up to the emergency department because their hypertension went untreated or undiagnosed?” he asked. “We’re in the thick of designing that so that patients can get the appropriate specialty care as soon as they need it.”

Panelists also noted that effective eConsult programs have demonstrated positive impact on total cost of care and avoided referrals—but reimbursement is often insufficient to justify the costs of allocating provider time and investing internal dollars to make those programs sustainable.

The Need to Standardize and Scale

According to David Burik, partner and Guidehouse Center for Health Insights leader, health systems can’t bring operational successes to scale until they simplify and standardize them.

Dr. Vial concurred and shared that two years ago, Sutter Health was turning away thousands of hospital transfer requests annually—40% of which came from facilities within its own system. Leaders determined which talent, technology, and process gaps were causing those high hospital transfer request denials and redesigned workflows, improving the metric by 28% to 40%.

“It’s possible to have size without scale, but what drives performance is scale-dependent,” said Dr. Vial. “We have to work out this tug of war between who’s setting standards at the right level versus who’s operating spaces and places. And that’s a culture change management issue before it’s a financial or operational issue.”

Committing to visit type standardization represents another opportunity to open up access in consumer-friendly ways, said panelists.

“If you can’t standardize your appointment types across the entirety of your system, you can’t fulfill people’s expectations of what good service means,” said Vial. “You have to align incentives and redesign workflows to open up access and satisfy consumer demand, which results in patients being ‘stickier’ and reporting higher consumer experience data points.”

Dr. Chang agreed and shared that Tampa General has cut its 20-minute established patient visit types across the enterprise from 84 to four. He also pointed to his organization’s scalability challenges with leveraging technology to build stronger consumer engagement, achieve more centralized communication, and enable clinicians to spend more time seeing patients instead of answering phones.

“When you call into us and the person on the other end has no idea who you are, it’s a bad thing,” he said. “Implementing patient relationship management software to really know the previous interactions that they’ve had with us in the past week or month that are relevant to the reason for why they’re calling today—that lends a lot more credibility. We can build the best health system possible, but if we’re not engaging with our patients on the level they need, then we’ve done absolutely nothing.”