Forget the Patient for a Minute

Patients today are shoppers. Customers. Consumers. It’s something we’ve heard before and will hear more and more as health care provider organizations adjust their inner workings to become more consumer-centric. As large organizations standardize care and experience to meet population health objectives, we also start to see them grapple with what it means for their physicians to practice said customer centricity. For me*, this was starkly visible at the Kellogg’s Business of Health Care Conference last week: Iyah Romm, Founder and CEO of CityBlock talked about his goal of making physicians interchangeable - a cog in the wheel when it comes to delivering good care. On the other hand, Suja Mathew, CMO of Cook County Hospital, took exception to even the term provider. “I don’t know anyone who went to ‘provider school’ to become a provider,” she said stressing the individual motivations of the doctors in helping them stay resilient when other doctors burn out. In these conversations, an underlying subtext is: what it means to be a doctor in the context of our system has changed, and organizations need to have honest - perhaps difficult - conversations about what it means for their providers to be customer-centric. We explore some emerging faultlines where this tension plays out.

Time

There is an increasing demand for accessible, efficient care and a move by organizations to try and supply it. Sure, catering to the patient by providing optimal times for appointments is desirable, but these hours may not align with when providers want to practice. Practices’ hours vary, but most coincide with a typical work week. Some doctor’s offices have strategically started to open as early as 6:30 AM, extend hours a couple days a week, or open for a part of the day on Saturdays to accommodate patients even more.

Juxtaposed against that move to work longer is the fact that two-thirds of physicians under 69 work 40 to 60-hour weeks, half of whom report a desire to work fewer hours. Indeed, the specialties with less work hours tend to report more career satisfaction. For example, dermatologists are among one of the ‘happiest’ types of physicians; that they work fewer hours than their peers might have something to do with it.

In the philosophy of care where doctors are not interchangeable, a doctor might find herself working additional hours to accommodate patient needs, or limit her patient panel in a concierge model of care provision. In a world where doctors are interchangable, each doctor can clock in and out as demand would predict, but might not be able to build the relationships with their patients that they have been accustomed to. Which is more customer-centric? Expect some soul searching here.

Flow

In an effort to increase standardization and efficiency, provider organizations are using technology to centralize access centers. This means translating the preferences of physicians into simple rules that access center representatives can follow. In this scenario we wonder whether physicians have the autonomy that would maximize their long-term performance. For instance, if a physician knows they work better with variety, are they actually able to have it?

Administrative staff and technology limitations determine the schedules of providers and often the number and type of appointments per day. In most cases, physicians’ preferences are translated into inefficient restrictions on their calendar. Someone might want to only see one Medicare patient a day, but when that’s translated to an 8AM Medicare slot that sometimes goes unfilled, it’s grossly inefficient for the doctor as well as for the system at large. In a private clinic the physicians incentives are aligned with that of creating access and the front desk staff generally knows preferences well enough to move slots around based on what’s happening at the location. But as centralization takes hold, this approach cannot scale.

What will win? The inefficiency of scheduling can impact the provider that is also a partner in a practice and has an economic incentive to maximize volume (and access). For employed physicians, it leaves the hospital subsidizing empty slots or creating incentives based on RVUs to increase access. In this world, does a provider organization’s ability to accommodate flexible preference become a competitive advantage? Will providers continue to exert influence on who sees them and when at the same rates as they currently do? Aligning practice patterns to physicians’ preferences may help reduce burnout and provide a better patient experience, but is it good enough, and the governance cost low enough, for large organizations to give it a shot?

The Wealth of Patients

For many physicians, the socioeconomic status of their patients is not something they need to consider in their treatment protocol. Sure, many doctors subscribe generic versions of drugs when available in recognition of economic conditions of their patient panel, and there is more significant change driven by different forms of capitation and risk-sharing, which impacts the physician's’ own bottomline. However, most doctors didn’t sign up for double majors in accounting or health econometrics. They don’t help their patients make tradeoffs between cost and care. Furthermore, having conversations around money, or practicing under such economic constraints, might not be something they care for - it’s not what they were trained to do.

To be customer-centric and deliver a good patient experience, organizations and doctors will mutually need to decide what mix of provider and accountant fits and for whom. We can see a world where financial planning becomes more integrated with care provision. We see equally clearly from our experience providers who want nothing to do with that. In the middle of those two is where most of America currently sits, and we expect organizations to strive for greater clarity on this axis in the next couple years: some will become providers of care for whom financial counseling is integral to patient engagement and patient experience; others will strive for wealthier patients or a hands-off approach on finances.

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Ultimately, the broad trends impacting providers and the independence they possess deserve more attention in the conversation around patient experience and patient engagement. It is not enough to simply want to be more customer-centric overnight, and no technology - not even ours - is a magic bullet. Honest conversations around provider autonomy - especially with their time, their flow, and their scope of non-clinical responsibilities - need to play a broader role in helping organizations what sort of customer-centricity they will practice.

References:

  1. “How many hours are in the average physician workweek?” Retrieved January 31, 2019. https://www.ama-assn.org/practice-management/physician-health/how-many-hours-are-average-physician-workweek

  2. “Physician burnout: contributors, consequences and solutions” Retrieved January 30, 2019. https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12752

*Akshay Birla is Vice President of Sales & Marketing at Radix Health