Taking Digital Health to a Higher Order

Understanding patient jobs-to-be-done can uncover organic growth pathways in healthcare

The evolution of cloud computing has given rise to a desire for interconnectedness and convenience as we have never imagined before. Surveys across the main stakeholders in digital health (patients, physicians, payors) show an expectation that poorly defined terms, such as engagement and experience, will be adopted for their name’s sake. For instance, 70% of healthcare organizations said that patient experience will be one of their top priorities in the years leading up to 2020. While it seems that it has been, there is no common language used to describe what this means to each stakeholder, or how patients' needs will be determined and prioritized over and above the needs of the providers.

Recent history shows that adoption of the many ideas that have been tested in the market are failing to keep up with the expectations. While 80% of healthcare consumers believe they need to be more proactive in managing their health, 80% of "apps" in the market are abandoned within two weeks. And only 32% of American healthcare patients currently utilize a patient portal.

A 2014 Advisory Board report suggests that improving the experience of only 5% of patients would help a given provider earn an additional $2.5 million in just one year. But what does improving the experience really mean, is there a way to measure this, and can we ensure that it can be incorporated into consistent service design? While this is not only a Digital Health dilemma, this domain is one of the most important areas in each of our lives, and opportunities abound for those who can systematically target this opportunity in a meaningful way.

What is the Issue?

The consumer. We forget that in order to serve them, we need to see the world through their eyes. We need to understand their objectives, and set ours aside until we do. Consumers of healthcare, insurance, food and fitness options simply don’t care about your constraints, or your competencies. They care about the jobs in their lives and the more you can help them get those jobs done, the more valuable you will be to them.

The way the healthcare market has pieced solutions together over the years simply hasn’t been successful…in the eyes of the consumer. There is no single solution that addresses the entire life cycle of he consumer’s desire to maintain lifelong health. They are designed for other stakeholders, and are constrained by regulatory compliance.

We’ve ignored the primary stakeholder (the human, patient, consumer) and focused on service providers, for services that no one really wants (in a perfect world). As a result, the solutions that are designed cause consumer frustration, which inevitably lead to abandonment. In fact, many cause frustration with the providers as well.

For example, in 2009 the American Reinvestment & Recovery Act effectively mandated that healthcare providers utilize Electronic Health Record (EHR) technology. These were essentially billing systems, yet with the advent of the digital revolution, more and more was expected from these systems. Since they don't integrate well with other clinical resources, physicians have actually had to add FTEs in the form of scribes to get data into the system. Essentially, the rise of digital has actually complicated matters in the healthcare world.

Patients, on the other hand, have not engaged with gadgets, apps and portals as was hoped. Gadgets are typically designed around a single interaction (e.g. a fitness tracker) and offer very little value on their own. Apps are not well integrated with additional interactions. For example, you might find one designed for a specific hospital visit, but not for the entire physician / patient relationship cycle (which could span years).

What if there were a multi-sided platform that addressed every life stage and every objective you must face as you try to maintain lifelong health? It would essentially support the ability of consumers to get all of their jobs done on a single platform independent of specific brands, hospitals, provider networks, payors, etc.

Portals have been hamstrung by defensive design brought on by strict interpretations of HIPAA. Many of these problems reflect prioritization of down-stream stakeholders at the expense of the current consumer/patient's experience. These problems can be tied to specific interactions, or they can span the life cycle of the consumer experience, and the decisions they must make to maintain their health, or obtain healthcare interventions successfully.

Are we looking at this market the right way? Should we be looking at digital health through the lens of gadgets and apps, or should we instead look at it through they lens of the ultimate objectives of patients? Hint: it’s the latter.

How might we view market potential? Instead of asking stakeholders how much they would pay to have an app or a gadget, we could ask them how much they would pay to reach their objective of maintaining lifelong health perfectly. Instead of referring to this as digital health we should refer to this market in an organic way, as people who are trying to maintain lifelong health. That is a market that will never change, even if the solutions do.

If we want to establish a dominant foothold in such a market, we need to understand what each of the stakeholders must accomplish, and what decisions they must make during their lifetimes and introduce solutions that align seamlessly to support them.

Why Now

Over the past few years, the driving forces behind the renewed focus on patient experience have been the Affordable Care Act, and rapidly changing customer expectations. The Meaningful Use (MU) program administered by the Center for Medicare and Medicaid Services (CMS) has required the implementation of patient-centric technologies such as EHR’s and patient portals, and to those ends has been successful in facilitating an improved awareness of and emphasis on the patient experience. 

However, according to statements from Andy Slavitt, the top CMS Administrator, MU has run its course and will soon be replaced by a new policy which not only mandates technology adoption, but also incentivizes patient-centric solutions. The Medicare Access and CHIP Re-authorization Act of 2015 (MACRA) will not reward providers merely for the use of technology, but will instead tie financial reimbursement incentives to the actual outcomes providers are able to achieve with their patients.

The new regulation will reduce the onerous requirements to comply with the needs of the government and will allow providers to be able to customize their digital technology platforms to the needs of their individual practice and the needs of their patients. 

This paradigm change in regulatory policy marks an opportunity for providers to readdress the Institution for Healthcare Improvement’s triple aim from the outside-in:

• improve overall health of populations

• decrease costs

• improve the care experience.

As early as 2011, the Press-Ganey Pulse Report identified the nation’s top 25% of hospitals as the same hospitals at the forefront of patient engagement. Since that time, momentum has continued to build. Patients now more than ever before crave the same seamless experience in healthcare as they receive in other industries.

Patient experience is the foundation to patient loyalty and customer retention, suggest the experts. However, consumers (and patients) are loyal to their ultimate objective(s) (the job-to-be-done) and delivering a more complete set of solutions, and wrapping them in the right experience, is how you’ll get them to remain loyal to you (the brand). Now is the time for patient-objective-centric innovation from solution providers to separate market leaders from market laggards. 

Note: Don’t forget how I defined market

How does it affect you?

Ultimately, this affects each of us. At some point in our lives, we will need individual care or we will be caring for a loved one. We have come to expect certain digital functions in our everyday lives. Let’s look at retail. When a consumer tries to return a sweater to a department store without a receipt, the consumer expects the retail store to be able to look up the receipt. This is now occurring in the healthcare world as well.  As technology expands in our everyday lives, we will come to expect, and demand, these same functions in every area of our lives, including our health. 

This ever evolving digital landscape can ultimately enable providers to administer better care. Patient-centric platforms can help the patient or caregiver throughout the patient experience rather than at only one point in time (e.g. prescription refill). Imagine the ability to schedule a doctor visit, dispute an insurance claim, and monitor blood pressure all from the same platform. What if a nurse could monitor your blood pressure or oxygen levels in real time while you are sitting on your couch instead of the have to visit your physician’s office?

What's the fix?

The rumblings in healthcare innovation have recently been about providing better outcomes for patients; such as ensuring they get sick less rather than fixing sick people. If the current thinking is that healthcare should be more about outcomes than activities, perhaps we should understand those outcomes (objectives) and the success measures patients use when evaluating their ability to reach their objectives. It’s not for us to decide because when we do, we get a thousand different versions of what an outcome is, and what an experience should be.

This will require a universal model of the job(s) of consumers who are trying to maintain lifelong health. Such a model will inform service designers well into the future, prevent costly over-delivering and continually point to hidden opportunities for value creation as capabilities evolve over time.

In other words, patient-centric does not mean focus on the patient. It means we need to focus on the jobs that patients are trying to get done. Generating thousands of ideas that we have no way of assigning value to has proven to be a failed approach.

Instead, we must capture each and every way patients measure success (these measures don’t change, only their priority does) across the array of health-related objectives or decisions they might have during their lives. These will describe a perfect market, and the goal of providers should be to reach perfection one day

Over time, this approach will allow us to align digital capabilities to actual unmet needs as they emerge (and before solutions exist). This capability is a key differentiator for customer-centric innovators. Knowing how to do it can be learned. Wanting to learn is the real challenge we face in digital transformation. 

And the question we all want to know is whether the current players (solution providers) will be the disruptors, or the disrupted, once somebody figures this all out?

Closing notes

I have not provided a model in this post. Also, I’m not sure whether to use the term patient, consumer or some other descriptor for those of use who are trying to maintain lifelong health. Patient doesn’t seem appropriate, it seems too closely tied to fixing sick people. Do you want to be a patient, or are you trying to avoid getting sick? You can put your thoughts below.

You can learn more about the approach I use in other posts, or at jobs-to-be-done.com. If anyone is interested in how I would model this particular area, I’m happy to discuss it.