In September 2021 I sat down with K. R. Prabha Vice President, Strategy, Growth & Innovation at Optum and Zain Ismail, Healthcare Innovator and Strategist and co-host of the Healthcare Rap podcast to hear their perspective as health care strategy leaders on how they are approaching the changing environment in health care. In particular, new and non-traditional entrants. What I found was unexpected, a new perspective health systems should consider. Rather than looking at these newcomers as competition, think of them as partners, solidify and define your role.
Q: Talk about your background, and how you draw on past experience (outside of health care) to think about the future with greater emphasis on the human center design concept?
Zain: My background experience comes from my time working in the hospitality industry at the Hilton. We learned early on that our guests had expressed and unexpressed desires. We had to be good at getting deeper with our clientele to understand how we could best be of service to them. It's the art of asking questions.
Success in the hospitality industry comes from having insane attention to detail, it feels as though we do not have the same drive in health care as compared to the attention to detail in the hospitality industry, like making sure the lighting is correct, coffee pot is in correct place/ polished, Nordstrom's- have great acumens and semiotics, it's the art and science on how things make you feel, it's the microdetails that create the feeling – we don't offer that in health care or have the skill sets to tackle this dynamic of a person’s experience. People who bare the problem are the best people to solve the problem.
Retail is good at having a pulse on their customers- building products and services that people want (e.g Zara). This is only found in some areas of health care service like ambulatory and low acuity – where they start pulling patients to codesign- asking "how do you want this done?"
What we do in the hospitality and retail industry we believe should be mirrored and used in the health care industry. We must keep in mind that patients express a medical problem when they come to us but not the entire problem. When we think about clinical needs, we need to reflect these needs but include the emotional, spiritual, and psychological needs to create an experience. This gains trust and loyalty and brings the patient back to our health system.
Prabha: My background is international—having lived and worked in India, Canada, and the U.S. which have vastly different health care ecosystems. I believe there are learnings in each model that can be shared and adapted here in the U.S.
I agree with Zain on being attuned to expressed and unexpressed patient desires. In health care, we are hyper focused on solving a specific problem and at-times we can lose the big picture. Take for instance, a health system that was planning to establish a cancer center. They envisioned healing gardens and muted colors to convey healing, warmth, and caring. But after surveying patients they heard that what people wanted was to feel confident about where they were getting treated, and they wanted to see more steel and glass as a representation of cutting-edge innovation and modern technology – they wanted to be reassured that they were coming to the right place that is going to cure them. Systems need to focus on understanding the best way to convey to consumers that we are here to cure you and take care of you. Sometimes in health care we don't always get it right the first time, but we learn fast.
Zain: This is human-centered design. The people baring the problem are the people best suited to solving it. We need to truly listen to develop a solution. Retail and hospitality do this much better. We do not do this in health care largely because the incentives are not here. Health care is not driven by the consumer but with CDHP employer steerage and other programs like COEs and value-based care it's becoming more of a factor and coming more into play now more than ever.
Q: You have a vision that to partner with non-traditional players and in fact rather than run from these new entrants, embrace them. Walk us through your vision.
Zain: Something that we learned with Covid was that the non-traditional players that had surfaced can only do so much i.e., well branded clinics and some digital capabilities. But they need much deeper clinical experience and health systems can stand behind these channels and have the expertise to solve for the problem especially when the clinical needs and acuity levels are higher.
We need to look at Amazon, Walmart Health, Publix and others with the goal to become the health system that these players want to partner with. Similar to how online travel agencies (OTCs) like hotels.com changed the way we travel and disrupted direct "referral patterns" to owned hotel booking sites, we are seeing the same with health care and disruptions in primary care.
Prabha: U.S. health care is very complex—I will even venture to say that it is the most complicated of all global health care systems. We have multiple stakeholders (patients and families, hospitals and health systems, health plans, employers, and federal and local governments) who each play a part whenever an individual seeks to engage in a health care event. Each stakeholder is looking to maximize their interests for the single event vs. taking a long term viewpoint. It is important to build a supporting and collaborative partner ecosystem that provides the patient and families with information (clinical care, financials, roles) and empowers them to truly participate in the decision making about their care.
This future can be enabled when we utilize the unique strengths of the various traditional and non-traditional players to build the health care ecosystem. For example – imagine a fictional partnership scenario where non-traditional tech player superlative in customer relationship management owns access and engaging with the customers, partners with a specialty digital-first primary care delivery model and a traditional health system for specialty and complex care needs. The trifecta when partnering in the right way provides a superlative value proposition to the consumer with delightful experience, being cared for at appropriate locations, and with superior quality and care outcomes. A win for all stakeholders.
Taking this further, if this care were offered as a defined bundle with clear financial responsibilities administered by a health plan, the patient and family will be informed of the choice, the price, and options before they start the clinical care journey.
Zain: For example, companies learned through Covid that when working with occupational health vendors, traditional and new, they can only do so much digitally enabled care delivery. This is a sign and lesson from Covid that when things get rough these newcomers will need folks who have a much deeper clinical expertise.
Where we can partner with the non-traditional is leveraging their ability to search, book appointments navigate, like hospitability online travel agencies like Kayak where you can book hotels that starts showing a demand towards health systems. Partnerships are important. The plan is to be the health system that can partner. It's important because of the money that stands behind some companies no hospitals can compete financially or with talent especially now with the workforce shortage.
Prabha: It is extremely important to develop a strategy that includes both an approach of figuring out what our system is going to do AND more importantly what we don't want to do. As a health system it's our role to bring patients and populations together to reduce and heal the societal disease burden. Often, the technology industry identifies issues and develops point solutions to relieve tactical pressure points – unless these solutions help bridge process gaps seamlessly, they end up becoming a hindrance to care delivery.
Each tech solution or app becomes a data collection point with siloed insights that further fragments the ecosystem—increasing the decision making time and burden on clinicians to utilize disjointed data and insights when developing a comprehensive view of the patient's problems and care treatment options—does an elderly patient with a heart condition and a new bee-sting require additional treatment steps vs. an adult presenting with a new bee-sting could now require the clinician to consider outputs of more than what is documented in the patient’s clinical records. An extreme example is that a misinformed clinician's actions or mistakes can lead to death or extreme disability.
The overreaching goal here is to aim for whole-person care and this can be achieved by building an effective partner ecosystem. It's time to try something new and break through the pack.
Q: Why have non-traditional organizations struggled to enter the health care space?
Prabha: The first big reason is that while most startups are digital natives most of the US health care is still conducted in-person "hands on the patient". Further, many startups focus on developing apps utilizing the latest digital capabilities and often do not employ rigorous health care expertise to pressure-test and guide them during design and development.
Science and biology are global, but health care is local, and the individual patient is unique. Health care does not work like other industries, for e.g., manufacturing, where most things in the process are widgets and interchangeable things—here each person requires a focused and customized approach to solve their specific health issues.
It is for this reason non-traditional players need to partner with the incumbent health care players. Therefore, human center design is so important. We need to get to both what the consumer really needs for their care and what they want for experience.
Q: What is the providers role to adopt these new entrants?
Prabha: The fundamental role of a provider as the care planner does not change with the arrival of the new entrants. Physicians primarily follow a "do no harm" guideline and adhere to evidence-based protocols to formulate the best care actions for their patients. Physicians not trained in newer tech will not trust or use it in their decision-making process. The current provider core education and medical training is limited in familiarizing providers to emerging digital technologies (e.g., AI, ML, RPA, advanced analytics) that startups bring to health care.
The tools, technology, and analytics the new entrants bring to the equation can equip the providers in formulating better individualized patient care plans after analyzing alternatives based on more comprehensive data-based decision insights. We need the providers to use these enablers to inform their care actions - (e.g., ordering fewer duplicate diagnostics, avoiding an unneeded test or treatment, prescribing an alternate treatment).
Over time, as providers get comfortable with new tech enablers the adoption and use rates will increase. For this, providers need to learn new tools and their trade associations can lean in here to educate and support introduction and adoption of new and emerging technology so they can understand what and how these non-traditional entrants can support the clinical work and not see them as threats. Providers are used to learning best practices they just need to trust best practices that come from the non-traditional player.
Zain: Physicians need to teach physicians about technology beyond telehealth, teach them new business models. Physicians need to be thinking more about partnerships and must get out of the mindset that the way the system worked in the past will not evolve.
For example, Everly Health offers at-home lab testing kits and education for self-collected lab testing. But some providers will not accept these results should a patient provide them because the provider did not order the test or was not done by their lab, we need to change this mindset. In the end it will be much better if the patient is involved and feels that they are a partner with their provider.
Q: Can non-traditional organizations partner with incumbent health systems?
Zain: These non-traditional organizations need the expertise of the health systems. Integrated delivery, with health plans can start to think about partnering with gym memberships (like they are with discount to memberships) but will have a tighter relationship with the providers particularly primary care providers. I.e., can you set up a telehealth solution at the gym to create a crossover to the fitness space.
Prabha: Yes, they absolutely can – knowing your role is the key. It's going to be important for a health system to thoughtfully decide what health issues they will own, which space are they going to play in, and who they need to partner with, building the right ecosystem. Do what you do best and partner with other stakeholders that have the expertise in what they excel at doing like some of the big tech firms known for single-minded consumer-focus or big-data and analytics around disease burden and risk prediction for populations or taking it all to the cloud.
Health care providers will need to rethink their partnership paradigms and business models to capitalize on these new capabilities. Your goal is to investigate how emerging digital tools will allow providers to move care "upstream" by influencing the thought, activity, and consumption habits of health consumers.
Q: In your opinion what does this look like in 5-10 years?
Zain: I think we will see more connected care that is better integrated into population health. For example, the lululemon mirror gets acquired by a company more on the medical side. Or some sort of technology that becomes the aggregator and navigator. Like hotel and flight bookings that will connect you to a provider. We see this happening now with Amazon Prime and PillPack a technology platform that manages the consumer and consumer navigation then partners with hospital and providers and navigates to the health system.
Prabha: We are going to see a clarification of roles between the health care experts and the navigators. It's imperative that stakeholders deliberately clarify their roles and find their niche in the new health care ecosystem. Today it's not clear who plays in what space and everyone wants to be everything to everyone.
If this continues as our approach, we will fail. I do believe in the future it will be clearer and traditional health care organizations and non-traditional new entrants can all win. This will benefit all stakeholders but most importantly the patient, the provider, the consumer, and the community. Health systems must stick to what they do best and partner for the rest.