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Winter 2019 ache.org/journals 37

The author declares no conflicts of interest.

Getting to the Heart of Consumer- Friendly Healthcare MaryEllen Pratt, FACHE

C O M M E N T A R Y

DOI: 10.1097/HAP.0000000000000073

MaryEllen Pratt, FACHE, is CEO of St. James Parish Hospital in Lutcher, Louisiana.

The feature articles in this issue of Frontiers of Health Services Management capture the current state of consumerism in healthcare. The au- thors discuss how increased access to data on the internet and the friction-free experi- ences of online shopping are contributing to the rise of healthcare consumerism. Patients today are more informed and have higher expectations for convenience and service than in the past. They want easier access, greater choice, and more personalized ex- periences. In addition, they are responsible for a higher proportion of healthcare costs, which drives their growing interest in pric- ing and transparency.

We as healthcare leaders must under- stand consumer behavior to identify the strategies that will create patient loyalty. Success will depend on our ability to create a healthcare culture that fosters innovation so that we can design new and different ways to connect with our patients without losing our patient-centeredness.

The authors of both feature articles are from large healthcare systems, Christiana Care Health System on the East Coast and EvergreenHealth on the West Coast. Both articles describe impressive examples of consumer-focused strategies. As the CEO of a small critical access hospital (CAH) with

limited resources, I initially questioned the applicability of their experiences to my hospital. The implementation of a consumer- centric infrastructure using digital tools can be cost-prohibitive for a small facility. Fur- thermore, our data analytics are impaired by low volume, limited information technology staffing, and a lack of reportable data fields in our electronic health record (EHR). How- ever, after considering the basic tenets that embody consumerism in healthcare, I con- cluded that all hospitals—large and small— can apply consumerism principles and that our smaller scale can be an advantage at times. At St. James Parish Hospital, “Large enough to serve, small enough to care” is more than a slogan.

The Consumer-Driven Experience St. James Parish Hospital is a state hospital service district in southeast Louisiana. As a CAH with only 25 beds, we generate 90 per- cent of our revenue through outpatient ser- vices. We have six physician clinics, three of which are family practices. Although we are the only hospital in the parish (county), we are located midway between New Orleans and Baton Rouge. The urban expansion of these metropolitan areas is encroaching on us and creating increased competition. Al- though our HCAHPS (Hospital Consumer

38 Frontiers of Health Services Management Volume 36 Number 2

Assessment of Healthcare Providers and Sys- tems) survey scores exceed state and national averages on eight of the survey’s nine dimen- sions, retaining our patient base and growing new service lines still require vigilance and the execution of a consumer-driven strategy.

Recently, we rewrote our vision state- ment to include principles of consumerism. St. James Parish Hospital’s new vision is to “unite the parish by being the community’s first choice for all health and wellness needs by leading innovations to make care more convenient, coordinated, comprehensive and advanced in order to offer the very best value.” In healthcare, perceived value is the result of outcomes divided by cost. It is the measure our stakeholders expect, whether they are consumers or payers.

As Edmondo Robinson and Kay Taylor highlight in their feature articles, the retail consumer (patient) expects convenience, ease of access, choice, transparency, and a personalized experience. Meanwhile, whole- sale consumers (employers and payers) want to improve population health, drive down cost, and increase value.

Consumers Crave Convenience According to NRC Health’s Market Insights survey, about half of consumers consider convenient access to care to be the most important factor in their healthcare deci- sion-making. In fact, 80 percent of patients select providers based on convenience fac- tors alone (NRC Health 2019). Convenience for the healthcare consumer is represented by a choice of locations, whether physical or virtual. St. James Parish Hospital opened an urgent care clinic to offer expanded hours of operation, including evenings and week- ends, for nonemergent needs with walk-in access. Using the same system as our pri- mary care clinics, the urgent care EHR is also integrated with our physician clinics

to provide continuity of care and a single patient portal.

The Mississippi River divides our parish, so we opened a clinic across the river from the hospital to create a new access point for patients residing there. Both the urgent care and west bank clinic are successful in meeting the needs of our community. In ad- dition, we expanded access to specialists by constructing a medical office building that offers timeshare space. Physicians can take advantage of half- and full-day rental op- tions for exam rooms. With this flexibility, they can rent only what they need instead of leasing a suite that goes unused when they are not there. Since opening the clinic in 2013, we have attracted nine new physi- cians in eight specialty areas and more than tripled the volume of visits. Before these services were offered locally, patients had to drive between 20 and 45 miles to their appointments.

Kaufman Hall’s 2019 Healthcare Con- sumerism Index found that only 3 percent of health systems had high capabilities for offering a variety of virtual access points, although 27 percent had made developing such services a high priority (Crnkovich et al. 2019). At St. James Parish Hospital, we provide telecardiology and telestroke con- sultations for inpatients and emergency room patients. Because both of these service lines have time-sensitive interventions, tele- consults have allowed us to respond quickly and decisively to patient needs and deter- mine if transfer is necessary. As a result, we can keep patients closer to home and help families avoid unnecessary travel. In the fiscal year after initiating the telecardiology program, admissions to the acute care unit increased by 5 percent, and the telestroke program reduced the number of patients transferred out for stroke symptoms by 30 percent.

Winter 2019 ache.org/journals 39

C O M M E N T A R Y

From the consumer’s perspective, ease of access refers to the number of touch points required to accomplish a task. The goal is to create frictionless processes. Pro- cesses for bill paying, scheduling, wait- listing, checking in, wayfinding, messaging, and taking patient histories and health in- formation can all be accomplished through online tools such as a patient portal or website. St. James Parish Hospital’s current portal features basic online functions such as bill pay, patient history, and messaging. Although online scheduling is not yet avail- able, we have centralized scheduling of ser- vices such as radiology, cardiology, surgery, therapy, and lab work for our hospital.

We have found that being small and flex- ible can be an advantage for consumers in a number of ways. We often adapt our sched- ules to meet our patients’ needs. We can easily schedule an MRI after school for a student or before work for an industrial shift worker— and we empower our frontline staff to make this happen. Extending therapy hours to ac- commodate before- and after-work appoint- ments is standard practice. Accommodating a same-day mammography appointment request for an anxious patient who has been told by another, much larger imaging center that she would have to wait a week or two reflects our staff ’s compassion and desire to serve. Meeting patients’ individual sched- uling needs is commonplace because our organizational culture fosters customer ser- vice. Leaders are proud of the work they do in serving our patients, and they readily rec- ognize staff for going above and beyond. We are gratified that 94 percent of our employees believe their manager values great customer service and that our employee engagement scores rank us in the 80th percentile in the Press Ganey national database.

Easy access to health information is an- other aspect of consumerism. An element

of our vision statement, noted earlier, is to be the “first choice for all health and well- ness needs” for our parish. We know we do not provide all services to all people, but we want to be their partner in navigating the wider healthcare environment. We use our robust website and social media channels to provide all of the information patients need to be better engaged in their care. In addi- tion, our care management services embed population health nurses at our primary care clinics to identify at-risk patients and coach them throughout their care journeys.

Angst About Affordability Healthcare consumerism is often charac- terized as patients shopping for the best value for healthcare services. Because value is determined by the relationship between cost (price) and the quality of the outcome, consumers need to know prices and quality scores before they can make an informed decision. Price transparency continues to be a conundrum for healthcare providers; nev- ertheless, more than a third of consumers search for pricing when deciding about com- parable services (Crnkovich et al. 2019). St. James Parish Hospital patient financial rep- resentatives calculate patient estimates prior to service. We also post charges on our web- site, with detailed explanations about how to understand a chargemaster. We urge patients to call us if they need more clarity, because that is the surest method to communicate accurate information. Also, our patient fi- nancial representatives go out of their way to help patients understand healthcare billing. When they contact a patient about a billing issue, they use the opportunity to educate the patient on his or her insurance policies. While working a recent claim, for exam- ple, our financial services team found that a patient had changed insurance plans and was unaware he still had the other policy. In

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reaching out to the patient, we were able to educate him and resolve his problem. Being small allowed us to connect directly with the patient and, we hope, prevent future issues.

Personalized Patient Experience NRC Health’s 2019 Healthcare Consumer Trends Report found that most patients’ comments about clinical providers were positive—87 percent praised their clinicians’ courtesy and respect. However, 26 percent thought the interaction regarding their med- ical history could be improved and that clini- cians could be more familiar with their prior health episodes (NRC Health 2019). These data points indicate that patients, as consum- ers, want personalized interactions. It is not enough for their healthcare provider to know their name; they expect clinicians to know their clinical problems, visit history, and cur- rent status, too. The new patient-consumers want a greater degree of information sharing between themselves and their providers.

We expect St. James Parish Hospital primary care physicians to spend sufficient time with patients and respond to their concerns in a timely manner, but as part of our efforts to foster a consumer-centric mind-set, we also want to prevent physician burnout. Teaming up with our physicians to ensure a balance between work and time off has been helpful in that regard. By including physicians in strategic planning and our ef- forts to improve quality, we have been able to align them with our organization’s goals. A survey of St. James Parish Hospital physi- cians conducted by Press Ganey revealed an engagement score at the 97th percentile and an alignment ranking at the 99th percentile. We believe that physician engagement translates to improved patient experiences and stronger patient loyalty.

Loyalty is important. St. James Parish has only 22,000 residents and many families are

large, so our patients are our friends, family, and neighbors. As is typical in small commu- nities, the sense of belonging is strong. People support each other in times of need, whether hosting a jambalaya fundraiser for a family in financial straits, sandbagging for flood protection, or organizing a prayer line in a personal crisis. This spirit of community is evident in the culture of the hospital and val- idated in our employee engagement surveys, which identify “a strong sense of belonging” as a key element of our high performance. The unique and memorable moments we share with our patients are evidence of the service culture at St. James Parish Hospital.

At a CAH such as ours, skilled nurs- ing patients make up a significant percent- age of our inpatient census. Their length of stay can be as long as two weeks, and when they are in the hospital for an acute care stay prior to their skilled nursing status, they can be away from home for an extended period. That can be a worrisome prospect. Recently, when we needed to gain a patient’s consent to be admitted to our swing bed unit for much-needed therapy, our nurses promised to take care of his dog. They took turns keeping the dog until the man was discharged and able to care for himself (and his dog) in his own home. Another patient refused care and wanted only to go home until we brought his cat to visit him. Seeing his cat brought the man to tears. After the visit, he became compliant and progressed to discharge. These examples and the thou- sands more that occur every year illustrate the value of personalizing care and creating memorable experiences that impart ever- lasting patient loyalty.

Employer and Payer Partnerships A wholesale consumer strategy targets the purchasers of healthcare on behalf of their enrollees who consume services. The goal is

Winter 2019 ache.org/journals 41

C O M M E N T A R Y

the Institute for Healthcare Improvement’s Triple Aim to improve population health, re- duce the cost of care, and improve the patient experience—generating greater value as a re- sult. As mentioned, in healthcare, perceived value is the result of outcomes divided by cost. It is the measure that payers want to re- ward and that stakeholders expect. Our area, with its access to the Mississippi River, is attractive to large plants in the petrochemi- cal industry. New construction in St. James Parish over the next five to seven years will exceed $12 billion. These large employers are safety conscious and understand that healthy employees are the key to peak per- formance. We are partnering with these employers by providing employee physicals and screenings, monitoring their health, re- sponding quickly to injuries, and coordinat- ing referrals.

St. James Parish Hospital is also partic- ipating in an accountable care organization (ACO) shared savings program. Population health nurses support the primary care clin- ics in conducting annual wellness visits and providing chronic care management. The nurses round with the case managers twice each week to coordinate transitions of care and ensure warm handoffs from inpatient to ambulatory care. Our first year of data re- vealed a cost per beneficiary that was below the national average, the ACO average, and our target.

Future Initiatives To continue the momentum and drive our consumerism strategies, St. James Parish Hospital actively monitors patient feedback. We monitor social media comments con- tinuously and immediately notify manag- ers of any information or issues relevant to their areas. In addition, we have added a feedback-on-demand link to our website’s patient information page so that patients can

contact us immediately and anonymously after any service. People reach out through these electronic channels expecting a quick answer and timely help. Our hard work to meet that expectation has been recognized by Facebook, which noted our 100 percent timely response rate to all requests.

Our website and social media accounts are not just marketing tools for us—they are communication tools that patients al- ready understand and use. As more data are collected from consumers, our ability to develop consumer-based insights and per- formance measures will evolve and inform future initiatives.

To deliver a great consumer experi- ence, healthcare executives must make that experience a cultural priority for their orga- nizations and support it with the necessary technology (Crnkovich et al. 2019). To meet that commitment, St. James Parish Hospital plans to implement a new information system with more consumer-centric capa- bilities. We are evaluating the ability of po- tential vendors to support consumerism and digital health, with the overarching goals to improve quality and outcomes, increase rev- enue capture, reduce costs, gain loyalty, and enhance the patient experience.

Conclusion Technology, automation, and digitization are often praised when it comes to consum- erism, but as the CEO of a small hospital, I am comforted to know that a personal expe- rience is still important to patients and their families. At St. James Parish Hospital, great interdepartmental relationships and a cul- ture of customer service empower our team to create a personalized, convenient, and valuable customer experience that would please any consumer. Technology may come with a big price tag, but its potential to be the heart of healthcare delivery is priceless.

42 Frontiers of Health Services Management Volume 36 Number 2

I agree with the other authors in this issue of Frontiers that consumerism in healthcare is here to stay. CEOs must develop the data to measure it, the analytical capabilities to understand it, and the innovative culture to capitalize on it. Whether your organization is large or small, consumer expectations are the same. Strategies such as those shared here can be deployed to reduce friction and create easy access to affordable and value-based care.

References Crnkovich, P., D. Clarin, G. Kingdom, and R. Duffin.

2019. “2019 State of Consumerism in Healthcare: The Bar Is Rising.” Results of the Kaufman Hall Healthcare Consumerism Index. www.kaufmanhall. com/ideas-resources/research-report/2019-state- consumerism-healthcare-bar-rising.

NRC Health. 2019. “2019 Healthcare Consumer Trends Report.” Accessed September 12. https://nrchealth. com/resource/2019-healthcare-consumer-trends/.

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