Technology-Enabled Strategies to Provide Patient-Centered Care: A CHIME Roundtable Sponsored by DXC Technology

With a growing emphasis on patient-centered care, healthcare organizations are developing portals, telehealth capabilities and other IT-driven solutions to help engage patients in their care. Convenience may be a strong motivator for patients, but if the tools are not user-friendly, patients are less likely to adopt these resources. DXC Technology sponsored a thought leadership roundtable that included senior healthcare executives who are members of the College of Healthcare Information Management Executives (CHIME) to explore innovative technology-enabled strategies that support patient-centered care, population health and business growth. CHIME President and CEO Russell Branzell and DXC Technology Vice President and Worldwide Head of Build, Healthcare and Lifesciences Dave Bennett co-moderated the discussion. Participants were:

• Pamela Arora, Senior Vice President and CIO, Children’s Health, Dallas, Texas
• Steve Hess, CIO, UCHealth, Aurora, Colo.
• Ali Olia, former Chief Technology Officer and Vice President, IT Strategy and Architecture, based in Sterling, Va.
• Shafiq Rab, MD, Senior Vice President and CIO, Rush University Medical Center, Chicago, Ill.
• Donna Roach, Vice President, Information Services, BJC HealthCare, St. Louis, Mo.
• Michael Vesser, Director, IT Operations, Palomar Health, North San Diego County, Calif.

Engaging the Patient

The healthcare ecosystem is undergoing massive changes with the addition of new technologies, new payment models and new competitors entering the sector. These factors are shifting the traditional patient-provider relationship, challenging healthcare organizations to reimagine how they interact with their communities. In today’s digital world, some patients also approach healthcare with different expectations, demanding care when, where and how they want it. Healthcare IT provides a potential platform for meeting these needs, one that some organizations are using strategically to connect with patients and help their hospitals and health systems transform how care is delivered.

How organizations use IT to engage patients depends on their mission, patient population, technical maturity and long-term strategic goals. Driven by the mission of making life better for children, Children’s Health understands the need to focus on consumers and meet families where they live, learn and play, said Pamela Arora, senior vice president and CIO at Children’s Health. New programs like  school-based telehealth allow Children’s Health to partner with schools and other institutions to offer remote, onsite care.

As an acute care organization, Palomar Health focuses on the patient experience within their facilities, according to Michael Vesser, director of IT operations at Palomar Health. For instance, Palomar Health uses the EMR to inform clinicians about patients’ personal goals during their healthcare journey as well as their clinical needs. “We want patients to be emotionally engaged with Palomar Health while they are there,” Vesser said. “We were given the task to figure out how can we make it so that every caregiver who comes into a patient’s room has some emotional connection, like ‘I know you want to be at your daughter’s wedding in a month. Don’t worry, we’re going to get you there.’”

Steve Hess, CIO at Aurora, Colo.-based UCHealth, explained that the 12-hospital healthcare system developed a virtual health strategy that extends across its bricks and mortar facilities, thanks to its Virtual Health Center, a centralized command center 5.5 miles from the system’s largest medical campus and staffed with technicians, nurses and physicians who remotely monitor patients 24/7.

A big benefit for patients is the convenience that technology-enabled options provide. UCHealth, for instance, tracks miles saved (not driven) as a measure of benefit to rural telehealth customers. Hess estimated that totals 111,000 miles a year. Parents served by Children’s Health also enjoy the convenience of having their children treated at school rather than through a trip to the hospital. With a 65% Medicaid patient population, school-based care also saves parents from having to secure transportation and take time away from work or the family. Ultimately, that eases the financial burden on the health system, too, with children getting treatment before a condition advances into an emergency room visit. “That’s expensive care for that ear infection, and we can address that in the school setting,” Arora said.

DXC Technology Vice President Dave Bennett offered the perspective of a parent whose son has a progressive genetic disease that requires twice daily treatment using a gene-based therapy. “I don’t want to use the health system, and I have to use it with my son all the time with that type of disease,” he said. “We’re unwilling buyers, so what do I care about if I’m an unwilling buyer? I care about conveniences.”

Barriers and Challenges

CHIME President and CEO Russell Branzell cited results from an analysis of CHIME’s 2019 Most Wired data that showed many organizations offer tools like patient portals and telehealth solutions but struggle to get patients engaged. Most organizations offer some virtual services, for instance, but adoption is low: two thirds of those organizations with telehealth care reported that less than 10% of their patients have used it. Many of the roundtable thought leaders proposed that while patients want convenience, the experience is cumbersome, which creates barriers.

“If we think of ourselves as consumers, everything else we do besides healthcare is extremely easy,” noted Ali Olia, former chief technology officer at BJC HealthCare. “We can order food. We can call an Uber. From a digital perspective, how do we involve the consumer? We haven’t cracked the code yet. There is a lot of effort happening in that space at BJC to focus on making it easy for the consumer.”

Healthcare organizations need to simplify processes for patients, but the challenge extends beyond a technology fix, Arora suggested. She cited the Children’s Health mobile app that allows patients to find physicians, locate facilities and request – but not make – an appointment. Allowing patients to do that step with a click requires coordination and buy-in from many service lines within the organization. “The complexity behind the curtain is what makes it hard,” she said. “To make the appointments easier, we have to have the organization rally around it operationally and clinically.”

Healthcare is not only complicated but also intimidating for many patients, Bennett added. Many consumers know they have choices for banking or retail services, but healthcare is opaque. “One of the reasons for such slow change in healthcare is because people aren’t walking out,” he offered. “They don’t even know if their insurer takes the next player or will pay them for the next place they go.”

Inequity also poses a barrier, added Donna Roach, vice president of information services at BJC HealthCare. Some people who don’t qualify for federal aid and rely on the market exchange for insurance may still not be able to afford care when they need it, she offered as an example. “How are we going to deliver healthcare for everybody, not just the elite, and not just the people who have a job and healthcare coverage?” she asked.

Nontraditional businesses like CVS and Walmart are challenging hospitals and health systems by offering consumer-focused retail clinics that are both convenient and easy to navigate. That is adding pressure on healthcare organizations, which might count on higher-profit “elites” to offset the cost of other patient populations. The question becomes, do they take retailers head on or partner? “My view is they will keep chipping away at it until we get better at competing with them,” Olia said, “Where you can partner, you partner.”

Building on Success

Organizations that invest in patient-engagement solutions have a very powerful tool – data – that they can use to support operations and improve patient outcomes, participants said. By doing so, they position their hospitals and health systems to succeed under alternative payment models, even with retail competitors in the wings. Patient-engagement strategies combined with insights from data also help them cement their brands.

The lack of appropriate reimbursement has dissuaded some health systems from offering telehealth services, but Children’s Health saw it as an opportunity to build an evidence base that can be used to educate state policymakers about the benefits. In addition, although the health system may still accrue losses under Medicaid, they have shown the losses are smaller with telehealth. UCHealth takes a proactive approach with payers, Hess said, analyzing data collected through digital health initiatives to show reductions in length of stay and other cost and quality measures.

The data also provide a foundation for designing population health strategies, putting their organizations at the forefront in healthcare reform. Increasingly, value-based and alternative payment models are holding healthcare providers accountable for costs and outcomes, financially rewarding quality and cost-effectiveness and punishing poor performers. Population health helps providers identify and proactively manage at-risk patients within a population. At the same time, with sufficient data and analytics, health systems can provide personalized care.

“It offers a chance to see the big picture of similar patients with similar conditions (i.e., zoom out to see a population of patients) but then allows us to hone in on specific interventions at the patient level (i.e., zoom in to see what is specifically required based on an individual’s needs and desires),” Hess said. “We are starting to see the chance for incentives to start aligning across the patient, the provider and the payer.”

Rush University Medical Center has taken a multifaceted strategy that embeds the health system with the community, said Shafiq Rab, MD, senior vice president and CIO at Rush. That includes investing in local infrastructure, job training and educational programs, teaching in local colleges and collaborating with local churches and other trusted institutions. “Most people in the community have come to know us and we have learned from them,” he said. “Then we also do virtual care, E clinics, and for people who need mobility, transportation so they can move in and out of that community.”

As a leader in advanced technology, Rush has many initiatives within and outside its facilities to serve a diverse community. Retailers that want to enter the marketplace first reach out to Rush, he said, making Rush known as a collaboratory.

Building a strong brand may allow healthcare organizations to better engage patients, which can fuel population-based and personalized care programs while simultaneously helping them secure their markets, Bennett proposed. The thought leaders agreed that brand is very important to their senior executives, with technology playing a key role in their strategic plans. Although healthcare IT may help drive the brand, the fundamental message must tie back to patients to resonate with them, they emphasized. “It’s about telling the patient stories,” UCHealth’s Hess said. “We’re telling the patient stories, but intertwined with that are innovation, the relationships, the clinical expertise.”