Omni-channel Healthcare: The Future? Part 3

Part 3:?

In Part 1 of this series I made the case that omni-channel healthcare has not (yet!) delivered on its potential to improve healthcare because the healthcare industry has prioritized buzzy point solutions over the actual needs and desires of consumers. In Part 2 , I opined that the misalignment of the business models between healthcare’s major players and consumers' needs has created a system that is oriented to preservation of the status quo. As a result mainstream adoption of innovations like omni-channel care will only come when healthcare’s key actors collaborate to deliver a system that meets consumers needs.? In Part 3, I share a vision for what payers and providers sitting on the “same side of the table” could look like. To illustrate I offer a few examples of promising efforts that could serve as models to accelerate the adoption of omni-channel healthcare and other innovations. Let’s dive in.

While the majority of? Americans trust doctors and nurses (85%), they share a deep distrust of the business people who run the healthcare system–payers 33%, pharma 34%, government 56% (Univ of Chicago-NORC ).? Key drivers of trust in clinicians is the belief in the accuracy of the information being provided (“The doctor is telling me the truth”); the amount of time clinicians spend with patients (“The doctor prioritizes me”); and a feeling that they matter (“The doctor genuinely cares”). In contrast, business practices that inform the healthcare industry’s priorities such as relative value units and automation to drive “efficiency” prioritize organizations' bottom lines. This “solitary” focus on efficiency has resulted in large numbers of clinicians leaving the profession (The Moral Crisis of America’s Doctors ), nurses feeling pressured to defer to artificial intelligence? (When AI Overrules the Nurses Caring for You )--- leaving few patients feeling cared for let alone convinced that omni-channel care is anything other than a “cheap” substitute for “real healthcare.”?

Pay-as-you-go mobile services, tech illteracy, inadequate internet access and unstable or inadequate insurance coverage make engagement with omni-channel healthcare beyond the reach of those with the greatest need. For example, a study by Song et al Columbia University suggests that, as healthcare becomes increasingly reliant on technology, the digital divide presents significant barriers to accessing healthcare resources and services.?

In an effort to contain rising healthcare costs, payers (led by CMS) have lowered reimbursement rates and pushed to link payments to outcomes through value-based care payment schemes adding to the administrative burden felt by care delivery teams. In response, health systems have sought to maximize revenue by focusing clinician time on tasks that optimize reimbursement (chart entry, shorter appointment lengths, etc..). In this setting, the transition from fee-for-service to value based payment has been slow with value based care schemes comprising just 6.7% of the revenue for primary care practices. (RevCycle Intelligence ). Caught in the middle, consumers have not experienced commensurate value from omni-channel healthcare as its role in these efforts remains ill-defined.? (S. Brill-Time , R. Numerof-Forbes , R.Pearl-Forbes) .??

So how do we make omni-channel healthcare a “good reality" as industry people? Simple–we imagine a round table and recognize that payers and health systems currently sit on opposite sides of that table engaging transactionally – largely focused on reimbursements and rates. In order to deliver on the promise of omni-channel healthcare, payers and health systems must move beyond being adversaries. In other words, payers and health systems must move their chairs and sit next to one another and add a chair for consumers. Only when seated next to one another will we be able to look across the table, see our shared challenges and design omni-channel healthcare and related technologies to help solve them - together.??

Collaboration like this does not happen in a vacuum; it requires repeatable, transparent collaboration frameworks founded on the principles of co-creation and co-validation with shared objectives and measurable key results. (Harvard Business Review ). I call this the “Round Table Model”. To ensure accountability, health systems and payers would need to incorporate these measures into their strategic business priorities and report their progress to the public and their shareholders. In this model, what good looks like for payers, health systems and consumers becomes more aligned, business models shift accordingly and there is plenty of “skin in the game" at the top to deliver results.?

In the Round Table model, consumers are key participants informing conversations regarding the design and implementation of omni-channel healthcare systems and related innovations. Products are not released to market at scale until they’ve been validated within the environments where they operate. As a result, payers and health systems are incentivized to design their operations so that employees are well positioned to deliver on consumer expectations. Once released products are monitored, tested and validated to ensure they are delivering the outcomes expected. Lastly, payer and provider CEOs (together!), along with their leadership teams, would engage with consumers (members/patients) directly. For example, these leaders could participate in community town halls or fireside chats collecting “real world evidence” regarding the impact of products like omni-channel healthcare on consumers and communities. (Harvard Business Review ).

To the best of my knowledge, the Round Table model is a novel concept that I have experience implementing along with lessons learned (“bruises”) that go alongside innovation and new ideas.? Evidence suggests co-creation is the optimal path forward (Healthcare-Basel ) and other “industry people” are also seeking ways to collaborate. For example:

1. Graphite Health , is a new company created by Intermountain Health , Presbyterian Health , SSM Health , to “shape digital transformation together” by creating a technology platform and developing digital “plug and play” solutions for their health system collaborators. What’s promising is that one technology platform for digital health designed by and for health systems could lead to better alignment, standardization and consumer experiences amongst the 500+ health systems in the US.? What remains to be seen is how the Graphite team will engage payers who are also building platforms with “plug and play solutions.”
2. Risant Health , is a non-profit founded by Kaiser Permanente , one of the largest integrated health plans and systems in the US. If approved by regulators, Risant Health would acquire Geisinger Health with the goal of scaling the adoption of value based care across community hospitals.? Presumably KP will use its experience and model of practice as the framework for each organization that joins Risant. What’s promising is that Risant Health comes closer to moving payers and health systems to the “same side of the table.” KP has significant experience managing value and its model could certainly offer other systems an accelerated path to adopting value based care schemes. What remains to be seen is how omni-channel healthcare and related technologies will be scaled across Risant members and their myriad of technology systems. Whether or not consumers will have a seat at the table in the Risant collective has not been announced.?
3. Carbon Health - earlier this year, CVS health invested $100M in Carbon to pilot Carbon’s primary and urgent care model in its pharmacy based clinics.? While neither organization offers the full breadth of services that a traditional health system does, Carbon’s elegant tech stack, consumer friendly experience and lower cost of entry coupled with CVS’s scale could require health systems and payers to find ways to “plug” Carbon-CVS into their omni-channel experiences.? New entrants and novel partnerships like this one make a framework for collaboration a business imperative if we “industry people” wish to truly “fix” healthcare.

Dear reader, it's now your turn to chime in. Certainly the “proof is in the pudding” of any idea including my Round Table model. And many questions remain such as:

1. If payers, health systems and consumers? sat at the ‘same side' of the table would they work collaboratively???
2. And if they did, would consumers be willing to change their own behavior??
3. Would omni-channel healthcare be part of fixing healthcare at all??
4. Assuming consumers and industry were willing, is our society set up to make it easy or hard for us to fix healthcare??

Please add your thoughts and suggestions in the comments and feel free to opine on the original question as well, “What will it take to realize the potential of omni-channel healthcare?”? “What have I missed?” “Where shall we start?”?

I’m looking forward to hearing from you. Thanks for your time.

Author: Elif Oker, MD, FACEP | All Rights Reserved 2023