“I get told dozens of times a day what problems I have and how such and such a product can fix them.”
“If I answered every vendor call I wouldn’t have time to do my actual job.”
In my role at Relias I spend time interviewing healthcare executive about issues they are facing and how they are currently addressing them. Whether I am speaking to payers, heads of behavioral health centers or hospitals/health systems I hear some version of the quotes above when I ask how they onboard new solutions. The executives I interviewed said vendors rarely asked them about the problems their health system was trying to solve and the financial implications of those problem” Instead, vendors say, “Here is a solution, what problems do you have that fit for this?”
“What the executive hears is, “Stop, or slow your current initiatives, and dedicate / rededicate valuable staff communication time to implementing my new product and by the way I can’t promise a savings target.”
I can relate to this experience with vendors. When I served as Director of Policy, Planning, and Analysis of the State Health Plan of North Carolina, at the end of each week I would summarize how much money in aggregate various vendors promised to save me if I implemented their product and I’d regularly arrive at “savings” that exceeded our approximately $3,00,000,000 in expenditures. To realize the total vision vendors were proposing I would have needed an additional 150 staff and each working day to be three times longer so we could appropriately implement each product, communicate it to vendor partners and the provider network, and make sure my actual full-time job could be completed.
Even with the best intentions these product pitches fail to acknowledge how what they are proposing impacts the physician or nurse or health plan’s day. They lead with the best-case scenario outcome and forget that on any given day the following things need to happen:
• Patients need to be treated in the office, ranging from preventive checkups to treating chronic conditions to the terminally ill
• Electronic health records need to be updated
• Care needs to be coordinated within a system and outside of a system
• Current and future value-based contracts need to be considered and staff needs to be trained on them and there can be on average 5-7 contracts physicians are working within
• Keep up to date on changing medications, interactions and other emerging technologies
• Remain compliant with continuing education requirements and other state/federal mandates.
As physicians are burning out at an increasing rate, health plans and health systems are focused on not only retaining patients and margins, they are also focused on how to retain their physician networks. While the thousands of products and apps in the market claim to assist in improving one or more aspects of the physician or patient experience there is a short- to medium-term reality that anything providers and payers add takes time away from something else and there isn’t enough time in the day to complete what needs to be done.
Recently, I sat down with Don Turner, Chairman of Digital Health Impact and Transformation (DHIT) Global to discuss the challenge of how products come to market and how our organizations are trying to bring the right solutions to the right people at the right time. We discussed two core principles on how products should be developed to better meet the needs of health systems rather than just developing products the vendor wants to sell.
1. Start with this question to health care executives: What are the key problems you are trying to solve and if you could only solve one right now what would it be? The current quip in the health care space is “if you’ve seen one value-based contract, you’ve seen one value-based contract.” There is significant variance in what combinations conditions, services, and outcomes are being incented and/or penalized in value-contracts. Additionally, there is significant difference in the amount of dollars in play from contract to contract and system to system. This is further complicated by physicians, hospitals, and payers in multiple value-based arrangements at any one time. A health system and Aetna might be focused on managing diabetics while Medicare is asking the same system to put up 3% of their reimbursement on reducing avoidable readmissions.
Every provider or payer is going to have a different set of things that rise to the level of priority, so assuming any one product is the solution they need minimizes the complexity of healthcare and stressors on people’s capacity to change. For example, if a health system has 65% of their value-based incentives in treatment of COPD and avoiding readmissions, pitching a system that they need to stop initiatives around those areas and implement your diabetes management approach to save tens of millions of dollars fails to help a health system implement the solution they need most right now. That doesn’t mean the system doesn’t value improving care to their diabetic patients but rather the system is prioritizing areas where they most need improvement and understands they have limited capacity to add new things on their systems plate. Show how whatever you are pitching fixes or enhances the current approaches to problems health care executives want to solve today and tomorrow.
2. Articulate how anything you are providing gives physicians time back but acknowledge the true time cost. Almost nothing works well as plug and play. For any product or solution to be truly successful there needs to be buy-in from leadership and an owner, training on how to use the product, and regular, effective communication to socialize the product and maximize its use and effectiveness. People are getting pulled in multiple directions between core functions and process improvement, it is extremely difficult to grab people’s attention with one more new thing. Be honest about how much time is needed to achieve the optimal results in terms of patient impact but also be clear on how much time it can give physicians back on other activities. Remember that time is a fixed resource and physicians feel like they already don’t have enough of it, the best solution not only offsets the time it takes to use by saving time somewhere else but it gives physicians time back to see more patients, see their families, or better deliver care and succeed in their contracting.
The good news is health care is integrating and incentives are realigning. This is good for the patient who should benefit from better outcomes, this should reduce cost growth for payers over time, and should also give physicians an opportunity for greater margins down the road. There is an opportunity for smart products to be a part of this transformation but they need to understand the needs of the individual system, not the aggregate health care market. Everyone is trying to solve slightly different problems in this new health care landscape and people need tools built to help them address their ecosystem.
Thomas Friedman is the Group product manager in payer and community health at Relias. He brings executive experience working in healthcare payer strategic planning, finance, government affairs, and analytics having most recently served as the director of policy, planning, and analysis for the State Health Plan of North Carolina.