LAS VEGAS—What do consumers want when they interact with the healthcare system?

The answer may partly depend on their age.

At this week’s annual meeting of the Health Information and Management Systems Society, the themes of consumerism and patient engagement were front and center.

Patients are paying for a larger share of their healthcare through high-deductible health plans, and technology is playing a role in helping them find lower-cost care settings and prompting them to pay their bills.

And as more providers get paid based on health outcomes, the hope is that technology will be able to guide people toward healthier behaviors.

Yet the people who are the most tech-savvy aren’t necessarily the largest users of healthcare; those patients tend to be older and poorer.

“When you talk about technology engagement with patients and consumers, they each want different things,” said Tamara St. Claire, chief innovation officer at Xerox Healthcare. “We’re going to have to be flexible.”

For older generations, “It’s really about making their chores about healthcare easier,” she said. For instance, they’re most interested in technology that helps them remember to take their pills or schedule an appointment.

Millennials, meanwhile, tend to be research-focused; they’re finding their providers through online reviews, taking advantage of telehealth services and showing up to appointments armed with information about their conditions and potential treatments.

They’re also far more price sensitive, which means they be the most likely target for price transparency tools.

More than 80% of people under the age of 50 are shopping around for providers, compared to 69% of baby boomers and 56% of people older than age 70, according to a survey that Xerox released at HIMSS.

“People are putting off care because they can’t afford to pay for it,” St. Claire said. It’s strongest with the millennial generation, she added.

Providers are using technology to rethink how they relate to and communicate with their patients, said Hal Wolf, a director at the Chartis Group, an advisory group. They’re also paying increased attention to what’s happening to the patient during their end-to-end experience with the health system, from finding a doctor to paying their bill.

“Patient as consumer” is one of the investment themes this year for San Francisco-based Dignity Health, which every year works with three to five early stage technology companies to take them from startup to commercial enterprise.

That topic also has been getting significant attention at HIMSS, said Rich Roth, Dignity’s chief strategic innovation officer.

“I think there’s a big theme of patient engagement and that’s just such a huge opportunity, especially if you view it more holistically than just Joint Commission,” or patient satisfaction surveys, he said.

HIMSS’ core audience used to be chief information officers back in the days when the primary technology concern was implementing an electronic health records system, said Wolf, who is also the incoming vice chair on the HIMSS’ board of directors.

But today’s technology needs involve strategic concerns like revenue-cycle management, data analytics and population health management.

“Now we’re seeing the CEOs coming to HIMSS,” Wolf said. “They’re coming because they can see so much in one place. It’s all being driven by operations.”

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Substantial interoperability has yet to be achieved across healthcare, a recent report to Congress from the Office of the National Coordinator’s Health IT Policy Committee shows, held up by reasons including lack of standardization and security concerns.

Here are the five major roadblocks to more widespread data sharing, according to the ONC:

1. Lack of universal standards-based EHR systems’ adoption. True health information exchange won’t happen until a critical majority of providers have installed and are successfully capable using EHRs. Incentive programs have increased adoption nationwide; policymakers must continue to help the remaining providers make the transition.

2. Impact on providers’ day-to-day workflow. Technology has reached the capability of making interoperability possible, but process innovation has yet to catch up. Existing processes must be redesigned to incorporate new technologies – a more prominent problem in the healthcare arena, mostly due to a lack of standardization.

3. Complex privacy and security challenges associated with widespread HIE. Adequate privacy and security is at the forefront of healthcare institutions. The ONC has found HIPAA misunderstandings and privacy law translations detrimental to security, while electronic system design and accommodation rules for privacy laws have been formidable.

4. Need for synchronous collective action among multiple stakeholders. It’s crucial for all participants to agree on the “rules of the road,” especially related to the above issues, if effective interoperability is possible. Standards and rules for patient access must be uniform to bridge existing and future networks.

5. Weak or misaligned incentives. Economic incentives for interoperability can discourage providers. And traditional fee-for-service payment models aren’t enough to persuade providers the extra work is worth it. EHR developers have focused more on a fee-for-service model in the past, thus lowering the demand for interoperability.

Included in the report are ONC’s recommendations on processes to establish over the next six months to foster better interoperability. They are:

1. Develop and implement meaningful measures of the health information exchange-sensitive health outcomes and resource use for public reporting and payment.

2. Develop and implement HIE-sensitive vendor performance measures for certification and public reporting.

3. Set specific HIE-sensitive payment incentives that incorporate specific performance measure criteria and an implementation timeline, establishing clear objectives of required accomplishments under alternative payment models.

4. Convene a Summit of major stakeholders co-led by the federal government (such as, ONC and CMS) and private sector to act on the ONC roadmap to accelerate the move toward interoperability.

To be successful, interoperability will require “multiple stakeholders to act in a coordinated manner,” according to the report’s authors.

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HHS says few states have taken them up on an offer to receive federal funding for data-mining, which would allow their Medicaid fraud units to search claims. States say they don’t need it, even though the improper payment rate has nearly doubled as the number of enrollees surges.

A 2013 HHS rule allowed state Medicaid fraud control units to use federal funds for the audits, which the agencies previously had been explicitly prohibited from doing.

Only California, Indiana, Louisiana, Michigan, Missouri and Oklahoma have been granted permission to conduct the data-mining. Florida’s Medicaid fraud control unit received approval from the CMS to conduct data-mining as part of a Section 1115 waiver in 2010.

Earlier this year, the CMS revealed that the Medicaid improper payment rate has jumped from 5.8%, or $14.4 billion, in fiscal 2013 to 9.78%, or $29.12 billion, in fiscal 2015.

Richard Stern, director of the Medicaid Fraud Policy and Oversight Division in HHS’ Office of the Inspector General, said he wishes that other Medicaid fraud control units would get on board as increased use of data-mining could be an effective tool to reduce improper payments, especially those relating to fraud.

Still, many of the states reached by Modern Healthcare said they believe their state Medicaid agencies or health departments are producing enough leads from their own data-mining efforts for them to pursue.

“We’ve yet to encounter a situation beyond (our Medicaid agency’s) capacity to provide timely information that would necessitate the extensive investment in personnel, infrastructure, and equipment to essentially duplicate those resources,” said Josh DeVine a spokesman for Tennessee Bureau of Investigation.

Spokespeople for fraud units in Arkansas, Colorado, Massachusetts, Ohio, South Dakota, Texas and West Virginia made similar remarks.

State Medicaid fraud units in Hawaii, New Jersey and Rhode Island are evaluating how data-mining could benefit them, while a spokesman for New York said it may soon seek a waiver with HHS’ OIG.

Some said they want to see how other states fare before enlisting the HHS’ help.

“We are hoping that larger states can make progress in developing a road map for effective implementation before we commit to a specific data-mining strategy or technology,” said Carl Kanefsky, a spokesman for Delaware’s Justice Department.

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Consumerism has been a trending topic in healthcare for several years. Some warned that the increase in consumer research could negatively affect doctor-patient relations, as patients felt empowered to challenge practitioner wisdom through their new found online knowledge. While others extolled the benefits of it, as it might force doctors to take a hard look at their off-the-shelf treatment plans and come up with better solutions for patients.

Consumerism was born, but not fully baked. Fast-forward to last month, and we see consumerism expanding in healthcare quickly. Geisinger announces refunds for unsatisfied customers! It’s shocking! It’s alarming! It’s… nothing new, especially if you’ve been living in the world of the consumer.

But, traditional consumer-oriented industries and healthcare are different. Simply modeling tactics in healthcare after tactics in other industries won’t work. I’m not looking to sign up for a loyalty program with my urologist anytime soon. Instead, valuable lessons can be learned by looking at this from a higher level. Rather than looking at other consumer-oriented industries’ tactics, looking at strategies and processes can give us better insight into what will make a greater impact on the future of the healthcare experience.

The First Step: Understand the Journey

To maximize the patient experience, you have to first understand the full patient experience. It’s not enough to look at a particular point in time, you need to look at the whole process.

The healthcare patient journey isn’t that far off from the journey of consumers in other industries, but there are important differences.

The healthcare consumer and retail consumer journeys follows a similar path, but the tech opportunities differ greatly.

In many industries, the need and research phases see the highest investments in digital technology, but for healthcare, digital technologies can have a great impact on the lives of consumers further down the path. While many consumer brands step away at the point of purchase; healthcare, and its supporting technologies, can often do the most good starting at the point of care.

Step 2: Consider Purpose

Once you have an understanding of the consumer journey, the next task is to define your organization’s purpose and determine how it shapes your interactions with consumers as they move through the process, and interact with your brand both on- and offline. The purpose should be communicated by the way your employees interact with patients, as well as reflected in your online presence. A clear purpose will help you focus on the right strategies and tactics for your business, and keep you from getting distracted by fads and flashy ideas.

If we look back at the Geisenger example, we can ask how that fits with purpose. If the purpose of the business was to maximize revenue, it wouldn’t fit. A higher purpose such as, “Improving the lives of community members” fits better. A community-oriented purpose might have improved patient experience as a strategy, and refunds for dissatisfied patients as a tactic.

Step 3: Create Purpose-Driven Tactics for Every Phase of the Journey

Once we have a consumer journey mapped out and a purpose identified, we can start to map out the strategies and tactics that will support our purpose throughout the consumer’s journey.

For arguments sake, let’s assume your purpose is the one outlined above: “Improving the lives of community members.” If we look back at our consumer journey, we can start to think through the strategies and tactics that will make a difference in the lives of community members. From a technology standpoint, in 2016, consider the following for each phase to support your purpose and enhance the digital patient experience:


In traditionally consumer-centric industries, generating needs is a common practice. Did you need a phone that could connect to the internet in 1995? Do you now? In traditional healthcare, generating needs is less common. In community-driven healthcare, generating needs will be an important task. You will need to do more to ensure that the population is aware of its needs.

The technology is still pretty light in this phase, but there are a few supporting tactics that healthcare companies can leverage to generate and understand general and individual patient needs. For example, you could use your CRM or EHR system to email surveys to patients to gather need-based data to better serve and understand your patients. The data gathered from these surveys can help you identify potential patterns among patients to identify needs, and also use the data to better personalize each patient appointment and experience. Healthcare companies can also use their CRM or EHR systems to send out emails to patients to notify them of flu shot availability, or promote wellness programs.


As we continue in the shallow(ish) end of the technology pool, the research phase is all about web presence.

Reflecting on our example purpose — Improving lives of community members — a website can help consumers as they research by providing the right content. A content strategy should support tools that increase health knowledge and strengthen health literacy of the community. Following this purpose, your website should help consumers understand conditions and recognize when they need to make an appointment. It should also provide them with the information they need to get a feel for what it will be like to work with your practice and whether the practice will be a good fit for them.


On the surface, the booking phase seems to be one that is particularly inward looking. The way in which it supports a health system is obvious (more appointments = more money), how it supports the community at large is less so. However, this phase is essential to improved community care and patient experience, as booking can be a major obstacle to an individual’s ability to receive care. Health systems have begun to make the process of booking easier on patients within an EHR, but for the community at large, and potential new patients, the process is still cumbersome.

Removing barriers to entry by providing a new mix of appointment booking options can greatly improve the health of the community. The mix of tools for booking appointments should shift from the phone-only system that exists in many practices to a system that supports digital tools. Yes, booking through a website, but also chat on that same website, as well as text to schedule and potentially even integrations with third party chat apps like WhatsApp or Facebook Messenger. Third party apps may sound wild, but a similar tactic has been working in China through WeChat for the past year. As the demographics and usage preferences of the healthcare audience shift, this type of pattern will become more commonplace.

When it comes to care, the health of the community can be improved by extending the reach of a health system. This can mean a number of things, including an expanded role for telehealth. Video chat has gained momentum recently and should continue to do so, particularly for preliminary evaluations, as it allows doctors to reach patients quickly and also in areas that may not be readily accessible to healthcare services.

When a patient is actually in the office, it’s important to consider the shift in the doctor’s role. Doctors and their teams can no longer simply be practitioners, they must also be educators. Appointments should turn into education sessions. Instead of quickly jumping to a prescribed approach, doctors should use tools to explain options clearly. Every room now has a computer and a screen in it, it’s time to turn those outward and use them to facilitate explanations of options. Other new tools used to display 3D models of the body will also become important.


After the appointment, the real work begins. Patients are expected to do more on their own than ever before, and they need to be educated and prepared to take on the balance of care that occurs outside a clinical setting.

This can mean a number of things. To begin, better sharing of appointment notes, apps for tracking progress, and improved communication between appointments can help prepare patients. Native and web apps can facilitate much of this work, and the right strategy depends on the usage patterns of your audience. The key is to find the right tactics to connect with and enable consumers.

Step 4: Observe and Optimize

Perhaps the best thing healthcare can adopt from consumer-centric industries in 2016, is to never stop learning and improving. Collect data, conduct user research studies, find out what works and what doesn’t. The tactics mentioned above are a great starting point for a single purpose next year, but the key to deploying the right tactics for your consumers is to never stop learning and improving.

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People over the age of 60 are likely to be driving the healthcare market around the world in less than five years, according to global research firm Frost Sullivan.

By 2020, Frost Sullivan estimates 22 percent of the world’s population will be age 60 or older. In order to encourage independent living, IT service providers need to support the development of smart homes and communities that leverage technology-based solutions for the aged, researchers conclude.

The report identifies three anticipated market trends that could help aging people participate in their healthcare:

  1. High adoption of remote monitoring devices, which are useful for personal physicians, nurses and family, will help all senior citizens who prefer to stay in their own homes.
  2. Information and communication technology-based assistive technologies, including computer-based or other electronic communication aids, object locators and reminder systems, will also gain traction.
  3. Employing robots as a support system will emerge as an excellent aged care model.

The aged population’s requirement for specialized medical technology will create strong long-term opportunities for wireless network, IT service and software solution providers, researchers point out, so, service providers are making concerted efforts today.

“Wearable devices are increasingly becoming an integral part of senior citizens’ lifestyle,” said Frost Sullivan Information Communication Technologies Senior Research Analyst Shuba Ramkumar, in a news release. “While it is true that a wearable device or global positioning system tracker does not in itself provide better care, it can facilitate remote monitoring of senior citizens and help prevent major accidents. For example, it can prevent a patient with memory loss or dementia from going outside and endangering themselves.”

However, seamless connectivity, irrespective of whether it is low/high bandwidth or short/long range, is important for the accurate functioning of the aged care ecosystem, Ramkumar added. Even the smooth operation and integration of assisted living technologies in the healthcare sector is dependent on the resolution of connectivity, data privacy and regulation issues.

Today, the need to certify some community and technology devices for deployment and restrictions on the use of data collected by devices prove to be major obstacles for the end-user market, according to the report. Nevertheless, development of stringent data security regulations and partnership with healthcare technology companies can help overcome some of these challenges.

“IT service providers must collaborate with large private and public aged care providers to design and deploy solutions that integrate with the healthcare system,” said Ramkumar. “For residential care communities, they should also provide end-to-end Internet of Things platforms to enable communication between smart devices for monitoring patient activity. These solutions are necessary to integrate home/residential care systems with the central healthcare system to facilitate automated healthcare delivery.”

The Frost Sullivan report supports the same concepts Eric Dishman, director of health innovation and policy at Intel, has been talking about and advocating for years.

As he sees it, the graying of the Baby Boomers offers and requires new ways of delivering care, and at the same time it presents new market opportunities.

Back in 2004, when Dishman testified before the U.S. Senate Special Committee on Aging, he noted the world was graying rapidly, and healthcare was yet to come up with healthcare innovations needed to care for seniors, and particularly to care for them “in place” – in their homes.

He called on senators to use their imaginations.

“Imagine a pair of socks that can detect swelling in an older person’s feet and relay the change to a caregiver. Picture a “smart” cat that can calm an agitated Alzheimer’s patient by purring at their bedside. Envision tracking devices for the soles of shoes that can monitor an older person’s gait for irregularities, and ultimately prevent a crippling fall. These are just a few of the innovations that promise to transform the aging services field — from an overburdened safety net to a highly efficient preventative system.”

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