embracing healthcare consumerism

Embracing Healthcare ConsumerismMark Herzog, President & CEO, Holy Family Memorial

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Holy Family MemorialMANITOWOC, WI

•Manitowoc County Pop. 82,000

•City of Manitowoc Pop. 55,000

• Ice machines, Wind Towers & Netflix

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Milwaukee

Green Bay

Madison

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Independent, Single Market, Tightly Integrated System

• Laboratory for integration, improvement & innovation

• Physicians: 90 provider employed multispecialty group

• Hospital: Orthopedics, OB, Interventional Heart Center, Cancer

• 1200 employees avg tenure 14 yrs

• Community grounded & focused, Faith-based organization

• ACHE Congress Presentation 2010-2016

• AHA’s Healthcare Forum, Societies & Summits

• University of Michigan HMP lecture/mentor

• CoDev 2013 International Open Innovation

• National Center for Healthcare Leadership

• Becker’s 150 Top Places to Work in Healthcare

• New North Workplace Excellence Award

• Innovation Award from Insight Magazine

• AHA’s Most Wired multiple times

• American College of Surgeons top 75 Cancer Centers in America 2015

• American Heart Association Designated Heart Attack Receiving Hospital 2014-present

The Holy Family Memorial Story

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Core Belief: Doing What’s Right

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“Start by doing what is necessary; then do what is possible; and suddenly you are doing what is impossible”

St. Francis of Assisi 1181-1226

“Are you meeting the needs of a community, or the needs of a corporation?”

Sr. Laura Wolf 2013

Holy Family Memorial’s Mission

Holy Family Memorial is a network of health professionals who,

rooted in the healing ministry of Jesus Christ, provide services to help

Individuals and our communities achieve healthier lives.

Adopted 2008

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• The most effective evidence based approach possible

• The most cost effective, safest, highest quality and greatest value

• Achieve the greatest long term benefit to the patient and society while minimizing physical and financial risk

RIGHTCARE

RIGHTSETTING

RIGHTOUTCOMES

RIGHT CARE MODEL:Core Care Belief

“Moving care to the right” is what makes HFM’s processes, outcomes and value unique today and for tomorrow

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Top-Quadrant Performance in Quality and Efficiency

All Commercial Payers, Wisconsin (Source: BSG Analytics, 2014 data)

HFM is identified among the most efficient hospitals in Northeast Wisconsin

*Data is Severity and Risk Adjusted

Health System #1

Health System #2

Health System #3

TRANSFORMATION IMPACT ON

Hospital Use and Cost to Society

Brown

Manitowoc*

150%

75%

100%

Outagamie

Regional Growth in Hospital ChargesPopulation Adjusted 2004 through 2014

Source: WHA 1/9/16

88%

125%

76%

*If HFM were the only provider the increase would have been 22%.

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200%

300%

*Includes Appleton and OshkoshSource: HTR 9/20/14, Wisconsin Health Insurance Rankings Report 10

Regional inflation in monthly health insurance large group premiums from 2000-2015

100%

Fox Valley*

247%

Green Bay366%

Manitowoc225%

TRANSFORMATION IMPACT ON

Hospital Use and Cost to Society

“Starting right about here, our profits are faith based.”

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Population Health ModelUNIVERSITY OF WISCONSIN

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Policies & Programs

Health Factors

Health Outcomes

Health Behaviors (30%)

Clinical Care (20%)

Social & Economic Factors (40%)

Physical Environment (10%)

RANKINGS BASED ON THE FOLLOWING:

FOUR TYPES OF HEALTH FACTORS MEASURED:

Adapted from Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute County Health Rankings

Source: flowingdata.com

More Bars

More Grocery Stores

Where Bars Outnumber Grocery Stores

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At 21st & Franklin Street September 2012

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21st & Franklin Street, Manitowoc WI June 2013

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Meet Harold, HFM Customer

Harold is a retired long-term resident of Manitowoc who now finds enjoyment in his time gardening, fishing and golfing.

He’s an attentive family man who finds strength in his church and community.

When it comes to his family’s healthcare, he is frustrated by the rising costs and complex discussions about treatments. He doesn’t like doctor turnover. He sees himself as in charge, but in reality, his wife plays a strong role in his healthcare decisions.

Harold likes Holy Family Memorial because he sees it as a reliable organization with caring services and good doctors.

He feels reassured and valued there-- like he is truly seen and understood as a person and patient.

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Meet Emily, Prospective HFM CustomerEmily and her husband Mark are expecting their first child. Manitowoc is home to her now but she was not born here.

Emily tries to find a healthy balance in her work and life. She uses technology to help her stay in touch with family, schedule her social life and stay current on the best ways to stay healthy.

She currently considers herself to be very healthy, and therefore chooses to use walk-in care instead of beginning a patient relationship with a primary care physician. This will change now, as she needs an OB.

She appreciates getting as much information before and after her appointment online from the doctor and would prefer to actually schedule her appointments this way too.

When she thinks about HFM, she worries it only covers basic care and will not provide her with the highest level of care she might need for herself and her future family.

When visiting the clinic, she would like to feel like she is the only person the clinic cares for that day--listened to and involved in the decisions.


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The Good, the Bad & the Ugly

• A very inefficient way to produce miracles.

• The “system” that has evolved reflects the best and worst of competition, innovation, the clash of capitalism/community, societal inequities,excellence and economic impact.

• Diversity & choice = inconsistency & fragmentation.

Consumerism in transition.As one customer researcher puts it…

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The Eyes of the Consumer

"I pledge allegiance to myself and not to the maze ofthe United States of America healthcare system, norto the customer-averse bureaucracy for which itstands, one industry, with care for the rich, andjustice for the few".

~Ryan D. DonohueNational Research Corporation

January 2015 Governance Institute

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The Consumer Environment Today

High Deductible Health Plans dominate insured market; family plans $5000-$8000-$14,000

Uneven local economy: $42,000 per household income, population aging and shrinking

Tools for transparency developing but still lack access and understanding

Difficult to engage consumers’ prevention benefits because they fear follow up care costs

“First we’re going to run some tests to help pay off the machine.”

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“Quick” Fix of the DayHigh Deductible Health Plans

Goal: Involve patients economically in their care.• Leads to greater personal engagement.• Transfers most risk to the patient.

Rationale: Insurers & payers haven’t resolved how to buy value in healthcare. So, make individuals pay lots more for it. After all, they’ll figure it out.

What could possibly go wrong?

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High Deductible Health PlansQuick Fix or Rocky Road?

Quick FixLower premiums for much less coverage

Direct consumer involvement in decisions

Risk transferred to consumer, provider, society

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Rocky Road Consumer simply avoids care; <15% actually use their HDHP insurance.

Out of pocket costs increased 5-10x. Wages stagnant.

Choosing needed vs. unneeded care?

How patients have adaptedAdult care delayed/foregone because of cost.

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10%

15%

5%

Acute Visits

EDVisits

Chronic Care Visits

Checkups Tests

HDHP

Traditional

“Delayed and Forgone Care for Families with Chronic Conditions in High-Deductible Health Plans”, Journal of General Internal Medicine, 2012. Alison A. Galbraith MD, MPH, Stephen B. Soumerai ScD, Dennis Ross-Degnan ScD, Meredith B. Rosenthal PhD, Charlene Gay BA, Tracy A. Lieu MD, MPH

“Try to focus less on a cure and more on a treatment you can afford.”

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How’s it Going so Far?

“If I believed in reincarnation, I would think that American hospital CEOs must have done something wicked in an earlier life to be condemned to their current role in this life.”

~Uwe Reinhardt

Renowned Health Economist

MODERN HEALTHCARE

January 12, 2015

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“Quick” Fix? Engaging the Consumer

The greatest innovations over the past decade lie in beginning to really engage patients in their care.

Intelligent health plans encouraging RightCare. Patient Cost Transparency- estimates up front. Patient Portal: Own your report card. Direct Access: Own how you use care. Web-based access, tools and education. Trusted relationships.

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Patient Engagement Quick Fix or Rocky Road?

Quick FixEncouraged by Federal funding, most consumers will be able to access personal health information and coordinate some of their own care by 2018.

Some providers and all retailers offer direct access to care.

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Rocky RoadPopulation health is based on primary care, currently undergoing a tsunami of change.

Consumers don’t usually know where to start!

Industry not prepared to deliver consistently or truly engage consumers.

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What story are we telling?

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Caring, compassionCaring, long term sincere interest in patient’s whole healthIntimately involved with patients as individualsCompassion, empathy, sincerity

Caring, Compassionate Place


Interviewees see us as the caring, local provider

Hospital Building

Their local HospitalLocalCommunityWe are part of the familyBeen in the community so long it feels like family

The “Local” Provider

What is the first word or idea you associate with Holy Family Memorial?

N=47 Board, Patients and Community

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Brand Personality

The kind of person who...

Compassionate, Creative and Understanding.

• Shovels my driveway when I’m away without being asked.• Throws a festive and fun surprise party!• Makes me feel like I’m the only person who matters.


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Delivering “Inspired Caring” to Emily, free-agent consumer

• A day of Inspired Caring at HFM (entries on what happened today - Facebook)

• Inspired Caring Talks at the worksite


HFM RightNow: • E-Visits & On-Site Clinics

• My Personal HFM Health Record

• Direct Access Lab Testing

• Develop an HFM phone “App”

• Notifications by mobile phone/text/tweet

Direct Access Lab Testing Trends

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Why E-Visit?

Telemedicine is natural for 'next generation' of docs. ~Fiercehealthit.com

Patient-friendly e-visits improve access, streamline payment. ~Healthcare Financial Management Association

Almost one in six doctor visits will be virtual this year. ~Computerworld

Why Telemedicine's Time Has Finally Come.~Forbes.com

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Scope of treatment

• Acne

• Athlete's foot

• Canker or cold sore

• Cold, sinus infection, or sore throat

• Constipation and/or diarrhea (Irritable bowel syndrome)

• Diaper rash

• Eczema or dermatitis

• Female bladder infection (UTI)

• Hay fever/allergies

• Heartburn or acid reflux (GERD)

• Influenza (the flu)

• Influenza prevention

• Jock itch

• Malaria prevention

• Medication refill for mild or exercise induced asthma

• Motion sickness prevention

• Pink eye (conjunctivitis)

• Quit tobacco

• Refill current oral birth control medication

• Ringworm

• Tinea (Fungal skin infection)

• Vaginal yeast infection

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HFM Right Now Visit Flow

1. Interview

Software-guided interview

collects the patient’s history and symptoms.

2. Diagnosis

Holy Family clinician reviews

and makes a diagnosis in

minutes.

3. Treatment

Patient reviews their treatment plan and fills prescription

instantly.

HFM Right Now10/14/15 - 12/31/15

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1625

40

16

0

TotalEncounters

Completed Triaged Abandoned Diagnosed Unable toDiagnose

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HFM Right Now01/01/16 – 10/14/16

306

82115 109

66

16

TotalEncounters

Completed Triaged Abandoned Diagnosed Unable toDiagnose

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Delivering “Inspired Caring” to Harold, seasoned customer

IDEAS: Customer focused and well understood medical home model- team of caregivers

Clinic experience focused on consistency, respect and trust


Notifications by phone & text; portal

Integrate full medical clinic into skilled/LTC facilities- one stop

Care Navigators

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Brand Story

RitualsPersonification

Product/Service

Rational Alibi

Brand Icons

Tagline/languagebrand model

Brand PillarsCompassionInnovative CareStewardshipExcellenceRespect

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Brand Personality:

Compassionate, Creative & Understanding

Brand PromiseInspired Caring

To feel safe and cared for

InnovativeCaregiver

Worldview:Life is a precious miracle, inspiring us every day to seek new and better ways to care for the whole person-mind, body & spirit.

Foundation Story:1899, With no resources, Mother Alexia of the FSCC rallies the community to start an innovative hospital for the community and mariners of Manitowoc County

Questions?

embracing healthcare consumerism

Documents