How practices can keep patients in the age of consumerism

June 12, 2019
Todd Shryock
Volume 96, Issue 12

In the past, a practice could offer a handful of Saturday appointments and that was about the only convenience patients expected. But patients are now demanding the same expectations from practices that they do from restaurants or retailers, and if they don’t get them, they find another doctor.

There’s a growing consumer force making its presence known in medicine: convenience.

In the past, a practice could offer a handful of Saturday appointments and that was about the only convenience patients expected. But patients are now demanding the same expectations from practices that they do from restaurants or retailers, and if they don’t get them, they find another doctor.

“If practices don’t adapt, they will see patients slowly migrate elsewhere,” says Susanne Madden, MBA, president and CEO of The Verden Group, a Nyack, NY-based healthcare consulting firm. Madden has first-hand experience, having recently switched providers herself.

“I was on hold for 12 minutes to book a simple annual physical,” says Madden. “I used that time instead to fill out a transfer medical form and booked an appointment with a larger practice online and picked a new doctor.”

Twelve minutes may not seem like much, but it was enough of an inconvenience for Madden to make the switch. She says if practices want to survive, they need to cater to consumer behaviors in medicine, even if there are no other doctors in town. “Some rural doctors might get
patients not because they are amazing doctors, but because there aren’t many options,” she says. “But the day a competitor moves into town with a higher level of care access and communication, they’ll be out of business. They need to take the time to up their game.”

Competition is coming from urgent care facilities as much as other medical practices, experts say, and often have the funds and expertise to give consumers exactly what they want and redefine what an appointment with a doctor looks like.

Take GoHealth Urgent Care. Backed by private equity, its mission is to “redefine the healthcare experience.” It has 125 centers and is opening 30 more in the next year.

GoHealth partners with local health systems and builds facilities with convenience at their core. Patients can compare wait times for GoHealth facilities online, make an appointment at the one with the shortest wait, and upon arrival, check-in via kiosk. Office designs are bright and open, and patients enter exam rooms where high-tech electrostatic glass walls change from clear to frosted for privacy. All equipment is either in the room or brought to the patient, so no moving about the office if, say, an x-ray is needed. Wall-mounted screens show the patient what the doctor is looking at and entering into the health record, and there is no checkout when the patient is finished-they just leave.

“We compare ourselves to a restaurant, where consumers will not return after one or two poor experiences,” Dev Ashish, CIO of GoHealth, said at HIMSS19, an annual health IT convention. “The same rules apply to healthcare.”

He said that instead of relying on the long patient satisfaction questionnaire with a low response rate that many in the healthcare industry use, GoHealth relies on a simple Net Promoter Score, which asks how likely someone is to recommend their services to a friend on a one-to-10 scale. Their response rate is between 40 and 50 percent, providing GoHealth with lots of data and is the same method used by the nation’s largest retailers. The company follows up with anyone offering specific feedback, good or bad.

The transformation toward consumer-focused convenience in healthcare is similar to what he saw in the banking industry, says Mat Kremke, MBA, the vice president of the American Osteopathic Association. “When I started [in banking], we would sit at a desk and people would just come to us,” says Kremke. “Then banks added Saturday hours, then they opened up branches in grocery stores, then extended hours to 9 p.m.-if they didn’t adjust, they would be forced to close down. The medical industry is next on the list for consumers, who expect convenient-to-use digital platforms.”

Consumer expectations are changing in part because they are shouldering more of their healthcare costs through higher premiums, copays and deductibles, says Madden. “I’ve seen patients seeking out everything from price transparency to wanting the same sort of service they can get elsewhere,” she says. “If they can book a hotel or flight at midnight, why do they have to call during the workday to book an appointment and get to spend time on hold for the privilege of doing so? They are looking for the same level of service and access as they would get from a service business.”

Adapting to the patient as consumer

The first step to adjusting to the patient-as-consumer is to understand how they view healthcare. “There needs to be an acknowledgement that we are in the service industry,” says Ken Hertz, FACMPE, chief consultant for the Medical Group Management Association. “We provide a service, just like a restaurant. We have to see ourselves the same way.”

The biggest thing consumers want is convenience, even more so than a relationship with their doctor.. “They want their interaction to be easy and simple,” says Hertz. They are looking for convenient appointment times that fit their schedule and visits that are fast and efficient, he adds. In addition, they want to understand all the costs, including whether any referrals are in or out of their network, and be given online payment options.

While this list may sound daunting to a small practice owner, experts say there are some basic steps that can identify the conveniences most important to their patients. The first step is to ask the patients, says Madden.

“Every day as a patient is checking out, hand them a two- or three-question survey, and that will tell you everything you need to know,” says Madden. If a practice is looking at extending office hours, ask what days and times are most convenient for them. “Also, don’t forget to survey your staff for their ideas,” she adds. “They are hearing from patients and observing when the process begins to break down and patients become unhappy.”

Kremke says to also look at what conveniences competitors are offering, and leverage technology to help be more efficient and offer a positive experience. This means offering online check-in, easy payment options, and increased communication. “The patient is expecting the experience to be seamless and not time consuming, and wants it to be almost as quick as ordering a drink at Starbucks,” says Kremke. “They want to see the physician as quickly as possible and walk out.”

Finding the right technology solution is important, but everyone, including the staff, has to buy in to the commitment to customers, experts say.

“You can’t do things the old way; things have to change,” says Hertz. “Every team member in the practice has to be engaged in the vision, mission, and values of the practice and needs to be held accountable for creating an experience for patients that is second to none. One of the most important things anyone can do is just listen to people.”

Prioritizing solutions

When survey results are analyzed, certain patterns of what patients are concerned about will start to emerge. Madden says to identify the top three and then do a follow-up survey using open-ended questions to get more information about these areas. This will provide the details to help the practice figure out how to meet patient demand, whether it’s a piece of technology or just a different process.

She says it’s vital to involve the staff when discussing survey results and potential improvements. “The buy-in piece is important, and without it, you won’t be able to implement anything,” says Madden. “You will end up with a lot of information about what’s wrong, but not have any mechanism to transform the practice.” Focus on the first three areas identified in the surveys and implement the solution that fits the culture and budget of the practice. “Once some meaningful changes happen in the practice, the staff will be much more willing to keep going,” she adds.

Start small to increase chances of success, experts say. For a primary care practice, the mere thought of taking the time to implement process improvements can be overwhelming. “Pivot slowly and build on your early wins,” says Madden. “You want to build a culture of ongoing process improvement.”

These changes will ultimately boost the viability of the practice. “What’s good for the patient is good for the practice,” says Alex Mangrolia, director of product management and digital transformation for Los Angeles-based Practice Builders, a healthcare consulting firm. “The practice is in business to earn money, and making customers happy is vital.”

Mangrolia says physicians should check with their EHR vendor to see what tools might be available through the patient portal. For example, if an online scheduling app is available that already connects to the EHR, using it might make more sense than looking for a solution that doesn’t integrate or requires additional IT work.

“One of the biggest things you want to look at when evaluating technology solutions is how easy does it tie in to the rest of your practice,” says Kremke. “The last thing you want is the need to sign in to 15 programs for one patient.”

Despite the demand for more convenience, Hertz warns against losing sight of building relationships with patients. “If you can offer all the things the patient wants in their care as well as consumer-like convenience, then you have a win-win situation where you can keep the patient over a long period of time. They want to know that you as a physician will really hear their issues and have a connection with them. But if you don’t do it in a convenient and accessible way, the rest doesn’t matter.”

Spreading the word

Once a practice adds new conveniences, experts say it needs to focus on getting the word out to both existing and potential patients.
One way is to use normal patient interactions to educate them about new options. “If a patient calls in to make an appointment, that’s a good time to mention that they can make an appointment through the portal now, how to register and how to use it,” says Mangrolia.

An email marketing campaign to existing patients, plus printed flyers for in-person visits can also be effective in highlighting new services, he adds, noting that it’s important to match efforts to patient preferences. “Some people might not respond to text messages or emails, so you have to call them,” he says.

Madden says to continue using surveys to educate patients. A check-out survey could highlight the changes the practice has made, ask if they noticed the changes and then rate them. This can lead to additional marketing through social media, such as posts that, for example, proclaim, “82 percent of our patients say our new online scheduling is a major convenience.”

Hand out cards with the addresses of websites such as Yelp, Facebook and Healthgrades and invite patients to review the practice. “If you don’t ask, you won’t get them. Having hundreds or thousands of positive reviews can cancel out the few people that had a negative experience,” she adds. “This will also make you look fantastic online and is a way to get more business.”

Call out all the changes on your website and use it to illustrate how this makes the practice  different compared to the competition, says Madden. Outline all the ways the practice values its patients’ time and the conveniences it offers.

Hertz suggests that whenever possible, illustrate the changes from the patient standpoint, not the practice’s. “A YouTube video from Mrs. Jones talking about what a great experience she had and what it meant for her can be powerful.”

Experts agree that for practices to remain viable, they will need to meet consumer demands for great convenience and access. Not doing so will most likely result in a steady drain of patients to a more convenient urgent care facility or a physician with a greater commitment to their needs.

“Understand this is happening whether or not you want it to,” says Hertz. “You can’t stop it, and you can’t opt out from consumerism. All patients have been consumers in other parts of their life, and now it’s coming to medicine.”

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