During an interview, heavyweight champion ‘Iron Mike’ Tyson was asked about his thoughts about his upcoming opponent’s plan to beat him. His answer was historic:
“Everyone has a plan…until they are hit in the mouth”
U.S. hospitals and health systems have now been financially ‘battered’ as revenues have cratered. The American Hospital Association (AHA) estimates losses at over $200 Billion from March 1st to June 30th, from COVID-related costs for hospitalization, purchasing, offering additional support for employees, as well as canceled and foregone patient services.
The current impact from COVID has become a sledgehammer of economic pain – yet it may be just the first of many strokes to come. No one truly knows how much of the 14.7% unemployment rate (close to 23% actual rate) will be reduced during future re-hiring and de-furloughing…and how this will impact patient behavior, services, and revenue.
In a May 9th article, AP Economic Writer Christopher Rugaber noted that after the previous three recessions, the vast majority of people who were laid off lost their jobs permanently. Some of it due to replacement from new software or factory robots. In other cases, the employers either closed down or entered new lines of business.
Not all hospitals, health systems, and providers/healthcare workers will make it out of the COVID crisis cleanly. The next 18 months will show the impact of our current crisis and how it gets digested in the market. Specifically with the behavior of healthcare consumers, patients, taxpayers, and employers – all of whom bear the brunt of propping up the healthcare system and its many interconnected segments.
While it is true that we were in a strong economy, but we should remember that a significant number of Americans were struggling with medical debt. Only a few months ago, a CNBC article reported that 32% of American workers carried medical debt —and over half reported having defaulted on it. Equaling surprising was that 28% of those who have an outstanding balance owed $10,000 or more on their bills.
Through all the challenges, a number of health systems and healthcare providers have already taken proactive steps to focus on post-COVID growth. The next 12-24 months will be a telling time for those provider organizations who can successfully get ‘off the mat’ and transition from crisis into growth.
My 6 tips for provider organizations to utilize for post-COVID growth:
1. ENSURE COVID-19 SAFETY & CLEANLINESS
The media has driven the reporting – and also the fear. We must remember that people are largely creatures of emotion. Seeking greater certainty, comfort, and confidence, which help drive their actions and decisions.
Begin by reaching out to and through both traditional and social media channels – as well as through your website and patient communication channels. Share any reports, awards, certifications, that focus on quality and safety. Providers may elect to work with celebrities or respected local and national media resources, to catalyze more trust and confidence.
Post-COVID times are going to be higher geared to the consumer, so keep risk management strong for possible legal claims and bad PR. Additionally, this is a time to empower your clinical and business employees to be contributors. Give them the clear green light for reporting issues they either see or overhear from patients regarding safety, cleanliness, and COVID-related concerns.
2. DIGITAL MARKETING & ENGAGEMENT
Post-COVID will be a time for building patient volume, revenue growth, population health, and reducing costs. Plus tightening up telehealth and RCM as tighter processes to existing engagement, patient retention, and acquisition.
It is also a strategic period for savvy provider business teams to focus on talent acquisition, especially with proven digital marketing and engagement experts. Focus strongly in picking from highly competitive non-healthcare and pro-consumer segments.
A good example of such a step up was back in 2016 when Providence St. Joseph Health (PSJH), hired now EVP Aaron Martin from Amazon. Martin hit the ground running, focused on a consumer-based marketing approach, rather than traditional B-2-B. The chief focus in providing better patient access, convenience, and personalization.
As a result of Martin’s mindset, the 50-hospital system based out of Renton, WA has become a powerful needle-mover in patient and healthcare consumer engagement. They created and utilized several unique content and digital care platforms to create a consumer journey and experience that delivers trust, loyalty, and results.
Separately, look to grow audience-centered content and channel-based content marketing. Getting patients involved in telling their own stories and experiences will become increasingly important in consumer choice and patient retention. I would also strongly suggest that business teams take note of the work done from content currency expert Amanda Todorovich at Cleveland Clinic. Her insights are well worth your time!
3. TELEHEALTH…PROACTIVE FOR GROWTH
Forrester analysts estimate virtual visits relating to COVID-19 could top 900 million for 2020. General medical visits are expected to go up to 200 million – more than 5 times the original 36 million yearly projection.
According to Roger Santos of telehealth company NGCC5, providers must stay strong in 5 key components of telehealth, including IT hardware/software architecture, utilizing a strong EHR/EMR portal provider, data transmission through proper applications, effective tool and services to collect and analyze patient data, as well as coordinating with the human capital/providers for engaging with acute, chronic, and behavioral health patient segments.
That said, let’s see providers shift their strategy around telehealth.
Today, we’ve come to think of and respect telehealth as a reactive-based tool. Of course it can be used for remote monitoring and collecting data, but it’s also employed when patients first come to providers with their needs.
The power of telehealth and of face-to-face communication between patient, consumer, and healthcare expert is powerful. In such, I strongly advocate for growth-minded health systems and hospitals to focus on proactively utilizing telehealth.
Here’s a 90-second portion of my prior keynote, given back in 2017 at the VSee telehealth conference. A competitive, connecting mindset is more important NOW than it was then…
The consumerism aspect of telehealth means not only serving patients and consumers who ASK for care…but in competing to capture same-state and out-of-state pockets of chronic, acute, and behavioral segments – both active and inactive. I state ‘inactive’ as many patients knowingly have issues needing to be managed or better managed, and have not done so.
Offensively-minded telehealth is a tip-of-the-spear tactic for growth, strategically added into existing provider business segments such as engagement and digital marketing. It may also be a billable or non-billed service, depending on the type of consumer and patient experience sought – and where that journey may lead.
In a non-billable engagement, perhaps a live chat or bot-based chat conversation can initiate a handoff of a patient or healthcare consumer to the appropriate doctor, nurse, or well-trained patient experience advocate, who represents a service segment or Center of Excellence.
Remember, this is about getting consumers to feel they are receiving value, as well as a bridge of trust and confidence to invest their future time and money. An investment of a few select ‘provider-minutes’ that shows others you stand behind caring and sharing, can lead to future revenue growth that may have never happened.
There’s a lot of creativity available in this area – including strategic partnering with affiliated and non-affiliated provider organizations, who have a brick-and-mortar footprint for follow-up services. Unique relationships are also available between provider and well-populated non-healthcare companies.
4. REVENUE CYCLE MANAGEMENT
The underlying theme is patient experience as a brand and a catalyst for greater RCM results. This begins with clean and quick patient registration and data access; and communication highly productive, personalized, and action-driven.
A ‘cleaner RCM’ includes providing estimates, price transparency, clean eligibility, and demographic verification. Plus being aware and upfront with any noted potential for patient OOP, surprising billing, balance billing, and offering options and usable recommendations (rather than lawsuits) for payment challenges.
RCM should be pulled in tighter to both the processes of digital marketing/engagement, as well as telehealth visits that have clear hand-offs into action steps to start patient services. Remember – you want to make it easy for the patient to say yes to reactivate, or for the healthcare consumer to become a new, valued patient.
Post-COVID will be a very important time for focusing on capturing younger/acute, older/chronic, as well as behavior patient bases. RCM strategies and conversations may be geared differently for these different care segments. Plus, always keeping our eyes on the payer mix, the underinsured, strategically communicating through patient emotions on live calls, as well as pre-screening (after registration/showing patient intent), per soft credit pulls.
In 2019, a number of healthcare systems came into the public eye with respect to the multitude of lawsuits filed against thousands upon thousands of community patients. Of course, collection will always be a need – but recognize that desperate times coupled with stress and an easily-reachable media can become your biggest PR nightmare.
So take into consideration the special circumstances of the many who will remain unemployed, underinsured, and in need of charity status. This can also, in certain circumstances, be moved strategically into positive PR for community awareness and strengthening.
5. ARTIFICIAL INTELLIGENCE
The chatbot experience must be strengthened across content platforms. Use of AI, ML, and NLP technology, combined with the aforementioned digital marketing and engagement growth component. Plus, feeding into the chatbot from organic search, provider organization website(s), and patient portal(s).
Second, the use of chatbots for managing non-life-threatening conditions, which bridge into same-day care and service delivery. The focus here is on healthcare decisions being made from the patient/healthcare consumer providing initial information, then determining whether an in-office visit is needed. This helps greatly for current capacity as well as also feeding into telehealth services.
2) Reducing readmissions. According to a recent JAMA article, hospital readmissions occur for almost 20% of patients hospitalized in the United States. A big focus is on identifying patients with the greatest risk of being readmitted. Studies show that clinicians may be greatly assisted by AI and ML that pulls in as many as 380 separate data points including demographics, polypharmacy, use of high-risk medications, marital status, multiple chronic conditions, and multiple previous admissions.
3) Care Coordination. Patients can become lost between their ER visits, in-patient admissions, specialist visits, and primary care follow-ups. With value-based care and cost-risk expected to be stronger than ever in post-COVID times, providers must move past manual EHR/data searches with follow-up phone calls, and move into smarter identification for tracking, notification, and reducing waste and potential re-admissions. Plus, sharing across an organization helps reduce duplicative human efforts.
4) RCM – Many RCM tasks that are manual and redundant can be streamlined and saved in cost. These include patient access, claim status checks, OOP estimates, coding, billing, collections, and denials. These carry a lot of variables, and are perfect for AI’s speed and pattern-spotting potential. In the long run, AI in this space can reduce the cost of human capital, as well as manual-based mistakes and lags.
Organizational culture is integral to rates of safety, quality of care, as well as employee relations, retention, and engagement. There are two chief areas of focus – burnout and incivility.
A recent report from the National Academy of Medicine finds 35% to 54% of physicians AND nurses experience burnout symptoms. A 2019 survey of 2000+ PAs showed a 41% burnout rate.
Burnout leads to increased patient risk, turnover, absentee workers, and malpractice claims. And here’s shock — a Mayo Clinic study from JAMA (~3,400 2nd year residents) found a correlation between the depersonalization aspects of burnout with increased negative attitudes toward black people. This impacts patient trust, communication, and adherence to ongoing care.
Big focuses here should at least focus having smarter scheduling, feedback mechanisms, EHR entry support, employee groups, and providing mental health resources.
It’s permeating all aspects of our lives. The lack of civility that causes poor interpersonal behavior that results in shaming, blaming, shunning, name calling, and animosity.
Incivility stifles employee relations, engagement, and can be a big challenge for retention. And providers certainly understand the challenges and heavy cost in both finding and replacing a physician or nurse.
We must also remember that incivility in provider organizations exists not only on the care team side, but also for employees and employee-interactions on the business side. Incivility is often undermanaged and can impact contribution and health of trust-based relationships.
Statistics show that for those employees who are treated with incivility in the workplace:
- 48% intentionally decreased their work effort
- 66% said their performance declined
- 78% said their commitment to the organization declined
- 25% reported taking out their frustration on customers
A remotely-delivered program called WALKING THE RIDGE is designed to help reduce individual and organizational incivility through a learnable human practice.
The program has great support for effective implementation…PLUS offering a benefit in getting near 100% employee participation to share anonymous and candid responses to key questions on current culture, management, and many perceptive positives and negatives HR may not be aware exist.
Post-COVID times, especially for meaningful growth, requires a workforce that’s knowledgeable, engaged and sought after for contribution. It also requires transparency, contribution, and key information sharing – both within and as a connecting agent to different business functions and staff.
Internal communication (IC) not only helps bring information TO workers at all levels, but it can be a powerful force for making decisions, building trust, bringing unique contributions and viewpoints to decisions, and helping launch initiatives.
IC is also very useful in not only improving, but outwardly sharing the positives of culture – for purposes of strong talent pools, quality of hiring candidates, as well as employee retention.
The time for leaders to treat employees as casual listeners and robotic hand-raisers (or else!) is quickly eroding. Smart leaders, at all provider organization levels see IC as vital for change management, corporate strategy, and organizational effectiveness. CEOs also recognize that their image and voice, at times, does not make the biggest difference in swaying the public.
According to Edelman:
52% of consumers trust an “Average” employee MORE than they trust the company CEO when receiving information…
…and content shared by employees received EIGHT TIMES the engagement of content shared on company brand channels.
When looked at as a part of overall business operations, IC becomes a powerful catalyst for better understanding your people and helping them become an empowered, proud army for telling others about your provider organization. If you don’t have it – get it. If you have it already, invest to strengthen in post-COVID times.