Breaking through barriers

Health care organizations must develop accessible, integrated systems of care that are convenient, affordable and intuitive. Importantly, the organizations do not need to own all the system components. These systems can be assembled through partnerships and virtually through technology.

Consumers have long relied on the health care system to provide them with the entirety of their health care, from routine doctor visits and treatment of episodic illnesses to chronic disease management and end-of-life care. In the past, having a trusted physician, hospital or health system gave patients a clear and immediate course of action for health concerns and simultaneously created a loyal customer base. This is no longer entirely the case.

New competitors and disruptors in the market are taking advantage of increasing consumerism by co-opting parts of the care continuum. Retail health models, mobile and e-health options, and new provider-patient relationships are challenging the old model. Progressive organizations are designing platforms that offer tailored solutions, allowing the consumer to select from an array of services to address their specific health needs in ways that are more immediate and appropriate for them and that offer access any time and anywhere. Most hospitals and health systems have a long way to go before such solutions are fully realized and integrated with existing systems of care delivery.

In today’s entrepreneurial environment, competition emerges from any number of places. An inexperienced person with a great idea and some crowdfunding, for example, can develop a concept, bring it to market and siphon off aspects of the business that health care organizations previously controlled. These types of startups are able to infiltrate the market and adapt quickly because of their willingness to challenge the perceived status quo and because of their basis in technology rather than because of a strong dependence on people. Enlightened consumers are open and willing to consider innovative products from nontraditional health care sources.

The challenge for health care organizations is to think more like these startup competitors while simultaneously finding ways to create end-to-end solutions that connect back to the health care enterprise. A truly integrated system of care can connect all aspects of a consumer’s health and wellness portfolio in accessible and frictionless ways.

Your organization can take the following actions to erase the boundaries that inhibit accessible, integrated systems of care.

Develop technology investment road maps

Health care organizations are challenged  to deploy consumer-facing technology to compete with more agile technology startups.

The best technology applications enable improved service models and seamlessly integrate into operational processes. Successful consumer-facing technology requires a keen understanding of user needs and behaviors. Your health care strategists are not expected to be technology experts. But they can help to set strategic priorities, identify the areas where technology is a critical enabler, facilitate workflow changes, and develop a framework for technology integration and deployment, maximizing the value and impact of technology initiatives.

Seek partnership over competition

The relationships and partnerships necessary to survive in health care’s next evolution are more complex and nuanced than ever before.

The notion of “co-opetition” — entities that may be partners in one market and direct competitors in others — is central to this concept. Models such as affiliations, joint ventures, physician networks and clinically integrated networks create access to key markets and a better bargaining position with payers, plus the opportunity to avoid expensive service duplication. While the alliances are formalized in specific markets, the individual health systems remain competitors in others.

Your health care strategists should understand these nuances, their short- and long-term implications, and how to structure novel partnerships to create a foundation for future success. As partnerships develop, the savvy strategist connects the best routes toward the integration of cultures, workflows and service design.

Apply different planning models

As the business model shifts from episodic care to population health, organizations must rethink traditional planning models and test more granular approaches that emulate those of other industries. Retail planners, for example, have developed sophisticated tools to identify specific intersections with the greatest volume and revenue potential by analyzing psychographics, social media check-ins, traffic flow and consumer behavior. These tactics shift services to become more relevant to how today’s consumers live, work and play.

Through the creation of so-called micromarkets in health care, planners are focusing more specifically on the unique characteristics of neighborhoods to make strategic decisions. Organizations also need to think differently about what data feed their business models. For example, drawing on purchasing and lifestyle data paints a more inclusive picture of a community’s overall health and provides visibility into actual choices.

Your health care strategists should understand new planning models, data sources and their applications in the health care market.

Align social and business missions

Hospitals and health systems are often the largest employers in their communities. They can use their influence, convening power and assets to lead change and economic development.

Business strategy and community benefits no longer can be considered as separate initiatives. Seventy percent of a person’s total health is influenced by nonmedical correlates of health [see “Health Policy Brief: The Relative Contribution of Multiple Determinants to Health,” Health Affairs, Aug. 21, 2014]. Those correlates include access to education, employment, safe housing, healthy food, transportation and safe neighborhoods [see also the American Hospital Association’s “Social Determinants of Health Series: Housing and the Role of Hospitals”].

It is no longer enough to conduct a community-needs assessment. New partnerships with agencies, social services, community groups and competitors are essential to addressing these complex issues. Additionally, as hospitals take on additional capitation, there is direct business benefit to managing overall health care outcomes.

Health care organizations can align all aspects of business activity, from employment to the supply chain, to make a positive impact in the local community. By combining diversity and inclusiveness practices with community partnership strategies, health care providers can develop a workforce capable of delivering culturally competent care.

Your health care strategists should lead the organization to partner with local communities to co-design the health care delivery system in a way that makes sense for that community and creates a sustainable business model.

Design ecosystems

Systems like the one developed by Lego are often called ecosystems, meaning a series of complex interconnections among different components. In general, ecosystems include service model, physical environment, virtual environment, operations/process, user experience, technology enablers, on-ramps to service, accessories and brand [see Larry Keeley et al., Ten Types of Innovation: The Discipline of Building Breakthroughs, Wiley, 2013].

As hospitals and health systems shift their focus toward the health and wellness journey of consumers, your strategists should consider how to design ecosystems of products and services that include acute care service lines, health and wellness offerings, and services that extend beyond the traditional boundaries of business. This requires thinking about the interplay among the ecosystem’s parts, considering new constructs and interrelated components, and evaluating which are better owned or executed through a partner.

Case example: The airline industry

The following example of successful execution illustrates the erasing of boundaries. Using this example as a thought provoker, your board can focus on the characteristics that make the airline industry successful and consider how these characteristics could be applied in the context of your organization and role.

The airline industry, like the health care field, is highly regulated and capital-intensive, and relies on the expertise of a diverse array of human resources. Many airlines need to extend coverage to smaller, nonhub markets while reducing their overall cost structure. Historically, major carriers were unable to serve shorter regional routes with reasonable cost efficiency. Yet, Southwest Airlines and others have built their business models around serving regional markets. These regional players provide a clear value proposition to consumers: lower fares, on-time flights and extraordinary customer service. In response, the major airlines extended their reach through regional carriers that operate under the parent brand in a "doing business as” arrangement.

Airlines also rely on a variety of partners for many critical aspects of the customer experience: travel agents and travel websites, government-operated security and air-traffic control, use of airport facilities and amenities controlled by separate entities, and inflight food-service vendors. These airlines must strike a delicate balance between engaging the consumer directly to build loyalty and offering fares through third parties. There is no differentiation among these parts of the experience by the traveling consumer, whether it is governed by the airline, the regional carrier or a separate entity. There is a tremendous amount of data integration that makes the booking process seamless, no matter how the reservation comes in. By offloading these aspects, the airlines are able to focus on the core of their business — transporting people from point A to point B efficiently and safely.

— Society for Healthcare Strategy & Market Development

Case example: Spectrum Health

Spectrum Health is a nonprofit, integrated health system based in Grand Rapids, Mich. Spectrum Health’s business development team combined data synthesis, integrative thinking, human needs analysis and storytelling to transform a collection of data into a plan to improve population health and reduce the cost of care. A large local corporation asked it to help evaluate the company's employee health data to determine what could be done to manage costs and improve outcomes.

The team used health statuses (e.g., well, preventive, acute, prechronic and multichronic) or personas to categorize the data from, for example, “Linda,” uninvolved and chronically ill, and “Jackie,” a proactive wellness junkie. To understand health care needs as well as lifestyles and preferences, the team added new data sources, such as purchase data from employee discount cards. With these personas, they were able to identify solutions to address common needs and health risks.

The outcome was a plan that helped the corporation to meet its employee health care needs while reducing costs.

— Society for Healthcare Strategy & Market Development