carlos ariza | health data management | 13 april 2016
Many may think customer relationship management (CRM) is just for marketing, sales and customer service, but there is a revolution underway in the CRM sector to become a central component in the population health ecosystem.
The reason is patient engagement. Most healthcare organizations struggle with how to help people stay on top of their chronic conditions, reach out for help when needed, and communicate according to their preferences.
Historically, providers have been interacting with their patients on an episodic basis. In the fast-arriving world of outcomes-based reimbursement, it’s critical to understand patients the same way financial and retail companies understand their customers: tracking interactions over time, capturing preferences and demographics, communicating with them in relevant ways and managing customer lifetime value.
Engagement is critical to the success of population health management initiatives. Engaged patients are more likely to follow their plan of care, reach out to care teams earlier when they have questions or concerns, and as a result are more likely to avoid unnecessary hospitalizations and reduce overall expenses. In a recent study by the Boston University School of Medicine, highly engaged patients were almost 50 percent less likely to be readmitted than those not actively engaged in their own healthcare.
However, in today’s fragmented and episodic healthcare system, patients struggle to put together care plans that align with their home environment, lifestyle and preferences. EMRs and other clinical documentation systems focus on what happens at the point of care and revolve around accurate billing and documentation, but they are ill-suited to provide a longitudinal view of the patients’ needs over time. They struggle to capture key elements about the patient’s daily life that are necessary to drive engagement.
Until recently, CRM in healthcare has just focused on marketing, sales and customer service. Most health plans, and an increasing number of providers, already use CRM solutions to help them understand their customers better, build their brand and create loyalty. But until recently, care management interactions have been handled separately, using legacy care management systems.
Traditional care management systems are usually closed, rigid and focused on documentation. They struggle to customize communications and track preferences; they have been built to satisfy the needs of the care provider, not around how those interactions should be adapted to maximize patient engagement. This is a key reason why we’re seeing a fast evolution of CRM platforms towards supporting population health.
CRM platforms are evolving to support population health in four major ways:
Consolidated view of care information: As EMR systems mature and consolidate, they have become easier to interconnect with other platforms. This creates an opportunity to combine EMR information with demographics and customer interaction data from the CRM system in order to create a holistic view of each patient, as well as their interactions with other caregivers. The goal is to have a single dashboard with clinical data from the EMR, contact center interactions, feedback from other caregivers, data streaming from home monitoring devices and wearables, and environmental factors such as weather, pollen count, or other relevant factors. While a traditional care management system would give a case manager information about previous calls, it would be difficult to capture additional details about the network of providers and family members that can help support the patients’ needs.
Targeted care management planning: With traditional systems, case managers rely on word of mouth to know whether a provider in the community has a good track record of effective care. With CRM, it is possible to document patients’ experiences with specific providers and analyze this to understand which providers are most effective with specific patient segments. Factors such as language/cultural fit, wait times and convenience can make a significant impact on engagement. The CRM platform becomes the mechanism to share these insights across case managers and provide evidence to provider partners about areas where they can improve.
Targeted messaging: CRM solutions have historically been very effective in direct marketing and customer communication. Providers can harness these capabilities and use demographic, lifestyle and customer preferences to customize population health messages so that they resonate with patients and family members. Targeted messages, sent through the customer’s preferred channel, are more likely to be read and more likely to result in positive behavior changes.
Care management workflow automation: EMR platforms tend to be centered on episodes of care and clinical activities. However, patients do not live in a clinical environment; they need to manage their health while they work, play or care for family members. CRM systems can complement the information available in clinical systems, and allow caregivers to better understand the challenges patients face once they leave the clinical setting. It is straightforward to integrate analytics into a CRM platform to drive workflows; for example, risk stratification models can help prioritize which patients are contacted first based on their conditions. Workflow automation increases productivity of care teams and leads to more effective interventions.
At this year’s HIMSS conference in Las Vegas, we saw tremendous progress in the CRM vendors’ ability to enable effective population health management. Salesforce’s HealthCloud, for example, is finally ready for prime time, greatly reducing the amount of development needed to convert their ServiceCloud platform into an effective population health platform.
Other vendors are quickly moving in as well. Microsoft, building on its Dynamics CRM and Azure platforms, has been used at Dartmouth-Hitchcock Health System for interventions with the purpose of moving care out of hospitals and back into communities. Evariant is quickly adding features to its CRM platform to track engagement activities and perform advanced analytics. CarePak, a Microsoft Dynamics-compatible offering from SADA Systems, is offering an automation platform to track patient engagement and help care providers identify high-risk patients. These vendors, and others, have identified the weaknesses of traditional care management platforms and are quickly filling in this market gap.
A one-size fits all solution does not apply here, however, so choosing the right platform for population health management requires clarity of business strategy, understanding the organization’s technology roadmap and the people and processes already in place. As you consider making a recommendation for population health management, CRM platforms should definitely be on your short list of options.
Carlos Ariza is a healthcare expert at PA Consulting Group