Healthcare’s misalignment means missed opportunities for all stakeholders
By Bill Coyle, principal, and Pratap Khedkar, managing principal, ZS Associates. This piece is an excerpt from a longer article, “Here’s what real customer centricity in healthcare looks like – and why we aren’t there yet,” which appears on ZS’ website.
The wheels of a car in need of an alignment point in different directions and effectively begin working against each other. As a result, the vehicle works inefficiently, which negatively impacts the driver’s experience and increases the financial pain he feels at the pump. If the problem is ignored for too long, his ability to safely operate the vehicle can become compromised. And when the car is operating at a high speed, the misaligned tires could have devastating consequences, making steering difficult and potentially leading to a crash.
Think of wheel misalignment as an analogy for the way that the various stakeholders throughout the healthcare ecosystem (the vehicle) now function to serve the patient (the driver). Pharmaceutical companies, providers, regulatory agencies, payers and PBMs are misaligned or out of sync. From the patient’s perspective, they’re often working against each other – and at the high speed of modern-day healthcare, the end result can be devastating to the patient.
Unfortunately, there’s no equivalent to a mechanic’s tune-up to get the healthcare ecosystem where it needs to go. To successfully put the patient at the center, all players need to start prioritizing customer centricity, ensuring that they’re delivering value to those stakeholders and that the stakeholders’ needs are met. In turn, the players can benefit from increased efficiency, less strain on resources and ultimately increased revenue. If a car’s wheels are realigned, the engine can function optimally and gas mileage improves, as does the driver’s experience.
Imagine if the whole healthcare ecosystem actually put customers at the center and designed their business models around the customer experience:
Would pharmaceutical companies send reps streaming into doctors’ offices all day – or emails streaming into doctors’ inboxes – if they really put themselves in the doctors’ shoes?
Would providers make patients wait and worry for six weeks before they can secure an appointment and get their health concerns addressed?
Would insurance companies and PBMs roll out complex benefit designs, actively block the fulfillment of prescriptions, or delay surgical approvals to discourage use?
Would regulators continue to impose rules that make it hard for stakeholders in healthcare to work together to help patients?
In healthcare today, customer centricity often seems like an afterthought. Patients are left to navigate lengthy wait times, unknown costs, endless paperwork, multiple referrals for difficult cases and approval roadblocks. They’re required to steward their own healthcare journey, advocating for their own needs and researching treatment options in messaging that practically requires a medical degree to decipher. For example, most patient-targeted prescription literature is written for an audience that resembles The Wall Street Journal’s subscriber base, while the average American reportedly reads at or below an 8th-grade level.
The experience that other healthcare customers have isn’t much better. An oncology practice, for example, might need to call five different numbers to get reimbursement support for five different products. Another specialty practice might need to know a special distribution system for each brand that it prescribes. Meanwhile, doctors struggle with insurer mandates to see high volumes of patients to stay in business – despite jeopardizing quality and negatively impacting patient care. And payers often find themselves wading through pharma’s drug claims when new data is released or a competitor arrives on the market to arm themselves with the necessary information for drug price negotiations.
The healthcare industry is, of course, taking steps in the right direction. The IHI Triple Aim, a framework developed by the Institute for Healthcare Improvement to optimize health system performance in the U.S., promotes efforts to improve the health of the population, enhance the patient experience and reduce costs. Now, with doctor burnout at an all-time high – 53 percent by some reports – and the impending physician shortage, many support expanding the Triple Aim to become the “Quadruple Aim” to promote customer centricity by ensuring that the equation covers care for providers. Other stakeholders, such as patients and caregivers who advocate for their own care, also are clamoring for relief.
Though a daunting exercise, healthcare’s various stakeholders have to start working together, and not against one another. And when we get to that point, we’re sure to move the needle on long-term costs. It’s like the car we discussed earlier: When the tires are out of alignment, the car’s engine is forced to work harder, gas is consumed more quickly and tires wear unevenly. But when the issue is addressed, the wheels are working in unison and the car is working more efficiently, the driver’s financial burden decreases and he stands a better chance at enjoying the ride.
