Insights Series, Issue 26: "How are innovators driving digital transformation in healthcare?"

Insights Series Issue 26 siemens-healthineers.com/ digitalizing-healthcare How are innovators driving digital transformation in healthcare? A thought leadership paper on "Digitalizing healthcare" co-authored with ECG Management Consultants SIEMENS Healthineers Preface The Insights Series The Siemens Healthineers Insights Series is our preeminent thought leadership platform, drawing on the knowledge and experience of some of the world’s most respected healthcare leaders and innovators. The Series explores emerging issues and provides you with practical solutions to today’s most pressing healthcare challenges. We believe that increasing value in healthcare – delivering better outcomes at lower cost – rests on four strategies. These four principles serve as the cornerstones of the Insights Series. Expanding Transforming Improving Digitalizing precision care patient healthcare medicine delivery experience Our Insights portfolio is an integrated collection of events, speaking engagements, roundtable discussions, and an expanding array of print and digital platforms and products all carefully curated to share ideas, encourage discussion, disseminate original research and reinforce our position as a healthcare thought leader. Please visit siemens-healthineers.com/insights-series Executive summary How are innovators driving digital transformation in healthcare? Healthcare has been changing rapidly for many years, The ECG digital maturity framework covers the following but the COVID-19 pandemic has accelerated the rate four strategically critical areas: of change like never before. In addition to helping drive the shift to value-based care, COVID-19 pandemic 1. Organizational data capabilities has intensified the consumer-like expectations that many patients now have of the healthcare systems. 2. Optimized internal business operations Patients expect to access care where they live, work, 3. Seamless patient care experience and play – and they want that access to be seamless and quick. 4. Personalized medicine While healthcare organizations around the globe are In each section of this paper, there is a checklist for self- making progress in meeting these expectations, they still assessment, as well as a real-life example of how a state- have a long way to go. Health systems that aspire to be of-the-art innovator uses technologies to improve its patient- or consumer-centric must find more and better operations, and what is required for others to reach that ways to remove friction and create simplicity for patients stage of maturity. at every step of their journey. Digitalization is one of the key tools for delivering more simplicity and convenience in healthcare. As is the case for other organizations in other industries, hospitals are looking to digital transformation as a core component of a strategy to achieve financial goals by better meeting customer needs. But the expectations of customers, in this case patients, are evolving and changing. Tracking, analyzing and meeting those expectations will require what we are calling digital maturity, and the goal of this paper is to provide hospitals and other healthcare organizations with the tools they need to acquire that maturity. Studies have shown that organizations with higher digital maturity are almost three times more likely to see above- average annual revenue growth and net profit margins than lower-maturity organizations.1 With that in mind, ECG Management Consultants, a leading U.S.-based healthcare consulting company, designed a Healthcare Digital Maturity framework to specifically help healthcare organizations assess how digitally mature they are today, in order to discover opportunities for growth tomorrow. Siemens Healthineers Insights Series · Issue 26 3 The challenge Digital transformation requires an enterprise-wide, holistic mindset. The COVID-19 pandemic has brought about significant ECG has completed more than 12,900 consulting projects changes to healthcare the world over, not the least of of different types for more than 2,500 leading healthcare which is the clear impact it has had on how patients organizations in the U.S. For digital transformation view and interact with their care providers. Patient projects, ECG identified four key strategic focused areas: experience and patient satisfaction must now be top organizational data capabilities, optimized internal of mind with healthcare leaders, because it is business operations, seamless care experience, and increasingly top of mind with healthcare consumers. personalized medicine. Based on that, they have devel- oped a framework that measures the digital maturity of a Indeed, “consumer” is a good description for how hospital in a holistic way. In addition to discussing the patients see themselves, and how they behave. Health technology enablers in each of the focus area, the organizations looking for ways of attracting and retaining operational enablers are also discussed for innovators or these consumers are turning to digital technology, in the those who lack those operational components. This hopes that it can help them identify and meet patient framework allows healthcare organizations to discover priorities. New digital health technologies are emerging opportunities, set benchmarks, and design a roadmap for rapidly and investments in digital health companies future maturity growth tomorrow. continue to smash records.2 According to a survey by the American Hospital Association, about 85% of hospital executives say digital innovation is part of their long- term strategy. But which particular technology is right for each organization? Furthermore, technology alone will not drive true change. The successful deployment of a digital initiative requires more than just technology enablers – opera- tional enablers are also critical to success for innovators. In addition, forward-thinking organizations understand that digital transformation needs an enterprise-wide mindset, not a series of siloed projects. There need to be clear targets and strategic goals, coupled with compre- hensive understanding of relevant operations and linked processes, in order to determine which technology would bring the greatest value. Measuring digital maturity helps organizations locate themselves in a complex digital landscape, and is a first step for bringing sustainable changes to the health system. 4 Issue 26 · Siemens Healthineers Insights Series Healthcare digital maturity framework Where is your organization in the four strategically critical areas of digital transformation? Stage four Innovators in Digital Health Stage three Early Adopters Stage two Market Average Stage one Novices OHO 1 Organizational data capabilities 2 Optimized internal business operations 3 Seamless care experience 4 Personalized medicine For a first analysis of your own organization, use our questionnaire after each chapter. Siemens Healthineers Insights Series · Issue 26 5 The solution 1. Organizational data capabilities You cannot be patient-centric without understanding Johns Hopkins Medicine*, an innovator in digital health, your patients. Who are they? What are their habits? built its population health analytics toolkit called the What procedures have they had in the past? ACG® System for better clinical, operational, and financial management. On the patient side, it not only The insights gained from healthcare data can paint a generates a comprehensive view of a patient’s care holistic picture of patient health history and directly journey using various sources of data, it also predicts impact outcomes. Data capability in healthcare is the which patients may need targeted care management, are ability to acquire, store, process and analyze large at risk of future hospitalization, or have chronic condi- amounts of health data in various forms, and deliver tions that may need proactive care. On a macro level, the meaningful information to users in a timely fashion.4 system has the ability to identify population risk factors While almost all doctors agree that easier access to and forecast population healthcare utilization. critical data can save lives, the data capability of Operationally, it provides performance analysis and healthcare organizations can vary widely. predicts patients’ resource use to anticipate staffing and resource needs based on population risk factors. Organizations with limited data capabilities struggle to make sense of the immense amount of data flooding in every day. This can be caused by a data environment that is siloed and lacking data governance structure. Ineffi- ciencies such as duplicate testing are the result of dispa- rate data sets, which can restrict the ability of doctors to get a detailed view of their patients’ care across the continuum. In addition, the operational and business insights drawn from such data environments are outdated. Innovators in digital health maximize their data 96% capabilities by consolidating data storage through data warehouses or data lakes in order to augment clinician Physicians agree and staff performance. Innovators are noted for their use that easier access to of advanced analytics and Artificial Intelligence (AI) such critical data can as natural language processing and machine learning, so save lives.3 that they can build patient Customer Relationship Management (CRM) systems and employ population health analysis to deliver a more personalized experience for patients. In addition, operational enablers such as having a data governance and data strategy plan in place are critical success factors. 6 Issue 26 · Siemens Healthineers Insights Series *Cases are not attributable to ECG. Healthcare digital maturity framework Which level describes your organization? 10 1 01 Organizational data capabilities Stage one Stage two Stage three Stage four Novices Market average Early adopters Innovators • Data migration from an • There is a singular, • Advanced data analytic • The organization has AI operating system to a central consolidated data storage capabilities provide insight to capabilities (e.g., natural repository is limited location such as a data support patient care (e.g., language processing, warehouse or data lake • The operational, tactical, and patient capacity planning, machine learning, advanced Information and analytics are clinical interventions) statistical analysis) to business information and • analytics that end-users have Automated augmentation augment clinician and staff real time or near real time • performance and deliver a access to is limited and points are available for represents historical • Has a detailed view into more personalized patient performance patient's total cost of care clinical teams (e.g., sepsis alerts, clinical trial matching) care experience across multiple care settings • Data insights regarding throughout the continuum, • Advanced augmentation operational revenue and including episodic and case- points are available for costs are outdated or specific detail nonclinical teams (e.g., insufficient Actionable data analytics is coding and claims denial) • used to identify clinical and • Advanced analytic operational improvement capabilities are available to opportunities reduce time spent on pre- and postcare activities • Drill-down capabilities are available to view specific information for patient and populations The checklists are designed by ECG Management Consultants to help you assess the current status of your digital transformation in each specific area. With this self-assessment, you can benchmark against innovators, identify gaps, and determine the next step needed to achieve your strategic goals. Siemens Healthineers Insights Series · Issue 26 7 2. Optimized internal business operations While not all internal business operations directly information multiple times. Manual transcription of this impact patient satisfaction, optimizing certain data by staff to electronic health records (EHRs) wastes processes can help patients navigate the care time and is error prone. experience and help providers track revenue easily. The journey starts with patients scheduling their Innovators in digital health not only offer patients the initial appointments and ends when providers get paid option of scheduling appointments online, but also via fully for the services provided. phone, text, and chatbots. Searching for a provider who is in-network is easy and returns accurate results. To evaluate the efficiency of this process, every step Patients can register electronically before the visit, and must be examined: from how patients find the right the software’s context-awareness allows registration to in-network provider, schedule appointments and be specific to patient demographics and health condi- register, to financial clearance, check-in, coding and tion. These health organizations also use different charge capture, billing and collections, and finally, automated methods to reach out to patients for referral patient follow-up. processing based on their preferences, such as using automated dialers, text messaging, or portal messages. Operationally, having an efficient staffing model, Registration and appointment scheduling standardized appointments, rules and templates are important enablers as well. According to a survey of more than 200 North American consumers who have booked a service appointment in Ascension*, a Missouri-based health system that operates the past year, nearly 70% of respondents say that they in 21 states, leads the pack in creating a seamless end- would choose to book services online, with the ability to to-end consumer experience for its patients. Besides schedule medical appointments online being the most having a mobile-friendly website, it also offers a Click-to- desirable.5 Online scheduling offers 24-hour availability Schedule service, which allows patients to see appoint- and can undoubtedly lead to higher patient volume and ment availability and schedule online easily.6 This simple revenue. Internally, online scheduling makes it easier to scheduling process is important not only for retaining fill empty appointment slots and reduces the adminis- current patients, but for attracting new patients. Since trative burden on staff. the rollout, Ascension has seen a 779% increase in primary care online visits scheduled, and approximately Novices in digital health do not offer seamless online 100,000 additional visits over the previous year.7 provider search and booking and consequently risk losing potential new patients. Patients have to schedule appointments by phone, sometimes with a long wait time, without knowing in advance what times are actually available. Even when providing online booking options, Novices have not optimized provider schedules to allow for timely availability. Once the patients arrive on site, they are greeted with a stack of paperwork for registration, and may even have to fill out the same 8 Issue 26 · Siemens Healthineers Insights Series *Cases are not attributable to ECG. Financial clearance Financial clearance Through its patient survey, Cleveland Clinic Health System learned that patients could lose some of their trust in the institution while simply navigating the billing experience. The survey showed that one of the reasons Patient follow-up why patients sometimes fail to pay their medical bills is Check- ni confusion and skepticism about accuracy.7 According to another report, as many as 80% of consumers have been surprised by a medical bill8, causing them to lose trust in the hospital and look to a competitor for future services. The Centers for Medicare & Medicaid Services (CMS) created a new rule that aims to radically change price transparency standards in healthcare and enable g & col el ct oi ns consumers to shop around for care.9 While cost Bill ni estimation is only a fraction of RCM digitalization, health systems with a consumer-friendly solution to price er ut pac e Cod ni g & hc gr a transparency will likely have a competitive advantage. One of the ways to increase transparency is to make cost Revenue cycle estimates available online, but novices in digital health do not offer this possibility. Patients have no easy access workflows to alternate coverage or charity care qualification. Patient benefits are only manually verified through payer have been organized into 5 categories of work and websites, which can potentially cause patients to be are dependent on the geographic location of the dismayed by the final bill. respective healthcare provider. The following content is mainly applicable for U.S. health systems. Innovators tap into digital technologies to avoid patient surprises. First, they make all cost or self-pay estimates available electronically, and they automatically roll any additional liabilities into existing payment arrangements. Innovators can also create a tailored strategy to communicate billing options to patients, thanks to their context awareness ability and patient propensity insights, allowing them to proactively offer different payment plan options even before treatment begins. Cleveland Clinic* makes its prices transparent by publishing patient price lists and provides cost estimates for their services online so that patients can easily access cost *Cases are not attributable to ECG. Siemens Healthineers Insights Series · Issue 26 9 information.10 It also offers patients different payment Novices in digital health are characterized by manual and options, such as zero interest payment, financial assis- paper-based check-in processes, long delays and patient tance, or financial advocacy. wait times. Patients arrive in a check-in area that is noisy and hectic. They have to fill out paper forms, and staff must scan insurance cards and informed consent forms Check-in into the EHR, while trying to enter data into the right fields. The lack of clarity around a particular patient's Hospitals with better patient-reported experience reason for visiting also puts time-of-service collections perform better financially.12 Check-in is the patient’s first out of the question. face-to-face contact with the facility. The check-in experience can influence a patient’s perception of how When walking through the door of an innovator in digital smooth or hectic the rest of the visit will be. It also health, patients check in automatically through geo- impacts the provider’s financial cycle. By correctly fencing. If they need to complete or sign any forms, they capturing patient information during check-in, including can do so through a mobile app, and pay any time-of- insurance and coverage information, staff can identify service charges through apps with touchless options. co-pays and deductibles ahead of time so they can collect Data entered by patients is automatically placed in the payment at the time of service. appropriate fields in the EHR. This frees up staff from repetitive data entry, and takes away the need for sharing clipboards, pens, or any surfaces, reducing the risk of infection. Operationally, innovators have an optimized staffing model with service standards in place, and provide regular training for staff. Innovators like Intermountain Healthcare* reinvented their formerly cumbersome, paper-based check-in process, creating a convenient, automated, digital one. Digital assistants continually scan the EHR for upcoming 2 out of 5 patient appointments, and send each patient digital registration and intake questionnaires via text or email patients are already two days prior to his or her visit.13 Using AI, these frustrated before their questionnaires are personalized according to patient check-up even begins.11 medical history and visit type. As part of the digital check-in process, patients can upload their insurance card via photograph with their smartphone and e-sign informed consent documents, allowing them to complete their entire check-in process before ever stepping into the clinic.13 After the upgrade of its check-in process, Intermountain saw a decrease of 25% in check-in time and earned a 96% patient satisfaction rating.13 10 Issue 26 · Siemens Healthineers Insights Series *Cases are not attributable to ECG. Coding and charge capture months in severity of illness and risk of mortality of 41% and 49% respectively.16 Over the same period, they have Charge capture is the process whereby doctors record captured an additional $2.7 million in reimbursement16, information about the services they have delivered, so and more importantly the new process frees up they are then able to obtain reimbursement. Yet the physicians’ time to focus on patient care. complex nature of documenting how a physician addresses a patient’s intricate symptoms, and then turn- ing that information into codes for reimbursement, is Billing and collections complex and prone to error. Research shows that health systems can lose millions of dollars in revenues from More and more patients are opting for higher deductible charge leakage.14 One survey found that 78% of health- and co-payment insurance plans, and are therefore care leaders characterize charge capture as "essential" to responsible for an increasing portion of their healthcare their organization's success.15 This is not surprising given costs. The resulting inability of patients to pay for the that hospitals survive on razor-thin margins. care they receive is now the top contributor to bad debt for hospitals and health systems.18 The amount of bad In healthcare organizations that are novices in digital debt expense reported in the U.S. reaches more than $55 health, note cards, post-its or even napkins sometimes billion annually.19 Digital technologies such as analytics end up being part of the charge capture process. and pay predictive models of patient’s propensity-to-pay Physicians enter information in the patient record could reduce the amount of bad patient debt. manually, and coders then assign procedure and diagnosis codes manually before keying them into the Since claims are submitted manually and sometimes on patient accounting system without any oversight paper, novices in digital health have to rely on manual mechanism to ensure accurate coding. reports to identify accounts that require follow-up. These reports allow only limited edits to ensure clean claims, Innovators in digital health are equipped with computer- making them more likely to be incomplete and thereby assisted coding to accurately generate medical codes result in lost reimbursement revenue. They also tend to that are then electronically interfaced into patient focus on denial resolution rather than prevention. accounting platforms. Using a combination of dictation and templated phrase completion for both routine care Innovators in digital health tap into the predictive power and surgical procedures, doctors can document patient of AI for better decision-making. They can predict which cases and validate medical necessity in real time. Given claims may be denied, and also analyze remittance and the size, complexity, and varying levels of staffing across denials to determine prevention strategies. Using its 30 hospitals, Ardent Health* looks to digitalization predictive analytics, they can determine propensity- and automation to improve documentation quality and to-pay for every patient, and determine the most optimize workforce. Its Computer-Assisted Physician appropriate collection activities. In some institutions, Documentation runs queries as patients progress and there is even gamification during the process to stimulate makes sure doctors do not miss documenting important staff engagement. On the other side, patients can strike diagnoses.16 By capturing more complete patient stories, up a conversation with an AI-supported chatbot to get Ardent Health has seen a reduction over just eight their billing-related questions answered in real time. *Cases are not attributable to ECG. Siemens Healthineers Insights Series · Issue 26 11 What is the right strategy for innovators such as Alina phone, text, email, or chats. AI supports payment Health*, who need to collect outstanding balances for arrangement modeling and monitoring, and patients 200,000 patients every month? The answer is targeted can access their clearly laid-out payment plans online. interventions with those patients who are more likely to If patients have questions regarding their payment, pay their bills.19 To do so, Alina Health uses 500,000 AI-powered text or chatbots are there to respond anytime training cases to develop the propensity-to-pay machine during the day. learning model to predict the probability that patients will pay their bills. Using this predictive model, Alina UAB Medicine* used to have a very fragmented process Health divides its patients into four separate high to low within a single health system. Sensing the need to be propensity-to-pay segments, allowing the finance team more consumer-centric, UAB was looking for ways to to focus its collection efforts on patients who are more remove friction in their patient care experience. UAB likely to pay and make the best use of its limited adopted an omnichannel platform that allowed patients resources. Since using this propensity-to-pay algorithm to communicate online or by telephone to ensure that all and collection strategy, Alina Health has seen a $2 patients would enjoy optimal experiences regardless of million increase in overall collections in just one year – their communication preference.22 In addition, the a 43.2% relative improvement.19 service extends to people with disabilities so that they can choose the method, frequency, and length of how they communicate. Patient follow-up The care experience does not end when the doctor’s gloves come off. Patient statements are how healthcare organizations get paid, but as many as eight out of ten patients want more handholding from healthcare providers when it comes to understanding their financial obligation.21 To be successful in patient follow-up, providers need to consider the diverse communication preferences of patients. 47% Novices in digital health send out statements to patients Hospitals in the U.S. manually. They generate reports to see if there is a need saw increases in bad debt in 2020.17 + to call certain patients for follow-up, but this process is manual. If patients have a question, calling by phone is the only way to reach the provider. Omnichannel patient communication is the key to meeting the patient follow-up challenge. Innovators in digital health can meet various patient preferences by communicating through multiple approaches using 12 Issue 26 · Siemens Healthineers Insights Series *Cases are not attributable to ECG. Which level describes your organization? Optimized internal business operations Registration and appointment scheduling Stage one Stage two Stage three Stage four Novices Market average Early adopters Innovators • Appointments cannot be • Online appointment • Online appointment • Appointment scheduling is scheduled online scheduling is available scheduling is available available through various Inbound (IB) and outbound through a portal, but options through a portal, and options methods (e.g., phone, online, • (OB) communication is for scheduling are limited for scheduling are text, chatbots) and options comprehensive available are comprehensive decentralized • A limited level of IB and OB communication is centralized • The majority of IB and OB • There is a single centralized • By default, patients have the communication is centralized hub for IB and OB onus to reach out to an • Phone outreach for referral communication organization to schedule processing is done manually • Phone outreach for referral their referral • Outreach for referral • Patient registration is processing is done through an automated dialer • Patient registration is paper processing is based on electronic but often collected based; patients must repeat at the point of service; • Patient registration can be patient preferences and is information multiple times interoperability is varied collected electronically prior automated and digital to a patient's visit (i.e., • Patient registration is digital • Provider search and match is • Patients can search for a provider based on a limited through a mobile app); and specific to patient's not available online interoperability is present demographics and condition number of filters (context awareness) • Patients can search for a provider based on a broad set • The system can suggest the best of filters provider for a patient to see based on the patient’s demo- graphics, financial profile, condition and health history Siemens Healthineers Insights Series · Issue 26 13 Which level describes your organization? Financial clearance Stage one Stage two Stage three Stage four Novices Market average Early adopters Innovators L • Patient benefits verified • Patient benefits are verified • Rules-based batch benefits • Bots used for benefits manually through payer using a real-time eligibility verification is in place verification websites tool • Alternate coverage is • Rules-based automated • Alternate coverage is not • Alternate coverage is identified electronically authorization management is identified for uninsured identified manually via payer in place patients websites • Authorization management is electronic (e.g., 278 file) • Cost or self-pay estimates for • Authorizations secured • Authorization management is all services are available through the phone or facilitated via work driver; • Cost or self-pay estimates for electronically website controls are in place to most services are available identify missing electronically • Context awareness and • Digital cost or self-pay authorizations Automated charity care patient propensity is used to estimates are unavailable • evaluation is in place determine a tailored strategy • Charity care qualification is Electronic cost or self-pay to communicate billing • estimates are available for a evaluated manually • Propensity-to-pay evaluation limited set of services is used to establish previsit • Charity care process are payment plans for self-pay facilitated via work driver patients Check-In Stage one Stage two Stage three Stage four Novices Market average Early adopters Innovators • Patient check-in process is • Patient check-in is electronic • Patient check-in can be • Patients are offered manual and paper based through the EHR completed through mobile contactless check-in via • Forms are completed on • Forms are completed app geofencing paper and scanned into the electronically with • Forms can be completed and • Patients can pay time-of- electronic health record e-signature signed through mobile app service charges via apps (EHR) Time-of-service payments are • Some payments are collected supporting touchless options • • There are no time-of-service collected and posted in real in advance of care event collections time in the patient account • Credit card numbers are securely stored to facilitate time-of-service payments 14 Issue 26 · Siemens Healthineers Insights Series Which level describes your organization? Coding and charge capture Stage one Stage two Stage three Stage four Novices Market average Early adopters Innovators L • Clinicians manually • Templates are in place to en- • Medical necessity is validated • Provider documentation is document in the patient sure optimal documentation using real-time edits based completed in real time using record on payer guidelines a combination dictation/ • Software is used to validate • Providers or coders manually medical necessity templated phrase completion • Electronic controls are in for all routine care and assign procedure and diagnosis codes • Nonsurgical procedure codes place to notify requirements surgical procedures for ABNs and waivers are assigned by the provider; • Some codes are abstracted • Charges are captured surgical procedure codes are • Computer-assisted coding is manually via paper and keyed abstracted by a coder; used more broadly using AI into the patient accounting radiology procedural coding • Preclaim edit resolution is system is assigned using computer- • All charges are captured recommended via AI or electronically and interfaced • No edits are in place to assisted coding software into patient accounting resolved using AI/robotic ensure accurate coding • Nonsurgical charges are platform process automation (RPA) captured electronically; surgical charges are captured • Revenue integrity and charge manually during abstraction reconciliation are validated by the coder electronically • Preclaim edits are in place to ensure coding accuracy • Revenue integrity is validated manually Siemens Healthineers Insights Series · Issue 26 15 Which level describes your organization? Billing and collections Stage one Stage two Stage three Stage four Novices Market average Early adopters Innovators • Claims are submitted • Claims are “scrubbed” in • Claim “scrubber” is integrated • AI is used to support edit manually and sometimes on bolt-on software or in the EHR resolution and denial paper clearinghouse processing • There is direct claim • Limited edits are in place to • Claims are submitted through submission for select payers • Staff activity is gamified ensure clean claims clearinghouse • Predictive analytics are used • Select appeals are submitted • Manual reports are used to • Secondary/cross-over billing for payer representative automatically identify accounts requiring is automatic availability follow-up • AI is used to analyze • Work drivers are in place to • Claim denial patterns are remittance and denials to • Payments are primarily prioritize accounts for analyzed to determine determine prevention manually processed follow-up prevention strategies strategies • Automated claim status • RPA is used for simple denial checks are in place resolution • RPA-supported payment • Underpayment detection and posting in place for eligible outreach is automated payers • Paper remittance is converted • Underpayment detection to 835 files for posting software is in place • Electronic remittance advice and electronic funds transfers are reconciled electronically Patient follow-up Stage one Stage two Stage three Stage four Novices Market average Early adopters Innovators L • Statements are submitted • Statements are submitted • There is omnichannel patient • Staff activity is gamified manually electronically communication • AI is used to support payment • Manual reports are generated • Work drivers are in place • Automated dialer is used to arrangement modeling/ to identify accounts for contact patients monitoring follow-up • Smart prioritization is in place (e.g., balance, • Payment plans are set up • AI is used to support text/ • OB calls to patients are dialed propensity to pay) online chatbots manually • Advanced call management • IVR is available to make • IB calls are answered by system is used to track payments whomever is available performance (e.g., abandonment rate) • Patients are provided care credit options • Interactive Voice Response (IVR) is used to route calls • Patients can live-chat with a and address common customer service questions representative 16 Issue 26 · Siemens Healthineers Insights Series 3. Seamless care experience A survey done by Cleveland Clinic identified pain Leaders at Mayo Clinic* believe that successful practices points that contributed to negative patient experience. of the future will infuse technology and innovation with These were: too little ease of use, lack of timely a human touch. Patients at Mayo Clinic can connect to responsiveness, and lack of communication and care teams through multiple channels, and they can view empathy around these issues.24 The key to addressing their health data from multiple health care providers in these pain points is creating a new way to communi- one place through Health Record on iPhone.25 Mayo cate, and patient portals are the way to do that. Clinic also launched an advanced care-at-home program, Patients can request refills, schedule an appointment, with doctors staffing a medical command center to care and even access their own medical information for people with a range of conditions such as cancer, whenever they want to. To deliver a seamless care heart failure, pneumonia, transfusions, and acute experience, patient portals are essential. Covid-19 care, allowing patients to remain at home.26 Yet patients have very limited portal access when dealing with novices in digital health. The triage assistance for patients in these organizations is also very limited. The only option for seeing doctors is through in-person visits and patients must call the practice to obtain information. Given the limited hours of service, they frequently get unsatisfactory responses or no response at all to their questions and requests. Innovators in digital health not only provide their 50% patients with up-to-date information, but patients can upload information to their health record and share of healthcare information with other organizations. Patients can consumers agree communicate with providers through various access that a bad digital points such as phone, portal messaging, text, or experience with a chatbots, and they can use these same access points for healthcare provider ruins the entire on-demand triage that is available anytime. At the experience with same time, providers and clinic staff can also send out that provider.23 proactive and personalized communication to patients. These organizations have the ability to augment virtual visits in real time with integrated remote capture technologies, a 360-degree view of a patient’s needs, and preferences for both administrative and clinical functions. This is enabled operationally by standardized workflows, staff and patient training, as well as a team of technical support staff. *Cases are not attributable to ECG. Siemens Healthineers Insights Series · Issue 26 17 Which level describes your organization? Seamless care experience Stage one Stage two Stage three Stage four Novices Market average Early adopters Innovators • There is limited portal access • Information contained on the • Patients have access to their • Patients can upload or portal is view-only and entire medical record on their download information and • Patients must call the practice to obtain limited; information may not portal; information is up to share their record with other date information; the process can be up to date organizations be challenging • Patients can call the practice • Patients can communicate • Patients can communicate to obtain information with with the practice through the with providers through • Patient outreach is conducted more ease patient portal in addition to various access points (e.g., as needed phone phone, portal messaging, • Proactive communication There is limited triage strategies are siloed at the text, chatbots) • • Proactive communication assistance for patients unsure of what setting to receive specialty/department level strategies are population • Providers and clinic staff send based and coordinated out proactive and care in or how to treat • Nurse triage is provided personalized communication symptoms present through a phone service and across the system may not be available 24/7 to patients • • Only in-person visits are Digital nurse triage is available through certain • offered • Asynchronous video visits are On-demand triage is available offered through a separate access points 24/7 through various access application; interoperability • Asynchronous video visits points with the EHR is limited and synchronous visits are • Virtual visits are augmented integrated through the in real time by the integrated patient portal; integration remote capture technologies with the EHR is functional • Administrative and clinical • Remote patient monitoring is functions have a 360-degree available for certain view of a patient’s needs and populations preferences 18 Issue 26 · Siemens Healthineers Insights Series 4. Personalized medicine The shift toward patient-centered healthcare has One success story from this initiative: investigators from opened the door for individualized approaches to prostate cancer PMCOEs have found that a genomic test diagnostics and treatment. Personalized medicine can estimate patients’ risk of metastasis, death from aims to provide the right treatment at the right time prostate cancer, and overall survival. Using results from for every patient, instead of a one-size-fits-all this test, clinicians can better determine which patients approach. It requires a precise understanding of the with recurrent prostate cancer may benefit from patient's condition, often through genomic testing, hormone therapy,30 which spares many patients from in order to offer tailored treatment without unnecessary side effects. Johns Hopkins has so far unwarranted variation. launched 16 PMCOEs, and it plans to expand to 50 centers over the next five years. Novices in digital health struggle with personalized care delivery and are characterized by encounter-based care. Patients are only treated for the presenting illness, and patient clinical alerts for follow-up and tracking do not exist. Population surveillance and data gathering are almost absent, making population health management difficult. Innovators in digital health provide truly personalized 25–65% whole-person care. Remote monitoring is in place so that S data can be automatically captured to alert care teams of all healthcare about adverse events. Innovators use AI to proactively costs are monitor patient data and provide alerts on outliers for attributable to clinical follow-up. Not only do they perform genomic unwarranted variations.27 screening on all patients to guide molecular-based treatments, but doctors also consider epigenetic factors in care decision making. Operationally, personalized care delivery is enabled by a population management strategy, genetic counselors to support patients, as well as training for patients and staff. One innovator that committed to a whole-person approach to precision medicine is Johns Hopkins Medicine*. The organization set up a strategic initiative called inHealth to increase precision and customization of patient care.28 Out of this initiative, the Precision Medicine Centers of Excellence (PMCOEs) were born to make it easier for clinicians to conduct big-data research and translate their insights into clinical applications.29 *Cases are not attributable to ECG. Siemens Healthineers Insights Series · Issue 26 19 Which level describes your organization? Personalized Medicine Stage one Stage two Stage three Stage four Novices Market average Early adopters Innovators • Care delivery is encounter- • Population-based programs • Remote monitoring is • Molecular-based treatments based exist for one or two chronic available for specific are guided by patient diseases but are basic Treatment is provided for the populations, data is genomic profile • presenting illness Pharmacogenetic testing is automatically captured, and • the care team is alerted • Genomic screening is available for one or two Population surveillance and about adverse events performed on all patients • data gathering is limited commonly used drugs • Technology prompts staff and • • Data gathering and tracking Population health Patient clinical alerts for management is managed by patients for follow-up directly • across the continuum of care follow-up and tracking do not dedicated staff is limited • There is increased attention exist • Drug therapies are targeted to epigenetic factors in care • Few clinicians or specialties based on molecular testing decision-making deploy data-driven diagnoses and customized treatments • There is a high patient • Pharmacogenetic screening is provided for multiple drug adoption of personalized regimens services, home hospital, and monitoring • Integrated best practices and predictive analytics are on • AI is used to proactively hand for providers monitor patient data and provide alerts on the outliers for clinical follow-up For more in-depth analysis or further assistance, please contact ECG Management Consultants (www.ecgmc.com). 20 Issue 26 · Siemens Healthineers Insights Series Conclusion Designing a roadmap for tomorrow begins with knowing where you are now All hospitals deal with their own specific patient demo- Digital transformation is not about simply adopting the graphics, and face their own specific challenges. It is by latest technology. The success of a digital transformation recognizing their own unique needs that organizations requires healthcare leaders to deeply understand their can reach the innovator stage. They must start with one patients’ values and expectations, and be able to build question: does our hospital have the right foundation to expertise and empower staff to work in new ways. But support all of our operations? As large volumes of data leaders do not have to be alone in this journey. They continue to flood in, investment in the right data would benefit from exchanging best practices and lessons infrastructure will be crucial to translating it into learned with other innovators. There are communities meaningful information. Only then can an organization around the globe where like-minded colleagues can begin to optimize its internal processes such as gather to connect and discuss the latest trends in health registration, scheduling, financial clearance, check-in, technology. Healthcare-focused consulting companies charge capture, billing, and follow-up. Not only are these can also conduct more in-depth analysis of individual processes critical to financial performance and workforce hospitals’ needs, and provide tailored recommendations. efficiency, they also have a direct impact on patient By having a clear understanding of the digital maturity experience across the care continuum. The care journey level of their organizations, leaders can design a begins before patients get to the hospital, and continues roadmap for future growth, leading their teams to new on after they have left, and a patient portal ensures a heights, and giving their patients the best care possible. seamless care experience pre- and post-care. Finally, technologies that enable personalized medicine allow organizations to offer the right treatment, at the right time, for every patient, which is the goal of true patient- centered care. Siemens Healthineers Insights Series · Issue 26 21 References 1. Looking ahead, Staying ahead 7. Boissy A. Insight Series: Patient Trust - 13. Intermountain Healthcare reduces [Internet]. 25th ed. Deloitte Insights; Why it matters for COVID-19 and check-in time by 25% with intelligent 2019 [cited 3 August 2021]. Available Beyond. 22nd ed. Siemens Healthineers; automation [Internet]. Notable; 2021 from: deloitte.com/content/dam/ 2021 [cited 3 August 2021]. 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Available from: a-good-patient-experience hopkinsmedicine.org/inhealth/ about-us/index.html Siemens Healthineers Insights Series · Issue 26 23 About the authors Joanne Grau Dr. Ralph Wiegner Thought Leadership Manager Digitalizing Global Head of Digitalizing Healthcare Healthcare at Siemens Healthineers at Siemens Healthineers Joanne Grau focuses on current trends and thought leader- Ralph Wiegner and his team engage in thought leadership ship content for Digitalizing healthcare. Prior to this role, and portfolio-related activities for Digitalizing healthcare. Joanne has had ten years of marketing experience in Earlier, he worked as head of Improving patient experience, Siemens Healthineers as marketing director for the head of Marketing Strategy and in global key account diagnostics division based in New York and as Head of management. Prior to joining Siemens Healthineers, Marketing for ASEAN countries based in Singapore. Ralph worked for several years in the Banking and Asset Joanne graduated from UCLA with a degree in Molecular, Management practice of McKinsey & Company on various Cell, and Developmental biology. Before joining Siemens European and international assignments. Ralph holds a Healthineers, Joanne was a research scientist in Quest Ph.D. in Theoretical Physics from University of Erlangen, Diagnostics (formerly Celera) and has authored multiple Germany, with several research engagements at the publications. Joanne is also currently a faculty member in Oklahoma State University, USA. Union University of California. Asif Shah Mohammed Ben Colton ECG Management Consultants ECG Management Consultants Asif leads ECG’s digital health practice, bringing business As the leader of ECG’s Revenue Cycle practice, Ben assists planning acumen and expertise in both strategy and health systems across the country in evaluating, implementation to help healthcare organizations under- optimizing, and improving their revenue cycles to support stand the current market trends, competitive landscape enhanced financial performance and operational and improve their technology strategies. His practice alignment. He is also an expert on the operational and focuses on helping organizations rationalize technology regulatory requirements for transitioning from acquisitions across the care continuum to design and freestanding to provider-based billing designation, and he establish long-term solutions that align with the over- has helped numerous organizations with this conversion arching strategic vision. He has led multiple transformation process. The focus of Ben’s engagements expands beyond engagements, including business planning and implemen- helping clients realize only a onetime opportunity, tation of digital health initiatives and go-to-market planning emphasizing instead the establishment of a revenue cycle and commercialization of new technology investments. environment that supports continuous improvement. 24 Issue 26 · Siemens Healthineers Insights Series Laura Barrera Nick van Terheyden, MD ECG Management Consultants ECG Management Consultants Laura is a results-driven consultant and Lean Black Belt Dr. Nick is a physician leader and business strategist who with extensive experience in ambulatory operations, draws on his clinical experience, technological prowess, patient access and engagement, digital health, and and relationship management capabilities to craft and strategy. Laura helps clients increase revenue, reduce implement transformative, patient-centered strategies expenses, and transform the consumer experience through aimed at improving operational performance and the creation of strategies and plans aimed at driving efficiency. He is an industry thought leader and a promi- operational improvement. Her knowledge and background nent healthcare IT influencer, having been featured in in performance improvement methodologies, human- the top 5 of The #DigitalHealth Power 100 list of leading centered design, and technology systems has been healthcare tech and AI influencers to follow. instrumental to the success of numerous implementation and optimization projects. ECG Management Consultants ECG specializes in providing consulting assistance to leading healthcare providers across the U.S. In Novem- ber 2019, ECG entered into a partnership agreement with Siemens Healthineers, the global leader in medical Onur Torusoglu technology and digital health transformation. ECG Management Consultants Through its knowledge and expertise built over com- pleting more than 12,900 major consulting projects of Onur is a healthcare executive with extensive digital different types for more than 2,500 leading healthcare organizations for nearly 50 years, it pulled together transformation and analytics experience. Having served best practices on digital transformation and developed as a C-suite executive, along with in a consulting capacity, a framework to measure the digital maturity of a Onur has worked with board-level members to frontline hospital in a holistic way. As an independent affiliate, ECG collaborates with the Siemens Healthineers’ global leaders at provider, payer, and life science organizations. enterprise services practice, providing subject matter Utilizing new capabilities in digital health, Onur assists expertise, smart counsel, and pragmatic solutions. clients in achieving national and international recognition in variation reduction, care coordination, and operational efficiency gains. His trailblazing approach to analyzing, visualizing, and managing the COVID-19 crisis earned the interest of the leading technology research firm Gartner, resulting in Onur and his team receiving a best practice in digital and analytics case study. In addition, his work in artificial intelligence achieved awards from AAAI and the Bell International Innovation Award. Siemens Healthineers Insights Series · Issue 26 25 Suggested follow-up on siemens-healthineers.com/digitalizing-healthcare • Siemens Healthineers Insights paper issue 12: This changes everything – The COVID-19 pandemic leads to a significant acceleration of digitalization in healthcare. Available at: siemens-healthineers. com/insights/news/accelerate-digital-health- transformation.html • Siemens Healthineers Insights paper issue 16: Who are the leaders in digital health and what can we learn from them in times of COVID-19? Available at: siemens-healthineers.com/insights/ news/leaders-in-digital-health • Siemens Healthineers Insights paper issue 21: Turning data into value; A thought leadership paper with Dr. Hee Hwang from Seoul National University Bundang Hospital on his strategic approach to data integration. Available at: siemens-healthineers.com/ turning-data-into-value i Information The Siemens Healthineers Insights Series is our preeminent thought leadership platform, drawing on the knowledge and experience of some of the world’s most respected healthcare leaders and innovators. It explores emerging issues and provides practical solutions to today’s most pressing healthcare challenges. All issues of the Insights Series can be found here: siemens-healthineers.com/insights-series Contact For further information on this topic, or to contact the authors directly: Dr. Ralph Wiegner Global Head of Digitalizing Healthcare ralph.wiegner@siemens-healthineers.com Asif Shah Mohammed Principal, ECG Management Consultants ashahmohammed@ecgmc.com 26 Issue 26 · Siemens Healthineers Insights Series At Siemens Healthineers, our purpose is to drive innovation to help humans live healthier and longer. Through our products, services and solutions we help physicians, medical staff, and healthcare providers prevent illnesses from occurring and to correctly diagnose and determine siemens-healthineers.com/ the right treatments for people who do become ill – insights-series resulting in fewer complications, shorter hospital stays, and faster patient recovery. Our mission is to enable healthcare providers to increase value by expanding precision medicine, transforming Did you enjoy the read? Make sure to subscribe to care delivery, improving the patient experience, and our newsletter to always receive the latest thought leadership insights. digitalizing healthcare. With our comprehensive portfolio – from in-vitro diagnostics and imaging to therapy and All issues of the Insights Series can be found here: follow-up care – we address the complete care continuum siemens-healthineers.com/insights-series for many of the world’s most threatening diseases. Every hour, more than 240,000 patients are touched by technologies provided by Siemens Healthineers. We are at the center of clinical decision making with almost three-quarters of all critical clinical decisions influenced by our solutions. We are a leading medical technology company with over 120 years of experience and more than 65,000 highly dedicated employees around the globe who are innovating every day, truly shaping the future of healthcare. Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Phone: +49 9131 84-0 siemens-healthineers.com Published by Siemens Healthcare GmbH · HOOD05162003225084 · online · 0921 · © Siemens Healthcare GmbH, 2021