Rae Woods (00:02): From Advisory Board, we are bringing you in Radio Advisory. My name is Rachel Woods. You can call me Rae. Healthcare isn't exactly known for having a robust digital experience, but we know that having a solid digital experience is a must have capability for healthcare organizations, especially as the landscape gets more and more competitive. So today I've invited digital health experts, Jordan Angers and Ty Aderhold, to tell us what we should actually be aiming for when it comes to the digital consumer experience. Plus, at the end of this episode, I've reserved a little bit of time to give you an update on what the results of the midterm elections mean for healthcare. Make sure you stay to the very end to get that update. But for now, let's go to Ty and Jordan to talk about digital consumer experience. Hey Ty. Hey Jordan. Welcome to Radio Advisory. Ty Aderhold (01:02): Hey Rae, thanks for having us. Jordan Angers (01:03): Hi, Rae. Excited to be here. Rae Woods (01:04): Yeah, first time, Jordan. No pressure. Ty has been on this podcast too many times at this point. Ty Aderhold (01:11): Too many times. Too many times. Rae Woods (01:12): I am excited to have your voice added to our repertoire. Jordan Angers (01:16): Me too. Ty has given me some advice so I feel ready. Rae Woods (01:18): We're going to be talking about the digital consumer experience, and I'm just going to caveat from the start that I think a lot of people have some perceptions about what a digital experience means, even what a consumer experience should look like in healthcare. I want to set the stage. What do we mean when we're talking about a digital consumer experience and how do we know what makes for a good one in healthcare? Jordan Angers (01:56): People often think about a digital experience in healthcare as following the consumer experience, so something that happens before the patient visit, during the patient visit and after the patient visit, but when we talk to organizations, what we found is that it's really hard to think about what can make that good and what are the goal posts that you're trying to achieve in each of those areas. Instead, we looked at how other industries have built really good digital experiences and we narrowed it down to five components that we think make for really strong digital experiences. The five that we narrowed it down to were functionality, customer service, self-service, personalization, and an omnichannel experience. Rae Woods (02:45): This is interesting to me because... And correct me if I'm wrong, but I'm not sure that thinking about the digital consumer experience in that patient journey was necessarily wrong. I'm just not sure it was also the most helpful thing, especially when that journey can look different depending on if you are the patient yourself or if you are the parent or the caregiver or if you are a helper. It just looks different every time, so maybe thinking about these components is just a more helpful way of deciding what our bar should actually look like. Ty Aderhold (03:19): Rae, I think that's right. What you're touching on is that oftentimes, especially now, these are not linear experiences either. Rae Woods (03:28): Yes. Ty Aderhold (03:28): You could be pitching up the digital aspect of your experience right in the middle of your journey or you go back and forth between digital and not, that view of the patient journey and following the experience through that journey just doesn't work as well as we think about how people consume healthcare today. The other caveat I want to bring in here about how we think about digital experience is it's so easy to think about how we consume any digital media or experience ourselves and apply that to healthcare and also assume that others are going to consume it the same way we do. I think that's what we see a lot when it comes to the healthcare digital experience as well. I am someone who wants to go use an app to figure out what I want or where I want to get care, and so, maybe I assume others want to do that as well and that's just not the case. Rae Woods (04:21): Let's talk about your five areas of focus, and I'm going to repeat them. They're functionality, customer service, self-service, personalization, and omnichannel. Now, some of those seem obvious to me. I would hope that anything digital is functional. Maybe you're going to tell me that there's a higher bar for what functional actually means in healthcare, but some of these, I've got to tell you, I'm worried about us being able to actually hit it. I'm thinking about omnichannel specifically. This is not something that healthcare is necessarily known for. Why is this the right level that we should be aiming for as an industry that frankly is really freaking behind when it comes to anything digital? Jordan Angers (05:03): I agree completely with you that healthcare is not known for having great digital experiences, but at the same time, a good digital experience is a good experience regardless of what industry you're interacting with, and healthcare doesn't get a pass for being healthcare because the patients and the members that are interacting with your healthcare organization are bringing all of the knowledge and experiences that they get from interacting with banking and retail and streaming service and all of those other examples that you hear all the time. Rae Woods (05:39): I completely agree. The bar is set by everything that is not healthcare, not by healthcare experiences themselves. Jordan Angers (05:47): Yes. Rae Woods (05:47): Maybe that's why you decided to look outside of our own industry. Jordan Angers (05:51): Exactly. I think for each of the five components that we identified, we do have examples of healthcare organizations who have been able to do it successfully. It shows that it's not impossible for healthcare to achieve that better digital experience. Ty Aderhold (06:08): The only thing I'll add here is you don't have to have all five for a good digital experience to exist. Even if you have one or two, that is likely a better digital experience than a lot of patients and members are getting today, which is not to say don't put an effort here, but it is to say that you don't have to achieve at all five to provide the experience that patients and members would appreciate. Rae Woods (06:36): I'm also guessing that there's some level setting to do within these areas of focus. I'm sure that you are going to tell me that some of your external examples come from the big heavy hitters in retail, the Amazons of the world, the- Ty Aderhold (06:52): JPMorgan Chase is a great example. Rae Woods (06:55): JPMorgan Chase. Again, things that we use in our everyday lives, but I'm also guessing there's a pared back version of that that is still net better for healthcare. Let's get some examples of these. Start with my one that I have a question on, which is functional. What is a functional digital consumer experience? Ty Aderhold (07:17): On a base level, I think a functional consumer experience is one that works and that could come across as... Of course everything works, but honestly no. Not everything works. I think in particular when you think about functionality, what we're talking about here is not just an app that doesn't freeze or a website that loads. What we're talking about here is an app or a website that lets the user do what they're hoping to do. (07:46): You could have an app that works, that you can click around in, but if it doesn't let the user accomplish what they're setting out to do within that app or what you're telling them they could technically do within that app, it's not actually functional. That's where I think the difference comes in and where there are organizations that have apps that technically function but maybe aren't functional from a consumer experience perspective. Jordan Angers (08:11): Our team ran an informal survey with our coworkers and friends and family about good healthcare experiences. The one medical app was a really good example that came up a lot of a good digital experience that actually worked. People could actually schedule their visits when it said schedule here and they could actually pay their bill through the app or they could find the information they were looking for. Rae Woods (08:36): The schedule one is a big one for me because oftentimes, either in an app or on a website, there is an option that says schedule an appointment, but it's not actually scheduling an appointment. It's, "Send an email," "Here's a phone call," "Schedule this and then somebody will call you and tell you that time actually never worked in the first place." Now, I understand what you mean, Ty, by actually functioning in the way that it is intended to. Scheduling an appointment means actually scheduling the appointment that you're going to have at the end of the day. Jordan Angers (09:07): Even though it sounds very basic to have an experience that works, this is the first building block to creating an experience in building that patient trust in the rest of your digital experience. Rae Woods (09:21): We know that that trust can be broken, which is maybe why customer service is something that's important. Jordan Angers (09:28): The reason that we included customer service as one of the components in the second component is because I think when a lot of people hear digital, they get worried that they're going to lose that human touch and that human relationship. The word to emphasize in customer service is service and that you can have that customer service experience even if it is digital, and it's really important to have it to help support your end user throughout their experience. Rae Woods (10:03): This is the biggest pushback that I hear from physicians themselves when they're really guarded against the industry becoming more digitized. Even when we talk about some of the disruptive innovators that Ty has talked about on the podcast before, Amazon being the big one, they say, "But they don't have that patient touch that we do." Ty Aderhold (10:22): I think that's right. Healthcare organizations need to find a way though to bring some of that customer service and patient touch into digital spaces as well. We shouldn't exist in a world where the only way to have some of that touch is through an analog channel as opposed to a digital channel. Building upon that, and actually, the next thing that I think we're going to talk about here is self-service, it's very different... Self-service and customer service. You can have a live person on the other end of a digital platform that you're talking with with customer service and I think that is an important distinction. We're not just talking about self-service, a patient doing everything themselves on their own when we talk about a digital experience. Rae Woods (11:09): What's the right balance? Because I don't think we necessarily need to just keep throwing more humans at it or having digital be this weird middle man between eventually getting to a person anyways. What's the right balance between self-service and having that human touch? Ty Aderhold (11:23): I think there are two ways to think about this. One, there are certain activities, and this could depend on your organization, that you never want a patient to self-serve on. Rae Woods (11:39): Like what? Ty Aderhold (11:41): An example would be a patient trying to schedule a specialty visit before they have gone to a PCP consult. That is not something that we want patients going out and self-serving on. Rae Woods (11:51): Right. You're not going to schedule a neurologist visit for headaches on your own. Ty Aderhold (11:56): Exactly. That's a place where we should never have patients self-service. That's one way to cut down on where we think about self-service. The other way to think about it is that we are, I think I would say never, going to reach the place where every patient or member is going to self-serve on anything. There are always going to be people who want an analog talk to someone or chat to someone option, whether that's because they just prefer that, they want to get the confirmation or have the conversation with someone, or because they may not have the necessary tools, the necessary digital literacy to do the self-service route. We can't completely over-index on self-service and leave people behind who either don't want to have that type of interaction or can't have that interaction. Rae Woods (12:50): This is the moment where every single listener is going to be nodding their heads and thinking, "Yeah, all the old people want to interact with a person." Is that the right way to be thinking about this? Ty Aderhold (13:00): Frankly, yes and no. I think there is something to be said for... There are a lot of people out there who just want to pick up the phone call and talk to someone. They feel much more secure in that type of interaction. Another thing to layer in here is trust. People can trust that interaction in a way they may not trust a digital interaction, but I want to expand this beyond just, "Okay, this is old people and eventually, everyone will age out of this behavior and everyone will just want to self-serve." It's very much not the case. I think people of all walks of life may have some trust issues, especially with things related to their healthcare data and how they interact with healthcare organizations, and that's something that we need to be aware of and can change or perhaps influence when we should be self-serving or encouraging self-service or not. Rae Woods (13:54): Maybe the fact that it depends so much is one of the reasons why personalization is in your top five. I'm even thinking about experiences in which I want to and should be self-serving as a consumer myself and moments in which I should not and it is possible and perhaps recommended that my organization be able to even personalize that so that I can self-schedule my PCP appointment but not the neurologist appointment that I necessarily want. Jordan Angers (14:23): That is a challenge that we heard a lot from provider organizations in that you shouldn't assume that some patients won't want to self-serve or that some patients will know how to self-serve, because what we've seen is that even though people use self-service in every other aspect of their life, like you can deposit a check online, they're not used to it in healthcare so some people just don't know that it's an option and so they don't even try it out or they don't look for it, or on the other hand, they see that it's an option and then it goes back to that trust where they forego that option because they don't believe that it will truly work. Rae Woods (15:03): Jordan, that is such an important point about the complexity of this problem. We already said that the bar is being set by every non-healthcare digital experience that you have, but because the bar is so low within our own industry, even when some of these options exist, patients and consumers don't know that they have access to them, and so, teaching somebody that there is an option for self-service or you can have a personalized experience or there are multiple channels for you to use is an investment that organizations are going to need to make. Jordan Angers (15:34): I think that's where the customer service comes in, helping your patients know when and how to use your solution. Rae Woods (15:41): So they're all connected. Ty Aderhold (15:41): Right. They're all connected. Rae Woods (16:53): I want to come back to personalization again for a moment because I think this is one where people intuitively know that's where the industry should be going. Everyone points to something like Netflix that's giving you recommendations on the type of show or movie you should watch, or Amazon even giving a recommendation of, "Hey, it's been a while since you've ordered those Tide pods. You probably are running low. It's time to re-up your subscription there," or even to choose a subscription as an option. What else is really important for us to know when it comes to personalization in the digital experience? Jordan Angers (17:25): Well, this is definitely getting into the trickier territory of how to make this work well in healthcare, but something we heard in a research interview the other day that I thought was really interesting is that this is where digital has the upper hand over an in-person experience for sure. You can really personalize a digital experience in a way that you can't with an in-person experience. Rae Woods (17:50): Or you can personalize a healthcare experience in a way that you cannot personalize a home shopping experience or movie watching experience. Ty Aderhold (17:59): Right. Jordan Angers (17:59): Yes, exactly. Ty Aderhold (18:01): I think the one thing with personalization I want to point out is that healthcare organizations need to be careful here because this can very quickly veer into creepiness, particularly when we're talking about healthcare and individuals' healthcare. I'm just thinking of a scenario where let's say there's a health plan and employer working together on a member's healthcare needs and they've decided to go the personalization route. (18:30): They anticipate the needs of an individual and can send them an email about a potential pregnancy before that individual has communicated this to the employer, and that is a place that I think most people would be pretty creeped out by. I guarantee you these organizations have enough data to do that, and so, they have to make the decision of, well, how personalized are we going to get before it becomes, "Wow. They know way too much about me. This is getting weird"? Jordan Angers (19:02): I think it's personalization inception because you have to personalize how much personalization you have in that patient's digital experience. Some people are okay with a lot and like Ty said, some people are creeped out by it. Rae Woods (19:16): Again, that's why there's a spectrum of things that matters here. Let's talk about your last feature, which I'm going to admit, this one's a tricky one for me. It's omnichannel. I have no doubt that my healthcare experience would be better if I had more options to actually access the healthcare ecosystem, but I don't want an app for everything. Maybe that's the right answer. I don't know. Ty, you're going to tell me. Should every single healthcare system, should every medical group, should every health insurance platform have an app? What is the right amount of omnichannel experience that is going to be better? Ty Aderhold (19:53): Rae, don't worry. We're not telling everyone to have an app. Don't go build app for your healthcare organization just because we're talking about omnichannel. I think the biggest thing here is you just need a way to pick up and transfer information from across platforms. From desktop to analog, from a website to an app if you have an app, and have that information that the patient has already given you in one medium transport over to the other medium. Rae Woods (20:23): And across all sites. Five elements is a lot. Is anyone actually doing all of this? Do we even have an example of someone who has a functional digital experience that has the right amount of customer service that allows for appropriate use cases of self-service in a personalized matter across multiple channels? Jordan Angers (20:45): I don't think there's one organization that's doing all five of these really well and I think that shows how hard this is, but there are organizations who are doing one or a few of these really well, which shows that it is possible for healthcare to make progress. Rae Woods (21:03): What advice do you have for leaders who are trying to move the dial on some or all of these? Where should an organization begin? Especially when, let's be honest, some might be really behind. Some might be hearing this conversation and thinking I don't even have a unified EMR. How can I do this omnichannel piece and then personalize the experience across multiple channels if I don't even have a unified platform yet? Ty Aderhold (21:29): I'll echo something Jordan said earlier that I think is really important, which is functionality is the building block of all of these. Don't start with omnichannel. Definitely don't start with omnichannel if you don't have the functionality figured out first. That'd be where I would start. Particularly, as I mentioned earlier on making it actually usable and letting the patient or member accomplish what they're hoping to do in the platform. Jordan Angers (21:59): I would just add on that being the laggard of the laggards, there is some positive to that and that's you can look at what others are doing and you can use their examples to learn from maybe their mistakes and then hopefully leapfrog and jump over to a better digital experience. Rae Woods (22:18): It strikes me that there might be one benefit to being an industry that has thus far been pretty behind when it comes to digital adoption and that's that we can avoid mistakes that others have made. What ripple effects do we want healthcare leaders to avoid that we've frankly learned and can get ahead of because we're really just getting started now? Ty Aderhold (22:42): Rae, I think healthcare needs to avoid making assumptions about who will use these digital solutions. It's very easy to picture in your mind the type of person that you might think you're designing a digital experience for. They're probably relatively young, relatively affluent, but that's not how we should approach the design process. We need to be designing for who patients are and who members are and not who we think are digitally enabled consumers out there. Jordan Angers (23:14): One thing that I would add to that, we heard this a couple days ago and now I'm going to steal it because I really like it, but an organization we talked to, their motto is, "Don't just assume that there will be people out there who cannot use your digital solution or learn how to use your digital solution. Instead, go into everything with the goal that you are going to design solutions and experiences that people can access and they can use." Rae Woods (23:43): I love that so much because it speaks to not just this young-old problem. I would love to dispel the myth that only millennials want digital products in healthcare as a proud millennial, but what you're speaking to, Jordan, is a bigger challenge and that's that we tend to design these products for technologically enabled people or people who already have access to these tools. Ty, you've been on this podcast making the very clear case that that is not necessarily true and my biggest fear is as the healthcare industry adopts more and more digital solutions, is that we actually make inequities worse and not better. How do we factor in digital inequities when we're thinking about the best digital consumer experience? Ty Aderhold (24:28): I think there's a couple things we need to do. First, we need to make, in general, the experiences we offer on the digital side easier to use. That's lowering the digital literacy barrier of the app, the website, the platform that exists, and at the same time, limiting the amount of available options or actions that the patient or user could take at any single moment. Instead of having 50 different places they could click or an action they could take, understand where they are at that point in time in their patient journey or their member journey and give them the actions that they're actually going to be taking at that point in time to make it a lot easier for them to use. The other point here is we need to be doing a much better job of designing for mobile users. Broadband access is not a given and stable broadband access, certainly not a given. We need to do a better job of building tools, building experiences that use limited amounts of data and work on mobile devices because that will widely open up who is able to use these platforms. Rae Woods (25:38): By the way, making something that is mobile first doesn't necessarily mean making an app. Ty Aderhold (25:43): Yes, retweet. Rae, the other thing I would be remiss to not mention is the trust angle. We need to be, as an industry, aware that people may not trust connecting with us digitally right now and actively going out and changing that. It's not just something of building a tool that is mobile first that has a pretty low barrier to entry and people will use it. (26:10): You need to go actively show and get in front of them and say, "This will make your life easier. We are protecting your data. This data isn't getting resold," but at the same time, you also need to make sure that's the case. We've seen headlines of scheduling tools that ended up sending information off to the Facebook or Meta servers and advertising. You need to make sure that's the case, and then after you do that due diligence, then go out and communicate that to your patients and your members. Rae Woods (26:42): Well, Jordan, Ty, when it comes to the digital consumer experience, what is the most important thing you want our listeners to take away? Jordan Angers (26:50): While there is a ton of interest and excitement about digital health, there's also this prevailing belief and acceptance by some that healthcare is behind and they're never going to catch up and there's nothing to be done about it, but I think that we've seen enough organizations make progress that proves that that's not true, and then same thing with digital equity. Healthcare organizations can make a difference and they can make progress and all of that progress comes with some real financial returns for the healthcare organizations that invest in it. Ty Aderhold (27:27): The last thing I'll say here, and this is a little bit of a curve ball I think to bring it to plate, but it's super important, is that you have to work with your partners on this. You can't work on this in a silo because if we think about the patient experience from the patient perspective, they, at times, are going to have no idea who is responsible for the bad experience they just received. (27:50): They don't know if it's the hospital, the physician, the payer, their employer. They have no visibility into that, and so, if you are an organization, you have to not only work on your own digital experience, but make sure your partner's digital experience is also working for those patients and members that they mesh together well. This is not something you can work on in a silo. Rae Woods (28:13): Well, Jordan, Ty, thanks for coming on Radio Advisory. Jordan Angers (28:17): Thanks, Rae. Ty Aderhold (28:17): It's great to be here. Rae Woods (28:21): Before we close this episode, I want to turn to an analysis of the midterm elections and share our insight on what happened, what matters, and what's coming next. It is Monday, November 14th, just after 9:30 AM and look. I know that you've already seen a lot of election analysis, but here's where things stand right now. Over the weekend, the Democrats secured their narrow majority in the Senate, and as of right now, it looks like the house is going to flip to GOP control. Now, that's not necessarily guaranteed, but here's what all of that means. Whether we end up with a split government or not, we are going to have even more narrow margins than what we've seen over the last two years, which means even more gridlock in Washington. (29:21): That gridlock is out of step with what voters want, which is action on healthcare. They have a lot of opinions about our industry. They care about their coverage, they care about costs, they care about access to reproductive services. We saw voters in South Dakota pass a state ballot initiative expanding Medicaid. California, Vermont, and Michigan all passed initiatives to protect access to abortion, and Kentucky voters followed Kansas in rejecting an anti-abortion measure. Voters also care about things like marijuana legalization and healthcare as a human right. (29:59): They care about interest rates and medical debt and more, and this is where healthcare showed up the most. At the state level. We're at this moment of rising federalism, which is going to make things more complicated for healthcare business. Obviously, organizations don't want to limit themselves to growth within the boundaries of a single state. AS states adopt different policy and political stances, or maybe even add different conditions to those policies, that makes the business of healthcare much more complicated for multi-state organizations and their partners. (30:37): Notice what I haven't said yet. There's not likely going to be any sweeping federal healthcare policies like we've seen over the last couple of years. Now, that's not to say that there's not bipartisan support for things like behavioral health reform, but it's yet to be seen how that will translate into actual legislation. I want to be clear. The absence of new federal policies doesn't necessarily mean that this is going to be a slow two years for healthcare. In fact, the technical challenges to come are going to be enormously consequential. This means it is time for you to sweat the small stuff. (31:19): Remember, there are existing federal laws that organizations still need to implement. I'm talking about things like the Inflation Reduction Act, which includes new laws around Medicare drug pricing. I'm talking about price transparency and the No Surprises Act. There are also changes the industry is eyeing very, very soon that are going to have serious ripple effects for health leaders. I'm thinking, of course, of the Medicaid cliff that will come when flexibility is put in place under the public health emergency end, plus the cascade of coverage transitions that organizations will need to plan for. (31:54): By the way, that's not going to happen immediately. Just like changes to telehealth reimbursement, state licensure, cost control initiatives and provider support won't necessarily flip like a light switch. It's the ripple effects of these changes that are going to be felt very soon and for the months and years to come. Remember, as always, we're here to help. (32:25): If you want to learn more about how leaders can address digital inequity, I want you to go back and listen to episode 87 titled Digital Inequities and Why You Shouldn't Call It The Digital Divide. Plus, we have whole playlists on our website dedicated to technology and disruption and health equity. If you like Radio Advisory, please share it with your networks. Subscribe wherever you get your podcasts and leave a rating and review. Radio Advisory is a production of Advisory Board. (32:57): This episode was produced by me, Rae Woods, as well as Katy Anderson and Kristin Myers. The episode was edited by Dan Tayag with technical support by Chris Phelps and Joe Shrum. Additional support was provided by Carson Sisk, Leanne Elston, Alice Lee, Nicole Addy, John League, Natalie Trebes, Ashley Antonelli, Sharon Yuen, and Sara Zargham. Thanks for listening.