CONCLUSIONS PAPER

Featuring:

Dr. Graham Hughes, Chief Medical Officer for SAS’ Center for Health Analytics and Insights

Cindy Berry, SAS Health Care Strategist

Mike Perkowski, moderator, co-founder and partner of New Reality Media LLC

An overview of the Dec. 13, 2011, webinar: Five Best Practices to Engage Patients as Active Members of the Care Team Sponsored by SAS and hosted by HealthData Management

21st Century Health Care Delivery: Patient Engagement Strategies That Work

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21st Century Health Care Delivery: Patient Engagement Strategies that Work

Introduction Can health care providers learn from outside industries that excel at forming deep, lasting bonds with their customers? Companies like Apple and Toyota not only have rabid fans – they constantly interact with their customers in effective, engaging ways. If the health care industry begins to engage patients in the same way, will it form deeper bonds with health care patients – and achieve its ultimate goal: to improve lives by increasing good behaviors?

The fact is, if care is limited to office visits, the industry is missing a real opportunity to change behavior and change lives. To truly influence the patients’ (or customers’) health, the industry must learn customer outreach and engagement lessons from best-in-class examples such as the automotive or technology industries. According to webinar speaker Dr. Graham Hughes, Chief Medical Officer for the SAS Center for Health Analytics and Insights (CHAI), “to really adopt a customer-centric approach requires that health care organizations reorganize their entire business around their patients’ needs.”

A patient-centric business model is not limited to the boundaries of the traditional office visit or hospital stay. Instead, it requires a 24/7 care management and delivery model supported by a variety of digital technologies. It’s a model Hughes calls “always-on health care” that adapts to patients instead of expecting patients to adapt to the needs of the health care provider. Interaction becomes continual using innovative ideas like phone coaching, digital home monitoring, Web outreach, SMS messaging and IVR systems.

By combining information from electronic medical records with both patient data collected between visits and less-traditional customer data (such as gym memberships, drug store purchases and demographics), we can now use advanced analytics to better understand the needs of at-risk populations. Advanced analytics can also improve our understanding of patient engagement techniques that encourage behavioral change to reduce avoidable costs and improve an individual’s health. This webinar details the best practices of highly customer-centric companies and how they can be applied to the health care industry.

How Engaged Are We in Patient Outreach? The best customer-centric companies rely heavily on customer data to inform their work. So, it was appropriate that this webinar began with a poll of the audience to determine its level of experience in automated patient engagement activities. Overall, the majority of participants had begun to explore the use of patient outreach and engagement tools, and as webinar moderator Mike Perkowski noted, “We are at a point where people have started the ball rolling, and would like to see more activity in the coming years.”

The 21st century health care

provider’s responsibilities

extend far beyond the office

visit. The time has come for

round-the-clock health care

management and a true

partnership between patients

and providers – with the patient

at the center of care.

Learn More

Download the white paper The Power of Health Analytics: Informed Decisions, Improved Outcomes: sas.com/reg/wp/corp/36698

To learn more about topics discussed in this paper, visit the SAS blog, A Shot in the Arm. blogs.sas.com/content/hls

View this paper’s webinar: http://bit.ly/zS7DqJ

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SAS Conclusions Paper

Are you actively using automated systems to help manage your patient outreach and engagement initiatives?

0 5 10 15 20 25

Comprehensive adoption (individualized to most or all patients) – 20%

Selective adoption (2-3 high priority conditions) – 20%

Piloting with a subset of patients – 20%

In planning phase – 16%

No activity – 23%

Figure 1: Webinar participants represent a wide range of states of readiness.

Principles of Patient-Centered Care in Action Most health care organizations have adopted patient-centric care models, and several progressive organizations have fully embraced a patient-centered care approach. Hughes observed that many of the principles of the patient-centered medical home (PCMH) model are not new, but in aggregate, they have the potential to revolutionize the way in which patients receive coordinated, high-quality care focused on overall improvement in health.

Key components of the PCMH model:

• Personalphysician. Each patient has an ongoing relationship with a personal physician trained to provide first-contact, continual and comprehensive care.

• Physician-directedmedicalpractice. Personal physicians lead a team that collectively takes responsibility for the ongoing care of patients.

• Whole-personorientation. Personal physicians provide all the patient’s health care needs, or take responsibility for arranging care with other qualified professionals.

• Integratedcare. Care is coordinated and/or integrated across specialists, hospitals, home health agencies and nursing homes.

• Qualityandsafety. Assured by a care planning process, evidence-based medicine, clinical decision-support tools, performance measurement, active participation of patients in decision making, information technology, voluntary recognition process, quality improvement activities and other measures.

• Enhancedaccess. Available via open scheduling, expanded hours and new options for communication.

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21st Century Health Care Delivery: Patient Engagement Strategies that Work

• Appropriate payment. Payment must appropriately recognize the value a patient-centered medical home provides to patients. For instance, payment should reflect the value of work that falls outside of the face-to-face visit, support adoption and use of health information technology for quality improvement, and recognize case mix differences in the patient population being treated within the practice.

“Organizations that embrace and adopt these principles are establishing a solid foundation for a more productive healing interaction with patients,” Hughes said. “Episodic (face-to-face) care is only one facet of patient management. We need ongoing, whole-person-centric care – not only focused on the isolated management of a single chronic disease or condition, but that considers the individual’s full medical history, personal preferences and readiness to change, and includes populations with common issues and needs.”

That means tracking broad priorities and needs at the population level while recognizing that each patient has somewhat different needs and preferences compared to patients with similar medical problems. According to Hughes, this type of targeted care requires “outreach and engagement models based on sound data combined with individual, patient-specific preferences and mutual goal setting.” Hughes added, “When executing these outreach strategies, it is important to evaluate the effectiveness of different approaches and to nimbly adapt to what works best for the individual.”

Best Opportunity for a Patient-Centered Approach: A $290 Billion SolutionThere are endless reasons patients don’t stick to treatment recommendations and medications prescribed by their physicians. Hughes says this lack of adherence costs the US an estimated $290 billion annually in direct and indirect costs. “There is good evidence to suggest that as many as half of all patients do not adhere faithfully to their prescription medication regimens,” he said, “and it has been estimated that better adherence to antihypertensive treatments alone could prevent 89,000 premature deaths in the United States annually.”

“Weneedongoing,whole-

person-centric care – not

only focused on isolated

management of a single chronic

diseaseorcondition,butthat

considers the individual’s

fullmedicalhistory,personal

preferences and readiness to

change.”

Dr. Graham Hughes Chief Medical Officer for SAS’ Center for Health Analytics and Insights

4

SAS Conclusions Paper

Figure 2: Source: Christensen, Clayton M., Jerome H. Grossman M.D. and Jason Hwang MD The Innovator’s Prescription: A Disruptive Solution

for Health Care

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Consequences are immediate

Weak:

Consequences are deferred

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Myopia

Hypothyroidism Psoriasis

Allergies

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Infertility

Depression

Diseases with immediate consequences

Diseases with deferred consequences

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Sickle cell anemia

Type I Diabetes

GERD

Asthma

Congestive heart failure

Type II Diabetes

Obesity

Addictions

Bipolar disorder

Alzheimer’s

Schizophrenia

Coronary artery disease

Cerebrovascular disease

Hyperlipidemia

Hypertension

Osteoporosis

Chronic hepatitis B

Cystic fibrosis

Parkinson’s

Minimal Extensive

Degree to which behavior change is required

Chronic Quadrangle

Using analytics to provide insights into patients, Hughes believes a client-centered approach could have a significant positive impact on what Clayton Christensen describes in his book, The Innovator’s Prescription, as the “chronic quadrangle.” Conditions in the chronic quadrangle include industry heavy hitters as it relates to health care costs and patient morbidity: diabetes, obesity and hypertension.

“We believe health care organizations can use predictive modeling to focus on the chronic quadrangle by providing better understanding of the likelihood of onset and progression of disease, which can allow us to intervene earlier to avoid or delay the onset of disease,” Hughes said. “And, perhaps more importantly, there is a great deal we can do in patient outreach and engagement by applying individualized, analytics-enabled, marketing approaches. These data-driven approaches help determine which cohorts of patients to engage for which purpose, and when and how to engage them.”

“Weareallpatientsinourown

way.Whatisitthatinfluences

us to get off the sofa and go to

thegym,togoforarunorbike

ridewiththefamily,orbeginto

eat more healthily?”

Dr. Graham Hughes Chief Medical Officer for SAS’ Center for Health Analytics and Insights

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21st Century Health Care Delivery: Patient Engagement Strategies that Work

Relationships Make It Personal

To understand “whole patient” or “patient-centered” care, we must first make it personal. “We are all patients in our own way,” Hughes said. “What is it that influences us to get off the sofa and go to the gym, to go for a run or bike ride with the family, or begin to eat more healthily?” Beyond emails, brochures and doctor visits, the circle of people and places that touch our lives on a daily basis influence us the most. Because of this regular interaction, these influencers can play an important role in patient-centered health care.

“There are various spheres of influence in our lives. Those closest to us are our family and friends,” Hughes said. “Beyond that, there are places of worship, neighborhood activities, Internet groups and an ever-increasing number of interactions through social media. These are networks that we must leverage to truly influence patient behavior.”

‘Always-On’ Health Care

Traditionally, health care providers spend the bulk of their time planning point-of-care visits. But the majority of a patient’s health-based activities happen outside of the physician’s office. Hughes suggests that health care providers extend care by connecting with the community via “walking clubs, exercise groups, remote monitoring and engagement campaigns.” But how do we begin? Hughes prescribes a foundation of good data that includes individual patient preferences and a shared understanding of agreed goals.

That means going beyond data traditionally collected by electronic health records and contacting patients via their preference of voice mail, direct mail, SMS or texting. Analytics allows organizations to identify cohorts of patients with similar issues and preferences, and can be used to track and report the effectiveness of campaigns and identify ways to make future engagements more effective.

Best-in-Class Analytics CapabilitiesAs health care organizations look for more sophisticated ways to identify at-risk patient populations and use data to improve outreach and engagement, they are exploiting the power of analytics running against existing and new data sources.

“SAS has a long history of providing our health insurers, hospitals and public health organizations with advanced analytics tools to gain insights into their business,” said Cindy Berry, SAS Health Care Strategist. “We also have more than 30 years of experience working with many other industries to deliver insights sometimes referred to as ‘customer intelligence.’ That includes the top 10 US banks, the top five US retailers and all of the top five telecommunications companies.”

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SAS Conclusions Paper

Interest from health care and life science organizations is on the rise, Berry noted. “We thought it would be helpful to share the insights we have learned from our broad client experience in other industries. When it comes to outreach and engagement in a health care setting, we see little difference between ‘patients’ as consumers of health care and what our retail clients call ‘customers.’” As we move toward a more patient-centric model of care and learn from other industries, health care providers should also put their “customers” at the heart of all future interactions.

SAS has specific goals for customer engagement, including these top three, best-in-class customer analytics capabilities:

1. Deepened customer insight.

2. Choreographed customer interaction.

3. Continuous improvement of plans.

Deepen Customer Insight

Put simply, there is no value in data that isn’t shared or commonly understood. That’s why deep customer insights are pulled from a broad range of data that can migrate among marketing, clinical staff, operations and those dedicated to customer engagement. “We need to develop a common view of the customer for all areas of the organization, including the integration of third-party data: Web behavior, social media and others.”

“It’snotjustaboutshooting

fromthehip.It’scriticalto

use customer insights to

design,prioritize,coordinate

and execute your customer

interactions.”

Cindy Berry SAS Health Care Strategist

Figure 2. Diagram illustrating a multi-channel customer experience.

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21st Century Health Care Delivery: Patient Engagement Strategies that Work

Deepening customer insight means organizations can:

• Predictcustomerbehavior. Understand customer behavior and personality attributes to predict behavior and readiness to take action.

• Profileandsegmentcustomers. Create a clear understanding of who the customer is, and segment customers to create plans of action.

Choreographed Customer Interaction

“It’s not just about shooting from the hip,” according to Berry. “It’s critical to use customer insights to design, prioritize, coordinate and execute your customer interactions.” In fact, Berry recommends making customer interactions a central part of campaigns and applying customer responses to continually adjust the customer outreach plan. In order to choreograph customer interactions effectively, best-in-class businesses must do two things: manage and optimize strategies and engage customers along the way.

Some examples of best-in-class tactics for managing strategies and engaging customers/patients:

• Manageinboundandoutboundmessagestosupportoutreachcampaigns.

• Connectwithothersystems–thecustomercallcenter,voiceresponseunits,customer relationship management systems, etc.

• Buildflexibilityintothecampaigntoallowroomtoassessandoptimize.

• Definethedesiredcustomerexperienceandensurealignmentwithyouroutcomes.

• Designeverythingwiththecustomerinmind.

• Focusonacustomerexperienceatalltouchpoints.

• Capturefeedbacktoensurethemosteffectivecommunication.

Continuous Improvement of the Plan

These customer-centric companies ensure that the entire company learns from data and continually makes improvements based on its findings. How do they do it? Berry outlined three tactics:

• Measureandreport–musteasilydevelopandaccessinformationinatimelymanner.

• Learnandimprove–allowbusinessuserstotestdifferentstrategiesinrealtime.

• Optimizethecommunicationsmix–providenear-real-timeresultstoallstakeholders and allow multiple business constraints to factor into the plans.

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SAS Conclusions Paper

What Can We Learn from the Best? SAS has helped a wide variety of organizations gain a deep understanding of customers’ needs and motivations. Leaders from the retail, automotive, banking, telecom, insurance and gaming industries have all used similar techniques to achieve the highest levels of customer engagement and loyalty. Their success is not based on one-off campaigns or other traditional marketing efforts. They put their customers at the core of all business activities, creating a potent, singular focus across the entire organization. So, how can health care organizations restructure their business to do more than pay lip service to patient-centered care?

Five Characteristics of Best-in-Class CompaniesNo matter how diverse their services or products, best-in-class companies share several things in common. At the heart of every successful, customer-centered effort is a true, companywide dedication to the end goal. But this is not about convincing management to embrace an idea or creating a line item in a budget. It is about complete buy-in from every person involved.

This is not about convincing

management to embrace an

idea or creating a line item in

abudget.Itisaboutcomplete

buy-in from every person

involved.

Five characteristics of best-in-class companies

As we look across industries, five themes differentiate best-in-class customer engagement.

There is unwavering support for, and commitment to, a common customer-centric business model at all levels of the organization.

They are confident in, and capable of, using data derived from customer interactions to fuel business decisions and activities across the entire enterprise.

Customer engagement functions and capabilities are highly integrated and well- governed ̶ across the organization.

They are extremely sophisticated in their use of data and advanced analytics, particularly as it relates to predictive modeling, evaluation and adaptation.

They are very adept deploying complex, automated multi-channel outbound interactions and evaluate their effectiveness and impact in real time.

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21st Century Health Care Delivery: Patient Engagement Strategies that Work

Hughes suggested using the following five characteristics of best-in-class companies as benchmarks:

1. Unwaveringsupportforacustomer-centricbusinessmodel,enterprisewide. Hughes emphasized that leadership must not only deploy, but evangelize for patient-centric care models. “This can’t be something that organizations think looks like an interesting topic to explore in a couple of years’ time,” he said. “Health care reform shifts increasing levels of financial risk to health care providers and, in response, providers must adopt specific patient-centric strategies that will drive changes in point-of-care delivery. That means changing workflow in the clinics, ED and hospital to enable a 21st century care delivery model that anticipates pre-encounter, face-to-face and post-encounter interaction.” Hughes also recommended that all strategy development must include patients (to ensure true stakeholder needs are understood), and cross-functional senior clinical sponsors who can champion the campaign rollout and funding based on enterprise goals.

2. Use of customer interaction data to fuel corporate decisions. “The more data, the better, whether it’s demographics, clinical information from EMRs, medical claims, prescription history, consumer data or social media information,” Hughes said. Use data collected on patient preferences to determine the best channel for patient outreach, whether it be via mail, smartphone, IVR or in person. Sifting through that data becomes a critical task. “There needs to be a deep understanding of which information is most valuable and how one will act on it. Best-in-class organizations will have a team dedicated to managing customer engagement strategies.”

3. Highly integrated and well-governed customer engagement. Organizations need to consider patient engagement technologies that extend beyond current Web portal technology (which are often simple extensions of an EMR) to include a broader view of how patients prefer to be contacted. Hughes recommends establishing governance to prioritize customer outreach campaigns and monitor their effectiveness. “With any of these methods, we want to make sure we’re analyzing the data resulting from campaigns to understand their impact and effectiveness.”

4. Sophisticateduseofadvancedanalyticsinpredictivemodeling,evaluationand adaption. Ensuring all data is used transparently means that the rationale for different outreach models is well-understood, and the expected financial and clinical impact can be measured against clear targets and end points. Advanced analytic techniques focus attention on specific patient groups that require intervention and differentiated outreach based on personal characteristics – including estimates of readiness to change. Automation that uses advanced analytics is essential to reduce the ongoing effort of planning, executing and evaluating multi-modal patient engagement campaigns.

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SAS Conclusions Paper

5. Successfuldeploymentofcomplex,multichannelinteractionsandreal-time effectiveness evaluation. “When leveraging multichannel messaging, organizations run the risk of duplication and false positive identification,” Hughes said. He recommends a focus on ensuring that patients perceive communication to be simple and helpful – not intrusive. “As automated outreach capability becomes more sophisticated, we should not choose to adopt technology for technology’s sake. Keep it simple at first and build from there. Make sure patients view the programs as delivering more personal access to their physician’s coaching and recommendations between visits, and not another form of depersonalized mass marketing. This requires balance, and we are learning how best to develop continuous coaching relationships with all of our patients. In the end, health care is personal, but technology can help.”

Closing Thoughts“We need to evaluate ourselves against the desired state, which is a deep understanding of the individual patient,” Hughes said. “What are their needs and motivations? Who do we target, and why are we targeting them? How do we design and test the communication model?” These are all questions that can be answered by observing best-in-class customer engagement and customer relationship management. According to Hughes, not only will these types of campaigns improve relationships between physicians and their patients, they can “improve patient adherence to medication therapy and their engagement associated with other risk-based behaviors that we’re trying to influence.”

During the webinar Q&A session, Hughes and Berry outlined the first steps organizations can take to begin using analytics:

1. Get buy-in. Make sure your organizational leaders support the vision and are committed to the journey ahead.

2. Identifydataneeds. Clarify the data sources needed to identify populations based on highest need, highest risk and highest level of utilization to begin the engagement.

3. Create the foundation. Establish a technology strategy that includes a robust analytics foundation and campaign management to allow you to take advantage of data.

4. Pickapilot. Pick an area aligned with organizational priorities, such as mammograms, diabetes checkups, birthday-related health checks or flu vaccination reminders. Start simply and make sure success criteria are clearly defined.

5. Broaden reach and complexity. Based on early pilots, refine and explore more advanced ways to increase “stickiness,” thus preventing network leakage and increasing patient loyalty. Then, explore more robust models for multiple disease states and multiple co-morbidities. Run multiple campaigns in parallel to compare their effectiveness.

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21st Century Health Care Delivery: Patient Engagement Strategies that Work

How SAS Can HelpSAS has more than 30 years of experience providing advanced analytics tools to improve organizations’ insights about customers. Health care organizations are entering a new era of accountability driven by health care reform that will require a new way of thinking about how to interact and engage more directly with patients in ways that make sense to them as individuals. We are committed to working with you on your journey to derive insights from your data that will allow you to thrive in this emerging health care environment.

About the PresentersDr. Graham HughesChief Medical Officer for SAS’ Center for Health Analytics and Insights.

Dr. Graham Hughes is an industry expert in SAS Institute’s Health Care and Life Sciences Center for Health Analytics and Insights (CHAI). He has 20-plus years’ experience working with leading-edge health care organizations in design and development of enterprise clinical software.

Cindy BerrySAS Chief Health Care Strategist

Cindy Berry has over 25 years of experience consulting and delivering solutions focusing on quality and safety, reimbursement, operational improvement, service excellence, and performance management in the private and government sectors.

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