healthcare in a digital world

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HEALTHCARE IN A DIGITAL WORLD THE WELLNESS WILDERNESS

The epiphany that comes when companies realize how much they could gain from the power of digital technology has caused many to confront their own existence by asking: what should our digital strategy be? The truth is there is no digital strategy; It’s simply Strategy in a Digital World. Companies no longer have time to develop a strategy before it can be executed, they have to place strategy alongside execution. As crazy as it may sound to build the rocket while you’re on your way into outer space, the truth is that is produces smarter decisions and reduces overall development time.

Much of our daily existence is enabled and monitored in one way or another by some form of technology. Strictly speaking, digital technology is a type of electronic transfer that involves breaking a message or form of communication between two machines down into binary code. More broadly, the world around us has evolved in a comparatively short time to leverage both the technology used for digital communication and the results produced by these interactions. Entire industries have emerged to create the technology, transfer and store data, extract knowledge and influence how people behave. Nearly everything we do exists in a digital world, one way or another.

Healthcare is an incredibly complex need that lends itself well to the digital world in three significant ways:

Patient Access Coordination with Providers and Payers Population Health Management

Here, we take a closer look at all three.

Patient Access Although the process of visiting a doctor should be straightforward, in practice it’s not.

TABLE OF CONTENTS Patient Access ..................... 1

Coordination Between Providers and Payers .......... 4

Population Health Management ...................... 4

The Future of Healthcare in a Digital World ....................... 4

Conclusion .......................... 5

About Genesys ......................... 6

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In theory, someone might sign up for medical insurance and use a physician referral service to find a doctor as part of advance planning; then, when the need arises, schedule an appointment, have an encounter, fill a prescription, and settle the bill. The reality is that most people don’t do much of anything until they are sick, at which point they want someone to wave a magic wand and make them instantly better!

The beauty of a digital world is that it works equally well for linear and indirect needs, because the underlying fundamentals remain the same. The patient and the medical record are at the core (in some cases a guardian or authorized caregiver may be present); the provider, pharmacy and payer are all in the periphery.

The applications for digital technology impact each connection in a different way:

Patient-to-Provider: each time a patient wants an encounter with a provider they could do one of two things. Many will schedule an


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appointment for a time in the future, others will have the ability to meet now. Some encounters will be in person, but increasingly this is being displaced with alternatives that are as good, and in some cases better. Initial screening and minor complaints can often be handled by a nurse or a physician assistant. Depending on the complaint, some issues may require a doctor. Regardless of the provider, digital technology makes it easy to schedule appointments and have a consultation over the phone, online or through a mobile app. Encounters where the practitioner needs to see the patient can be done in many cases using video, enabled on the patient side with a laptop, tablet, or smartphone with a camera. Patient information collected from wearable devices or equipped for remote monitoring can be sent to the provider in real-time, with appropriate alerts when readings are out-of-range so that immediate action can be taken. All of the interactions can be recorded, and the dialogue converted to text that is appended to the Electronic Health Record (EHR). Additionally, the dialogue can be examined by interaction analytics to remove human filtering and bias, thus ensuring full and complete facts are used for diagnosis and treatment. If follow-up encounters are needed, the physician and patient can schedule, and appointment reminders sent via SMS, email or outbound voice to the patient. For encounters that will be done over the phone or with video, relevant links would be embedded in the reminder in order to initiate the encounter by simply touching/clicking on the link.

Patient-to-Pharmacy: scripts can be issued and renewed by the physician electronically, stored in the patient’s EHR, and forwarded to the pharmacy for fulfillment. If the script needs to be refilled or renewed, the pharmacy can proactively reach out to the physician for approval to avoid any interruption in the treatment plan.

Patient-to-Payer: For some, health insurance is provided by their employer or the government. For others, it involves securing an individual policy. Once a plan is selected, the patient typically finds a physician and schedules an appointment. There may be a need to contact the payer for life events such as marriage or adding a child, customer service needs like filing a


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change of address or requesting replacement ID cards, or for claims. Most of these events can be initiated digitally using online or mobile applications; proactive notification of event status can also be facilitated in the same way.

Coordination Between Providers and Payers In many cases those providing services will need to consult with those paying for the services to:

Determine benefit eligibility Pre-authorize referrals and procedures Provide details needed for claims processing

These are often done without the patient’s involvement by staff in the provider’s office. When the patient is in-network, digital technology makes it possible to perform nearly all of these tasks without paperwork and automatically add to the EHR. Because these actions are tied to the EHR, updates and follow-on appointments can be sent digitally to the patient.

Things get more complicated when the patient goes out-of-network for treatment, but sometimes this cannot be avoided. This may be necessary when a benefit eligibility check determines that a need cannot be met in-network, or when there is an urgent or emergent need. Most out-of-network coordination will likely be performed by the patient.

Population Health Management On a broad scale, information gleaned from EHRs can be analyzed by healthcare professionals to determine effectiveness and the impact of change on patients in many ways: by panel, cohort, chronic disease, treatment, employer group, and so on. Particularly in cases where information analytics has been used to capture raw data uninfluenced by filtering and bias, the impact can be significant. Although early attempts like Google Flu Trends did not perform as well as expected, more recent efforts like Global Pulse (United Nations) are delivering promising results.

The Future of Healthcare in a Digital World One aspect of digital technology that could revolutionize healthcare involves blockchain. It emerged in 2009 primarily as a tool for online transactions using digital currency managed by a distributed database kept secure via cryptography. All transactions have to be approved and verified in the network using a process called mining.


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Bruce Broussard, president and CEO of Humana, posits blockchain will become the next big healthcare technology innovation, particularly as it relates to payments and payer contracts. For example, in a situation when a health plan and patient are dealing with a contract, the blockchain can automatically verify and authorize information and the contractual processes. "There is no more back-and-forth haggling with the health plan about what was paid, why it was paid or whether it should have been paid," he wrote. "With transparency and automation, greater efficiencies will lead to lower administration costs, faster claims and less money wasted."

The best part of using blockchain is that it fully protects the privacy of the patient, yet allows necessary actions to occur in a timely manner.

Another potential healthcare application is population health. Instead of relying on health information exchanges or other ways to aggregate data, organizations can eliminate the middleman and access patient databases on a large, population scale. Blockchain has the ability to leapfrog traditional methods of population health by providing trust where none exists for continuous access to patient records by directly linking information to clinical and financial outcomes.

Conclusion We know that healthcare is complex and loaded with privacy issues, yet it is a basic need that everyone has. Even a simple encounter requires many people performing


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multiple actions to drive a successful outcome. In fact, life itself is a series of fluid events that require fluid solutions—many of which can be found with digital technology.

With the ideas presented here, is it time for your company to ask: what should our strategy be in a digital world?

About Genesys Genesys is driven by our cause to save the world from bad customer service. We do it by applying a relentless focus on the consumer perspective of the customer experience — and the impact it has on your business. Genesys works with its customers and partners world-wide to deliver the experience that today’s digital consumers want. It all adds up to one seamless customer conversation.

Great customer service extends beyond the contact center to the processes and work streams involved in meeting your commitments. Genesys products give you insight into and control over these processes, so you can truly track the customer experience from end to end.

Corporate Headquarters Genesys 2001 Junipero Serra Blvd. Daly City, CA 94014 USA Worldwide Inquiries: Tel: +1 650 466 1100 Fax: +1 650 466 1260 E-mail: [email protected] www.genesyslab.com

Genesys is a leading provider of contact center and customer service software — with more than 2,200 customers in 80 countries. With over 20 years of contact center innovation and experience, Genesys software directs more than 100 million interactions every day, maximizing the value of customer engagement and differentiating the experience by driving personalization and multichannel customer service — as well as extending customer service across the enterprise to optimize processes and the performance of customer-facing employees. For more information visit: www.genesyslab.com, or call +1 888 GENESYS. Genesys and the Genesys logo are registered trademarks of Genesys Telecommunications Laboratories, Inc. All other company names and logos may be trademarks or registered trademarks of their respective holders. © 2013 Genesys Telecommunications Laboratories, Inc. All rights reserved.

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