HEALTHLEADERS: The ability to slice and dice data in real time is going to become even more important with accountable care. What are some of the streams of data that your executive team is going to have to manage quicker and better?
MATSEN: What we've done so far is use our Epic system to populate our own internal database. And we're able to work with our different service lines. We started with primary care and internal medicine, and we've looked at people who have chronic disease, diabetes, hypoglycemia, obesity, asthma, and found people who—this is very basic—had not returned for an appointment in 18 months, and used that as our simple standard. And we really didn't customize or personalize the message. We sent a general reminder message signed by a physician that they needed to come back in for an appointment. It was very low cost, but we got extraordinary response. We've now expanded that to include pediatrics for well-child visits.
HALLICK: The key question is, how do you use the information to communicate with an individual uniquely that creates compliance (i.e., do they come in for that test, did you get the response you requested)? That's where I start thinking about psychographics. How do they want to be communicated to? What will they respond to? What is right tone—fear or reassurance? Do we use a PURL or QR code that works on their smartphone? What about graphics and visual cues? Effective communication is more than sending out a single simple message. It isn't mass marketing; it's connecting at the personal level.
MATSEN: It could be outbound e-mail. But it's that data that will trigger the mailing or trigger the message, whether it's electronic or print, in your system. And it's going to have to be collaboration between the medical staff and the marketing team to determine what those triggers are, what's the appropriate time to do it.
ISLEY: What we're looking at is populations that we're already at risk for and understanding the health of that population. We're doing that with our employee plan this year. We're taking all that claims-based information as well as internal information. We're putting it through a tool to understand and aggregate all of the information that's available—the tool has predictive analytics to help understand your gaps in care for this population. We haven't fully deployed that yet, but that's what we're going to be looking at for managing patients under risk arrangements. Data drives programs that reach out to patients, so how do you use and serve up and make data compelling so that you achieve patient engagement? Because without patient engagement, we'll never reach the ACO objectives.
PELLEGRIN: There's a requirement, too, for specialization depending on the demographic assessment. And it has to be customized. Enormous resources are going to have to go toward that to engage the community and the patient. We are certainly not at the place where we are looking at all comorbidities, looking at all opportunities from a purely data and statistical standpoint. We're doing the ones that are intuitive. Let's say someone's had a bariatric surgery; in 12, 18 months, they may need plastic surgery. These are the pieces that we're looking at.
MATSEN: We are living in an era where patients are getting increasingly involved in making their own healthcare decisions as we move to high-deductible plans. Consumers who have the means are certainly doing their research and making choices. It's an evolution, but it's a rapid evolution. Between 70% and 80% of consumers are going to the Web to do research before they make a decision. They're still listening to their doctor, and their referring physicians play a critical role, but as baby boomers become the primary cohort consuming healthcare, they're different than their parents, who didn't grow up with that kind of access to data. Providing outcomes data on the Web, providing tools to find the physician so they can look at credentials, they can see where they trained, they can see what their publications are—that's a step in the right direction.
HEALTHLEADERS: With the ACO coming into play, hospitals are likely to have to take on a big disease-management role. So can it work on that level as well?
PELLEGRIN: I think so. Being a community-based hospital, we actually have already taken on that role for certain health concerns, like diabetes, asthma, and others. We've been proactive on the piece of wellness and prevention, especially in the pediatric population. With our immunization program, we are reaching out, actually having social workers go out and engage parents to get their children back in for immunizations. It is tough work, but mission critical. Part of the discussion that we were having earlier about market segmentation and service lines, looking for revenue growth, that's critically important for a hospital like ours because we do so many things where we lose money, we have to maximize other revenues to support our mission.
ISLEY: It's all about understanding each area's contribution. We're going through this now. We have a lot of components to our system: subacute, acute care hospital, physician practices, mental health facilities. What's their upstream, downstream value? What's their in-store value? You try to project out what it looks like under a capitated arrangement. Does the value proposition change? How is it performing? Is it performing well to established benchmarks where there's a mental health hospital and an acute care hospital? Because we're not going to be able to afford to run our systems in the future the way we're running them right now.
HALLICK: Over the last year, we executed about 3,000 communications campaigns. Every campaign is analyzed to see what worked and how to improve. Campaigns are synergistic. You could look at one discretely and think it didn't do what it was supposed to do. Then you look more broadly and see that it did have a secondary effect on another campaign. The bottom line is you have to look at both the individual campaign and the aggregate.