Customizing healthcare: How a new approach to diagnosis, care, and cure could transform employer benefits in a postreform world

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Touchpoint 2:

Fluent navigators

How, when, and where employees access the health system is another crucial element in the development of a patient-centered approach. Today’s health system can be confusing and overwhelming, and most individuals—well or sick—are not skilled enough or adequately equipped to navigate the system on their own.

Figure 2

Which of the following are barriers to individuals' managing their own health?

Again, information is the key: connecting individuals with information that is culturally appropriate by gender, age, and ethnicity. As Figure 2 indicates, about three-quarters of the global health leaders that PwC surveyed said inadequate access to health knowledge, among other factors, obstructs individuals from managing their own health.

One health leader described the goal as providing a GPS for the health system. Such a GPS is not a gadget, but it comes in the form of a knowledgeable individual: the fluent navigator. Fluent navigators play a key role in guiding people through the increasingly complex healthcare maze and help patients efficiently access their health system.

Fluent navigators fill service gaps and help patients access the right resources, specialists, and information. There’s no set model for the fluent navigator role; family members, hospital patient advocates, and social service employees, among others, all fill the role. Alternatively, a new market consisting of professional health agents may emerge to fill the need.

Pharmacists are increasingly taking on the role of fluent navigator, given their unique vantage point in the care chain.

Pharmacists are increasingly taking on the role of fluent navigator, given their unique vantage point in the care chain. Darrell G. Kirch, MD, president and CEO of the Association of American Medical Colleges, says, “Pharmacists are becoming more involved with direct patient care and are even involved in rounds in some hospitals. These pharmacists act as ‘air traffic control’ by helping coordinate and oversee the multiple facets of care that patients are given.”9

Pharmacists can also play a greater role in intervention, thanks to software that alerts pharmacies when prescriptions have not been refilled—an indication that patients may not be taking medication.

Health systems also are creating new fluent navigator programs that target specific populations.

For example, in South Texas, hospitals are hiring promotores, who serve as liaisons between local healthcare systems and the surrounding Hispanic communities.10 Promotores are state certified and trained in communication, interpersonal skills, service coordination, capacity-building, advocacy, teaching, organizational skills, and health knowledge.

Health providers realize that understanding patients’ beliefs, values, and cultural traditions enables them to influence how healthcare information gets shared and received. Many times, providers face ethnically diverse populations whose cultural beliefs about healthcare can hinder their treatment protocols for their patients.

To reduce medical costs related to hospitalization, to help workers manage chronic disease, and to get employees back to work as quickly as possible, employers are encouraging this increasing trend toward patient advocacy.

Touchpoint 3:

Patient experience benchmarks

Going forward, individuals will begin to set their own rules by which health organizations must play. Not only will they expect one-on-one customized service, but also their expectations will be broadcast at a speed and on a scale that could quickly separate winners and losers in the health marketplace. Thanks to a proliferation of online databases and patient communities, these individual patient experiences are creating new kinds of benchmarks.

The benchmarks can be used by patients, employers, and insurers to assess a health system, but they can also benefit health providers by delivering ongoing customer feedback, which will enable those providers to better meet consumers’ needs. First, though, health providers must learn to listen— not only through traditional surveys and focus groups but also through Web and social media that provide access to real-time conversations.

Figure 3

Where people go to find information to make decisions about their healthcare

The power of patient experience benchmarks stems from their broad reach via the Internet. In a recent survey, a majority of global consumers cited the Web as their top information source on health. (See Figure 3.)

Both online databases and social networking sites are setting new benchmarks tailored specifically for patients. PatientsLikeMe ( is a good example. Established in 2004, today it has 17 disease communities where members can enter data pertaining to their conditions. The site aggregates and shares this real-time data with all members.

One of the most visible patient experience benchmarks is wait time. Both health leaders (85%) and consumers (66%) said short wait times are important or very important for an “ideal” health system.

There has been a sharper focus on wait times, which are increasingly being mandated by law, such as new legislation in California that sets maximum wait times for HMOs. Via patient experience benchmarks, wait time limits will also be informed by consumer expectations. In response, health stakeholders will need to adjust the ways in which they determine resources and care pathways in order to meet both government and customer standards.

Until recently, individuals did not have good information about the length of waits. Further, because patients were putting their names on multiple waiting lists, the accuracy of the measures was undermined. As health systems begin moving toward individual-centered metrics, this is changing dramatically.

In response to the rise in the use of patient experience benchmarks, some health systems are beginning to look at care through the eyes of patients. As a result, they’re removing barriers to care—such as confusing signage, lengthy forms to be filled out, and so on—in an attempt to make patients’ healthcare experiences friendlier and more accessible.

To help employees take a hand in managing their own healthcare, leading employers are providing access to online communities where their workers can find and share patient experience benchmarks.

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