Healthcare’s Digital Front Door – Are We Ready to Remove the Cash Cows of Healthcare?

Yesterday, I came across this excellent piece by Sue Schade called “Knocking on the digital front door.”  Here’s an excerpt of what Schade shares:

An integrated strategy for a patient centered digital front door has many components including the core website, the patient portal linked to the electronic health record, improved access and scheduling capabilities, call centers, and care delivery through virtual visits. The goal is to meet patients where they are and guide them along the right care pathway with efficient, consistent, and easy processes in the background.

Schade then goes on to talk about the challenges healthcare organizations face in creating a new digital front door for their organization.  One of the biggest challenges is the fact that there are a wide variety of stakeholders that manage the front door for healthcare organizations today including marketing, IT, clinical, ambulatory vs acute, etc.

It’s a messy road and probably explains at least partially why it hasn’t happened before.  As organizers of the Healthcare and IT Marketing Community, we’ve seen first hand how big of a divide there is between marketing and IT in a healthcare organization.  Schade suggested that IT often provided technical support to the Marketing and Communications team for the website.  I’ve often heard of healthcare marketing teams having to work with a third party vendor because a hospital’s IT department was too busy to do the website.  An Epic implementation can have that effect on IT.

Needless to say, there’s a massive communication divide between marketing and IT and we’re all familiar with the various challenges between clinical and IT.  Bringing them together is a huge challenge as Schade aptly points out.  However, I think there’s a bigger elephant in the room.

The Elephant in the Room

The real elephant in the room for the digital front door is that doing it right by patients will have a massive impact on a healthcare organization’s revenue.

Let’s roll back 6 months to a number of conversations I had with amazing AI chat bots.  We’d call most of these symptom checkers that use an AI chat bot to walk a patient through their various symptoms and then direct a patient to the appropriate care.  In many cases, the AI chat bot would determine that a visit to the doctor, urgent care, or ED wasn’t needed and would instead direct the patient to some sort of at home or over the counter solution for their symptoms.  Sounds like an amazing patient centered solution right?

Indeed, this type of solution is a great solution for the patients.  It helps put them at ease in regards to their symptoms.  In some cases, it would actually encourage them to seek medical care when they might have put it off.  Early intervention is often key to great care and can save lives.  In other cases, they’d save the patient a trip to the doctor or the even more expensive ED.

No doubt there are questions about its efficacy, but remember that we have to compare a solution like this to the alternative and not perfection.  The alternative is often the patient themselves and Dr. Google.  Is a patient on their own as good or better than a well done symptom checking chatbot?  It’s a nuanced discussion, but there’s some evidence that the later beats out the former.  Why then wasn’t this implemented by healthcare organizations?

As one of these AI symptom checking chat bot companies told me, they did a trial with a healthcare organization with great success.  In fact, the trial was so successful that the healthcare organization realized that the chat bot would reduce their ED visits so much that it would cause major revenue issues for their organization.  Turns out, I’ve now heard this same issue from multiple healthcare organizations.  It’s a hard sales pitch to ask someone to buy a health IT solution which lowers their revenue.

How then did these healthcare AI chat bots survive?  After an experience like this, you know that selling your symptom checker to a health system is going to be a real challenge.  The ROI just didn’t make sense.  However, employers love the solution.  Employers are happy to have their employees utilizing the ED less, receive early interventions that will avoid chronic issues, and avoid visits to the doctor when it’s not warranted.  Especially self-insured employers.  That led to most of these solutions marketing their product to employers, not healthcare organizations.

Where Does This Leave Us Today?

In the wake of the pandemic, all of the symptom checkers quickly rolled out a COVID-19 screener tool that was of interest to healthcare organizations.  With the impending wave that many were anticipating, they wanted to ensure that only those that really needed to come in and get tested came in and they wanted to keep as much physical distance from their patients as possible to reduce the risk of spreading the virus.

The open question to me is how important will these factors be going forward and are healthcare organizations ready to take the hit to their revenues that effectively triaging patients digitally will have on their organization.  A digital triage pays a healthcare organization much less than an ED visit.

The reality for many of these organizations is that they’re already taking the hit.  Over and over I saw emergency doctors tweeting how they’d been seeing COVID-19 patients all day and they wondered where all their cardiac patients were that usually came in day after day.  The anecdotal conclusion was that they chose to stay home rather than risk coming in and contracting COVID-19.  Could a well done symptom checker help solve this problem and ensure that those patients still came into the ED?

I’m not sure we know the answer to that question yet, but it’s an important one to figure out.  Plus, it’s gotten even more interesting with the adoption of telehealth.  As telehealth has gone mainstream, it’s had the added challenge that there’s little differentiating a telehealth visit with a health system or a direct to consumer option.  In fact, there’s no reason a direct to consumer telehealth company wouldn’t implement this type of AI chat bot solution as their digital front door.  They don’t care if they reduce your ED visits or prevent in person visits.  If their tool becomes the digital front door for patients, they can control where that patient goes for their telehealth visit and that’s what they really care about.

Does this mean a healthcare organization better build the digital front door for patients or someone else will?

We’ve seen this happen in other industries and many have asked when it’s going to happen for healthcare. The problem with people who have suggested this in the past is that they’ve taken it too far saying things like it’s the “end of hospitals” or bombastic phrases like this.  A new digital front door doesn’t mean the end of hospitals.  At a minimum, hospitals will always have a place for many procedures that need to be done in person and need monitoring during recovery.  I don’t see a robot being droned to your house to take your appendix out remotely while you’re in the comfort of your home anytime soon.  However, who owns the digital front door for patients is going to impact health systems tremendously.

Sue Schade is right in suggesting that healthcare organizations should really be working on this problem and understanding it fully.  It’s a complicated problem that includes many departments and many external challengers.  However, it is core to the question of what healthcare will look like as we come out of this pandemic.  Will healthcare organizations want to retreat to their old “cash cows” or are they ready to embrace this opportunity to reinvent their business models and benefit patients in ways they were afraid to do previously?