It’s About Clinical Navigation not Just Provider Matching

Provider Matching has always sounded like something that should be relatively easy, but like everything else in healthcare, it is more complex than it appears. If all you had to do was match a patient’s needs with a physician who had the right expertise, there wouldn’t be a whole category of solutions in this space. This has always been a bit of a mystery for me so I decided to find someone who could help me better understand this space.

ArmadaHealth is a health data science company that makes tools and provides services that help consumers get the care they deserve. They provide well researched, data-driven physician directory information to help patients find the right provider that truly matches their unique clinical needs, insurance coverage, demographic preferences, and geographic location.

I had the opportunity to sit down (virtually of course) with Dr. Suzanne Clough, Chief Medical Officer at ArmadaHealth to dive into the world of provider matching. Right off the bat, I knew I had found the right person to speak with. Dr. Clough wasn’t afraid to call things the way she saw them – calling healthcare a “hot mess” and throwing her hands up while saying “things should be easier!”

Clinical navigation services not just provider matching

Dr. Clough set the stage for our discussion by expanding my thinking. Matching patients to providers is just one part of navigating through a clinical journey. I needed to think broader – to something she called Clinical Navigation Services.

“The reason I joined ArmadaHealth is because I feel this clinical navigation piece has been missing in healthcare,” said Dr. Clough. “There is zero transparency. There is no source of truth of who really does what and who really does it well. Healthcare has become so specialized. Ophthalmology, the eyeball, has 11 subspecialties. So if you have a retina problem you want to go to an ophthalmologist who is a retina specialist.”

A study by Johns Hopkins calculated that more than 250,000 people die each year in the US due to medical errors making it the third leading cause of death in the country (behind heart disease and cancer).  Dr. Clough believes that “getting the wrong care from the wrong doctor” contributes to medical errors.

“Companies like us invest heavily in data and data science so that we learn who does what and who does it well,” explained Dr. Clough. “We want to be able to offer up the right doctor, in the right geographic location, takes the patient’s insurance, is accepting new patients and who has a clinical area of focus that matches the patient’s condition. And we want to give you three choices of doctors who have been vetted – and who we know are very good.”

Navigating blind

Dr. Clough noted that when doctors make a referral, they are often relying on their own past experience, rather than up-to-date facts. It is easy for a doctor to refer a patient to someone who has relocated, no longer takes that patient’s insurance, or has sold their practice to someone else. Worse, there is no consideration given to the quality of outcomes. That is simply not something that enters into the minds of most referring physicians. It’s more about location, availability and familiarity. In a sense, doctors, in some cases, are blindly pushing their patients forward on their clinical journey.

ArmadaHealth has built their platform to take all these factors into consideration when making a recommendation for a patient. Everyone can feel confident that the specialist being recommended is more likely to be the right one to help the patient in their journey.

Better matching helps doctors too

Matching a patient to a provider’s specialty doesn’t just help the patient get the care they need, it also helps the doctor practice what they love to practice. According to Dr. Clough “over 40% of initial consults are with people who really shouldn’t be with that specialist”. That is a lot of wasted time (as well as frustration) for both patients and doctors.

Imagine if this could be eliminated. How nice would it be for a doctor to see a steady stream of patients with a health issue that aligned perfectly with their area of specialty and who had the right insurance (less billing headaches!). It’s not hard to see how much happier they would be.

Patients and Clients Love Care Navigation

With a net promoter score in the 80s for the last 10+ years, ArmadaHealth is definitely on the right track. Dr. Clough noted that the quality of the recommendations has been the primary driver of customer satisfaction, especially for conditions with high mortality rates that can be a significant source of stress and anxiety for people. “People can’t believe they didn’t have access to a service like us before,” she said. “We take the guesswork out.”

This is partly the reason why payers have been so interested in ArmadaHealth’s Quality Care Navigator platform. With this solution, payers can apply the data science of the platform to their own data and make the best recommendations available to their members who will ultimately see better outcomes.

Dr. Clough was delightfully candid throughout our interview and she gave one of the shortest yet most effective answers to my question about what her one takeaway from our conversation would be: “Don’t find your doctors on Facebook.”

Great advice indeed.

Watch my full interview and hear what Dr. Clough has to say about:

  • What we can expect as patients who had treatments delayed return to healthcare
  • What questions patients should be asking of their care providers to advocate for themselves
  • How care navigators improve patient experience (hint: health plan directories are inaccurate 50% of the time!)
  • Why she is excited about what’s next for ArmadaHealth

To learn more, visit www.armadahealth.com

This article is part of the #HealthIT100in100

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About the author

Colin Hung

Colin Hung

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

   

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