Work
Improving Interoperability + Pre-Care at Providence
Client
Providence Health System (52 hospitals, 1085+ clinics)
Timeline
3 months, 2023
Role
Service Design + Research Consultant
Team
Patient + Market Experience Service Design Team
Voice of Customer
Voice of Customer
Project Overview
As a Service Design consultant, I collaborated with the Revenue Cycle Patient + Market Experience team at Providence Health to explore and assess the potential of new digital ID verification solutions for streamlining patient demographics and insurance information. This initiative aimed to enable patients to consolidate their ID and insurance details into a single, easily shareable format with their healthcare providers, akin to the simplicity of connecting on LinkedIn. The envisioned outcome of this project was to significantly enhance both the caregiver and patient experience.
Moreover, it promised substantial financial benefits through lowered care costs by 1-3 minutes per patient, reduced contact by 1 call ($10.40 per patient), decreased Contact Center volumes of calls and chats relating to demographic + insurance updates by an estimated 11%, and reducing claims time in Accounts Receivable.
Moreover, it promised substantial financial benefits through lowered care costs by 1-3 minutes per patient, reduced contact by 1 call ($10.40 per patient), decreased Contact Center volumes of calls and chats relating to demographic + insurance updates by an estimated 11%, and reducing claims time in Accounts Receivable.
Challenge: Breaking the Cycle of Redundancy by Centralizing Patient Data
My primary challenge was to critically assess a vendor's solution for its potential to streamline the verification of patient information (demographic and insurance), aiming to enhance operational efficiency and financial return through reduced claim processing times and lower contact center volumes.
Translating Fragmented Care to a Singular Patient Identity
- Understanding the Current Experience: To address this, I embarked on a journey to deeply understand the experience from a caregiver's perspective. This involved conducting detailed stakeholder interviews to gather firsthand insights into the daily challenges faced by caregivers in patient information verification.
- In-depth Research and Analysis: I carried out a comprehensive literature review and competitive analysis. This step was crucial in evaluating the vendor's solution against our specific business goals and patient care standards.
- Strategic Alignment and Gap Identification: Leveraging the insights gained, I then retro-mapped the proposed solution against our current processes, identifying any gaps between the solution's capabilities and our actual needs. This involved a thorough analysis of how well the solution could integrate into our existing workflow, the potential it had to meet our prioritized needs, and its alignment with our overarching value proposition.
- Outcome and Value Proposition Alignment: The culmination of these efforts was a detailed gap analysis and a value proposition alignment exercise. This process allowed me to critically assess whether and how the vendor's solution could effectively address the identified needs, thereby breaking the cycle of redundancy and contributing to significant operational and financial improvements.
Value Proposition Mapping
I analyzed the functional, social, emotional, and secondary needs of caregivers and patients (Jobs To Be Done), starting with third-party vendor services. Then, I identified gaps by comparing our key pain points with the solutions these vendors offer.
Takeaway 1: Simplifying Care Team Overlap and Reducing Patient Information Mistakes
After identifying the potential for improvement, I organized a discovery workshop that brought together 20 members from the Patient Access team, the Service Design team, and our vendor partners. During this session, we applied the Jobs to Be Done framework to comprehensively understand the existing healthcare journey and caregiver experiences. This collaborative effort highlighted critical pain points, notably the complexity we termed the "Systemic Shuffle." By engaging with 20 Subject Matter Experts (SMEs) across Patient Access, Service Design, Technology, and vendor collaborations, we not only mapped out the caregiver experience but also confirmed and detailed the specific challenges contributing to this complexity.
This foundational work paved the way for considering how a digital wallet product could address these issues by simplifying processes and enhancing overall system efficiency, as well as establishing aligning baseline metrics between the Patient Access team and Revenue Cycle, such as 'clean' registration, caregiver productivity, and denial rates due to demographic or insurance matching issues.
This foundational work paved the way for considering how a digital wallet product could address these issues by simplifying processes and enhancing overall system efficiency, as well as establishing aligning baseline metrics between the Patient Access team and Revenue Cycle, such as 'clean' registration, caregiver productivity, and denial rates due to demographic or insurance matching issues.
Workshop snapshop with Patient Access Subject Matter Experts to Identify the pain points and current Caregiver flow.
Service Blueprint for our target pilot Surgical Department
Takeaway 2: Building Industry Relationships to Increase Adoption with Existing Identity Services (CLEAR + ID.me) and the CARIN Alliance
I thrive on forging connections between thought leaders to meet the evolving demands of healthcare. My initiative to enhance Providence's authentication system involved engaging with digital health pioneers like the CARIN Alliance, CLEAR, and ID.me, capitalizing on their collective network of over 120 million users to expedite system adoption. The CARIN Alliance, in particular, has been instrumental in pushing for interoperability standards, ensuring that our efforts align with the broader goals of secure, consumer-directed health information exchange. This dialogue is steering us toward a federated ID system that promises to refine caregiver workflows and integrate effortlessly with platforms like Epic, streamlining operations within Providence's complex ecosystem.
The result of these conversations was a revitalization of Pre-Care work our team had previously explored, driving Patient engagement and key Revenue Cycle activity to and through the Providence App that will be picked up by our partners at the Digital Innovation Group.
The result of these conversations was a revitalization of Pre-Care work our team had previously explored, driving Patient engagement and key Revenue Cycle activity to and through the Providence App that will be picked up by our partners at the Digital Innovation Group.
Revenue Cycle Revolution with Live Authentication
By integrating live authenticated patient ID and insurance eligibility, healthcare providers are seeing a dramatic reduction in time spent on tasks, errors in claims, and days in accounts receivable.
Learnings
The integration of systems thinking and active engagement in industry conversations has been pivotal in exploring the vast opportunities for interoperability. Engaging with policy and industry leaders has been instrumental in accelerating our growth and adoption goals, enabling us to leverage a collective wealth of knowledge and experience. What I enjoyed most was the dialogue with thought leaders, which allowed me to synthesize disparate pieces of information into a cohesive strategy. This approach not only had a significant impact on our revenue cycle metrics but also reinforced the importance of a collaborative effort in driving innovation and design forward.
Revenue Cycle Revolution with Live Authentication
