Don't Wait to Innovate by Dev Patnaik and Peter Mortensen of Jump Associates is a short column about increasing profitability at a disability claims processor that appeared in the online edition of Business Week on April 27. It was touted as an example of the potential power of innovation for enhancing performance in an already successful business. How could this be relevant to real health care? Well, I saw it completely differently. It was really all about how injecting humanity into a business resulted in decreasing resource use and liability - thereby enhancing customer satisfaction, decreasing costs, and increasing margin. Sound like outcomes we could use in health care?
Talking to Customers is an Innovation?
This article is the story about how Industrial Alliance Insurance and Financial Services changed its approach to disability claims processing by making a radical innovation - instructing claims analysts to actually speak to claimants about their circumstances rather than simply have them fill in the blanks on claims forms. The stunning result was that the company learned that claimants were real human beings with real problems and real motivation to overcome them and get back to work:
It turns out that the company's system for processing claims, though efficient and rational, was missing the real stories of the people seeking disability. The forms contained important information and were necessary, but they were ultimately too constraining. Essential information was being left out. That's because the process was strained out firsthand information in favor of provable facts. When analysts actually spoke to the people they were evaluating, they learned far more, and it led them to better solutions:
By simply connecting claimants (now seen as people), their complete stories, and appropriate medical advisors, modest investments in therapies and equipment increased returns to work, decreased benefits and litigation cost, and increased satisfaction of both the claimants and the analysts.
What About Talking to Patients ?
It struck me that in hospitals, physician offices, and medical claims adjudication we face a similar dilemma. Which presents a problem for health care leaders. Health care is, of necessity, becoming a more operationally efficient service. More forms, more automation, more decision matrices, shorter visits, more intermediaries using precisely defined scripts, and less time in human-human unstructured interaction. Ask anyone who has seen a physician in the past week.
This is probably good for efficiency and certainly good for adhering to standards of care and documentation. And likely great for charge capture. But I can't help thinking that something is missing. If we fail to consistently discern the humanity of patient needs how can we make the right decisions about the nature of the real health problems to be solved, which to investigate and in what order - and whether to deliver care, and how much care to deliver, and which kind of care and in what sequence. So consider the story below.
I joined my wife for a medical procedure today - we were concerned about ominous symptoms she had recently experienced. The procedure was certainly indicated and fortunately negative, thus ruling out serious pathology. But the symptoms are likely to remain, to be either monitored or investigated comprehensively. Left to our own devices, even though we are both physicians, we would likely have opted for investigation.
The decision for expectant management was made because the physician - whom we had never met previously - spent several focused and undistracted minutes with us reviewing the issues and alternatives, explaining why serious illness was a remote possibility, and reassuring us that the expectant path was unlikely to be dangerous. We departed reassured and disinterested in further expensive investigation at this time. Had we not been touched with humanity it would have been easy to go down a long and costly road to dissatisfaction. Regularly replicated, isn't this a viable component of a utilization management strategy? Only if we "innovate" by encouraging that professional time be spent this way.
Can Health Care Informatics Capture Human Health Care Information?
Taking this in another direction, consider the following. I've been working with a client to enhance physician adoption of EMR at a large southwestern medical center. One of the areas the docs are hung up on is the transition to electronic clinical documentation. They're mostly OK with CPOE. But many are concerned that using e-tools and scripts to document clinical histories and to communicate complex treatment plans sacrifices some of the art and nuance of telling the story - which are better expressed in a narrative history and physical or consultation note - in favor of capturing the "provable facts" which are essentially the data elements EMRs demand.
As a physician and management consultant, my role is to facilitate a useful conversation and process to bring the physicians and administration to an implementable conclusion. But we are left with these questions. Will the proper recommendations be made and decisions implemented if the narrative patient story is missing or truncated? Is this another example of losing a bit of humanity in favor of the data. While necessary, is the data sufficient to support the best decisions? Are we yet one step shy of getting it right - in favor of the patient? Will resources (and cost) be best conserved, and quality of care be most improved, by requiring fidelity to the EMR or by making compromises at some points - perhaps clinical documentation?
Physician leaders and executive health care leaders will need to wrestle with this dilemma for years until "the data" provides an answer. In the meantime, should we not choose humanity to satisfy patients and providers?
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