How Might Health-System Incumbents Treat Patients More Like Consumers?

Ramon Soto: How do we tie that data together with other sources of data, those socio-economic factors, those macro consumption factors, the racial and ethnic disparities in healthcare data and illuminate pathways of engagement with individual that are very different than what we've done in the past. If we can read those tea leaves effectively, it's going to open up really interesting chapters in different pathways of care consumption.

[music]

Detria Williamson: We live and work in a world of interlocking systems, where many of the problems we face are dynamic, multifaceted, and inherently human. We believe that design thinking can help solve these problems to provide answers, but big answers can only be found by asking big questions. Welcome to The Big Question: an IDEO podcast. I'm your host Detria Williamson.

Hey everyone. This is Detria Williamson, Chief Marketing Officer of IDEO and your host of IDEO's The Big Question. In this episode of The Big Question, we're joined by Tim Peck, IDEO Executive Portfolio Director of Health, and Ramon Soto, Northwell Health Senior Vice President, and Chief Marketing and Communication Officer. We're here today to explore a really important question. The big question today we're exploring is how might we give patients a more personal and desirable experience? I'm so excited to be here today, Ramon and Tim, why don't you introduce yourselves?

Ramon: Thanks so much for the invitation. Really looking forward to the conversation, IDEO has been a fabulous partner to Northwell, and I'm really excited to explore this really important topic.

Timothy Peck: Thanks for having us, Detria. This is going to be a great conversation. Ramon, you've been a pioneer of moving forward, the healthcare industry into a more desirable place, and IDEO has been happy to be your partner doing so thank you so much.

Detria: How did you two actually come together? How did you actually meet?

Ramon: We met probably I'd say three years ago when Northwell was exploring this very topic. It's interesting that one of our major touchpoints of the market is our digital front door, millions and millions of interactions. We found that it was really poor user experience because we were having trouble getting consumers to the end services that they were looking to consume.

We reached out to IDEO and you guys ran a few innovation sessions for us to help us reimagine what that front door could look like and how it might engage with consumers. It's been a fascinating journey. It's leading to new products and solutions that we're pushing out to the marketplace and super fruitful. We're thankful for the relationship.

Timothy: Yes. When we met for me and at IDEO, we look for enlightened leaders. We look for people who are looking to move the healthcare industry towards something that's more human-centered and we use design thinking to do so. In design thinking, we think about three pillars, there's the viability of something, the feasibility of something, and the desirability of something.

Healthcare itself has a system typically in the stale healthcare system that is out there focuses on the viability and feasibility. They focus on their own profitability and being able to exist and their operational feasibility and forget about the users, meaning the patients and the providers who actually run and interact with the system. But Ramon is someone who's very different in that respect. As you said, was thinking about how do those patients have an experience where they feel respected, where they feel like this large system that he helps run is personal to them. It seemed like a good.

Detria: I actually want to go a little bit deeper into remote owns background. Ramon, you are an exquisite leader, which has really been built on at least what I've learned, preliminarily around quite an authentic, fascinating journey yourself as a patient to the customer over the last decade. Can you do a double click on that for us and talk to us a little bit about your own journey?

Ramon: The reality is I'm a marketer's marketer who was born in marketing years ago, had a career that I'm super proud of, starting in the advertising world, working for General Electric for a number of years when it was a great company to work for, and then bridging over to the healthcare side.

I started my journey in healthcare, really for two reasons. One, just the layperson's observation that here we have an industry that's 20% of the USGDP and opportunity to really think differently about how we engage with consumers, how we take the journey with individuals, how we motivate them to take action. All that opportunity was born out of my own personal experience, where I went through a health event myself. Not to get into the details, but it illuminated to me how healthcare is just a mystery at every turn.

When you have a health event, you're immediately thrust upon this platform of uncertainty for yourself, really trying to figure out, okay, what's going on? Where do I go? What do I do? With these limited access points to clinicians, physicians, who are really the value creators, but even they go through these moments of discovery where they don't completely understand, and it's uncertainty meets uncertainty and the burden is placed on the individual to navigate that entire process. It's challenging, it's a travesty.

Here we are with a service that most consumers think is a right, and that there are so many forces that realize that it's inefficient. It is not necessarily in the service of consumers. It rarely takes the journey with the individual, typical treats the symptom, or the disease state, and it is ripe for change. If anything, this COVID era has illuminated the fractures in healthcare and the need to move this drastically in a different direction. You take that fodder and the observation that we to collectively think about healthcare differently with an industry that really wants to, but has quite a bit of institutional rusts and difficulty moving in a different direction. It is ripe for transformation.

That's one of the things that excited me about the opportunity. I look for an organization that really wanted to change itself, and how was viewed in the marketplace. I wanted to put my experience at the service of those who need care. It led to this fabulous opportunity to work for Northwell.

For those who don't know Northwell, we're the largest healthcare provider in the New York market. We're led by a legendary leader, Michael Dowling. He believes that you're either at the forefront of change or you're the victim of it. A change agent's change agent and surrounds himself with people who think in a like-minded fashion and allowed us to explore and really push healthcare in a different direction. That's led to this conversation with IDEO and I think a really fruitful journey to date.

Detria: Ramon. I want to do a double click into that uncertainty that you and Tim have referenced earlier in this discussion. How might we actually use Digital Platforms to enhance the visibility and choice and healthcare for patients and their caregivers?

Ramon: I'll start, and Tim, you guys have given us such great guidance, would love your perspective on top of this. If I reflect on my own situation, I remember going through a moment where my world was just very different and my health event was really impeding my ability to work and to interact with my family, to do things that everyone else could do for a short period of time.

I remember trying to self educate and figure this thing out. Here I am self-educating in this moment of fear, trying to understand who should I reach out to? Who should I talk to? What's actually going on with me? It was the first observation that this information asymmetry existed in healthcare delivery. That the answers are out there, but that they're super hard to connect to consumers, and the seed was planted and germinated over time. Luckily, I'm fine now and I had my wellness exam last week. My doctor said you are fabulously normal, so I'm grateful for that.

Fast forward to today and we do about 50 million consumer visits to our Digital Platform. Our platforms are transaction [unintelligible 00:09:35]. People don't come there to research. They come there to seek services. As a Health System, we know individuals are searching for the physicians who provide those services, and even in that moment, this information asymmetry continued to exist.

Here I have an individual who has raised their hand, has exhibited the highest form of purchase intent. I know the doctor that they are looking at. I know the categories of care that doctor delivers. We still as an industry have challenges in matching what that individual is looking for with the actual services that we need to [unintelligible 00:10:13]. Thus, we were looking to close the boundaries on this information asymmetry and match buyers and sellers much more efficiently.

That's where they ought to reimagine that gateway to information and gateway to services in a much more personalized manner. Where we could take advantage of the millions of interactions that we've had with consumers in the past. Use some intelligent design, design thinking, analytics to match what the consumer who was looking for services with historic consumers who have purchased services and unleash a trove of data at the benefit of the consumer to close that information asymmetry.

If you think about it, it is an opportunity to close the fear gap. I didn't know that other individuals have gone through health events similar to mine, and it would have been comforting to know that there were people like me who saw specific physicians that treated the health conditions or health symptoms that I was exhibiting. There was this wonderful opportunity to really reimagine what that might look like. It led to a product that's currently in beta, and we're proud to have taken the [unintelligible 00:11:30] with IDEO.

Detria: There's a lot there. Tim, I would love to hear your builds and just the role of design through that process of enhancing this ability and choice.

Timothy: Yes, there's a lot of depth and richness to what Ramon just said. For one, I'd point out to our listeners, that the word consumer is sometimes hard for people in health and patients to hear. That it's something that when they think of healthcare, it should be patient-centered care, it should be about being a patient getting services and care from people.

For us at IDEO and at Northwell, it has been very bold and comfortable with using that word "consumer" to their advantage and to their patient and consumers advantage. The idea that one has a choice, the idea that one should be respected to have an experience that allows them to navigate the system and reduce that fear and uncertainty comes with themes and words and words are important. "Consumer" is what they use over at Northwell and we tend to use it too.

When the pandemic hit, things changed in healthcare quite a bit. One of the big things that changed is that patients all of a sudden could vote with their feet a little bit more. Health care tends to be very local, you tend to be very much in your own environment and go to the closest hospital and the closest doctors, but all of a sudden that was unavailable to many patients. Especially pre-vaccination and technologies arose such as telemedicine and others to be able to engage with whatever physician group or doctor or hospital system that was catering to the needs of that patient and thinking about what they needed at home, what they needed to engage and what that experience was like.

[music]

Timothy: Northwell started thinking about that beforehand with us before the pandemic even started. We did start to build in this front door to say, regardless of the physical interactions in this modern world, there should be a sphere of influence beyond the buildings, beyond the personal interactions, the physical interactions, and how do we spread those personal interactions to where people actually are in their homes, at their workplaces, on the street, et cetera, and meet the way that they act today.

Through deep design research, we looked at how these consumers actually wanted to interact with the system and started to build with Northwell and design with Northwell a project that would do exactly what Ramon said. We'd match digitally using the power of data, using the power of the research, the design research, and human-centered design that we put in where that front door was more accessible or just as accessible as your banking front door that's digital, as your retail front door that's digital, as your hospitality front door that's digital. The role of design was to take the lessons, especially analogous lessons from other industries, and apply them to healthcare and fuel that consumer choice.

Ramon: Hey, Tim, if I could add, what's interesting is this word consumer, I'm not sure why it's so controversial in healthcare but it is. Perhaps it's the 5,000 doctors in our system who are very proud of the expert care that they deliver to their patients and it is still a debate going on today. I frankly, think it is one of the things that holds us back from innovation in health care. When you think about the word, the patient, you self-regulate to a transaction, a moment in time where you're providing services to an individual, and that in and of itself is self-limiting. We even have a word for it, we call it the episode of care. It's the point in time with which you provide services to an individual.

If you change your perspective slightly, and if you think about that individual as a consumer who is on a journey of consumption of health care over time, you realize that most of the issues that that consumer is going through that has resulted in a need for care, that transition to a patient happened well before the health event. This is where I think healthcare needs to go. This is the taking the longitudinal journey with the individual, regardless of their state of health, so that you can influence these upstream touchpoints, these upstream elements of consumption of care that can have profound impacts on the downstream.

If you change your perspective just slightly, it opens up this world of opportunity to reimagine what those touchpoints might look like. Whether it's defining wellness differently and having a wellness conversation with an individual instead of a care conversation, or even those digital elements that you laid out. This is one of the things that we learned really thoughtfully from our IDEO partners is that other industries have gone through this, the study of consumerism, and how relationships and engagement are built could profoundly inform healthcare. We don't have to reinvent this, we can learn from others who have already gone down this journey.

Detria: Ramon, this is really fascinating. I would love to actually hear more about how do we actually allow people to learn from others' care journeys? This seems super important.

Ramon: Yes, I think this is where healthcare has to look at all the assets that are available to them. This is where I do think there are powerful forces of change that are going to mandate that we start experimenting. This belief that healthcare is a right, you've got forces of change that are really taking place at the macro level, from a governmental standpoint. Health care consumption in five years from now, it's going to be very different than it is today.

I think one of the knock-on effects of COVID is going to be this re-examination of how is healthcare working for individuals? We saw that your socioeconomic status really dictated your access to care and how you consume care. It is an absolute travesty that your zip code can dictate how long you live. I do think the forces of change are there and that healthcare is going to have to address this in the near term, not the long term.

I do think the assets also to inform that change are also there, and unleashing the power of the information that we have, in different ways is really going to be at the forefront of how we illuminate the path forward. We have tremendous data, it's locked in EMR systems, electronic medical records. That data is at the service of physicians to provide care, and it provides tremendous value.

I think you're seeing health tech, really interested in what else can that data illuminate and how do we tie that data together with other sources of data, those socio-economic factors, those macro consumption factors, the racial and ethnic disparities in health care data, and illuminate pathways of engagement with individuals that are very different than what we've done in the past. If we could read those tea leaves effectively, it's going to open up really interesting chapters in different pathways of care consumption, and different partnerships may open up an opportunity to partner with your church a little bit differently as a healthcare partner.

I do think the relationships that we build, the opportunity to interact with individuals is only going to broaden and hopefully from this point of trust really there's really interesting extreme value that consumers place on physicians, really trusted members of society. It's also really interesting that that's mashing up against this trend to not necessarily believe in science and I think they didn't have to get ahead of that curve.

We own the patient-doctor relationship and think of the power of unlocking that in very different ways to advise individuals. Doctors are challenged with how they use their time to take the journey with the individual. We all fight for our five minutes with the doctor in the doctor's office and how do you force first multiply access to clinicians on a trusted basis who can guide you down a very different healthcare journey. I think these are all really interesting questions that are going to illuminate pathways that are going to change healthcare in a very positive way in the near future.

Timothy: The piece there that I'd like to pull out is this idea of what is health and how we have to find health today in terms of the processes that have been designed and what can health be. What is our north star where are we trying to go and I think Ramon hit a lot on these things. Health today is designed for itself more than for the user. We're trying to push it at IDEO with the partners that we see is to health system that is more equitable, more sustainable, and more human-centered.

[music]

Timothy: Ramon hits on it's not equitable right now, your zip code does tell you about your health outcomes. Thinking about how we can reach people whether that be digitally or physically and be able to make a more even playing field, be able to reach the people who need us more more often needs to be done in a hybrid approach, not just in a way that you're focusing on this episode, this one episode of care but looking at their whole life journey.

Sustainability part, this idea of how do we interact with people's churches? How do we interact with people's grocery stores that they go to and really how do we insert our influence into the community so that health becomes a community affair? An individual health becomes something that's shared really can focus on our sustainability of the changes that we design. Then finally human-centered design we talked about and we believe that health should be human-centered. Anyone that's been to that health system as Ramon talked about his own journey knows that experience is devalued and we believe that experience should be of utmost importance.

Detria: Quite frankly it's quite a new approach that design brings, and it seems like it's a departure from, Ramon, what might be a standard approach in terms of how people do look at healthcare. Have you found that it's been difficult internally for you in terms of engaging key stakeholders with this new way, this new human-centric approach to solving quite substantial healthcare problems?

Ramon: It's a great question, I think different parts of the organization are on different pathways through the journey. I'm a firm believer that culturally because Northwell sees itself as a change agent in the broadest sense of that word and the people who work at Northwell are always looking around the corner for the incremental improvement as well as that revolution, that I need with like-minded peers who want to change healthcare in a very positive direction in the right way.

I think the challenge is just that. There are multiple routes to success and you're talking about quite a bit of experimentation here and we all bring our own baggage as well as our own insights to the table when we're evaluating different pathways to success. What's interesting when I started my job I rebranded the organization and I had to influence and I had to build a changed mindset because there were a lot of naysayers on the rebrand.

Why are we going through this? We don't really need to go down this path and I would talk to my boss or CEO, Michael, and we would always discuss. My job was probably one-third change agent, one-third business partner, one-third marketer, forget chief marketing officer. It was like how do you illuminate these different pathways? How do you listen and call in those nuggets of information that allow you to provide broader value to the organization? It's very true on the product side as it is on the marketing side or the customer experience side.

I do think healthcare is terrible at product design, new product introduction. Everything is done on this artisanal non-scalable basis, that is one frontier opportunity that I think is pretty extreme. I do think that we speak the language of change so there at least we're approaching an opportunity from a similar mindset, it's then showing the path forward.

I can tell you my formula is to experiment pretty broadly, partner with those who have vested interests in moving things in a different direction to pilot, and to show a pathway of success. That usually creates a bit of demand for that success. We do experimentations all the time with our three regions. Our three regions, they are each $5 billion health systems. It's amazing how one will say, "Hey, I heard about that thing you're doing out on the eastern region, can we get some of that I'll be here in my market?"

In addition, I do think that there sometimes is a need to be brave and to step out front and to lead. I've done plenty of projects where I ran silent and ran deep and it was the covert mission and then we surfaced when we had the solution. Then it's a selling job to the rest of the organization because they don't know, they don't have the historic perspectives and without it, you won't necessarily have the opportunity to even drive the change.

We consider ourselves a challenger brand and we are fearless in terms of running forward and we try to learn as much as we can from failures and take success and broadly illuminate it and drive it hard and scale it. I think that attitude has served us well. That attitude needs a big adoption in healthcare overall. We just moved too slowly and you guys said it well, "COVID kind of illuminates the fact that we need to accelerate how we change and how we think about change."

Detria: Tim, I really would love to hear obviously as working with Northwell we have this fabulous partnership with a brand that gets it, with a company that gets it, with the leaders such as Ramon that gets it. Are you finding in the marketplace the industry of healthcare that it's difficult for people to understand and adopt this new approach of design?

Timothy: A lot of headwinds to it but there also is a lot of fresh perspectives and pockets that we do interact with. Again we use this word enlightened leaders, people who are ready for this change, who are ready to change their own organization, ready to influence change of the healthcare system and a health system in total whether that be in their local communities or in DC or their state government leaders who are willing to look outside of themselves in their own [unintelligible 00:28:57].

The issue that we find is healthcare has a lot of bureaucracy, has a lot of layers of red tape in it and it has a lot of fiefdoms of sorts where people are trying to protect the system that exists today. We need to change because as we talked about, the system that exists today doesn't respect the consumer as much as it needs, as it can, compared to other industries that we see and doesn't see the need for that change that we look to work with and have been working with. Ramon is one example of those and so what has to happen then is we start to do organizational transformation with these pockets of healthcare.

We look for the leader with them, we put in programs to workshops, to spread out what is design thinking, how we can infuse this, how things can be different, and we inspire, we try to inspire what the new North Star could be, what the new way of practicing can be.

[music]

From there, we set a new reality to look toward into junction with that leader and then help bring that organization through there. We look to do these beacon projects as I mentioned, one of which we did with Northwell to show that change is possible, show that we can respect the consumer, show that we can reach consumers and the most equitable and sustainable way as we possibly can. The project we put together with Ramon and Northwell was called Constellation. Again, this digital front door and Ramon wonder if you can bring us through, what's been made this far and a little bit about the--

Ramon: Tim, thanks for bringing that up. Constellation is in essence the manifestation of what we had talked about before where we reimagine the elimination of that information asymmetry, consumers shopping for services, physicians who can provide those services, and illuminating the path to connectivity. All by taking the data that Northwell sits on, the millions of transactions that we've had over the past several years.

In our case, we do over five and a half million transactions with individuals each year. You multiply that out by six years. It's a treasure trove of data with consumption roadmaps illuminated throughout that data. We put that into service of consumers. We personalize the information and we show consumers the physicians who have provided the services for the symptoms that that consumer's going through. It shortens this roadmap to overall consumption.

It's in beta right now. We've had great consumer feedback. We're doing some product modifications. We're looking to roll it out in 2022. It'll be new to the world type of experience for consumers. Quite frankly, we love for healthcare to look at it and understand it and adopt it. We think it's going to set a new standard for how you map supply and demand in healthcare consumption.

Detria: Ramon, thank you so much for sharing your own personal journey, your journey of self-educating, and how that really bred you into the exquisite leader that you are talking about the power of design and actually closing the fear gap that exists in the healthcare industry and the need for us to reexamine how healthcare actually works for our communities.

Tim, I really appreciated you discussing about how health has actually been designed more for itself rather than the user and the power of design to see our way out of that and posing the question around how a health system could be more equitable and accessible for everyone. Thank you so much, Tim and Ramon. Ramon, I have a popup question for you, which is, is there a big question that keeps you up at night.

Ramon: I can tell you that actually, I worry quite a bit about what the will be in this COVID recovery phase with regard to healthcare. I think there's opportunity, and I think there's peril in front of us. COVID has crowded out care consumption in so many different categories, people deferring care. I think there are still knock-on effects still to be witnessed that we have not really understood yet.

You have 800 people who have passed from the disease itself. You have a number of people who have deferred care. Think of how we all navigated this pandemic. I can tell you that my wine consumption, on a personal basis has gone up X-folds. I suspect there are consequences to be paid there. If you think about a burgeoning girl health issue that we're going to face as a society. Think of the millions and millions of students who have had a challenging consumption of education who have graduated and gone to college, or who are still in school and moving on the next year.

Students are and into individuals are resilient, but there are a number of knock-on effects that are going to play out. Now we as healthcare, we have to figure that out well and we will. I also think the optimist in me suggests that there's also a different window of opportunity in terms of how we have relationships with individuals. Healthcare has historically been a low-interest category until you need it. Most people do not think about healthcare until the moment of a health event and then all of a sudden it becomes a super high-interest category.

We're in this environment where people have reevaluated that paradigm. For all those who turn to wine to get through COVID. There were people who turned to their Peloton as well, and actually took command in what felt like an uncontrollable environment. I do think that awareness of healthcare leads to a window of opportunity for different relationships, and I'm excited about that. I think we have brand permission to have very different conversation with consumers. I think that can yield a tremendous amount of benefit in terms of how we deliver care and how we interact with individuals.

Detria: Ramon and Tim, this is not only fascinating but important conversation to have and bring to the world. I want to thank you so much for your time. Thank you Ramon and thank you, Tim.

Ramon: Detria, thank you so much for hosting and it's been fabulous to engage with you guys, share with you guys, take the journey with you guys. Thanks for being the strong partners that you guys are.

Timothy: Thanks, Detria, and thank you, Ramon, for the chance to redesign health. It's been an amazing journey and we have more to do.

Detria: The Big Question is brought to you by IDEO. To find out more about us and how we create positive impact through design, head to ideo.com and then make sure to search for The Big Question, on Apple podcast, Spotify, or anywhere else podcasts are found. Make sure to click subscribe so you don't miss any future episodes. On behalf of the team here at IDEO, thanks for listening.