Providence St. Joseph Health Meeting the Needs of Today's Health Care Consumer

Added on Jul 21, 2017

Digital Technology and Lean innovation help Providence St. Joseph Health Meet the Needs of Today's Health Care Consumer

By Audrey Doyle

In 2014, Providence St. Joseph Health launched its effort to transform the delivery of care by making its services more consumer-oriented through the use of digital tools. To accomplish that goal, the system formed the Digital and Innovation Group and tasked it with developing products and applications designed to provide patients with easy and convenient access to health care, as well as opportunities to improve their health by creating ongoing relationships with their providers between episodes of care.

Recently, two groups within the division began rolling out consumer-focused, technology-enabled online solutions that provide patients with on-demand access to health care that’s personalized to their needs. Through these innovations, the Renton, Washington-based health system aims to improve patient outcomes as well as the patient experience.

“People conduct much of their daily lives online today because it’s so convenient. That’s not the case when it comes to their health care, where online interactions are limited. Also, instead of being focused on the individual’s needs, health care transactions are focused on the structure of the delivery system or the needs of providers,” said Sara Vaezy, chief digital strategy officer of Providence St. Joseph Health (PSJH). 

“We aim to entice new and existing patients to engage with us online by building online experiences that are 10 times better than what patients experience offline. We’re doing this by developing cost-effective health care solutions that patients can access conveniently and easily,” said Aaron Martin, PSJH’s executive vice president and chief digital officer leading the Digital and Innovation Group. “Making health care access as seamless and frictionless as possible will lower cost, increase convenience and improve the quality of care for our patients,” he added.

A Brave New World of Health Care

Providence St. Joseph Health is the parent organization of Providence Health & Services (PHS) and St. Joseph Health, which together employ more than 110,000 caregivers at 50 hospitals, more than 800 clinics and a range of health and social services agencies across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. 

Martin joined PSJH in January 2014 after a successful career in technology, which included founding two early-stage technology companies and leading the Kindle North American Trade business for Amazon. PSJH leadership chose Martin to head the Digital and Innovation Group because of his strong background in creating real consumer value using technology.

The group, which currently employs approximately 200 people, consists of four teams, two of them responsible for product development. The Digital Innovation Group, composed of a team of nearly 150 tech professionals—around 85 of them software engineers—develops software designed to make patient interactions with their health provider simpler and more frictionless through digital tools. The roughly 20-member team comprising the Consumer Innovation Group, which Vaezy described as a “consumer health incubator,” partners with Providence caregivers and patients to create new services and tools designed to support patients’ ongoing engagement in their health between episodes of care. 

Working alongside these two development teams is Providence Ventures, of which Martin is the managing general partner. Providence Ventures was founded in 2014 to manage a $150 million venture capital fund on behalf of PHS through direct investments in innovative health care companies that improve quality and convenience, lower cost and improve health outcomes. According to Vaezy, the group has committed approximately half of its capital so far across 10 portfolio companies. 

The fourth team is Digital Marketing, which comprises eight people who “focus obsessively” on search engine optimization and digital marketing. “These people came to us from Amazon, so they have the e-commerce mentality around how to optimize online search so people can find us online, receive information that’s personalized and relevant, and get the care they need,” she said.

According to Martin, when setting out to design a new product or service, the development teams follow a process that’s focused on achieving scale in innovation and that begins by “identifying the biggest organizational problems, or as we call it, the big ‘needle movers,’ so that where we focus our efforts will make a big difference to our system and to our customers.” 

The next step is to determine whether a solution already exists, either within or outside the Providence network. “If there’s already something in our portfolio, we’ll work with the asset’s owners to deploy it across the organization,” said Vaezy. “Otherwise, Providence Ventures will search the market to determine if there’s an early- to mid-stage startup that has developed something that will move the needle with respect to the big problems we’re trying to solve.”

In cases where a solution doesn’t exist, one of the development teams may build it. To do this, they follow a Lean innovation methodology designed to quickly test and iterate on products that deliver value. In this process, a prototype known as a Minimum Viable Product (MVP) is built and given to patients and providers for testing and feedback. The developers iterate on the MVP based on the feedback, measure how the patients and providers respond, and then repeat the process until they’ve identified what will deliver demonstrable value. The developers continue incorporating patient and provider feedback throughout the process to ensure that the product will meet the needs of patients and the organization once it’s launched and distributed.

Leveraging Digital Technology in Innovate Ways 

As noted earlier, Martin and his team aim to attract new and existing patients to engage with PSJH online by building online experiences that are far more convenient than what patients experience offline. Toward that end, the Digital Innovation Group has developed Express Care, PSJH’s consumer-facing, on-demand health care platform for low-acuity, episodic conditions.

Express Care focuses on “the transactional side” of the patient-provider relationship, quickly and conveniently delivering health care to patients with low-acuity conditions when and how they want it, according to Vaezy. The platform offers three services. With the Express Care Virtual service, patients can use their phone, tablet or computer to have a real-time video chat with a nurse practitioner. For nonemergency conditions requiring an in-person visit, patients can schedule an appointment online with a Providence provider at an Express Care Clinic, a service that’s currently deployed at 33 clinics in the Seattle/Portland area, 25 of which are located in Walgreens stores. With the Express Care at Home service, a nurse practitioner can be summoned to visit the patient at home or at work. 

Since Express Care was launched in January 2016, it has gained a large following. “This year, we’ll see about 140,000 visits coming through the platform, 10,000 of which will be virtual visits” Martin said, adding, “The beauty of the solution is that all of these interactions are captured in the patient’s EMR [electronic medical record], so a patient’s primary care physician can see whenever the patient goes into any of the Express Care offering because Express Care is integrated into the patient’s EMR. Also, it’s easy for the patient to use- instead of 30 clicks and a lot of typing to input their health information, it’s one-click scheduling and virtually no typing.”

Vaezy added, “It’s like a duck on water. Above the surface, the duck looks like it’s moving smoothly, but beneath the surface, it’s paddling furiously. That smooth experience is what the consumer sees.”

Meeting Patients’ Unique Needs

Whereas Express Care focuses on making patients healthy, products coming out of the Consumer Innovation Group focus on keeping patients healthy and engaged between episodes of care. 

One of these products is Circle, a free app that connects expectant women with relevant content, products and services, all personalized based on information in the EMR and from the patient herself; once the child is born, Circle continues to supply relevant health information through the child’s 17th birthday.  The goal of Circle is to become the new mother’s health partner for life, helping her manage her family’s health from the time she begins her family.

In addition to PSJH curated content and clinically approved answers to common questions, Circle provides a to-do checklist to guide women through their pregnancy; trackers for monitoring and sharing with providers such data as weight gain during pregnancy and newborns’ feeding habits; appointment reminders; easy access to providers in traditional settings and through live video chat; and information on local classes and support groups. 

According to Martin, the division has short-term and long-term goals for Circle. In the short term, the goal is to create loyalty with expectant moms so that they’ll keep their children within the PSJH primary care network post-partum, who Martin says have embraced the app and equate it to “having their OB in their pocket.” Over the long term, the goal is to create loyalty with women. “We’re focused on mom because she controls 90% of the health care spend in the family—she’s the CMO of the home—so we want to develop a great relationship with her,” Martin said. The strategy appears to be working. “Before we deployed Circle, the rate at which moms became established in our primary care network post-partum was around 30-40% on average. Circle has in some cases doubled that.” 
According to Mary Haggard, group vice president of the Consumer Innovation Group, Circle is currently being released across the PSJH network and is being used by several thousand women in Washington and Oregon. “Users are accessing Circle about two times per week on average and are adopting our recommendations for things like vaccines, classes and pediatric care at twice our current rates in some cases,” she noted.

At the other end of the spectrum from Circle is Optimal Aging. A set of non-medical partner services curated by the Consumer Innovation Group, Optimal Aging is designed to help seniors live independently in their homes, in a safe way, for as long as possible. “It does this by connecting seniors to companies and individuals we’ve partnered with who’ve been background-checked and provide services at a much lower cost than either a facility would charge or someone trying to find them on their own would end up paying,” said Vaezy.

PSJH caregivers recommend the Optimal Aging program to patients who are showing signs of decline, or are recovering from a hospitalization or other inpatient event. In addition to companionship, patients can receive assistance with personal care, yard care, home repair, housework, errands, medications, chores, grocery shopping and cooking. The program is currently being released across the PSJH system and thus far has provided services to several hundred clients in western Washington and northern Oregon.

According to Haggard, outcomes research is under way for both Circle (improvements in pediatric and maternal outcomes) and Optimal Aging (improvements to health and well-being and reduction in emergency services). “The metric we’re measuring against for Circle so far is pediatric retention—how many additional pediatric patients are we retaining in our system because of mom’s utilization of Circle,” Haggard said. “To date, we’ve increased that number, on average, across the regions where we’ve launched by 21%, with actual percentage varying by facility.”

A third solution coming out of the Consumer Innovation Group is Xealth. Founded as an executive-in-residence initiative within PHS’s Digital and Innovation Group, Xealth provides a technology platform that enables physicians to “prescribe” anything that is non-pharmaceutical, like digital content, services and other applications to their patients straight from provider’s EMR workflow. 

“The Xealth platform is based on the concept that physicians can prescribe pharmaceuticals relatively easily, but when it comes to providing content or services relevant to their patients’ conditions, they do it verbally or they don’t do it at all because they’re so strapped for time,” explained Martin. “Xealth makes prescribing non-pharmaceutical products as easy as prescribing medications for the physician.”

For example, for patients at risk of developing diabetes, physicians can prescribe an app called Omada that provides a 16-week online digital diabetes prevention program. When the patient downloads the app from the PSJH patient portal, his or her physician is notified so that they can monitor the patient’s progress. 

The Xealth technology consists of an EMR-integrated prescribing platform and analytics to enable physicians to assess and monitor patients’ use of the applications. Xealth was officially launched this past January and received its first round of funding in June. At press time, more than 1,700 documents and videos, and more than 8,000 programs and services had been delivered to patients both within and outside the Providence network. 

According to Martin, whenever he and his team decide to build a new product or service, they consider whether the solution can be commercialized. “In addition to asking if our own health system would find the solution valuable, we ask if another health system would find it valuable,” he said.

Thus far, both Xealth and Circle are being used both internally and externally: Physicians at OSF HealthCare and Hoag Health Network are using Circle for expectant and new mothers, while the University of Pittsburg Medical Center is using Xealth to prescribe content on comprehensive joint replacement education and recovery, and the Hennepin County Medical Center in Minnesota is using Xealth to prescribe rides for patients with transportation challenges in order to address the problem of no-shows. 

In addition to these products and services, Martin and his team will continue to look for new and innovative ways to leverage digital technology to make and keep patients healthy. “Most patients, unless they’re chronically ill, don’t engage with their doctors more than a few times a year,” he said. “By engaging patients around their health online, we’re making it easy and convenient for them to connect with their providers, and we’re giving providers more chances to improve their patients’ health, both now and down the road.”