Why is CX so Hard in Health Care?

Posted Friday, January 20, 2023 in Customer Experience by Patricia Seybold

In the health care field, we call it "Patient Experience" and we measure patients' health outcomes as well as wait times, costs, delays, and mis-diagnoses and/or inability to diagnose and heal conditions promptly that should be treatable. In the United States, there are too many parties involved in the health care ecosystem. This leads to innumerable "moments of truth" or patient show-stoppers. 

For example, in primary health care--what you get when you go to your local doctor's office--prescriptions often can't be filled or renewed due to insurance constraints. A medication that is the best one for the patient will often be rejected by the insurer at the pharmacy and kicked back to the prescribing physician. This leads to unnecessary delays for the patient, and more work for the physician and pharmacist. Or, a primary care doctor refers the patient to a specialist, but it then takes days of unreimbursed staff time to convince the patient's health insurer to grant a "prior authorization" to see the specialist or to have the procedure. 

The US health care ecosystem has many layers:

  • Physicians (or other health care providers)
  • Pharmacies
  • Specialists
  • Hospitals/Nursing Homes
  • Home Health/Physical Therapy/Speech Therapy/Social Workers, etc.
  • Primary Health Insurers
  • Secondary Health Insurers
  • Benefits Managers
  • Employers (who often select the health insurance and benefits managers)
  • Regulators (e.g. FDA, etc.)

It was during a customer experience mapping session with some players in the health care industry, that our clients first suggested adding CUSTOMER METRICS to the Showstoppers in each key Customer Scenario. Their customer experience/scenario map had about 10 layers of players on it. And it was clear that each party in the ecosystem was optimizing around different metrics.

"What if," our client said, "the entire ecosystem optimized itself around the patients' ideal metrics?" For example, how long should it take to get a Prescription that your physician has prescribed? Patients would tell you that they want to walk out of the doctor's office with the Rx in hand (which is possible if the practice has its own pharmacy, but is not the norm). So, if the patient  does need to go to a pharmacy, how long is a reasonable wait? (30 mins? 1 hour?). Certainly not more than that. 

We then had a great time figuring out how all the players in our 10 layer-map would need to transform their business practices in order to meet that CX requirement. And, of course, we also discovered how much time and money would be saved by all the players in the ecosystem!


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