Red Flags: Using Contextualization & Technology to Transform the Consumer Healthcare Experience

By Jeff Rubin, Ed.D and Umair Khan

Jeff and Umair will be presenting on this topic during Stanford MedX on Saturday, September 17 at 5:30 p.m. PST.

When it comes to quality care delivery, understanding the patient context is king. The more providers know about their patients and the myriad of circumstances impacting how they engage with their health — from financial struggles, to emotional stress, or even an inability to travel to a doctor’s office — the more targeted, meaningful and actionable their patient care plans will be. Having the right context allows them to optimize their medical decisions according to each patient’s very unique set of life circumstances, while also maximizing the probability of follow through and plan adherence.

Sounds great! So what’s the problem? By and large, providers don’t have the right tools, training and especially time to dig deeply enough to understand their patients’ broader life context. But you can’t address an issue if you don’t know it exists — you need to see the red flags to get the right patient context.

Understanding and adapting to patient context is not only a concept, it’s a science. We’ve methodically applied this science to millions of patient interactions over the past decade. It’s the core of what drives our ability to engagement patients. As such, we know when it’s applied well, and when it’s missing from patient interactions.

Missing patient context harms patients and increases the cost of care. Looking specifically at costs, if a provider is missing context and makes a contextual error — prescribing a medication a patient can’t afford or referring them to a facility they can’t access, for example — the cost of that error has been shown to be nearly eight times higher than that of a biomedical error, such as an adverse drug interaction ($231 vs. $30).[i]

Our focus on the science of contextualization has shown us that there are an average of 1.5 contextual “red flags” present during each patient interaction (i.e., they come up a lot!).[ii] Providers are only questioning or probing patients on those issues 35 percent of time, and only taking context into account when developing their care plans in those instances 68 percent of the time. These rates are simply not good enough, especially when it comes to managing care for chronically ill and high-risk populations in a value-based, MACRA-driven world.

Knowing this, taking a blended approach to working with patients becomes paramount — employing intelligent technology and clinical science with equal parts human-touch and compassion in order to improve care quality, drive engagement and cut skyrocketing costs. It’s because of this that our probe and contextual plan development rates among our clients are much higher, reaching 70 percent and 83 percent respectively, as compared to doctors who are not utilizing our services.

We are also readily applying these key learnings as we build better apps to support patients on their healthcare journeys. But how can the Accolade experience — one that is dependent upon both human interaction and technology — translate into a patient-facing app? When taking the leap to mobile app design, we have learned that the following issues are key to consider:

· Support the cognitive and the emotion:

People think and people feel. You can’t focus on one at the expense of the other. When designing a mobile tool for consumer engagement and care management, don’t just struggle with how to account for the cognitive, but the emotional as well.

· Build the UX to match the pace of real life:

For a consumer-facing tool to be useful, it must make its users more useful. Self-service is the name of the game for consumers today, and the apps designed for them must be adding utility and value — able to both keep up with changing consumer demands and the varied pace of real life — especially when it comes to managing their health.

· Strike a balance between human touch and technology:

It’s not either/or, but striking the balance in both. Technology can’t feel, so don’t try to have it fulfill a role meant for a human. In other words, both human touch and technology are essential, but it’s finding the synergy between the two that’s the key when developing patient-facing solutions, mobile or otherwise.

At Accolade, we care about our clients — our patients — and recognize that the sum total of technology and human-touch together is greater than each of its parts. Health systems, health plans and employers are all increasingly evaluating new services and tools that can help both their staff and patient populations make smarter healthcare decisions. We look forward to fostering new partnerships with these stakeholders and sharing what we learn as we continue to redesign care management and the patient experience through equal parts technology, science and compassion.

For more information, please visit and be sure to follow Accolade on Twitter, Facebook and LinkedIn.

[i] Schwartz, A., Weiner, S., Weaver, F., et al. (2012). Uncharted Territory: Measuring Costs of Diagnostic Errors Outside the Medical Record. BMJ Quality & Safety, 918–924.

[ii] Accolade, 2016.