Consumer Digital Innovation in Healthcare

This article summarizes the product I currently oversee and facilitates some of my in-person conversations. It also provides product managers with a case study that might help them learn about (or break into) the healthcare industry. For healthcare professionals, I hope this article provides a technology perspective to a bigger picture.

Problem

The US market for health systems (hospitals) is massive (~$1T or ~30% of healthcare spending). However, health systems’ finances are under increasing pressure. Approximately half of health systems ended 2022 with a negative margin. And the economics are getting worse.

Post-Pandemic, demand for elective procedures has not recovered at the expected rate. The situation is exacerbated by increasing labor expenses, lagging payer re-negotiations, and a macro downturn (e.g., inflation of everything, rising cost of money, investment losses, tightening spending).

The longer-term picture is not better. Demographic trends of an aging and sicker US population put costs on a path where the math will not work.

Competitors continue to chisel the “healthcare department store” business model. Care is shifting from inpatient to lower-cost, outpatient destinations, such as near-site (e.g., ambulatory, urgent care, retail clinics), on-site (e.g., work, home), and virtual (e.g., telehealth).

Vertically-integrated healthcare (e.g., UnitedHealthcare, Cigna), retail (CVS, Amazon), among other well-capitalized behemoths and nimble startups are also siphoning patients from hospitals.

How can health systems not only survive changing market conditions, but thrive by finding new drivers of growth?

Opportunity

As a non-profit health system, Mount Sinai Health System (MSHS) serves a diverse population of patients in the New York metro area (including Medicare, Medicaid, under-insured, and uninsured patients). MSHS cannot practically move hospitals or pick and choose patients.

In order for the economics to work, MSHS needs to increase its share of “more profitable,” commercially insured patients to cost shift (subsidize) its “less profitable” patients.

MSHS’ strategy to acquire and grow this patient segment is through emerging models, such as Direct to Payer (DTP). MSHS, as a provider of care, wants to partner directly with payers/receivers of care. This gives MSHS valuable channels for delivering new care offerings, improving patient outcomes, and improving its finances.

Mount Sinai Solutions (MSS) is the internal business unit responsible for growing the DTP business. Its customers include:

• Employers: NYC-based SMBs and Fortune 500 companies that purchase healthcare benefits for their employees
• Consumers: People who live or work in NYC that want a dedicated clinic to complement their healthcare needs and situation

Below is an overview of MSS’ membership-based offerings to customers:

MSS aims to offer a comprehensive menu of care “programs” for customers to best meet their needs (e.g., primary care, speciality care, in-person, virtual/on-site/near-site, etc.). To differentiate, Mount Sinai Solutions wants to design new programs, quickly go to market, and experiment. This requires MSHS to reach a new level of operational and digital agility.

Value Proposition

The Consumer Digital Innovation team (CD) owns the digital experience and technical infrastructure needed to achieve the mission described above. CD offers a proprietary software system, The Consumer Digital Platform (CDP), which allows MSS to go to market with new care programs, such as:

• Health Center: For employer customers, Mount Sinai runs an employee-only clinic at their offices. Employees get an employer-sponsored benefit that is convenient and 100% private.
• Hudson Yards: For consumer customers, Mount Sinai offers a members-only clinic near their home or work. Members can easily and quickly get care that meets their specific needs.

A top reason customers buy from Mount Sinai Solutions is a quality digital experience. This is not about having an app. The point is providing patients with a seamless journey — clear, easy, and immediate, which contrasts the typical healthcare experience.

For the business, CDP helps actualize new models. An example is diversifying Fee For Service reimbursements with subscriptions (upfront, direct revenue). This positions MSHS for more complex, risk-sharing population health initiatives, such as value-based care.

Tech is increasingly accepted as a core competency to providing effective care. But past innovation attempts were constrained by the use of off-the-shelf software. CD building a homegrown solution is part of MSHS’ larger investment thesis to own its roadmap and control its destiny. The COVID-19 pandemic was another (albeit major) accelerant of the ongoing digital transformation.

Strategy questions continue to be discussed — how can MSHS best execute its vision? What is the balance of buy vs. build? How is ROI measured, over what period? How can the org execute within the (serious) financial constraints? How can tech become a lever for revenue growth, not just a cost to be minimized?

Solution

Consumer Digital is a key technical asset to the larger, cross-functional solution. Below is a high-level overview of the Consumer Digital Platform:

Business model:

• Enterprise SaaS
• B2B2C: CD’s customer is the internal business unit, Mount Sinai Solutions. MSS’ customers are employers and consumers
• Live MSS customers: Include Fortune 500 financial services companies, Big Law firms, high-growth startups, and consumers

End users:

• Patients: Members can enroll in one or multiple programs to personalize their level of care. They can get and manage care from a single view
• Agents: Staff users, such as care navigators, can support multiple program populations with access to different services. Navigators can chat with members to unblock any issues preventing them from getting care
• Admins: Program managers can go to market with new offerings, customize the digital experience for customers, and monitor/improve engagement

Product:

• Offering: Cross-platform (web, iOS, and Android) software application
• Properties: Patient portal and staff portal
• Enterprise-grade: Live with multiple Fortune 500 enterprises in highly-regulated industries, including the largest asset manager in the world
• Healthcare-class compliance: Meets HIPAA and industry standards for cyber and info security. BAAs executed with key vendors
• Accessibility: Limited WCAG 2.2, English-only
• Product Analytics: GA (top of funnel), Segment, Amplitude, and QuickSight

Technology:

• Architecture: Multi-tenant. Modern, distributed web app; evolved from a monolith to an increasingly modularized/microservices-based architecture
• Hosting: AWS
• Tech stack: Includes PostgreSQL, Redis, Go, Javascript, React, Flutter, iOS, and Android
• Key integrations: Epic Systems, Twilio, Vouched, and Stripe

Patient Portal

The digital front door is accessible as a web/iOS/Android app and allows patients to:

• Onboard: Register for a CDP account and enroll in care programs
• Chat with navigators: Get support from a real human based in NYC to ensure the best possible service and care
• Schedule appointments: Depending on their program, members can access a range of primary and specialty health services (e.g., annual physical, women’s health, behavioral health, physical therapy, flu shot, lactation room reservation)
• Conduct a video visit: Members can have a video call with a provider for various clinical reasons

Patient Onboarding

New patients can register and enroll in various care programs. The example below shows an employee eligible for an employer-sponsored program:

The consumer funnel is different and includes steps to select and pay for a program subscription.

The UX may seem simple but complex things are happening on the backend. In order to activate a new patient, several steps need to happen:

• Register account: CDP creates a digital account for the user with an email and password
• Link health record: To get care, a patient must have a verified Medical Record Number in the EMR. This enables scheduling, charting, and reimbursements.
• Verify identity: CDP must ensure that the patient is who they claim before releasing sensitive health data. This is a critical security and compliance step
• Enroll in a care program: The patient must be eligible and placed into a specific program which has compartmentalized rules, services, and data. This becomes particularly tricky when a patient is enrolled in multiple (sometimes conflicting) programs

A patient can onboard themselves, completely online. Digitally enrolling and segmenting patients into multiple populations was a big win, particularly when the COVID-19 pandemic struck. Automating steps that previously required human intervention led to a decrease in errors, delays, and costs, and most importantly — a smoother patient experience.

Home and Navigation

From the Portal, patients can get care, see announcements, get prompted to complete tasks, schedule appointments, chat with navigators, have video calls, access health data, and manage their experience.

Patient Chat

As shown in the screenshot above — patients can message care navigators for live support on a range of issues, including care options, getting to the best point of care, and managing appointments and referrals. Chat is staffed by teams based in NYC and operational hours vary by program.

Patient Scheduler

Depending on their enrolled programs, patients can self-schedule from a range of options, including:

• Primary vs. speciality care
• In-person vs. virtual
• Clinical vs. non-clinical (e.g., booking a lactation room at the office)

The scheduling workflow can show screeners, such as checking for COVID-19 and ensuring telehealth compliance:

The Patient Scheduler integrates with Mount Sinai’s EMR, Epic, on the backend. Non-clinical resources (e.g., lactation room scheduling) are managed by CDP. This is currently a capability gap for Epic.

Patient Video

Patients can start a video call with their provider from the Patient Portal, whether it uses CDP’s video capability or a third-party app (e.g., Zoom). After a patient schedules a video visit, she gets email and text message reminders to join the appointment. The patient can simply click a link to join the video call.

During a video call, the provider and patient can share their screen, chat, and invite other people to join the call.

Staff Portal

The Staff Portal is used by several personas:

Admins (e.g., program managers):

• Configure a program’s digital experience, such as patient self-scheduling rules
• Monitor/report patient engagement

Agents (e.g., care navigators, care coordinators):

• Manage a program population by proactively addressing issues, such as access, getting care, and follow ups
• Chat with members to provide live support and drive engagement

Providers (i.e., physicians, nurse practitioners):

• Conduct video calls with patients
• See the purpose/context for the video visit and patient info

Configuration Tools

Business users can customize a program’s digital experience from a simple UI. For example, Scheduling Manager allows an admin to instantaneously update the providers available for patient self-scheduling. Changes to the scheduling rules and patient UX can be made easily, without onerous change approvals, technical staff, or regressive changes to the underlying EMR.

Admins have permission to access a program’s scheduling settings:

Providers (as well as visit types, specialities, and physical types) can be configured to customize a program’s scheduling experience:

CD plans to add more self-service configurations, including program enrollment, chat, video, reports, patient notifications, and other modules that customers find valuable (e.g., text messaging, email, VoIP calling, remote monitoring, referrals management).

Patient Manager and Profile

Staff can see a program’s patient roster. They can proactively identify any issues that may prevent a patient from getting care. Program managers can ensure that only eligible employees are enrolled. The functionality also helps them improve the conversion rate of eligible-to-engaged members. The resulting performance data helps win new customer deals and renewals.

The Patient Profile is a CRM view of a patient’s journey — the interactions they had across all touch points. Patient Profile was designed to show customer service interactions, in addition to clinical encounters, in chronological order. Longitudinal context yields better patient service and care, particularly those with chronic conditions.

Staff Chat

Navigators can easily communicate with patients and answer any inbound inquiries. Mount Sinai Solutions has an internal service level agreement of replying to all patients within 60 seconds. Alerts on and off CDP nudge navigators to reply. Navigators and supervisors can easily switch between various programs to ensure all outstanding issues are resolved.

Provider Video

Providers frequently work with Epic’s Hyperspace. To respect their existing workflow, a CDP video visit can be started with one click from the Hyperspace UI. These types of integrations fit into how a provider works, avoiding another app to log into.

Reports

Admins can see patient engagement data at the aggregate or program level:

Each program can be configured with report templates that are most relevant.

The Backend

When I demo the product, it’s easy for people to focus on the commoditized features. But it is CDP’s backend that is the heart of the Platform and source of intellectual property value.

CD’s strategy is not to compete on building the thousandth, unused feature, but “horizontally integrating” existing systems and workflows to yield the most seamless patient experience. CDP takes a patient-centric approach, which is often diluted as a health system introduces more services and rules.

CDP does rebuild some commoditized features, but we do it to guarantee a quality experience. Much of our resources are allocated to building technical infrastructure providing MSHS with agility to experiment and launch new programs. CDP realized that the digital experience needs to fit how clinical and operational staff work. Vended solutions can have the opposite effect — forcing staff to change their workflows–adding more complexity and another tool to manage.

The simplicity of the Patient and Staff Portals is the result of tireless effort to abstract the underlying complexities of healthcare. While many health systems shoehorn commercial-off-the-shelf (COTS) software, CDP has carefully captured the business’ needs and complexities into its domain model. That is, the Consumer Digital Platform was built from the ground up for a post-Fee For Service, only-in-person world.

One of the team’s greatest assets is what it learned solving highly complex problems in a leading healthcare system — the R&D of abstracting and simplifying, integrating, and operating within the confines of many constraints.

To improve the patient experience, CDP addresses the gap left by existing systems. Emerging models of care, such as Direct to Payer, and its “multi-program” world represents an underserved need. The Platform’s design also helps MSHS to grow customer lifetime value with commercially insured patients. Examples:

• Up-sell: Employees Essential members love the experience so much they decide to upgrade to Employer Premier
• Cross-sell: The success of Employee Essential leads to the sale of a new Executive Physicals program (comprehensive, multi-speciality checkup). The execs happen to be the purchasing decision makers.
• Next-sell: An executive who got Employer Premier access through work, switches job and decides to buy her own Consumer Premier program

The Backend can scale to handle whatever the business throws at it.

What’s next?

Over the years, there has been positive feedback from customers and end users. Revenue has been multiplying. One health system expressed that Mount Sinai has a multi-year head start in a critical arena.

There are many opportunities going forward. Mount Sinai continues to invest in the patient digital experience and sharpen how it proves return on investment.

Healthcare continues to change rapidly, and the digital experience needs to evolve accordingly.