Should We Spell ACO “CRM”?

By Kim Bellard, January 15, 2013

CMS released a list of 106 more ACOs, bringing the total of approved ACOs to over 250.  On the list there were some familiar names, and many organizations sponsored by familiar types of organizations.  It reminds me of how NFL coaches who get fired almost always get hired by another team – here’s a shout out to you, Norv Turner! – despite their demonstrated lack of success.  As the old saying goes, if you keep doing what you’ve been doing, why would you expect anything to be different? 

Don’t get me wrong; I hope ACOs prove successful.  I hope they help reform our health care system into a more integrated, cost-effective system that is centered around the patient.  Still, I wish we’d see some ACOs sponsored by organizations with more non-traditional orientations – an American Well or an athenahealth, for example.  And definitely wake me up when an ACO asks a company like Salesforce.com to help them.

Most of the approved ACOs are driven by hospitals or physicians, which should come as no surprise.  They’ve always been the center of our health care system, and will remain integral to it.  I was pleased to see, though, that Walgreens is also dipping its toes in these waters, leading three of the recently approved ACOs.  Walgreens’ ACOs may not prove any more successful than other ACOs, and will obviously still rely on hospital and physician partners, but at least they come at the problem with a much more retail orientation. 

ACOs are focusing on clinical integration, care management, financial risk management – really, all the things providers should have been doing all along but which they haven’t done such a great job at.  I’m wondering, though, if they are like the guy who only has a hammer, and thus sees all problems as nails.  Maybe instead of a care management problem, we have a CRM problem. 

CRM, for those not used to non-healthcare jargon, is “customer relationship management.”  It has many definitions and many applications, but at the risk of oversimplifying I’ll boil it down to this: knowing your customer, and using that knowledge to drive all interactions with that customer.  In health care (ACO), of course, the customer would be the patient. 

Here’s a set of things that would be true in a truly CRM-driven organization:

• A singular focus on earning and keeping customer loyalty;

• A customer database that can be accessed as needed throughout the organization;

• Each contact with the customer – at every touchpoint, with every representative of the organization – is informed by the existing information about the customer, and then becomes a source of new information about the customer;

• Contacts with the customer trigger rules-based algorithms that tailor what the organization wants stressed during the encounter, based on perceived (or expressed) needs and anticipated benefit to that customer – reminders, messages, additional services, etc.; 

• Contacts include both ones initiated by the customer and proactive ones initiated by the organization, with outgoing contacts being specifically targeted as to timing, purpose, type of media, and from whom;

• Contacts are, to the extent possible, tailored to customer preferences – e.g., physical visit versus virtual, mail/email/text/phone communication.

Now ask yourself: how many of the 250+ ACOs are likely to have all of these?  Most of these?  Any of these?  I have to admit that I’m not optimistic.  I mean – how many ACOs have an ACO-wide contact system?  How many ACOs even have a patient portal, especially one that incorporates both clinical and administrative information, from all ACO providers?    How many ACOs are even thinking about these kinds of things?

A physician in an ACO with a strong CRM platform would be up-to-date on what is happening with his/her patients, based on their own interactions, interactions the patients have had with other ACO providers, and even results of, say, home monitoring, especially for at-risk or chronically ill patients.  They’d be alerted immediately of an ER visit, potential adverse drug interactions, or test results from throughout the ACO.  Now we’re talking care management.

A recent report from Rand casts concern about how easy achieving any of this is likely to be for ACOs.  The report admits that HIT has fallen short on its promise, in large part because the various systems are neither interconnected nor easy to use, sad though that is to report.  It’s hard to do CRM with those kinds of barriers. 

Still, HIT provides so much promise for improving the health care system, in ways we’re only beginning to figure out.  For example, Optum and Mayo just announced Optum Labs, a collaboration that will pool their data and technology assets, with the goal to drive long term improvements to delivery and quality of care.  They’re not alone in this approach, with The New York Times recently reporting on researchers who plan to use electronic medical records to do medical research faster and more inexpensively.  HIT allows us to use data in ways paper records never could.

We’re in the era of Big Data, and the possibilities are as yet largely untapped.  CRM lives on robust data and targeted use of it.

I was also encouraged by an article by Linda Green and colleagues, which argues that our concerns about a physician shortage can be addressed by using alternative approaches towards delivering care, including “team” approaches, technological solutions and physician extenders.  The past does not have to be the future in terms about how patient care is delivered.  If anyone doubts that, they should read the recent survey by Harris Interactive about the use of retail clinics: some 27% of American adults have used such a clinic in the past year, up from only 7% in 2008.  Give consumers faster, easier options for care, and they will take advantage of them.

Of course, those options are not just bricks and mortar.  It should come as no surprise that the Internet plays an important role.  The Pew Research Center reports that 35% of U.S. adults have gone online to try to self-diagnose, which sometimes results in visits to providers and other times allows them to manage on their own.  Sixteen percent of online health information users have tried to find others on line with similar conditions, and 30% of internet users have consulted online reviews or rankings of health services or treatments.  Information is power, and more of that power is going to consumers.

Or take InTouch Health, which just won FDA approval for its “remote presence robot” that uses telemedicine to take care coordination to new levels.  Telemedicine is no longer exactly new, but FDA approval is a big deal.  Telemedicine promises – or threatens, depending on how one looks at it – to redefine what it means for providers to be available, and which providers.  Distance becomes less of a consideration.

Then there is the “mHealth” revolution.  Deloitte just issued their latest mHealth report, and sees a bright future: they expect some $305b in industry productivity gains over the next 10 years from mHealth solutions.  That’s a heck of a lot more than CMS forecasts ACOs may save, and it suggests that ACOs who aren’t incorporating a broad suite of mHealth and other technological solutions will do so at their own risk. 

At the end of the day, it’s not about these various slick technological solutions.  They just give us more options.  It is about doing the right thing at the right time in the right way for the right person.  If that’s not what CRM is for, I don’t know what is.  If that’s also not what we want from our health care system, again, I don’t know what is.

CRM is not easy to do, and it is rarely an all-or-nothing approach.  Even in the best case a CRM strategy can take years to implement, building incrementally.  It takes a committed, long term strategy to succeed with CRM.  And, as I see it, an ACO without a CRM strategy may not have a viable strategy at all.