HJNO Mar/Apr 2024

HEALTHCARE JOURNAL OF NEW ORLEANS I  MAR / APR 2024 27 become severe. Moving away from episodic interactions toward a connected relationship revamps a health system into a proactive care organization with deeply connected relation- ships that create differentiated levels of reten- tion, loyalty, and advocacy. Woe to those poor health systems who have failed to begin their digital transformation journey because the future is much closer than they think. Those systems that figure out how to move beyond episodic interactions with their patients to a connected relationship overcome many short- comings of the traditional care approach. Connected strategies need to be carefully designed and curated and are comprised of both a connected patient relationship and a connected delivery model that, when done right, results in patient delight, retention, loy- alty, and advocacy. Design dimensions of the connected relationship are comprised of the four R’s and include the capability to recognize when a proactive intervention is needed for a patient, or for a patient to request a response from their care team without having to go through the difficulty of scheduling — and wait- ing for — an appointment for an in-person visit. The care team will respond with helpful solu- tions, but the real magic of this process lies in the repeat phase of the relationship. Through many repeated interactions over time, the care team can gather enormous amounts of data that assist in learning and continuous improve- ment of the solutions and processes in a way that a randomized, controlled clinical trial could never equal, at least not in a cost-prohibitive way. The connected delivery model consists of the connection architecture, technology in- frastructure, and a revenue model to recoup costs of investment. The revenue model piece is why traditional health systems have likely delayed investment in the needed infrastruc- ture to deliver this type of 21st-century care. But for systems that deliver health, who real- ize that value-based care where we health sys- tems bear partial or complete actuarial risk for total cost of care, these types of investments are necessary for future economic viability. The connection architecture is comprised of a care team ecosystem that represents technology- enabled human connection via pharmacists, behavioral therapists, fitness instructors, dieti- tians, health coaches, and providers who can leverage the data to drive upstream interven- of these prescribed treatments rapidly and it- eratively during the trial. These superimposed research constraints can unfortunately slow progress toward identifying the upstream so- lutions that are most effective in preventing downstream complications such as clinically evident heart, kidney, or metabolic disease. Fortunately, there is hope on the horizon that is being made possible by the digital age and for those forward-thinking health systems that deliver health, who have been wise enough to invest in a robust digital strategy. When large numbers of consumers — or in the case of healthcare, healthcare customers — interact with digital platforms, we can begin to attain large amounts of data that can be analyzed to generate insights into improvement opportuni- ties, thus rapidly identifying the most effective solutions. To understand why, let’s use a very basic example that has become quite com- monplace in the digital age. “A/B testing” is shorthand for a simple randomized, controlled experiment in which two different samples (e.g., A and B) of a single vector variable are compared. Suppose you want to test the ef- fectiveness of two different approaches for behavioral modification health coaching strate- gies targeted at helping people increase their activity level. We know at least 150 minutes of moderate exercise can have profoundly favor- able impacts on overall health. Using an A/B approach, you test strategy A on some and strategy B on others and then monitor data that is being collected about their activity and exercise patterns. If strategy A turns out to be significantly more effective, then you start us- ing that approach until you find an alternative approach that may be even more effective, thus rapidly generating loops of continuous improvement through digital relationships that are carefully augmented by human connection. Connection: Both Digital and Human In their book, Connected Strategy: Building Continuous Customer Relationships for Com- petitive Advantage , authors Nicolaj Siggelkow and Christian Terwiesch discuss how a con- nected strategy moves the doctor-patient rela- tionship from an episodic encounter every few months, at best, to a continuous flow of data from the patient to the care team, enabling medical needs to be addressed before they In a prior article, we discussed the concept of upstream solutions versus downstream in- terventions. Traditional healthcare has been heavily weighted to the delivery of downstream interventions, such as angioplasty with stent placement or coronary artery bypass graft sur- gery for ischemic heart disease; hemodialysis for chronic kidney disease (CKD) that has pro- gressed to end-stage kidney disease; or even bariatric surgery for metabolic diseases such as obesity. Under prevailing transaction-based fi- nancing mechanisms, each of these traditional downstream interventions is not only viewed as potentially lifesaving, but they are also very well reimbursed financially. As a result, you see sig- nificant investments made by health systems in securing ownership or partnerships with cardi- ologists and cardiothoracic surgeons as well as attempts to partner meaningfully with dialysis centers and bariatric surgeons. These interven- tions are reactive in nature and exorbitantly ex- pensive for the people who pay for healthcare — meaning all of us — but financially lucrative for those who view these interventions as a rev- enue stream. However, there is considerable downside to patients for these reactive, tradi- tional healthcare interventions, namely that the health system is overwhelmingly responding to a need only after irreversible damage has al- ready been done. And even if the intervention is deemed effective in the traditional sense — meaning a heart attack is averted by the stent, life span is extended by the bypass surgery, or metabolic improvements are rendered by the bariatric surgery — there is still the potential for procedure- or surgery-related complica- tions that may dramatically impact a person’s quality of life or interfere with their capabil- ity to engage in what matters most to them. In contrast, proactive investments in up- stream preventive solutions have received relatively short shrift. In traditional health sys- tems, they have been nearly devoid of mean- ingful investment because remuneration for these types of services is lacking. They are also not as well studied or published in medical literature, and, even when they are, the solu- tions typically adhere to a set of prescriptive criteria that are outlined in a clinical research trial. An example would be a weight loss trial that “prescribes” a half dozen nutritional con- sulting visits and a psychological evaluation, without being able to test the effectiveness