ADAM: Hey guys, Adam Peebles and Jason Nardella, here, from Trilliant Health. Each week, we will be bringing you the "Prescription for Growth" series focused on data-backed strategies and tactics that hospitals and health systems can use across the country. To be able to get this content, all you have to do is like, or follow us on LinkedIn, or just connect with Jason or myself, and we'll make sure that it gets in your feed each and every week. Thanks guys.

Alright, Jason, so one of the questions really what's the difference in having an encounter-based thought process for hospitals and health systems versus a patient-focused thought process for health systems. So maybe you can walk through the old view of how people are trying to engage patients and more of that episodic one-time instance versus how we're seeing the advanced and forward-thinking systems, think about more of a patient-centric view ongoing for the lifetime of that patient.

JASON: Yeah, it's a good question. And it's easy to be like, well, Jason, you know, patients equal encounters, duh. However, it's a lot more nuanced than that. And I think the more you're able to actually focus in on the patients, the better off you are, the more strategies that are really at your disposal. So, what's the difference really between the two? An encounter based strategy is setting your budgets and setting your priorities around filling up your capacity on an encounter basis.

So, 100 orthopedic surgeries this year, maybe next year, I try to do 103 orthopedic surgeries, 104 orthopedic surgeries. That encounter level, that discharge widget that goes through the health system is a key performance indicator. No doubt. However, if you start to focus on, well, who are the people behind these encounters? What do they need? Where do they work? What is their household size? Where do they live? All of those types of factors. You can actually start to wrap around a patient and you can't necessarily do that with an encounter. The encounter you're really just stuck with, I have an agent for a patient. I have a service of the patient, and I have a payer of the patient. If you wanna add in more context, if you wanna add additional data in there to help you really understand what that patient needs and how to best care for them, you wanna start to look at them at a patient level. So that's the two different strategies there.

ADAM: Yeah. Well, I think it's really interesting you say it because I was talking to somebody the other day and they said that the historic way to think about it is really in a funnel. You have somebody come in the top of the funnel and they go to their primary care doctor. And that PCP then refers to maybe it's an imaging center or where they do go straight to a surgeon and that's the encounter, but what this group was talking about it, which I like the analogy, they said, we're thinking about it as a flask. And so we're thinking about it as, instead of just working somebody through that funnel, instead how do we have that omnipresence approach to the individual patient? How are we always in front of them, whether they're going to a primary care doctor, whether they're going to an imaging center or whether they don't need care right now, how are we making sure that we're staying top of mind, whether that's our branding, through our marketing teams, through our outreach teams, there's so many different ways that people can do that. And I know that we obviously take a data-backed approach to making sure you're tracking and monitoring those patients over time. But I do think it's important for hospitals to get away from just that stick counting counter-based metric system and move more towards that holistic, more granular approach of what's happening with each of your unique patients. So certainly something interesting that's going on. And I think it kind of lends itself into another question, which is really how are hospitals needing and health systems in general, needing to think about those patients when they are evaluating that, that growth strategy and market share when they're putting together their next budget or when they're putting together their next strategic plan, how do you have that patient view as opposed to the encounter view and how does that work its way through those strategy plans?

JASON: Yeah, it's a great question. Coming back to one of the things that you said there, all of the technology companies now, they're free services, so to speak. Can you imagine if their key indicator was key visits every day or just visits every day. It would be very different than if like I have a user. Because with that user, you get to track them. With that user, you can understand what their habits are and their behaviors are and what they like and what they don't like and their tendencies. That is the data that makes it really weird. That is the data that is actionable. And you can start to put strategies around even from just a consumer standpoint, but I digress a little bit there. Back to your question, what are those different strategies look like. Within your EMR itself, you have taught a ton of data on things. Now I'm the first person to know that not all the fields that are within an EMR are filled out consistently or diligently. I get it.

ADAM: Our lives would be so much easier if they were. Everyone's lives would be a lot easier.

JASON: I think everybody's right. Everybody's life would be so much easier, garbage in, garbage out. However, there are some key things that you can get from your EMR data, just from your own patient, who are they? When was the last time they came in? What was their last address? What is their ZIP code? What was their payer? Do they have any guarantors on their file? That would essentially establish somebody else in that household that's associated with them. All of that information is really rich and it's something that you can query and you can get at just within your own system. So if you have a bariatric campaign that you wanna get off the ground, right? Well, you should go right to your own PCPs or your affiliated PCPs and you should query the medical records and say, how many of these people have an E66 diagnosis, a morbidly obese diagnosis? That right there is your first set of people that you might wanna reach out to just to get the bariatric campaign up. Do the same thing with orthopedics, the same thing with cardiology, all of these diagnosis, you've got a rich plethora of data within just your own system that you've got access to. And the better you fill out phone numbers, the better you fill out emails, the better you fill out household address, zip code, all of those things, the more information you'll end up having and the better your strategies can be to actually get to them. Now, at some point, you're gonna realize that the patients that you have in your system are not enough and you need to grow. And that's really what we're all about. We have data and we've got things for your whole market. So now let's take that same approach and let's look at the whole market. Let's look at the whole market for a morbidly obese patient. Let's look at the whole market for an orthopedic PT referral for joint pain or back pain. Those become also your strategies, those patients that you wanna bring into your system. And again, once you bring them in, they become sort of these resources, these data points that you have to really care more to them.

I'll quickly just do one more quick example of this. If you understand all the people in your service area, your primary and your secondary service area, if you understand what their ages are, what their sex is, where they're located within your ZIP codes, if you have employer information or per capita household income information, well, you can very simply then just start to look at so what is the care on average that these people need? A 33-year-old male, what kind of care do they consume? You can just start going through your whole market. And then what you're gonna end up seeing is a typical market utilization for your whole market. Now how does that compare to what you offer as services? Are you overweight in some areas, where you have all this endocrine supply and these doctors, but I don't actually have that many patients that might even need endocrine in the market. Those are the margin optimization strategies. By that same token, maybe you need more of a certain doctor. Maybe you have an aging population and cardiology is gonna be one of those areas that you wanna invest in now, because you can see the bubble coming. That is really, at the core, the core difference between I'm looking at encounters. I just want every encounter to go up that stick count versus taking a global view of the market and taking patients at the center of that and using them as your strategy, as your information to care for them.

ADAM: Well, I think it's so critical, critical, especially now, because we've heard it for years and you've seen it on the health system side that well, markets don't change that much and that frequently. And that things are staying the same and they're gonna grow two to 3% every year. And the same forecast projections always say the exact same thing. And so where we didn't believe that before, because we have the advantage of being able to look under the hood and see what's actually happening. Now, that's just abundantly obvious that how the consumers are operating inside those markets is so vastly different today than it was four months ago or even six months ago that you need to really have an understanding of that total addressable market, not just from the unique patient count, but from a unique consumer count. And so that's one big gap, retail, software, so many people know everything about the consumers in their market. Hospitals have a really good understanding of their patients, but what we need to make sure, people are really pushing towards understanding that total addressable market from a consumer perspective. And so I think two places that we have historically seen that is in real estate and in online. So the marketing team's looking at the online presence and how they're using the digital front door and getting people into their system through the online search function or their website. And then also real estate departments, a lot of those guys and girls are coming from the retail based world where they're looking at traffic patterns, they're looking at consumer demographics and psychographics and tapestry. Can you talk a little bit about how you see that's being underutilized in both those spaces today and what hospitals and health system executives need to be thinking about investing in, especially in this new era of healthcare?

JASON: Yeah, really good questions. We'll take them both a little bit separately. If we can talk about real estate for just a second. The only reason you're in real estate is to reach your patients. An encounter level focus would say, I've got an office that's too busy and I'm landlocked. So I need a bigger office to then care for more patients.

That's great. If you take a step back and do what a lot of other consumer and retail businesses do, they look at the whole market and say where are the customers that I want to reach? Where is the aging population? Where's the healthy population? How far are they willing to drive? And where do they typically drive for me to get out there? All of those things, when you start to pull it back and you start to look at the patients, where are people located? What are their habits? Where do they work right? If you looked at where somebody lives and where they worked, if you're not in between there, there's a pretty high chance that you're never gonna get them. So understanding what those patterns are, understanding where to be, to meet those patients is really important. Now I'll use that same analogy of meeting the patient where they are; that's real estate, getting onto the online and then the telehealth side. So how do you meet your patients online? We are all spending so much more time online, whether it's instructing kids who aren't going to school, whether it's like just not being able to get outside or have the same social networks that we used to have in-person. Now, all of that has moved online. So if people are spending more time online, if people are doing a lot more decision making and research and understanding online, you need to be there to meet them as well. It's the same concept of putting the doctor's office on the busy corner that everybody has to go past. That telehealth strategy is really just another way of engaging your patients, meeting them where they are and providing access to them. In a prior life, it was all about access. And when you increase access, there is a supply side demand to this. So if you can increase access to patients, but more often than not, people are gonna come in the door. So using digital, using telehealth type of services, to then just increase your access, does a couple of things. One, you're meeting the patients where they are, and you're able to care for them. Number two, as we talked about before, you now have a lot more information on them. How did they contact you? Was it through which web browser, what is their MAC address? What is their email address? What is their phone number? When were they scheduled? Was it during office hours, after office hours? All of these data points can be used to then just help you formulate a strategy that is both efficient and profitable.

ADAM: Yep. No, absolutely. And said so many things here I wanna address. And one of them is today, as we sit here now, virtual care is obviously just taken off. And so many people have deployed some type of virtual care strategy. And I think we certainly support that here, every one of our partners that we've talked to, we've encouraged to have that as an additional access point now. But I think that that's not a check-the-box, right? It's not just something that now you've got virtual care so you're done on the digital side. We think that people need to continue to invest in that online space in general, whether it's having an easier to navigate website, is small things like that that just make a massive impact, especially in a larger metropolitan area, having online self scheduling, having really clear communication and messaging about what's going on with your COVID security and safety policy? Where are you accepting patients and where are you not accepting patients? Simple things like that that we time and time again, see that people are not doing and it's a really easy opportunity. It's also really low cost. You don't have to go invest in a new software or a new tool or build out a whole new website just to better communicate with your patients. And those are some of the great things we're seeing. One other thing though, is really that sure--

JASON: Well, it’s also really scalable, right, Adam? You do have to make that investment if you do need to put some money up front. Unlike a doctor's office or unlike something that you've got a finite amount of people that can run through there at any given time. Well, digital just opens you up to so much more and it's so much more scalable. So a dollar there is gonna be increased margins and increase your scale a lot more than just the dollar in other places.

ADAM: Yeah, absolutely. And speaking of the dollar piece here, we are thinking about consumers and patients, making sure that hospitals and health systems have a way to start tracking, even if it's just directionally right now, but have a way to track that share of care and share of wallet is so critical in this new age of consumerism. If you're not setting up the infrastructure today to track that and see how your patients are working through that continuum, we certainly see that as a problem. If you go to Amazon, if you go to Whole Foods or Publix or really, any retail-based business, they know that Jason is going to Publix and they also know that Jason's going to Whole Foods and how much money he's spending at both, relatively. And hospitals just don't have that insight right now. And setting up that infrastructure to know how much of Jason's healthcare does health system A own versus how much does the ASC versus the competitor across the street is gonna be so critical and being able to track that and make better decisions about consumers today. So I think that's super helpful. Any final words that you'd pass on to the audiences as we're looking at moving into using COVID as, again, another catalyst point for consumerism and healthcare? 

JASON: I think I'm very bullish, obviously, on the patient focus of things. Not only can you get a lifetime value of a patient, you can care more for the patient. You can establish type of loyalty and brand recognition with the patient that you cannot do with an encounter. It can really actually also help you on the financial side, especially with payer negotiations. Understanding who your patients are, understanding where they work and what type of insurance does employers have opens up a whole bit of opportunity for you. If you're in a market that is actually much younger, maybe that's a market where we need the Blue Cross Blue Shield contract comes up, or a United contract comes up, you start to ask them about maybe taking on more risk getting an AQC type of contract where whether or not the patient comes in, you're gonna care for them regardless. And then you're gonna be able to take part in some of the upside, if they don't go over budget or they are able to stay under budget. That's another way of increasing margin. And then again, just more focused and more caring on the patient side. The other side of that is you could look at your market and say, hey, there's, a lot of fee for service stuff out here, it's a much older population. I'm not sure I'd be able to manage this population, at least with the current infrastructure. Knowing that up front, before you get into those area of negotiation is really, really important. Understanding who your patients are and what their psychographic profile is, are they a Willful Endurer?

Are they going to not go to see a doctor for nine months and then have something very bad happening and show up in your ER and cost a lot of money or are they you're the Priority Juggler, who wants to stay on top of things, who wants to continue to have that maintained practice or that maintained doctor visits every once in a while so that they can stay healthy and juggle all those priorities. Those again are just key aspects that you can then start to wrap around a consumer or a patient that you can't just get by looking at an encounter, a tick-based type of focus.

ADAM: I wanna thank you, Jason, for carving up the time. Also wanna thank the audience for joining today. If you do have any questions again, we're gonna be continuing to put out the Prescription for Growth on a weekly basis. If you have questions, comment in the section below. Jason and I would love to talk to you, answer anything else that you have, or if you have another topic that you want us to address, please let us know. We're always happy to dig into to other things. So with that, thank you. Stay safe, stay happy and healthy. And I will talk to you next week. Thanks guys.