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Designing a Healthier AI Future 

How AI can enhance and create new value across the patient experience. 

AI offers significant promise to help solve long-standing challenges in the U.S. healthcare system. Some gains are already well documented, from diagnostic tools and curriculums to GenAI-powered transcription and coding solutions.  

But the U.S. healthcare ecosystem is also one of the most fragmented, complex and data-sensitive industries within which to consider effective AI implementation on a broader scale. As we step into 2026, amid the rapid evolution of AI capabilities, continued public concerns and a capricious regulatory climate, it’s necessary for healthcare leaders across systems, payers and technology solutions to identify how to use AI for lasting value, and identify the greatest areas of untapped potential in ways that make sense for patients and caregivers. 

To address this challenge, Prophet’s Healthcare team took a consumer-centered lens, starting with our global AI survey, to understand where people see opportunities for AI to add value to their healthcare experience. We then engaged AI-focused healthcare leaders to react to these consumer views and share their own perspectives on opportunities across the patient journey. 

Our research explored two key questions: 

  1. Where can AI unlock value in the consumer experience? 
  2. What must be true within organizations to realize that value ethically and effectively? 

Opportunities and Organizational Imperatives 

While there are countless potential areas for adding value, our study found that consumers across generations and demographics want AI tools in healthcare to help them personalize their experience (63% of consumers agree or strongly agree that Gen AI will help with health monitoring and proactive advice, and also save them time and money). This was balanced with clear preferences to maintain the human element of healthcare, with consumers pointing out the AI should not be the final decision maker in place of a doctor, nor should it be so intrusive that it’s always monitoring them without their control (“I really see AI as just helping us, but it’s not the final say [in medical decisions].”). Our leader interviews also revealed similar opportunities to meaningfully enhance care beyond the patient visit, improve navigation, and streamline the way people experience healthcare. These findings point to three key areas of opportunity for healthcare leaders across the ecosystem to capitalize on AI while balancing patient autonomy and dignity, which are:  

  • Guiding Care: Navigation tools that reduce system complexity
  • Personalizing Care: Personalization that respects autonomy 
  • Extending Care: Coaching models that scale support out of acute care facilities 

We also recognize that identifying the opportunity area won’t spell success without the organizational environment to succeed. Our interviews validated how leaders must understand how to translate opportunities in ways that will be most relevant for the unique populations they serve and operationalize AI tools with governance and foresight. This all means that there are critical organizational and cultural components to successful AI adoption that go beyond the data backbone and infrastructure, namely:  

  • Setting a strategic vision  
  • Implementing a governance model that can adapt 
  • Addressing change management & cultural adoption 

We explored both the consumer-focused opportunity and the organizational requirements for healthcare companies to succeed with AI. 

Opportunity 1: Guiding Care – Navigation Tools That Reduce Complexity 

Navigating U.S. healthcare is notoriously difficult, and often the most complained about pain point in healthcare, from finding care and resources to demystifying pricing and payments (Tufts). It’s also an area where patients typically don’t have the benefit of reaching a human to help them, which costs them significant time. In 2024, nearly two-thirds of physicians used AI for documentation, diagnosis, and care planning (AMA), but on the patient end, there’s a need for AI tools to similarly save time and effort. Given the capabilities for AI tools to synthesize data and summarize disparate information, this is one, if not the biggest, area for AI to enhance the patient experience, particularly in micro-moments where patients feel most burdened.  

There are good reasons why care navigation remains a clear opportunity. Patients are engaging with a deeply fragmented ecosystem that no single player in the healthcare ecosystem can solve. Healthcare leaders across providers and payers might start small, through “narrow applications to alleviate specific pain points across the journey” as one leader whom we spoke with pointed out, but over time these AI-driven solutions can serve the incredible value of empowering with options and enabling patients to make clear decisions about their health providers, treatments and costs. 

Opportunity 2: Personalizing the Experience – Personalization That Respects Autonomy 

Personalization is the cornerstone to humanizing the healthcare experience, but the U.S. healthcare system isn’t delivering (Harvard Business Review) despite consumer preferences (Human Centered AI: Culture as the Catalyst for AI-enabled Growth). With the computing power of AI there’s clear opportunity to enhance how patients feel known, heard and understood to add to moments of care, but also to add value across the entire healthcare journey in ways that have never been done before.  

When integrated into care delivery, AI-driven personalization can help redefine patient engagement and amplify the patient-provider connection, equipping providers with comprehensive patient health reports, patients’ ingoing questions and personalized therapeutic options so that patients feel known and understood. As noted by the leaders we interviewed, when AI is deployed transparently in the care setting and decision-making stays with the provider, it’s a win-win in terms of value and trust building. Outside of the doctor’s office, AI-powered personalized platforms can enable real-time personalization (and assistants) that give patients more peace of mind and control of their health management, such as we’re starting to see with Twin Health, Televox, Luma Health, Klara, and others. Capitalizing on AI-driven personalization can also extend beyond care, affording patients greater access and options to suit unique preferences, language needs and lifestyles. The opportunities for AI-driven personalization that enhance the patient experience are rich, and while much has been discussed about the limitations of data and privacy, with the right design, there’s a wealth of value in even the earliest steps forward. 

Opportunity 3: Extend It – Engagement Tools Augment Remote Care

Extending care delivery without compromising quality is an ongoing, major challenge where patients are often left without the support they need, particularly within the context of chronic care needs. Here, AI tools can provide significant value that patients feel immediately. This can include AI tools for prospective care (monitoring and anticipating risks based on patients’ lifestyle choices, adherence and activity levels), to responsive care that enables more orchestrated, complete care across the patient journey. Remote care companies are leading the charge with new AI platforms, such as Teladoc Health’s intervention-focused AI-model, and Verily’s Onduo for coordinated virtual care of chronic diseases. These platforms bring care out of the clinic in ways that go far beyond the remote models of the past decade, and there’s a significant opportunity to capitalize on this opportunity across the healthcare ecosystem.  

What It Will Take to Deliver  

As we’ve noted above, adopting AI tools for the patient experience requires a host of careful considerations about patients, their privacy and your organization, as well as examining emerging regulations and ethical guidance. The leaders we spoke with emphasized not only the opportunities, but also the challenges with organizational silos, data readiness, and cultural burnout or skepticism. As we think beyond the opportunity and start to address the organizational component to power effective AI in healthcare, most leaders are immediately focused on the infrastructure and workflow integration, which is essential. But any AI driven transformation should be focused on adding value for people so they are guided, equipped and empowered to be successful with new AI tools, particularly along the patient experience. 

At Prophet, we help organizations embed AI into their DNA, mind, body, and soul, aligning purpose, scaling skills, redesigning workflows, and deepening human connection.  

DNA: A Consumer-Backed Strategic Vision  

A successful consumer-oriented AI strategy begins with a clear vision for how AI will enhance consumers’ patient experience, which should include defined goals and targeted use cases based on clear patient and provider needs, particularly as organizations seek to balance adding sustainable value without breaching confidentiality or trust. We’ve identified three broad needs, but any AI-driven strategy will need a depth of understanding for how these needs can best be addressed in context. 

Body: Governance That Champions Transparency and Security  

Strong AI and data governance is essential to unify accountability, transparency, and security across the organization. In the context of an AI-enhanced patient experience, leaders also emphasized how governance and human oversight need to extend to the caregivers themselves, to ensure there are clear systems for active oversight. Plus, as AI tools become more broadly used, governance needs to include ongoing assessments to identify gaps in underserved populations and to monitor AI model behavior for fairness and accuracy. Clear liability structures must also be established to protect clinicians and patients, while ensuring compliance with regulatory standards and ethical guidelines. Multidisciplinary teams beyond the care setting, including data scientists and IT professionals, should be formed to support implementation and maintenance.

Soul: Employee Engagement & Cultural Adoption 

Effective employee engagement is critical to drive adoption and minimize resistance. This involves crafting a comprehensive plan that fosters engagement and collaboration across all levels of the organization. Bridging the gap between executives and frontline staff by involving both in planning and decision-making helps build trust and accelerate cultural adoption of AI technologies. 

For more read our research report, Human-Centered AI: Culture as the Catalyst for AI-enabled Growth. 

Organization & Culture

FINAL THOUGHTS

Healthcare organizations across the ecosystem are navigating a complex reality today: legacy systems, overburdened and siloed teams, and the pressure to adopt compliant AI tools that deliver on consumers’ needs. But to stand out, you’ll need to move forward, and we believe the most differentiating moves lie in a focus on improving the patient experience for value, while respecting their autonomy and building trust. When coupled with the organizational components that help people inside of the organization deliver, healthcare leaders will be able to unlock sustainable, ongoing value and steward AI adoption in ways that are not only compliant but also compassionate. 

Ready to explore what human-centered AI can do for your organization? Connect with us to discuss a kickstart workshop to help your team evaluate hypotheses and opportunities to inform your strategic vision for AI. 

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Platforms are Reshaping Healthcare: How to Lead the Change 

Here’s why health systems must think beyond IT to unlock platform power. 

Getting healthcare no longer means “going to a place “—increasingly, it’s a platform you interact with. Platforms are the way to enable companies to observe, interact with and provide value to consumers as they engage with the organization. From virtual-first care to AI-powered diagnostics, platforms are transforming how patients engage, how providers deliver and how systems create value. Over the past decade, platform-based health startups have generated 2.6x the returns of pure healthcare SaaS businesses (Summit Health) because they know success is about the interactive business system, not just the IT. 
 
Prophet has conducted extensive research on how to build a platform business model to unlock uncommon growth. Our findings are outlined in the book “Winning Through Platforms: How to Succeed When Every Competitor Has One”, which breaks down 24 platform plays to transform and grow your business. 
 
We see health systems facing urgent demands to invest in platform plays: to serve and connect multiple types of customers (i.e., patients and payors), to measure healthcare usage patterns and to effectively use this data to optimize the customer and end-user experience. Health systems that create this feedback loop will find that successful platforms aren’t just point solutions like MyChart; they’re complete business systems that attract diverse users and continuously optimize care. 

Platforms are Already Changing the Game 

Digital-First Platforms Are Reshaping Expectations and Outcomes 

Patients expect to manage their health like their finances or travel: digitally, intuitively and on their terms. In the past decade, the share of patients who accessed their digital medical record or patient portal has seen a sharp increase from 25% in 2014 to 65% in 2024. Health systems that meet these expectations are already seeing returns. One Medical, for example, has demonstrated that ongoing patient engagement through its app results in fewer ER visits, simplified same-day booking and a three-fold increase in digital encounters. More generally, according to Panda Health, nearly two-thirds of health system leaders report their investments in digital health solutions have met or exceeded ROI expectations. 

Data Is the New Medicine 

Remote patient monitoring (RPM), AI and smart devices are generating vast amounts of data and using it to anticipate readmissions, optimize triage and personalize interventions. Powered by Biofourmis’ AI-guided RPM, one health system cut 30-day readmissions by 70% and slashed care costs by 38%,a clear signal that data can improve outcomes. 

All predictive systems come with biases and limitations. However, at their best, these systems streamline routine care so clinicians can focus on atypical cases. In turn, these edge cases present an opportunity to help retrain models, refine classifications and ultimately make care more inclusive. The result? A shift from reactive responses to proactive, personalized care that works better for everyone. 

Insurers Are Becoming Platforms and Setting the Rules 

UnitedHealth Group, Cigna and CVS/Aetna are becoming vertically integrated payors and providers. United’s Optum, for example, has acquired hundreds of clinics and physician groups, positioning itself to own every part of the patient experience, from insurance to diagnosis to treatment. They own the data, the clinics and the billing systems creating closed-loop platforms that manage risk and deliver care. These models are driving better coordination and incentivizing lower costs, with 24.5% of U.S. payments now tied to two-sided risk contracts. 

Health Systems Have Unique Platform Advantages 

While startups and behemoths have moved quickly to establish a platform advantage, they haven’t fully realized the value platforms can provide. That’s because most solutions remain fragmented. For example, virtual care programs often succeed only when properly scaled across populations, conditions and with enough utilization. Without patient engagement and trust at scale, impact is limited. 

Health systems have the breadth and reach to change this. They already own the patient journey, physical infrastructure and care delivery staff. They can integrate platforms more thoroughly than competitors, turning isolated solutions into a cohesive experience that builds trust between patients and their providers. 

Platforms Extend Physical Infrastructure 

As care delivery expands across outpatient clinics, urgent care centers, ambulatory surgery sites and newly acquired hospitals, digital platforms are becoming the connective tissue that makes these assets work together efficiently, intelligently and at scale. 

Platforms Expand Revenue Opportunities 

Digital platforms open new pathways for revenue generation, especially in areas that traditional infrastructure can’t reach. By offering services like chronic condition management, behavioral health support and preventive care through virtual channels, health systems can tap into new markets and patient segments. 

Platforms Guide Smarter Investment 

Platform-generated data helps health systems make more informed decisions about where and how to invest. By analyzing patient engagement, service utilization and care outcomes across digital and physical touchpoints, systems can identify gaps and forecast demand. This intelligence enables leaders to optimize both digital and physical assets, ensuring that new clinics, services and technologies are deployed where they have the greatest impact. 
 
So what? Established health systems don’t need to become disruptors, but they do need to learn from them. The challenge is to evolve while staying true to their mission, assets and community relationships. That means integrating digital platforms not as standalone tools, but as strategic enablers of their broader business. 

Experience & Innovation

FINAL THOUGHTS

Digital platforms are no longer optional; they’re foundational. Health systems must prioritize platforms as an organizing and transformative principle for their business, creating proprietary feedback loops between the health system and its customers. 

At Prophet, we help health systems navigate this transformation. Whether through strategic workshops, platform audits, or growth planning, we bring clarity to complexity and help leaders build systems that scale. We don’t just understand technology; we understand the business of healthcare platforms. If you’re considering the impact of platforms on your health system, let us share our perspective with you. 

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Integrating Brand and Demand Marketing for Maximum Impact in Healthcare

Chief Marketing Officers who engage strategically, advocate for patients and demonstrate marketing’s value can help unleash growth even in uncertain times.  

It seems that every CMO, in every sector, faces increasing pressure to demonstrate value for every dollar in their budgets. It’s the classic brand-demand tension, where CFOs and other senior business leaders seem to prefer the clear and tangible metrics (e.g., lead generation, conversion) associated with demand or performance marketing over the softer measures of brand value (e.g., awareness, propensity to buy).  

Senior marketers know this tension. Prophet recently conducted interviews with senior marketing leaders from health systems and hospitals and their input was clear: effectively integrating brand-building with demand generation campaigns has never been more challenging. Partly that’s a function of cost pressures and resource constraints. Partly it’s due to the unique dynamics of healthcare marketing (where consumers don’t necessarily want to buy your products).  

But healthcare organizations that get brand and demand working in sync see clear and compelling benefits: stronger brands, more satisfying patient experiences, higher customer lifetime value and – most importantly – better health outcomes.  

Prophet’s extensive research, Brand and Demand: Marketing’s Greatest Love Story, shows how top-performing marketing organizations are 3X more likely to fully integrate brand and demand. And the research, The Multiplier Effect, we conducted in partnership with WARC, Analytic Partners and BERA.ai and System1 shows how a balanced approach can lift overall revenue returns by 25% or more.     

So how do marketing leaders successfully integrate brand and demand to optimize results? From our research and market engagement, we see three proven practices. 

1. Engaging senior leaders to align marketing strategies to business priorities and outcomes. 

Too often, marketing in healthcare is seen as a service function, activated only in response to external pressures or internal requests. But the most effective CMOs reposition marketing as a strategic lever for growth, leveraging brand and demand investments to drive measurable business results. 

Strategic engagement with boards, the C-suite, clinical leaders and other stakeholders is essential to shift the perception of marketing as a PR or communications function. When marketing is tied to system objectives—whether that’s growing a service line, expanding reach in a rural market or strengthening reputation with policymakers—it becomes easier to make disciplined choices and avoid reactive spending. 

Take the “billboard dilemma,” for instance. Many CMOs face pressure from internal stakeholders who ask, “Why don’t we have a billboard like our competitors?” But this isn’t really a question about outdoor advertising. It’s a proxy for a larger issue: Are we doing enough to be visible and competitive in the market? When CMOs have already built alignment around business goals and shared metrics, these conversations become strategic rather than reactive. It’s no longer about appeasing concerns, it’s about showing how brand investment fits into an integrated marketing mix designed to drive outcomes. 

“The best decisions are made collaboratively, with everyone looking at the same data,” said Jason Vandiver, a senior marketing and communications officer. “Because we all understand and agree on the most important activities, there’s no competition for resources.” This alignment allows marketing leaders to advocate for the right choice at the right time—explaining when and how brand investments will pay dividends in the long term and when performance marketing should take the lead to deliver short-term results. And when trade-offs are unavoidable, CMOs who are aligned on strategy are best positioned to guide the successful integration of brand and demand. 

20%: minimum proportion of the marketing budget that should be allocated to brand-building

40-60%: the “best practice” range for branding spend of marketing budget

Source: The Multiplier Effect report 

2. Embracing patient centricity and advocacy as a North Star for disparate investments and activities.  

CMOs should ensure all marketing activities and investments link directly to the organization’s mission: helping people lead healthy lives. CMOs can be advocates for patient needs, which can—and should—be a unifying force for the entire organization and essential to the brand vision. “We try very hard to focus on the consumer, rather than going to market with a product orientation,” said David Hook, executive director, marketing & consumer experience, John Muir Health. “Yes, we need to sell services, but in our marketing, we invite customers to come to us for their overall health, not for a specific surgery or procedure.” 

Delivering on patient centricity requires deeper customer insights, another area where healthcare CMOs can make meaningful contributions. For instance, core insights can be used to articulate a clear brand promise that guides all marketing activities and focuses on patient needs, according to Hook: “When it’s clear to the organization what patients care about, it becomes less about the advertising and more about how we deliver better healthcare.”  

In this sense, demand campaigns don’t just produce revenue; they also help people access the care they need. Marketing delivers on their mission when consumer targeting drives people to preventive screenings and procedures.  

What leading marketers do:

  • 87%: use customer insights for brand positioning and value propositions vs. 66% of all marketers 
  • 86%: apply customer insights to all parts of the marketing discipline, vs. 63%  
  • 82%: tie customer data and insights to measurable business outcomes, vs. 59%  

Source: Prophet Brand & Demand research 

Several CMOs highlighted the value of detailed patient journeys across service lines, which can help support consistent branding and promote “right-time/right-channel” messaging. Mapping these journeys also ensures marketing efforts align with patient needs at each stage of care, which increases relevance, enhances experience and strengthens trust. “We have defined some amazing patient journeys that guide our engagement and retention teams,” said Kim Reed, senior marketing manager at a large pediatric health system.

3. Demonstrating both short- and long-term results via data-driven modeling and analytical rigor  

As with their peers in other sectors, healthcare CMOs must balance short- and long-term objectives and be data-driven and analytics-led in sharing results. The pressure to carefully measure value will only intensify given the challenging financial situations of most organizations today. 

What leading marketers do:

84%: confidently measure and management long- and short-term performance simultaneously, vs. 57% of all marketers 

Source: Prophet Brand & Demand research 

“The need to show hard dollar-impacts lead us to do more performance marketing,” said Hook of Muir Health. He also highlighted the importance of showing leadership what different types of media can deliver. “We bring estimated numbers to the leadership group and say, ‘if we do this, our awareness and preference will go up this much and it will cost this much.” Such efforts are necessary, because “there’s still a disconnect between what we can show actually works and what leaders think works,” according to Vandiver.  

Jennifer Horton, associate vice president of marketing, communications and media at UT Health San Antonio, embraces a model that balances brand, engagement, reputation and growth, which she finds resonates well. “These are things that are top of mind for our boards, senior leadership, and our physicians.” 

Sophisticated propensity, attribution and marketing mix models, as well as more powerful analytical tools, are becoming more common. Some marketing teams build their own; others rely on external partners, though smaller institutions may be challenged to find the budget for advanced tooling. At Corewell Health, the brand analytics team uses proprietary models to “triangulate the different data sets and go beyond linear reads and gain multi-dimensional visibility into our performance and how to improve it,” according to Holly Sullivan, vice president, system brand and marketing.  

Corewell tracks fairly closely to the classic brand-demand budget allocation and aims to be “thoughtful in building long-term brand strength for top-of-the-funnel awareness.”  To track brand strength the organization uses a variety of metrics like unaided awareness and system of first choice.  Some measures are more specific to healthcare to understand feelings of trust. 

Healthcare by its nature creates unique tracking challenges. Vandiver noted that it’s not just the clicks or someone calling a number that shows ROI. “Because the average consumer isn’t looking for healthcare at any time, but only when they or a family member has a need, it’s hard to figure out how we get from interest to conversion to the financial output,” he noted.  

In this sense, the brand advertising that creates awareness may be the difference maker when the actual medical need arises as a demand signal. Disconnects between CRM platforms and back-office financial systems also make attribution trickier than in, say, consumer goods or financial services. 

Marketing Excellence

FINAL THOUGHTS

Healthcare marketers have always faced unique challenges due to the complexities of the industry. And the perennial tension between brand and demand adds an extra dimension for CMOs facing budget cuts and intense pressure to demonstrate value.  

Still, strong marketing teams are critical to keep hospitals and health systems financially stable and individuals and communities healthy. And the more effective CMOs are at integrating intentional, data-driven tactics to drive near-term demand with long-term brand-building programs the more successful they’ll be in helping their organizations fulfill their mission and meet their objectives.  

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How the CEO at Curative Accelerates Growth by Meeting Consumers’ Needs

Unlock. Create. Execute: A conversation about uncovering growth by delivering better health outcomes.

Growth is rarely easy – specifically, growth driven by customer interest and market demand rather than the temporary variety driven by acquisition, cost takeout or organizational restructuring.

Because markets are moving faster than ever, we believe sustainable growth results from:

  • Unlocking compelling customer insights to inform growth strategies
  • Creating relevant, impactful growth moves
  • Executing faster and more efficiently

Through this series of interviews with healthcare leaders, we explore the driving insights, key actions and anticipated impact of their recent growth strategies.

In this edition, we sit down with Fred Turner, chief executive officer and co-founder of Curative, to learn more about his unique vision and approach to driving change in the insurance industry.

Curative is a groundbreaking healthcare services company that created and launched the first-of-its-kind employer-based health insurance plan. Founded in 2020, Curative reengineered health insurance by providing unmatched simplicity, enhanced engagement and cost transparency with a competitive monthly premium and zero additional costs. Curative is all about building the next generation of large employer health insurance – focused on preventative health and removing barriers to care.

Fred Turner is the CEO and co-founder of Curative. Under his leadership, Curative has shifted from the leading COVID-19 testing provider to an innovator in health insurance, offering plans with no copays, no deductibles and no cost-sharing for in-network care (with the completion of a baseline visit). This model has achieved a 94% member engagement rate, far surpassing industry standards. Turner’s vision is to create a healthcare system that supports holistic patient health.

What Is the Major Unlock That Informed Your Approach and Strategy for Curative?

When Curative was founded in January 2020, we initially focused on improving sepsis outcomes but quickly pivoted to supporting COVID diagnostic testing. That work exposed us to two key learnings: one, we touched every type of payer and health plan and saw cracks in the system, and two, we learned that consumers have serious fear and anxiety when it comes to healthcare expenses. That fear may prevent them from getting care, for example a COVID test, even when COVID tests are fully covered. We knew we wanted to do something that would move the needle on U.S. healthcare, something that could drive meaningful change in the system.

“Our experience during COVID made us say, the payer dynamic is a real problem with the U.S. healthcare system, and we could build a payer that can drive preventative care and better long-term outcomes.”

We saw the untapped space, where there hasn’t been innovation for decades, as the employer market, which is where 50% of Americans get their health insurance. The U.S. has run a natural experiment over the past 10 to 15 years with High Deductible Health Plans. Fifteen years ago, about 10% of plans met the American Care Act (ACA) definition of high deductible. Today, we’re closer to 60%. Did it work? The answer is a resounding no. Consumers aren’t great at price shopping, and people don’t make rational decisions, particularly when it comes to emotional subjects such as health and their finances.

“The other substantial effect when patient cost sharing goes up is the deferral of care.”

The National Bureau of Economic Research ran a study that followed a group who moved from a low deductible to a high deductible plan over three years. In the first year, you see about a 12% reduction in spending, which looks great – like we reduced healthcare spend. The problem is when you dig into what is happening, you see people putting off primary care visits, checkups and screening tests – even though in the plan design, certain preventative screening tests, like colonoscopies, were covered at $0 out-of-pocket cost. The care that gets put off is lower acuity preventative care.

“If you have a heart attack, you’re still going to go to the hospital, no matter what your deductible is. What the high deductible plan does do is prevent you from getting the checkup that might have avoided that hospitalization.”

How Did That Insight Help You to Create the Curative Platform in a Relevant, Differentiated Way?

We’re trying to approach preventative care differently in terms of the value that we assigned to it. The typical way that an insurance plan looks at loss, or medical loss right now, is every dollar spent as $1. Whether you spend $1 on preventive care or you spend $1 in the hospital, it’s still just $1. The way that we look at it is that dollar spent on a preventative visit could avoid inpatient stays, emergency room visits or specialty drug use.

“Preventative care that keeps people well is a dollar significantly better spent than a dollar on a preventable hospital stay.”

We’re committed to making an investment upfront, to getting people engaged in their care early and then seeing that payoff downstream with lower ER, hospital or specialty drug use. Most employers get stuck in this cycle of deferred care, where the population’s health is decreasing and costs continue to go up. Curative flips the script. We make it easy for people to engage upfront. The cost sharing is zero, so there are zero out-of-pocket costs, no copays and no deductibles to go and access care – as long as you engage in a preventative health visit within the first 120 days of signing up for the plan.

“If you want people to engage with care, you have to make it really simple.”

And the only way to make it simple enough that people really understand the cost to them is to make it zeros across the board. That’s the fear that any engagement in care is bad because I might get a bill for it – that’s what we have to fight. We think the only way to reset people to see a doctor if they’re sick or in a preventive manner to avoid becoming sick is to build trust that those actions won’t cost them a dime. Our philosophy, the long game, is that we will have a higher spend in the first year because people will get the care that they need. But in the second year, we’ll get back to baseline and, by the third year, we’ll actually be saving money because this population will be healthier.

How Are You Proving That Curative Can Execute Results That Employers Are Looking For?

We’re still in the process of building trust with members and employers, but the engagement piece via a preventative visit is key. We get an hour of the member’s time to do two things: one, we aim to educate them about accessing their care through a Care Navigator session. How do they make appointments? What is a deductible? What’s a copay? How do you figure out what doctors are in-network? When should you go to the ER?

“We’re demonstrating that we want them to access the care they need versus an adversarial relationship that members often have with their health plan that doesn’t want to cover what they need.”

That kicks off the relationship in a fundamentally different way and drives a higher degree of engagement. Two, members then meet with a clinician who is looking for gaps in care. If we see a pre-diabetic patient, we want to get them to a primary care physician who’s going to manage their pre-diabetes or even reverse it, rather than letting that continue to full-on type two diabetes, where, if unmanaged, could lead to major health complications that result in tremendous expense – that’s bad for the member and for the health plan. In the longer term, we expect to be able to keep rates closer to flat by managing this care over time, rather than the typical 10% increases you’re going to get from BUCA carrier every year. We’re new to the space and want to make sure that we’re here for the long term.

“It may sometimes seem like moving the boulder of the American healthcare system is impossible, but I think with a lot of dedicated, smart people chipping away at it, piece by piece, we really can make substantial change.”

FINAL THOUGHTS

Growth has become more challenging to generate and sustain driven by customer interest and market demand. Even top performers can no longer rely on their past strategies to achieve the next phase of growth. Beyond well-known barriers like tech-driven disruption and fickle customers, less tangible factors such as lack of executive clarity and short-term thinking pose significant threats. Sustainable growth now depends on unlocking compelling customer insights, identifying impactful growth moves and executing strategies quickly and efficiently. Ready to accelerate your growth? Schedule a workshop.

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How the CEO at Northwell Direct Accelerates Growth with a Clinician-First Approach

Unlock. Create. Execute: A conversation about uncovering growth by disrupting traditional models.

Growth is rarely easy – specifically, growth driven by customer interest and market demand rather than the temporary variety driven by acquisition, cost takeout or organizational restructuring.

Because markets are moving faster than ever, we believe sustainable growth results from:

  • Unlocking compelling customer insights to inform growth strategies
  • Creating relevant, impactful growth moves
  • Executing faster and more efficiently

Through this series of interviews with healthcare leaders, we explore the driving insights, key actions and anticipated impact of their recent growth strategies.

In this edition, we sit down with Nick Stefanizzi, chief executive officer at Northwell Direct, to learn more about the company’s origin and philosophy around growing its integrated care network.

Northwell Direct is a subsidiary of Northwell Health, one of the largest healthcare providers in New York. Established in 2020, Northwell Direct offers a direct-to-employer health care network of more than 31,000 providers and customized wellness programs to support employee health. This allows employers to offer high-quality healthcare to their employees without going through traditional insurance companies. Northwell Health utilizes Northwell Direct’s provider network for its own employee health benefits, ensuring comprehensive and cost-effective care for its workforce.

Nick Stefanizzi is the CEO of Northwell Direct, where he is responsible for the strategy, operations, growth and financial performance of Northwell Health’s direct-to-employer organization. Stefanizzi has been with Northwell Health for 16 years, serving in various roles, including assistant vice president for HR innovation and organization effectiveness as well as director of management services for Northwell’s ambulatory network.

What Is the Major Unlock That Informed Your Approach and Strategy for Northwell Direct?

Northwell Health had its own insurance company (Care Connect) that was incredibly successful – but we were not prepared for risk adjustment, so that business venture shuttered in 2018. While that was challenging, what wasn’t lost was our belief that playing in that space was the right approach. At the same time, our organization started to grow. We’re the largest private employer in the state of New York, in addition to being the largest healthcare provider. Organically, we started to get inbound inquiries from employers saying, we’re having these kinds of challenges in our employee plan – can you help us figure this out as both an employer and a provider? We saw that we had an opportunity to do something different for the communities we serve. That was really the genesis of Northwell Direct. We then built a business around that concept, not only to meet employer needs but to disrupt the payer space.

“It’s our belief that a more direct relationship between those who provide the care and those who pay for the care is beneficial, and that today, payers have inserted themselves between those two entities.”

There’s still a role for the major carriers to play, but they don’t need to sit between us, and in fact, by working together with the employers and their employees, it’s our belief that we can better manage care and drive improvements in quality and outcomes.

We only work with self-funded employers in their benefit design. In New York state, that means more than 100 employees, and we don’t carry any financial risk, as we do not offer an insurance product. We’re on the hook for performance. Our focus is on delivering value, savings, efficiency and outcomes for our employers. The other thing we didn’t do was invest in building an insurance company. There are third-party administrators that have the capabilities needed to support an employer-sponsored plan, so why not partner instead of building it ourselves and going at it alone?

“We saw a business model that was ripe for disruption and employers who were hungry for support, grappling with the challenges they’ve had with their employee population and desperate to arrest a trend that had been moving in the wrong direction for over a decade.”

We saw an opportunity to build the platform differently with partners.

In Addition to Opening a New Line of Business, What Impact Did Northwell Direct Create for Your Key Audiences?

We’ve made a concerted effort to remove the traditional denials and hurdles in this space that don’t add value or drive for the member or material savings for the employer. While we can accommodate any benefit design requirements, we have examples of clients for whom, if their employees receive care within our tier one network, there are zero prior authorizations needed. And it doesn’t lead to higher costs. There is no statistical difference in unnecessary utilization or unnecessary testing.

“We take a clinical-first approach – what does the doctor believe is necessary?”

We trust that we have providers who are going to do the right thing by the patient and by the plan, and then manage the care intensely to make sure it’s as efficient as possible. It’s about administering consistently with the benefits plan but providing clinically oriented insights into how that benefit design can be enhanced to drive the right patient behaviors and the right patient choice of the highest quality, lowest-cost providers, and then wrapping the member with support that is integrated with and endorsed by the clinician. By taking a provider-oriented approach, our engagement levels are much higher. We’re able to share the care management information back with the provider so they can take a more holistic view. And lastly, what we can do locally that the national carriers can’t is get on the ground. If we have a member who is admitted, we will send a nurse care manager to their bedside to coordinate their follow-up care, their appointments and make sure they’re clear on what happens post-discharge. You can’t do that from a contact center across the country.

“Clinical-first, integrated care management, boots on the ground and a structural approach that is different in terms of our philosophy around denials versus provider enablement – that’s what we’re doing, and it’s fundamentally different from how carriers think about this.”

How Challenging Was It to Get the Business Running, and How Will You Execute Your Growth Future Plans?

It’s hard for health systems to get into this business because it takes investment, and health systems are struggling financially. They are under enormous pressure, there are a lot of competing priorities, and it takes a lot to stand up a new venture like this.

“You cannot do this by having somebody do it off the side of their desk.”

You have to build competency and capabilities. For example, we brought in people with skill sets that traditionally don’t exist within the health system. We’re selling an incredibly complex product in the insurance space, even though we’re not an insurance company. I have licensed brokers that work for me – that skill set and those broker relationships don’t exist in health systems. You have to invest in building the appropriate infrastructure. You need talent that doesn’t necessarily exist from within the organization, and you have to build capabilities. But you don’t need to do it all. Just pick one thing that an employer might need or have a conversation with a major employer in your region and ask what they would want help with and start there. Yes, there are competing priorities, competing investments and a tremendous amount of pressure, but I believe this strategy in the long term will alleviate those pressures.

In the next five years, we will expand the field of play and be a major regional player. There’s an opportunity to grow our network and the geographic footprint of employers we serve. In addition to that growth, we’re diversifying the ways in which we partner with employers. That means new products and services. That means rolling out digital platforms to augment our clinical capabilities. That means partnering differently, even within the insurance space. We’re going to roll out our own bundles and centers of excellence.

“I believe, fundamentally, there is a national opportunity here for health systems to partner together and for us to take the work we’re doing here, to line it up with the work that Baylor is doing in Texas, what Orlando Health is doing in Florida, what Providence is doing up in Washington and California, and for us to figure out how to stitch something together that would allow us to scale nationally.”

That’s a very complicated proposition. I don’t know exactly yet how it will come together, but I believe there are enough health systems that see this as an interesting space and that there’s opportunity for us over time to figure out how to make that possible together.

FINAL THOUGHTS

Driven by customer interest and market demand, growth has become even more challenging to generate and sustain. Even top performers can no longer rely on their past strategies to achieve the next phase of growth. Beyond well-known barriers like tech-driven disruption and fickle customers, less tangible factors such as lack of executive clarity and short-term thinking pose significant threats. Sustainable growth now depends on unlocking compelling customer insights, identifying impactful growth moves and executing strategies quickly and efficiently.

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Transforming Healthcare: Advocate Health’s Shift to Platforms 

In Conversation: Exploring the Journey of Building Momentum and Implementing a Platform in a Health System

Jeff Gourdji, Senior Partner at Prophet, spoke with a number of healthcare leaders to learn more about the challenges and opportunities for platform thinking in healthcare. Here, he speaks with Jamey Shiels, SVP Consumer & Digital Experience at Advocate Health, on the process of driving momentum for and implementing a platform in a health system. 

Deploying a platform approach will be crucial for businesses to thrive going forward. As our colleagues Ted Moser, Charlotte Bloom, and Omar Akhtar observe in their book, “Winning Through Platforms: How to Succeed When Every Competitor Has One” platforms illuminate parts of the customer journey that have historically been dark by enabling companies to have a better, holistic understanding of how customers engage with the organization. In the last decade or so, health systems have begun to observe customers during the “choose” part of the journey, but platforms could enable health systems to understand the “use” part of the journey and how to personalize it to consumers.     

In this illuminating interview with Jamey Shiels of Advocate Health, he shares how he overcame the barriers to building a platform – from driving organizational buy-in to clearly defining a set of metrics to measure key experiences. He highlights how a clear connection between patient needs and business requirements was key to demonstrating potential impact and showcasing the value for a health system in adapting a platform approach. 

What enabled you to align the leadership that platforms were the right move for the business? 

First, our Chief Marketing Officer at the time, Kelly Jo Golson, made [the LiveWell platform] a priority for our brand marketing and experience teams. She determined we were going to be a consumer first organization and platforms were the way to get there. She was able to onboard senior leadership to that vision and align support across the enterprise. 

Second, we built a consumer-first executive committee that allowed us to bring [together] all the key stakeholders that knew we were going to need — Operations, Medical Group, Finance, HR were all in the room with us as we presented the strategy, got buy in and support, and achieved goal alignment.  

Third, we developed a set of metrics called ‘ease of use’ metrics that measure different encounters patients have on the platform and allow consumers to give feedback. We created a closed feedback loop [that allows us to] make improvements that both benefit the consumer as well as the operational people on the other side. We also built those metrics into our incentive plan, so anybody in the organization who was incentive eligible was very interested in embedding the platform into their day-to-day work.  

How did the business determine implementing a platform strategy was beneficial for the reputation of Advocate Health and its success? 

Our challenge was– especially in healthcare – ‘consume’ means ‘use’ and doesn’t mean ‘choose.’ The idea of a patient as a consumer was difficult for some to understand, so we had to go upstream and find a way to understand consumer choice.  

We first aligned consumer insights to our core business metrics of awareness and acquisition. We wanted to go into market with a brand and an experience that would encourage consumers to choose us before [they] use us. 

The second step was in the form of acquisition. Consumers are looking for their wants and needs [to be met when] finding a physician. Therefore, we looked into some of the metrics that the operations team was using in the onboarding experience and connected those to the clinical experience to demonstrate if we lift consumer metrics, we can lift business metrics. That connection between what matters most to consumers with what matters to the businesses was key.  

“I think that’s where platforms can really play a role, by making those connections and making them much easier than they historically have been.” 

Was there a specific leader whose support was crucial in getting marketing, compliance, and clinical leaders on board with this initiative? 

The key leader was our Chief Operating Officer, who had accountability for the medical group, operations, and P&L for the organization and knew the different parts of the business that we needed to align with.  

A big piece [of getting alignment] was saying: ‘We want to co-create this with your team.’ We emphasized how we’re solving consumer needs as well as the business problems.  

Can you talk about the capabilities you built in the platform as you started to build momentum? 

The core functionality that needs to be in a platform is your EHR and transactional HR data. We wrapped that EHR data with a fledgling platform. That gave us the infrastructure to start to add features that improved the patient and clinical experience – and extended into health and wellness.  

We’re also working on integrating third party products into the platform for care-at-home and digital therapeutics. We want to create a true multi-sided marketplace for healthcare that connects health and wellness creators to consumers.   

What was the role of the clinicians in all this? What role are they now playing in advocating for the platform? 

Whether it was governance or co-creation, [clinicians] needed to have a voice in the room. We designed a partnership with a clinical leadership team [to drive] co-creation across the board. We asked: ‘How does this improve your work and fit into your day?’ The benefit is that now, when you go into one of our physicians’ offices, you’ll hear them talk about LiveWell.  

“We’ve seen continued uptake with LiveWell; it is now fully embedded in the operations of our organization.” 

What operational challenges were you solving for with platforms? 

There are three problem areas that we’ve looked at over the last few years: 

  1. Online scheduling takes call volume out. When you can message your provider in a secure platform it reduces call volume at the front desk, but you have to ensure you can manage and service the messages on behalf of physicians. 
  2. We have a mail order pharmacy that in our Midwest region generates 7 million calls a year related to prescription refill. We think we can take half of that out through new systems automation feature functionality in the platform.  
  3. E-Check-In, self service capabilities built in the platform make the consumer’s life easier and helps the frontline staff.  

Where is the platform going in the future? 

“We think the idea of platforms as a business model [in healthcare] for the benefit of consumers and the business is where the future is.” 

The challenge we’re facing from a healthcare perspective is the battle for the soul of the platform. Is that going to be the EHR? Vendors? EPIC primarily? Or third parties? Or are the health systems going to try to step up? Do you want to differentiate within your market, and do you want to deliver an exceptional consumer experience?  

“We’re going to go big into the platform space because we think it is the right decision for our business, and the future of business.” 

About Jamey: As Senior Vice President, Consumer and Digital Experience at Advocate Health, Jamey Shiels leads enterprise activities focused on creating a personalized and seamless consumer experience that improves engagement and health outcomes as well as business value through growth and cost-savings.  

About Jeff: Jeff Gourdji is a Senior Partner at Prophet and is responsible for leading client engagements across the firm’s range of solutions. As a leader of Prophet’s healthcare industry practice, Jeff works with clients across the healthcare ecosystem, including provider systems, payers, healthcare technology and life sciences companies. 

FINAL THOUGHTS

Transformation in healthcare is not a new topic but rethinking how a health system organizes itself to better observe, engage with, and deliver value to consumers is. Health systems that are infusing platform thinking into their organizations are starting to see the immediate return on those efforts – as well as the path ahead to greater impact across the communities they serve. Now is the time to activate and advance platforms in health systems, reimagine how an organization is set up to deliver a full continuum of engagement, differentiate against competitors and elevate the value delivered to consumers  

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Transforming Healthcare: The Power of Platform Thinking

Platform thinking is the path to consumer-centricity in healthcare – and the key to its transformation.  

Platforms are the key to illuminating the consumer journey. They allow companies to light the “dark” side of a consumer’s journey, the post-purchase “use” side, when previously, only the “choose” side was visible. As our colleagues Ted Moser, Charlotte Bloom and Omar Akhtar observe in their book, “Winning Through Platforms: How to Succeed When Every Competitor Has One,” platforms are the way to enable companies to observe, interact with and provide value to consumers as they engage with the organization. Many industries are already immersed in the platform race – from Amazon Prime’s offering (i.e., ecommerce, Whole Foods, streaming content) to Uber and Uber One (linking rides and eats). Even financial services companies are in the game with strategies from Chase, Bank of America, and more. So, how will healthcare players engage in this new value exchange? 

The beauty of healthcare is we know more about our customers than pretty much any other industry. It’s about how we use that knowledge to personalize, drive conversion, and close gaps in care.

Jeremy Rogers, Executive Director, Digital Marketing & Experience, Indiana University Health

Broadcast connection reflects the one-way communication that marked most of the 20th century. With the launch of the internet, websites and digital analytics, businesses were able to shine a light on the “choose” side of consumers’ engagement. While it’s often the darker side of the consumer journey, the “use” side that reflects the greatest value – both for business and for consumers.  

(Lighting the choose and use journeys graphic Int. 1.2) 

In the era of platform connection, health systems have an opportunity to capture and deliver greater value to their consumers. And the stakes couldn’t be higher. In healthcare, the data and knowledge gained by this level of consumer engagement could have profound effects not only on that patient and their care delivery, but a systemic impact on how to manage disease states, reduction of challenging SDOHs and improved health equity. Currently most health systems are focused on patient portals and transactional engagement, making this transformation feel daunting, elusive, or even operationally impossible. 

Healthcare is behind, and we all acknowledge this. Think about the hospitality industry and how their rewards programs generate loyalty and word of mouth – the best experience you have anywhere is the experience you want everywhere – and that includes in healthcare.

Ken Chaplin, Chief Marketing Officer, City of Hope 

There’s no doubt this is hard work. There are several reasons why healthcare leaders say it’s been an uphill battle – from a lack of integrated technology systems to concerns around patient data privacy – these are valid reasons to be concerned. However, other highly regulated industries have shown how to connect and protect consumers data. We spoke with several leading healthcare innovators to understand why this work is daunting and what they are doing to overcome the challenges:

1. Non-Proprietary Platforms Are Not Designed for Optimal User Experience 

Health systems often started with their EMR as the main platform, and what was the EMR developed to do? Billing, coding or quality documentation. They certainly weren’t designed for the user experience of a clinical physician or clinical nurse user – let alone a patient.

Jodi Rosen, Vice President Innovation & Digital Strategy, City of Hope 

2. Barriers to Risk-Taking 

We can have zero failure when lives are at stake, zero failure. That doesn’t apply to the business-oriented things we can do. We need to ask to experiment and fail and then fail forward, to learn and get better. But it’s just culturally very tough for people nowadays.

Jeremy Rogers, Executive Director, Digital Marketing & Experience, Indiana University Health 

3. Internal Resistance to Change

How do you have large scale change when you are changing the way people work? Number one, we cannot innovate and bring customer centricity to life without the operators – we can’t move forward until everyone comes to the table.

Sara Saldoff, Head of Product Management & User Experience, OhioHealth 

4. Overcoming Data Concerns With the Right Data Value-Exchange  

I don’t think it’s truly a challenge to get consumers to believe their data is safe. I think it’s about translating, what’s the benefit to them? We must help patients and health consumers understand the value of sharing their data. How do we tell the story in the right way to facilitate their willingness to share private health information or behaviors?

Jodi Rosen, Vice President Innovation & Digital Strategy, City of Hope 

5. Competing Priorities, Competing Investments, and Tremendous Pressure 

You have to invest in building an appropriate infrastructure. You need talent that doesn’t necessarily exist in the system already. You’ve got to build a lot of capabilities. But these strategies, in the long term, will alleviate some of the pressures we’re all facing.

Nick Stefanizzi, Chief Executive Officer, Northwell Direct 

Challenges aside, shifting to a platform-based model is the solution to achieving the transformation C-suite executives have been collectively working towards to achieve better business and health outcomes for patients. 

There’s a massive amount of data that health systems today have access to. If we can get this right and gain more consumer trust, we can harness that data in a way that can help with precision medicine, drug discovery, disease prevention – it’s so incredibly powerful.

Jodi Rosen, Vice President Innovation & Digital Strategy, City of Hope 

Inherent in this shift to platform thinking is a value proposition for consumers: I share information about myself so that a company can provide me with more value via content, loyalty programs and tools. Equally as important is the value generated for the organization. Today, many consumer engagements with health systems are transactional, leading to drop off, and overall brand neutrality. This is exacerbated by behaviors of younger generations (Gen Z and Millennials) who often don’t have a PCP. For health systems, the opportunity to develop meaningful relationships with consumers, whether they need care today or in the future, is essential for driving loyalty and patient volume in any market. 

Beyond the acquisition and retention of patients, there is a halo of benefits for building strong consumer relationships including increased adherence, proactive preventative care, lower costs for the system (both administrative, e.g., faster bill pay, and clinical, e.g., getting preventative screening) and better negotiating power with payers. Properly collected, synthesized and actionable data could ultimately shape future innovations in disease prevention or treatments. Platforms help C-suite leaders optimize and personalize the patient experience with critical knowledge and data-driven insights.  

Platforms are the way to: 

1. Make Holistic Care Real 

This has been an ongoing topic in healthcare. Health systems struggle to deliver holistic care, particularly for marginalized groups. Collecting data and applying insights to deliver better care, based on what patients really need, would drastically upend engagement and loyalty in healthcare. Consider how Amazon uses its data – from grocery shopping to prescription drugs to baby care essentials, to deliver better experiences.  

 Patients are doing all these things in the wellness space that are tangentially attached to their health, but that health systems don’t know about. We don’t know where it’s happening, and we don’t necessarily provide all the tangential services that customers want or need. The question is how much of that experience can we stitch together in partnership with the customer so we can treat the whole person?

Sara Saldoff, Head of Product Management & User Experience, OhioHealth 

We’re creating communities that connect cancer fighters with prospective patients – it’s incredibly powerful and allows us to drive deeper, meaningful relationships with patients.

Ken Chaplin, Chief Marketing Officer, City of Hope 

2. Empower Ongoing Engagement With Health 

It’s no surprise that consumers are willing to pay to engage with their health (i.e., Fitbit; Apple Watch; fitness, sleep, wellness tracking apps, etc.) Connecting the healthcare experience to meet consumer needs and their desire to be “always on” has the power to turn engagements from transitional to longitudinal. Facebook enjoys regular engagement from users drawn in by sharing features, community connections, and a focus on life’s moments (“on this day,” birthdays, etc.). 

So much of the journey happens outside of the clinical experience. What are we doing to engage patients in between those appointments, those procedures? Modern consumers demand autonomy- agency in their healthcare journey. If we can give them agency, they’ll take advantage of it.

Jeremy Rogers, Executive Director, Digital Marketing & Experience, Indiana University Health 

We envision a world where care support is everywhere – a doctor prescribes a curriculum where the patient can access tools and educational content about their prescription regimen, diet, broader wellness – and not have to go digging and find it on their own.

Ken Chaplin, Chief Marketing Officer, City of Hope 

3. Create and Drive New Revenue Streams 

Platforms have the power to optimize white space opportunities to create new revenue streams. They also have the potential to shift health systems’ focus from “sick care” to “well care”. Northwell Direct saw an opportunity to disrupt the traditional payer model and better serve employers by strengthening the connection between health coverage and care. They implemented a plan to reduce the hurdles for providers and patients, to drive to more comprehensive wellness for the employees they serve.  

We have an opportunity to serve our communities through a different pathway. We took this idea and said, how do we create a business around this? Yes, to meet employer needs through services…but also to disrupt the payer space because it’s our belief that a more direct relationship between those who provide the care and those who pay for the care is beneficial to delivering higher quality care and to better managing and improving outcomes.

Nick Stefanizzi, Chief Executive Officer, Northwell Direct 

4. Make Personalized Care Scalable 

The balance between the hyper personal and the need to scale across a health system is daunting. There are myriad nuances that impact or shift an individual’s health journey. Value-generating data collection through platforms can help to bridge this gap. Consider Nike’s app family – from workout classes and SNKRS drops to monitoring runs and alerts when footwear needs replacing based on the integrated mileage tracking, they can serve consumers what they need before they know they need it. 

The dream of our Smart Rooms is to give us real time feedback so we can solve problems with a patient in moment – but down the road, we could use the increased data use and AI to help us anticipate when something could go wrong and recommend solutions so we can get ahead of an individual’s care needs.

Sara Saldoff, Head of Product Management & User Experience, OhioHealth 

If we can hyper personalize, for example, for a person whose family was touched by asthma or coronary heart disease or cancer or diabetes, and determine how to engage that individual over a lifetime with preventative behaviors and interactions, it can cut across things like health, education, literacy, economic status and be inclusive of race, religion, gender, etc. It’s going to be hard – but it’s also going to be a big game changer.

Jodi Rosen, Vice President Innovation & Digital Strategy, City of Hope 

We see exciting signs of progress. It is still early days for health systems, though clear signs of progress are emerging. From OhioHealth’s “smart rooms” to City of Hope’s connected patient communities, there are signs on where health systems are heading. Others, like Advocate Health, are already leading with their LiveWell Platform, which helps consumers manage both their health and their wellness. Jamey Shiels, SVP Consumer & Digital Experience at Advocate Health emphasized that driving organizational alignment required connecting the vision with pre-determined patient needs with business requirements.  For example, easier check-in process means less stress on front-line staff, on-line scheduling means reduced volume in the call centers and more  

We are constantly improving LiveWell, listening to what our consumers are telling us about the experience to create a feedback loop we can engineer back into the experience. We mapped the consumer needs to the business metrics and showed how lifting those needs could improve the business metrics; connecting what matters most to the consumer to what matters most to the business is our biggest challenge but where I think platforms play a large role. We believe platforms are the business model of the future. Healthcare is behind, but we want to get into the game and lead the way.

Jamey Shiels, Senior Vice President Consumer & Digital Experience, Advocate Health 

If platforms are the answer, how do we get started? To begin building a Platform Connection, start by thinking about how to align your platform’s needs with your organizational ambition. Winning Through Platforms lays out a path to success, and it starts with cultural shifts to gain three key advantages: Strategic, In-Market, and Alignment. 

Strategic Advantage: Bring Something Structural to the Market That the Competition Doesn’t Have  

  • How might the organization’s portfolio of solutions (i.e. care, coverage, ancillary services) better connect to demonstrate the value of the care network it offers? 
  • How can teams better share assets to reduce efforts and increase flexibility? 
  • How can the organization align on the customer personas (patients? payers? referring physicians?) and journeys to align strategic intention? 

In-Market Advantage: Grow at Higher-Than-Market Rates Through Better-Than-Competitor Practices, Spanning Go-to-Market and Innovation 

  • What technology is required to capture patient information and organize it for action that results in customer and system benefit? 
  • How can content across the journey be personalized by life stage, condition type, and relevant social determinants?  
  • What role might community and patient-generated content play in enriching the overall engagement experience – and keeping patients engaged beyond the transactional? 

Alignment Advantage: Translate Better Internal Alignment and Teaming Into Stronger Customer Engagement and Superior Organizational Performance 

  • How might the traditional functional silos be restructured into a full journey, collaborative, go-to-market model? 
  • How will internal teams align on and ensure a consistent set of customer interaction standards? 
  • What will define best practices when it comes to an elevated patient experience? 

There’s too much at stake to not figure out the right way to partner for better outcomes for patients.

Jodi Rosen, Vice President Innovation & Digital Strategy, City of Hope 

FINAL THOUGHTS

Transformation in healthcare is not a new topic but rethinking how a health system organizes itself to better observe, engage with and deliver value to consumers is. Health systems that are infusing platform thinking into their organizations are starting to see the immediate return on those efforts – as well as the path ahead to greater impact across the communities they serve. Now is the time to activate and advance platforms in health systems, reimagine how an organization is set up to deliver a full continuum of engagement, differentiate against competitors and elevate the value delivered to consumers.

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REPORT

Impossible Math

Why the healthcare labor crisis is more than just a people problem – and how to solve it.

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The healthcare industry is facing a massive labor and operating model problem – one that involves a predicted workforce shortage of up to 3.2 million people. With more than a quarter of the industry workforce planning to leave in the next two years and $9 billion in annual burnout-related turnover costs the healthcare industry is at a crossroads. So, where do we start?  

Prophet suggests that the solution starts with our nurses. In this report, we clarify the magnitude of the crisis, identify tangible issues to tackle and introduce viable solutions that will begin to drive impact against this behemoth of a challenge.  

Key Takeaways:  

  • Addressing the workforce shortage starts with a focus on nurses. By starting with the largest population of clinical workers, we can begin to make a more meaningful impact on the collective workforce challenge.
  • Sustainable solutions to this crisis are not just about workforce retention. They will require us to revisit hiring and talent development practices, redesign care delivery models and the roles required, and rethink the infrastructure needed to support innovation and scale care.
  • Ultimately, to drive meaningful impact for nurses, we need to hear from nurses. Once nurses have a say in the tools and solutions we develop for them, real change can happen.
  • Before jumping to the most ground-breaking innovations, we must bring ourselves back to the day-to-day needs of our nurses. Simplifying their routines with technology can help them feel heard and improve employee and patient satisfaction.
  • Prophet’s Human-Centered Transformation Model can help you understand where your organization can begin to tackle organizational and cultural dynamics that contribute to the labor crisis.

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Five Rules for Optimizing Omni-channel Clinical Care Models 

Building a human-centric healthcare organization that delivers on patients’ needs. 

With the pandemic increasingly in the rearview mirror, many healthcare organizations are coming to terms with the big and small changes that have become permanent parts of the healthcare landscape. Ushered in during the pandemic, omnichannel care delivery is now a fixture and will play an influential role for many years to come; that’s a good thing, as patients prefer having options and are often enthusiastic about new channels, technologies and treatments. More caregivers now see the value of omnichannel care, especially telehealth and in-home care, because they work so well for patients.    

In our recent work with clients, we’ve seen how different types of healthcare organizations can capitalize on leading practices for change and transformation as they seek to refine, optimize and expand their omnichannel clinical care models.  

The common denominator with healthcare leaders is human centricity. Organizations that successfully drive change design their care models around what patients want and need. Similarly, organizations that adopt a human-centered approach to transformation are more likely to succeed in winning hearts and minds, instilling new behaviors and changing the culture in sustainable ways.  

1. When transforming the clinical care model, start small and iterate fast. 

There are ample transformation opportunities across healthcare but organizations that take on too much change too fast are bound to struggle. The key is to focus on the achievable while understanding the distinct needs of underserved populations and addressing drivers of high cost. 

Organizing around a condition or a use case, rather than a service line, can be useful both for making progress and setting up for broader change over the long term. Breaking down big changes into manageable steps is the only way to go. For example, to redesign diabetes care, leaders will need first to address issues typically treated by primary care, endocrinologists and cardiologists, as well as supporting clinicians in nutrition and other related aspects of care.  

Our work with one national player confirmed how many patients with kidney failure “crash” into dialysis in an unplanned fashion when longitudinal care models can address the holistic needs of such patients. When Geisinger launched a home care program, it realized impressive results, including reduced ER visits and lower costs, largely due to its careful patient selection, a focus on chronic conditions and proactive outreach by care teams.   

Within value-based care models, better patient communication can increase HCAHPS scores, which directly impacts reimbursement. That’s a relatively small-bore change that can yield potentially big results. 

2. Recognize that every healthcare organization is also a software company. And an AI and data science firm, too.  

Whether or not they want to be, all types of healthcare companies are in the technology business – and we’re not referring exclusively to electronic medical records (EMRs). Software now underpins every step of the care delivery process and is essential to making the “anytime care from anywhere” vision a workable operational reality. And yet, there’s no denying that tech has contributed to significant burnout among healthcare workers, including physicians.  

Healthcare organizations would benefit from several tech innovations, including agile sprints and experience design principles, to continuously enhance features. Had EMRs been designed in this manner, they would more seamlessly fit into the clinical workflow and not contribute to provider burnout as they are today. Healthcare organizations can take a similar approach as they design omnichannel care delivery models and deploy new technology.  

Thinking like a service designer will help orchestrate the linkages between backstage systems and data sources and, ultimately, create a seamless experience for all types of users. Accommodating the needs of users with different levels of technology access and literacy – including both patients and caregivers – is the key to developing high-impact solutions. When designing a patient app for patients receiving home dialysis, we went through multiple rounds of design and user testing to ensure that the experience met patient needs in an intuitive way and delivered the right information at the right time. That’s how to empower – rather than overwhelm – users.  

Organizations must also change the perception, common after initial rollouts of EMR systems, that technology is the enemy. One way to overcome that persistent bias is to co-create solutions with patients, caregivers and providers. That’s what we did with a national player seeking to shift the site of care from clinics and inpatient settings to the home. Service designers worked directly with nurses and nurse practitioners who could speak empathetically to the day-to-day needs and challenges faced by home healthcare teams and provide feedback on initial design sketches. These foundational insights, as well as those from patient groups, guided the design of new tools.  

AI Goes Everywhere

There’s no talking about tech without talking about artificial intelligence (AI). AI seems to be taking over healthcare. Payers are using it to digitize claims, conduct audits and monitor payments. Clinically, AI is helping physicians scan X-rays and get ahead of emerging risks and adverse outcomes. Providers use AI to design care paths, personalize care coordination and model the financial impacts of different treatment plans. AI promises to revolutionize clinical trials in the pharmaceutical sector.  

Embedding AI-enabled technology deeply into care delivery processes can make routine tasks simpler, faster and safer. And it’s the most effective way to use technology as a “force multiplier” in delivering care, which is the primary motivation for many healthcare organizations that acquire technology companies. Technology that enables caregivers to do their jobs more effectively and operate at the top of their licenses is invaluable in a time of provider shortages. Equipping end-users (including physicians) with training, skills and knowledge to use the right tech at the right time is how tech can directly support better outcomes.  

That sort of human-centered approach is necessary to change minds, create advocates and smooth the transition as the organization evolves from being healthcare-centric to thinking and acting like tech, AI and data science companies.  

3. Transformation takes an ecosystem.  

Achieving ambitious change objectives will almost certainly require collaboration with others – including payers, specialty care providers, technology companies or other third parties. So finding the right partners is critical, even when focusing on a manageable, well-defined issue or opportunity.  

The massive complexity of healthcare – both as a business and in terms of delivering care – makes broad organizational buy-in an absolute imperative for effective transformation. Overlooking a key constituency can make the difference between success and failure.  

We define stakeholders as anyone playing a role in care or invested in its outcomes. Thus, the universe of stakeholders includes everyone from institutions (e.g., payers and large employers) to back-stage actors (e.g., hospital management, pharmacies) to front-line care providers (e.g., PCPs, specialists, therapists, care coordinators, social workers) and, of course, patients who must remain at the center. These stakeholders have wildly different incentives, hold different values and operate with different information and authority. 

The broadest ecosystems require teams to think like systems designers in working outward from the patient to the entire stakeholder ecosystem, including front-stage actors (e.g., caregivers, PCPs and specialists) and back-stage actors (e.g., care managers, pharmacists, hospitals, payers, regulators).  

Ecosystem design requires incorporating the needs and perspectives of many different stakeholders.  

All of these players have widely different incentives, hold different values and operate with different information and authority. Misalignment among ecosystem partners can manifest in systemic problems that reach deeper than any single touchpoint. When we design healthcare ecosystems, we apply such principles to understand current systems and envision those that will be necessary tomorrow. Design tools such as ecosystem and value exchange mapping are a critical part of incorporating the entire innovation ecosystem into specific solutions. 

Leveraging Internal Ecosystems

The most successful transformation programs also involve many different internal constituencies. One Fortune 500 healthcare organization seeking to disrupt renal care with increased use of in-home dialysis built a diverse, cross-functional team, including digital strategists, product teams, client nurses, nephrologists and other specialists, in its ideation process. It gathered ongoing input via iterative design and feedback sessions. The testing process of initial solutions involved 40+ external users, including patients, nurses and other caregivers and social workers.  

Organizations enacting large-scale strategic change often convene a leadership council for regular reviews and feedback. Typically, such groups include chief medical officers, clinical business unit leaders, medical specialists and senior operational and administrative leaders.  

4. Embrace regulation and payer mandates as inspiration for innovation.  

The expanding adoption of value-based care shows how regulatory requirements can prompt necessary change for organizations with creative leadership and high degrees of operational agility. By default, many leaders resist new rules and love to complain about old ones, which can lead to regulatory oversight being used as an excuse not to change.  

Federal regulators are certainly looking to foster innovation and prompt greater use of in-home dialysis via reimbursement changes in kidney care and other areas. The acute shortage of clinicians is another area where regulators are likely to be flexible in allowing healthcare organizations to experiment with new care delivery options. Consider how pandemic-era stop-gap measures to allow providers to practice telemedicine across state lines have remained in place. We believe the clinician shortage is an existential threat that must be at the forefront of the design of omnichannel care delivery models. Certainly, it will force provider organizations to automate more low-value tasks as they seek to expand their reach.  

Social determinants of health (SDoH) are also being incorporated into regulatory frameworks as their importance to health becomes clearer. Medicaid changes are more likely in the short term, with Medicare following suit in the long term. Organizations that are proactive in developing solutions – ideally in collaboration with regulators and other partners – will be positioned for future success.  

Working with a national provider organization to address the needs of diabetes patients, we focused on SDoH in determining how to shift the site of care to the home. Patients with mobility issues, those that lived in food deserts, or lacked reliable WiFi for remote diagnostics each required different design decisions. As innovation strategies more frequently intersect with regulatory requirements, we help clients think through the implications and find opportunities to streamline compliance processes as an outgrowth of experience design and technology development.  

5. You can’t change your clinical care model without changing your business model.     

This might be the hardest challenge in healthcare, because of the frequent tension between what’s good for patients and what’s good for the bottom line. In theory, clinical care organizations can find the financial backing to move to a more consumer-centric clinical care model in one of two ways:    

  • Improving patient loyalty and outcomes to become a recognized market leader or provider of choice, with the net effect of boosting both patient volumes and financial returns. 
  • Maximizing reimbursement for all kinds of clinical care services including those delivered outside the traditional clinic.    

We’ve found the first is a harder recipe for success and following it can lead to internal disbelief at best and barriers at worst. Financial incentives need to align with care incentives. Organizations that invest in transforming their care model should expect to realize financial rewards or at least figure out how to get paid for providing services that benefit patients.  

To make it happen, we have helped strong leaders think outside of existing markets to create new categories of care based on patient needs. To model the potential for a new home health business that a diversified healthcare giant was launching, we created a consensus view of existing service lines that could be brought together to meet patient needs in the home, from infusions, to telehealth, to diagnostics and monitoring. Here again, the key was getting stakeholders to collaborate and communicate in new ways.  

FINAL THOUGHTS

Is there a more human-centric industry than healthcare? With technology becoming ubiquitous in all forms of care delivery, it may seem an odd time to ask the question. But in our experience, healthcare organizations that master the human touch in both care delivery and designing and implementing their own transformation initiatives realize the best clinical and business outcomes.  

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Your M&A is Likely Hurting Your M&S (Martech & Salestech)

Avoid falling victim to cost-focused consolidation efforts that potentially limit growth. 

Historically, corporate mergers and acquisitions (M&A) were undertaken to help companies scale, find cost efficiencies, gain access to distribution and block competitors. In the past decade, we’ve seen a digitally driven shift in M&A activity, with the focus moving away from barriers and efficiencies, and towards true growth: leveraging digital technology and business models to offer better products, more engaging experiences and more effective ways of working. 

Beware of Antiquated Approaches to Integrated Management Offices 

The most important role in a successful M&A event is the Integration Management Office, or “IMO”.  With the digital-centric M&A model, IMOs need to change their approach from an operational focus of pruning off duplicate assets, consolidating teams and looking for organizational synergy, to a strategic rethinking of the firm’s approach to growth. 

One critical foundation of growth that IMOs typically mismanage during M&A activity is the MarTech & SalesTech infrastructure. IMOs often focus on identifying and eliminating duplication of systems and subsequent cost reduction but don’t proactively explore improvements such as tighter cross-system integrations, cleaner data or more thoughtful process automation. While these sound like minor operational factors, they can become the underpinnings of more effective customer engagement strategies, compelling user experiences and powerful upsell/cross-sell/retention initiatives. 

If organizations aren’t careful, MarTech and SalesTech can fall victim to cost-focused consolidation efforts and might come out of an M&A deal tied to systems that will suffocate growth. Here’s how to spot these dangers and avoid them. 

Do Not Assume Your Options are Binary 

We have yet to see a sales or marketing team 100% satisfied with their existing tech stacks and workflows. After a deal, you will have to invest time and money into consolidating and migrating systems. You will also have a large pool of vendors -many of which you have great interpersonal relationships with- feeling the pressure to hold onto their accounts. 

Fight the urge to pick from a subset of existing vendors. You may find yourself with a system that is only designed for half of the company, or unable to scale into the new larger enterprise. Take the time to step back and make a holistic and strategic set of choices before diving into a large migration effort. It’s better to be at the bottom of the right ladder than halfway up the wrong one. As Amber Sundell, head of demand generation at Merative, a data and technology healthcare company, puts it, “We might have fewer marketing and sales systems these days, but everyone in this space continues to feel those budget and data standardization cuts/missteps.” 

Clarify Your Desired Future State and Look Backwards  

Your CEO and the deal team likely won’t stop talking about this future utopia of the new combined organization. That utopia two, five, or ten years from now probably doesn’t have tech stacks designed when the two companies were operating with different intentions.  

For example, lead handling systems typically put potential customers into different categories or types. What if those categories are different between the two merging companies? And what if those categories are hard-coded into all sales flows and reporting systems — how will you operate? 

Or what if your organization uses Platform X for email campaign management, and the acquired firm uses Platform Y, but they both use different sets of templates and other source data to trigger the message? Is it possible to send a demand generation campaign or order confirmation message without a manual workaround? 

These sorts of “differences” are assumed and understood when framing an M&A event, but rarely is there budgeting for the hard work of standardizing data taxonomies, refactoring (reducing) templates, or re-integrating systems outside of core billing. What starts as potential synergy quickly becomes invisible technical debt. Often, that debt becomes a long-term liability for the resulting Marketing or Sales Operations Teams, and it persists for years beyond the merger event. 

You are Building Pipes and Plumbing, not a Funnel  

If you’re not already operating in a multi-business unit enterprise, the latest acquisition might spur it, or will in the near future.  There is already an invisible wall between marketing and sales on a variety of dimensions, incentives, cultures, skills, styles, etc. And as you move towards –or deeper into – a multi-BU enterprise, you’ll likely have fragmented sales teams and centralized and decentralized marketing teams. From a demand gen perspective, you need to stop thinking of lead flows as a funnel, and more like pipes and plumbing. And don’t underestimate the people risks associated with M&A activities. Sundell states, “The employees who are redistributed or leave the organization after an integration, take legacy knowledge with them. You also find yourself missing reasons why things were or were not done in a certain way.” 

How do you move forward with this approach? Examine each joint and pipe and look for leaks. Measure the pressure and flow rate at each valve and faucet.  

And check the temperature frequently. 

Translation: Standardize data formats and integration points to make sure systems are talking and information flows correctly from one step to the next. Use reporting to capture meaningful operational metrics and KPIs for each overall process and important sub-step. And use ROI analyses with clear and simple dashboards to know when the process is working and the effort was successful. 

FINAL THOUGHTS

It is said that most mergers and acquisitions fail. Many believe that it is because deals are normally predicated on growth, but the integration process is dominated by cost-related decisions.  The answer is both, and most importantly, your Salestech and Martech are your biggest demand gen investments. There will be opportunities to combine stacks to lower ongoing operating expenses.  But don’t lose the opportunity to step back and fully re-evaluate your platforms to maximize your demand gen efforts to support the growth of the newly combined enterprise. 

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3 Ways to Transform Customer Engagement for the Future of Medtech  

Customer engagement models are essential to maintain a thriving business, learn how Medtech firms can get theirs fit for purpose.

For a long time, the customer relationship between MedTech companies and healthcare professionals (HCPs), as well as healthcare providers (HPs), has been changing. The Medtech industry, like many others in the past couple of years, has been faced with an acceleration of nascent changes such as digital transformation and an increase in customer expectations – causing trends to solidify and become the new normal. Now, with basic assumptions around interactions and relationship building fundamentally altered, traditional customer engagement models can no longer deliver against their ambition for the future. We have witnessed different approaches by Medtech companies, some learning from inside and others from outside the healthcare space, to rethink their approach to customer engagement and how to make it more future fit.  

Based on our experience, we have identified three crucial ways to transform customer engagement strategies so businesses can succeed in this new world of Medtech. 

Hybrid Engagement with a Purpose 

COVID-19 has permanently changed how the healthcare system works, forcing Medtech to quickly shift to remote engagements and digitize offline processes. Now, that the pandemic is more under control, it is apparent that there is no way back. Today’s customer engagement preferences have changed.  

So, what does this mean for Medtech moving forward?  

Medtech needs to engage with customers in a blended way – balancing the online and offline worlds – making permanent use of remote channels while at the same time recognizing the points at which a more human interaction makes a difference. In-person interactions remain a valid and irreplaceable tool at various points in the customer journey, but Medtech companies need to be targeted and purposeful in which types of interactions they favor for this and leveraging virtual interactions and multi-channel where relevant and feasible. 

How to achieve a more hybrid engagement model? 

  • Shift your mindset from sales to customer: One crucial element in our work in this space is about the organizational mindset shift – from a sales funnel mindset that focuses on closing the “deal”, to more of a customer journey mindset, where building longer-term relationships is of higher priority. The closing of a sale no longer marks the end of the journey, it is only one additional step in the MedTech-HCP/HP relationship.
  • Adapt engagement approach to customer type and journey stage: Different customer groups have different needs and preferences at different stages of the customer journey – understanding the journey both from a funnel perspective (awareness to conversion to loyalty/recommendation), but also from a touch point perspective (I.e. which touchpoints does a customer use across their journey). For instance, a hospital’s procurement lead will have different engagement needs than a physician who owns a single practice. Vivantes, the biggest hospital system in Germany, has different needs than a rural doctor. Understanding these needs and preferences is key to identifying which type of interaction adds the most value at each point along the customer journey.  
  • Capture individual customer preferences: Medtech should focus on customer preferences and align with them where possible. Accurate tagging in CRM systems helps paint a stronger picture of customer understanding and personalization. It is important that this knowledge is shared within the Medtech organization so that all stakeholders act upon it accordingly (sales reps from different divisions, marketing, etc). 
  • Ensure engagement and experiences align seamlessly: Individual high-quality interactions are relevant but diminished if a customer feels that follow-on connections are disjointed. A set of well-orchestrated interactions across the journey can improve the overall customer experience. MedTech organizations should work towards ensuring sales and marketing have a holistic view of the customer and follow through on the captured learnings. 

Optimized Interactions in the Virtual Space 

The pandemic has forced many to embrace tools they weren’t previously comfortable with, and these changes are permanent. The use of online tools has grown – and HCPs are using online information sources more than ever. The key benefits of more digital interactions are around convenience – research shows aspects such as flexibility of timing, less travel, less impact on workload and a more extensive selection of webinars instead of conferences. But purely digital interactions also have their shortcomings: loss of personal relationships with the sales reps, inability to network and overall, less engagement between reps and their customers. The focus should be on optimizing virtual interactions and reducing these drawbacks.  

With so many competing demands on attention, nurturing and managing leads with targeted engagement is even more relevant in categories where the typical product lifespan is longer, given fewer windows of opportunity to sell the product. And digital channels allow for much more customized and recurrent interactions that permit Medtech to stay within the relevant consideration set. 

Excellence in virtual events is driven by recognizing where efforts should be refocused when designing the experience. The key is to ensure virtual interactions are optimized to take advantage of the technologies used to engage customers, rather than be seen as a lesser alternative to in-person interaction. How can that be done? 

  • Update and optimize content online: While online sessions are usually seen as more convenient, it is also harder to keep the participants engaged and focused. Digitizing content used in offline interactions was the first step many Medtechs took – and quickly found that this was not sufficient. The content needs to be fully adapted to fit different channels and delivery mechanisms, in terms of level of detail, structure etc. 
  • Use data and insights to underpin decisions: One benefit of digital is its measurability. Data and insights need to be used to ‘test and learn’ when selecting and enhancing channels, content and delivery methods. Establishing the right KPIs and monitoring them is key. Virtual interactions provide an excellent opportunity to collect further customer insights, which can help inform both future remote and in-person interactions.
  • Reimagine interactions to facilitate discussion: Oftentimes, virtual interactions don’t provide the same opportunities for participants to connect with peers and share experiences. Duplicating offline approaches into an online channel does not work, and MedTechs need to refocus their activities accordingly. Optimized virtual events prioritize connection and community elements while reducing the relevance of purely communicational elements.  

Content is King (even more than before) 

Customers are looking for convenient ways to educate themselves on specific topics. An individual Medtech’s authority in specific fields can make them a trusted source to provide education or even build connections in a non-commercial way. But they are not alone in this endeavor, and companies are feeling the pressure to deliver high-quality, relevant digital content like never before. While not all companies can keep up with the accelerated pace of content creation, Prophet’s Altimeter colleagues found that those that are successful in meeting this demand have implemented an “Agile Content System.” For many Medtechs in particular, and healthcare companies in general, internal compliance processes  are a key obstacle to timely content creation, but there are simple ways to improve this:  

  • Ensure technology and workflows are working to streamline approval processes: Approval and compliance processes need to be structured in a way that allows for speedy, efficient publishing. In healthcare specifically, reviews by multiple stakeholder groups such as the ethics boards, legal teams and subject matter experts can slow down the approval process significantly. A modular content creation approach can help, as well as clearer content ownership and roles. 
  • Restructure content teams for greater agility: A centralized content team does not necessarily work for all Medtech firms. Depending on the key objective and business need (i.e. brand awareness building vs demand/revenue generation), the ideal structure should be set up but it’s essential they work together on a shared agenda. Our research shows that the most effective organizations balance both brand and demand.
  • Set bolder, clearer goals that go beyond brand: Oftentimes, Medtech organizations are focused on content to drive brand awareness. With the changing preferences of their customers, there is a need to revise this approach. This shift in thought leadership (i.e. Siemens Healthineers Insights series or their Healthcare Challenges podcast), also requires a review of the KPIs to ensure the correct content metrics are being tracked and reported on. 

FINAL THOUGHTS

Customer engagement is a critical aspect of any business, and this is no exception in the Medtech industry. The complex ecosystem and the diversity of customers do not make this an easy task for Medtech organizations, but there are strategies that can help to transform and succeed in this new world of customer engagement, enabling Medtechs to become the customer’s first choice of engagement. 

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Five Healthcare Trends To Watch in 2023

Healthcare leaders can drive change in 2023 by thinking boldly and targeting investments in the following trending healthcare spaces.

Looking ahead to 2023 in healthcare, the big macroeconomic clouds on the horizon make for a less than cheery outlook. The combination of an economic downturn and higher costs will be a dominant theme for the entire healthcare industry and a huge challenge for organizations across hospitals, health systems and device makers, pharmaceuticals, and life sciences companies, as well as players in technology. 

Still, taking the glass-half-full view, we see many opportunities for leaders across the business to drive operational discipline and innovation by focusing on investments that matter most in driving better outcomes for all stakeholders. As we point out in our transformation playbook, changemakers that push beyond the many common barriers to innovation can achieve a great deal. Yes, the economic pressures will be greater. But 2023 will see plenty more disruption – and thus plenty of growth opportunities – as our annual list of healthcare trends below makes clear.  

1. Holistic Wellness Solutions Continue to Influence the Market  

Successful one-off wellness apps and small niche solutions are adopted by large employers and payers to enhance benefits programs and give people more options to live healthier lives. As consumers adopt wearable data trackers in support of that goal, they will increasingly choose to work with healthcare organizations that are committed to holistic wellness.  

 It’s not about the gadgetry, but rather driving good outcomes, particularly relative to social determinants of health (SDoH) and patients’ lived experiences. The start-ups and tech firms with the most attractive and powerful solutions will achieve rapid scale by going the B2B2C route. We think the biggest winners will emerge in in-home diagnostics, preventative health opportunities (e.g., perimenopausal women and metabolism and nutrition) and mental health, which will be of interest to large employers, as well as individuals. Apps and widgets that empower individuals with their own data, plus timely prompts and attractive incentives, will crack the code on growth.  

2. Venture Capital Focuses on the Best and Brightest  

While we expect to see a few big winners among tech players, most firms will face a tighter funding landscape and more intense due diligence. Venture capital, which has been flowing freely and voluminously for years, will become less available as investors scrutinize business models more closely and back only the best and brightest.  

 We suspect the firms that attract funding will be those that focus on narrowly defined patient cohorts already engaged in self-monitoring behaviors and where innovation can move the needle on cost control or value delivery. Those that can collect real-world data from outside the four corners of traditional clinical environments, and integrate seamlessly into core systems, will be specially well positioned to attract funding and potential partners. Chronic disease management, patient engagement and population health solutions will also be priorities because there is clear clinical and financial upside in all these areas.  

3. The Workforce Shortage Worsens as a Full-Blown Crisis  

With continuing burnout among healthcare workers, large provider organizations face issues with care quality and deteriorating patient experiences. The supply-demand fundamentals are inescapable: There are simply not enough doctors, nurses and paraprofessionals – not to mention data scientists, business analysts and experience designers – to fill all the vacancies. 

However, there are multiple potential solutions to resolving talent shortfalls. Workforce optimization and workflow efficiency are necessary, so too automation and more advanced technology in everything from reading x-rays to identifying payment fraud. More support for patient self-monitoring, continued expansion of telehealth and in-home care will also help alleviate chronic talent shortages. There’s also a large cohort of tech-savvy talent looking for jobs with a higher mission after layoffs from Silicon Valley giants.  

4. Value-Based Care Models Become Innovation Labs  

The inevitable momentum toward value-based continues. More than 40% of U.S. healthcare reimbursement now has some value-based component, a proportion that will only rise in 2023 and beyond. Though pockets of resistance remain, more provider organizations will advance and mature their Value-Based Care capabilities. And they’ll do so on several fronts. More sustained preventative outreach efforts to underserved, high-risk and high-cost populations for routine screenings will continue producing strong results. Shared-incentive contracting will be more attractive for capital-intensive equipment, such as MRI machines and CT scanners.  

Sophisticated technology usage will be a hallmark of VBC winners. Consider how the burden on the workforce could be reduced with digital apps and AI-enabled patient engagements leveraging HIPAA-compliant natural language processing on existing voice platforms (e.g., Alexa). Such applications also free clinicians to operate at the top of their licenses. The next year will see many pilots of creative concepts in the space.  

The tightening economic backdrop, alongside rising consumer expectations, more powerful technology and the prevalence of chronic conditions, will fuel further adoption of VBC models. Large employers wanting to know what they are getting from higher rates will be yet another prompt for innovation.  

5. Consolidation Increases as Non-Traditional Players Press on  

Challenging macroeconomic conditions will drive more consolidation and spark aggressive plays from tech platforms and large retailers. In this sense, 2023 will look a lot like recent years. Retailers and other non-traditional players are cracking the code on healthcare, faster than healthcare players are cracking the code on consumerism.  Amazon, Walmart and other large players will continue experimenting on their own, buying up promising ventures and looking for partners that can further their huge ambitions.  

And their ambitions won’t shrink just because the economy does. If you already thought these companies were relentless competitors when the economy was good, then you can expect them to press their advantages even more forcefully in pursuit of ever greater market share as cost and capital pressures rise for others.  

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FINAL THOUGHTS

The healthcare industry has seen plenty of change during the last few years. The next year will continue that trend. And as challenging as the economic conditions will be, healthcare leaders can drive change for the better by thinking boldly and targeting investments in the most promising areas of opportunity.  

Contact our healthcare team today. We’d love to talk about the transformation opportunities at your organization. 

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