Want to Know How To Improve Healthcare? These 2 Groups Can Help

Dr. Z Colette Edwards, MBA, has worked in healthcare in many capacities–doctor, executive, consultant, and author. She believes by empowering patients and staffers, healthcare leaders have the opportunity to revolutionize the industry. She joins host Chris Hemphill to discuss ways to put that strategy into action as well as talk about her book, Navigating Your Healthcare Journey.

Key Takeaways

Untapped resources: Patients and staffers can provide valuable insights and perspectives that can lead to better decision-making, innovative solutions, and operational efficiency

The more arduous road often offers the best results: It may require effort and may not be the easiest path, but it is the right one for achieving meaningful improvement in care and outcomes.

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Read the Transcript

(edited for clarity)

Hello, everyone. This is Meeting of the Minds “Navigating Patient Journeys. (You’re a Patient, Too).” The reason we put “you’re a patient, too” in the title is to remind us, when it comes down to it, the types of decisions, and the way that we build this healthcare system and deliver care affects people just like you and me.

I just wanted to bring that up before introducing Dr. Z. Colette Edwards. Dr. Edwards released a book called Navigating Your Healthcare Journey that is targeted toward a patient audience on how to navigate within these complex systems.

Dr. Edwards, by way of background, is, I’m going to say, a Renaissance woman. She brings many different things to the table with a background in business writing for Wharton Healthcare Quarterly, as well as many years as a practicing gastroenterologist, and she has been a medical director and healthcare consultant working with large health systems, payors, many facets and areas of the healthcare arena.

So this book is informed not just by experience in giving care and as a patient but also understanding many business mechanisms in different parts of the institution.

I have been in a lot of the different stakeholder areas within the healthcare arena over the course of my career. First and most important was as a practicing gastroenterologist. I have had training in health and wellness coaching and training in health disparities at the NIH.

And I’ve been a patient, as everyone will eventually be unless they are way off the grid. I have been in roles where my focus was building, maintaining relationships, and finding ways to collaborate with medical groups and health systems related to a health plan.

I’ve done a lot of program design and implementation and looked at many digital health companies from a vetting perspective and vendor management in terms of finding solutions for patient populations, for employers.

And then I’ve also been in the nitty gritty as an associate medical director for a large multi-specialty group practice that had medical campuses, satellite primary care offices, its own pharmacy, had its own lab case managers, etc.

In terms of the motivation for writing the book. My co-author, Charlene Rothkopf, asked me to participate with her after having had quite an interesting healthcare journey over a number of years. She had a brain tumor that was first flagged from a seizure, and then she was kind of off and running.

But I would say in every role that I have been in, there have been things that have gone very well. But there have been times when things have not gone well and, you know, times when they’ve gone very badly. There’s always something to be learned from that and lots of opportunities for change, enhancements, and improvement of the system for people to get the best care or the highest quality, have it be affordable and not burn everybody out and have the system go bankrupt in the process.

Thank you for sharing that story. We know the book is written for someone who is receiving healthcare services and needs guidance to make sure that they’re advocating for themselves. I wonder, just knowing that we’re dealing with an audience of healthcare leaders, change-makers, and professionals. What would you say you’d be excited for people to get out of this conversation?

As overwhelming as things can be, as complicated as the system is, as limited as it may appear–or actually be–as it relates to things like budget staffing, etc., people do have the power to make a difference and focus on the patient. And I think that regardless of what part of the healthcare arena you are in, the vast majority of people went in that direction to do just that.

It’s not necessarily easy to keep that top of mind because of life and because of the behemoth that the system has become. For me, at least, staying focused on the patient as my North Star, regardless of the role, brought a lot of clarity and ease in terms of decision-making. Now, it didn’t necessarily make things easy to accomplish, but then a lot of other things automatically kind of fell into place in terms of what needed to be done and how it needed to be done.

On the data science side, it is easy to forget about people and only be looking at rows on spreadsheets and within data frames and forget that each of those incidents, each of those encounters that you might be seeing or analyzing, represents a time that somebody came in and tried to get care for themselves.

I would say another lesson that I learned early on was to go to the people who will be doing the job. When I was an associate medical director of the multi-specialty group practice, one of the first things that I was asked to do was take over the billing and encoding function for internal medicine.

I had gone to medical school but didn’t learn anything about it. Had gone to business school but didn’t learn anything about it. So I had to get up to snuff pretty quickly. In doing that, I met with every single person in the department, trying to get their take on what had gone on before. What are your ideas? How can it be made better? How can we make the system the easiest for everyone and the most efficient for everyone?

I’ve been a healthcare consultant; healthcare consultants are fabulous people and can be extraordinarily helpful. But sometimes, your best consultants are right there in your midst. They’re seeing it up close and personal every single day.

They have all these ideas that they would love to share. And it can happen much more quickly with greater buy-in at lower cost by taking that opportunity.

If our goal is to help people better navigate their care journeys and their experiences, what happens if we don’t meet that goal? Are there any stories at an individual or a patient level of what happened when somebody faced too many barriers and couldn’t sufficiently navigate their care?

If the system is set up with a patient portal, as an example, does the person even know how to get to the patient portal? Does the staff in the office? Are you really staffed for them to pull it off, get it to you quickly, and turn that around at a reasonable time, or has the portal created an issue where it’s not happening in the portal, and therefore now people are calling so that your staff has two things to do instead of one?

Or, often, the results are in the portal before the physician has had a chance to see them themselves. Sometimes that is the preference of the patient. For other people, it’s not.

So then you’ve created this whole other loop. This was supposed to be empowering. It was supposed to help people. It was supposed to be less work for the staff, supposed to be less work for the people in the office. And for some people, that absolutely was the case. But for a lot of people, not so much. And if you have people who find that when they try to navigate the system, it is very, very difficult.

And if what they have is a problem is not something that they perceive and feel every day, then it becomes a whole lot easier not to continue in the system. So the person who has hypertension ends up presenting as having a stroke. Yeah, they’ve been told they have hypertension, but they aren’t feeling it, they aren’t in pain, they’re not having headaches, etc., etc.. That’s just one straightforward example.

When you’re talking to other healthcare leaders or focusing on helping entities address these problems, do you find that, in many cases, they’re creating disparities that they are unaware of?

The area of health and equity in general is something that more and more people, thankfully, are aware of. As you know, one of the silver linings of the pandemic. But it’s not something everyone in the field has been well aware of. It seemed pretty obvious. But it’s still the case that lots of people have that deer-in-the-headlights look.

And so an example that I would give is I was reading data about health disparities in terms of access to care, etc., for people with disabilities. A little bit of work has been done to address that. We have the ADA (Americans with Disabilities Act), we have more ramps, etc. But after reading a story about a wheelchair-bound woman and what it takes to get to the doctor’s office–getting herself together, getting onto transportation when it’s snowing, and what she’s dealing with if things have not been shoveled.

So for her, that becomes a massive undertaking. Until I read her story, it was like, yeah, there are issues, but I never even thought about that one single thing. It’s snow, and it’s not even a lot of snow, but it’s slush, and it hasn’t been removed. You have to address the issue then because it can’t be unseen, it can’t be unheard.

That little bit of snow that causes a minor inconvenience for some people is a whole lot different for other groups of people that sometimes aren’t being addressed as much.

Much legislation has been written because [the author] had a personal experience. A family member has had a personal experience, a staffer has had a personal experience, or a constituent. Personal experience brought it to the fore, and made it real for them. Then legislation got passed. When it’s unignorable, that’s when things change, whether it’s at the individual level or whether it’s at the group level. Someone identified a problem and said “This shouldn’t be. It doesn’t have to be, and we can make it better.”

The nature of that legislation, it just follows a path where something adverse has to happen. And then all of a sudden, the attention goes to it versus being proactive and kind of understanding where some of those challenges are coming from ahead of time.

And adverse at the level of the individual that people know. Because it’s been a problem for a very long time. But when it’s in the background, and it’s at the group level, we don’t think about it in the same way.

When it comes to identifying these types of scenarios–the woman who couldn’t roll her wheelchair in the snow–I’m curious about your research process for the book and finding the right types of stories to address. During that process, did anything come up that surprised you?

Each chapter has a story related to the topic of the chapter. So, for example, one of the chapters is having a baby. One of the chapters is about facing health disparities. One is dealing with mental illness. Is anything surprising per se? The one thing that comes to mind is that people don’t know about the resources that are out there. They were set up for a particular reason, and either they were not widely advertised, or I don’t know what the root cause is, but resources are sitting out there that are for people who are greatly in need, but people don’t know about them and their physicians don’t necessarily know about them or the system doesn’t even necessarily know about them. I would say that that was probably the one thing that was surprising for me.

Are there any examples that come to mind?

Coverage for certain services for patients with a multitude of health issues and health issues related to social issues like their economic status. In a situation like that, at some point in time, someone thought this was a problem. They were actually able to get something accomplished and get funds allocated.

But as we all know, if it’s sitting out there and no one’s using it, then someone will discover it and ask, do we really need this anymore? And it’s gone.

I think that’s when the social worker’s role comes to the fore. Are they leveraged as much as they can be? Are there enough of them that could solve many problems that directly or indirectly impact health costs of care, quality of care, etc.

But if we are in a system where programs are being made available, and these programs could help people, but they’re being ignored, that’s one of those examples where people should put on that healthcare optimist hat and start looking for programs that might fit the unmet needs among populations.

There’ll be some eye-rolling, probably with what I’m about to say. In terms of care management programs and benefits that are available to employees, patients, and to members–they are actually very good programs when physicians are made aware of them, and you walk through what is involved and [how] it can serve as an extension to their work and do lots of things that would be helpful to the patient. But usually, you don’t have the time, you don’t have the staff, and you don’t have the resources to do that.

An example that I would give from my past was about a large oncology practice. I was approached because the contracting was not going well, shall we say, with provider contracting and the practice.

It was a huge practice that absolutely was needed in the network for the greater good of patients. I’m a gastroenterologist, I’m not an oncologist. So I reached out to another medical director who was an oncologist who would understand the concerns, the rationale, etc., in a way that I could not.

So we were able to address those. We had a conversation, and we asked how we can work together to provide more resources and support to your practice. We were then able to assign specific case managers to that practice and actually ended up with a co-branded brochure with the practice so that patients would know this practice exists.

The physicians in the practice felt comfortable about it, knew what it involved, and were then going to make referrals to the program. Would anyone have ever imagined that you go from a very contentious scenario where the group was going to walk to a co-branded brochure and referrals? That’s not how you would typically expect that story to end. So even just little things like that can make things happen.

Are there thoughts on newer engagement models to make patients aware of some of these programs?

The example that I can give you of engaging people is a start-up. It is focused on the engagement of patients of lower socioeconomic status. They actually focus on people. They’ve gone out to people and had conversations where the people are and asked them what their needs are, what their concerns are, what their fears are.

After having those conversations, the percentage of people who actually followed through–because they tracked it–significantly increased. Now, you can’t have that type of model necessarily at scale, but the next step is taking that information and synthesizing that in a way that can be applied at scale.

Also, finding out what people’s preferences are around communication–many people would respond to a text or not an email. There are lots of people who respond to paper and not anything with regard to technology. But it’s also important not to make assumptions because there are a lot of people who are over the age of 65 who are very much engaged with technology, and there are lots of people younger than the age of 65 who still want the desktop version, and they don’t want the app.

So it’s really finding out from people how do they want to engage as opposed to thinking this is going to be the most efficient, cost-effective way to do things, which may sometimes be the case.

And it’s also getting upfront information about the person’s perception of the problem. So your diabetes program, you want to get down that A1C, and you want to increase medication adherence, but does that have anything at all to do with the patient’s concern and whether or not they’re going to take the medication?

And if they aren’t, why they aren’t? Is it because they forget and they need reminders? Is it because they aren’t so sure about the medication? Is it because they got side effects? I mean, technology offers lots of ways to communicate with people, with lots of ways to engage with people. So you may go in with an assumption that it’s going to be this and find out that it’s going to be something else.

And particularly with technology, it is often the case that it’s incredibly easy and inexpensive to change things quickly. I mean, that’s some of the beauty of technology.

We’ve been talking about these stories around navigating care. I wonder what are some examples of health systems or payers that are getting this thing right?

So I’m thinking of a health system. One thing that stands out is they started off with a ten-year view. Now, obviously, when you have a ten-year view in healthcare, it’s going to change. But they were looking longer term.

They were also looking at many different factors that people were not considering. They were listening to patients and their needs and the best way to get them what they needed. People talk about meeting people where they are. They were literally doing that.

And they also put money behind it. They were willing to put money down to stand behind the work that they were doing, which is a powerful statement in and of itself. And a statement that not that many people make. And certainly, at the time that they started, no one was doing that.

I can think of another health plan that has done exceptionally well with its medical home program. The quality of care did go up. The cost of care did go down, patient engagement went up, and they invested enough money to make it worthwhile for physicians to make the changes required to operate as a medical home. Conceptually, it sounds great, but it’s a lot of work to set up the workflows and get the staff aligned and have the trigger systems, etc., and they really understood it.

They put enough money down to make it clear to the physicians that they understood what they were going through and that it would be worthwhile. At the end of the day, after they made all of those changes, it did make things better. Financially, not only were they going to be whole, they were going to be more than whole.

What keeps an organization focused on seeing an initiative like that through to the end?

They were focused on the patient and took care of the people who were taking care of them. People always say that but how often do people actually do it? And in any industry, not just healthcare.

I can think of a restaurant chain where the founder of the chain–that was his mantra. I take care of the people who take care of customers. And he actually did it. And it worked out great. I mean, he had one restaurant, two, another restaurant, and multiple chains with different cuisines. Benefits for their waiters and the whole staff, etc.

There are things that we know, the data has been pulled, the research has been done, the white paper has been written, but when it comes time to, are you really willing to take that step? Especially when you look around, and no one else is doing it?

I’ll give one example, and this isn’t just for healthcare either, but this still sticks in my craw decades later. In a New England state, at a time, malpractice premiums were just staggering and growing by leaps and bounds for anesthesiologists. The anesthesiologists in that state, through their medical societies, came together, developed pathways, developed guidelines, worked with the malpractice carrier, and came to an agreement. Number one, if they follow these guidelines and pathways–obviously with the ability to go off the pathway based on a particular patient–then the malpractice premiums would be reduced. If someone was sued, the malpractice carrier would actually defend them in court because sometimes those things get settled, whether or not the physician wants that to happen.

And what happened? The quality of care went up, adverse events went down, malpractice premiums went down, and all in a relatively short period of time. So I said to myself that when the anesthesiologists have their national meeting, this will be a story that will be told as one of the presentations. And then, in relatively short order, this will be happening all across the country.

Nope, not then, not now. Even when you see those success stories, something still holds people back from taking that on. People go into healthcare for many reasons, but I think it starts with the patient, the consumer, the member as their area of focus and with a goal of helping that person in some way.

The system is perfectly designed for us to be where we are. It’s a system that we created, and it’s a system that we can fix. Is it going to happen overnight? No. But we can’t afford not to do more and do it more quickly than what we’re doing right now, given the direction that we’re headed.

Well, I appreciate that answer. And honestly, I appreciate the many stories you’ve shared that highlighted challenges and breaks in the system.

At the end of each of our interviews, we give a magic wand out. And with that magic wand, you can change one thing about the healthcare system. What would that be?

For people to remember the North Star and see people as people, whether it’s with the patient, whether it’s with staff, whether it’s with the janitor. Because once you see people as people, it makes it harder not to do things that should be done.

It also makes it easier and is encouraging and gives you motivation and inspiration and encouragement to keep moving forward.

Thank you for sharing. I think that goes even deeper than system-wide incentives.

Just to end it as it relates to the book, people shared their stories because they wanted others not to go through what they went through. They didn’t have to share their stories. They didn’t have to tell us a thing. But they wanted people to know their stories so that the next person coming along could learn that lesson, do things differently, ask this question, whatever it was, to make it better for others.

Meeting of the Minds