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Grasping a Better Understanding of Poor Provider-Patient Matching


January 16, 2020

Erin Jospe, MD, chief medical officer, Kyruus, discusses the impact of “poor” provider-patient matching on the entire care team, and highlights ways technology can be utilized to address this problem.

Podcast Transcript

My name is Erin Jospe. I'm an internist by background. I've been with Kyruus for the last two and a half years as their chief medical officer. I additionally oversee the account management team as the SVP for account management.

I've been in the clinical space now for over 20 years, but on the vendor side of things, in health IT, really, for about the last seven or eight.

I believe that when we think about how poor provider/patient matching occurs, I think it's very important to start with how we're defining poor and by whose perspective.

Poor can mean wait times for a patient, which again can have subsequent impact around outcomes to their overall health, as well as just their convenience. Poor can mean clinically misguided, where a match happened such that not only did it not meet the time frame that people would ideally want, but where they're landing with somebody that's not clinically suited to meet their need.

I think that poor can also be from the health system’s standpoint, where that match occurred at a level of care or a setting of care that was not of the best quality, best value for cost. Poor can mean a lot of different things. We see all of these different avenues manifest when we're talking about poor patient/provider matching as it exists today.

When we're thinking about all of the different ways that provider/patient matching can be poor, I think we are also really well positioned to think about how technology could help to speak to that because there are so many different facets that go into dictating a successful match that we can think about how technology can be leveraged to surface all of those facets from all of those different perspectives.

The perspective of the consumer or patient, the perspective of the provider, and the perspective of the health system. How, exactly, could technology go about doing that? It's really giving an opportunity for facets to be surfaced to ensure that the data that informs those assets is accurate.

Rather than rely on a person's subjective understanding of the situation, we're now positioned to capture all of those different elements as data that technology, like a matching solution, can leverage to help perform that match.

Some examples of the different data elements or facets that could go in there. From the consumer or patient perspective, even before I spoke about convenience. Understanding if there is a same day appointment available is something that is going to be important to be able to surface, to make sure that that's accurate, that you're not displaying something that's wrong.

Being able to integrate with a scheduling system that's contained within an EHR is going to be an important aspect here. In addition, there are things like do you know the preferred gender, or language, or insurance of the next provider of care for your consumer or patient? How could that be captured and surfaced to the patient to be able to make those decisions?

How can we understand at a really granular level the types of clinical needs that different providers can speak to? I like to think that providers are way more than just their specialty. You could be an electrophysiologist but you have a special interest in maternal arrhythmias. How could that be captured and understood?

Likewise, what are the different data elements that a health system already has access to about routing patients to preferred levels of care that both meet the clinical need but are at an appropriate acuity level? You don't want to just open up the door to your emergency department.

Your emergency department's wonderful, but there are certainly way better avenues in which your patients and prospective patients could be receiving their care. Are you directing your patients to urgent and retail? Are you directing your patients to primary care? Did you just invest in a new endoscopy suite, and so you'd like your colonoscopies to go there?

Really understanding that and knowing that no one perspective is dominant. There's a place and a role for all of them to contribute to understanding what that best match is and ensuring that accurate sources of those data elements can be presented to make that match.

We're seeing, now, a tremendous amount of mergers and acquisitions and creation of clinically integrated networks that are really expanding the field of clinical expertise that can be surfaced up to consumers and patients.

While access in a timely fashion is always already going to be an important endeavor, so is understanding where clinical expertise resides within your clinical community.

By creating these networks of provider communities, we go well beyond the little micro networks that, as providers, we tend to create for ourselves. We can't possibly know all of the different competencies and where they exist within our network without having some kind of tool to surface them because I can't know all of the orthopedic surgeons.

Beyond that, I can't know which ones are really good at shoulders because we just acquired or merged with another health system. Now, there's a whole new avenue of care that could be present for my patients. To really advocate for them to get what it is that they need, we need to be able to understand where those competencies reside.

Again, it's not just having a quick appointment. It's having an appointment with a person that can speak to what your clinical need is in a way that you will understand and respond to, that takes your insurance, that's located in a place that you need them to be located, and leveraging technology to understand that.

Surfacing it in a workflow of patient/provider matching that makes sense allows both the clinically integrated networks and the patients to benefit.

One of the groups that I haven't mentioned yet is the payers. We certainly understand that there's a patient or consumer perspective, that there's a provider's perspective, there's the health system's perspective. It's very reasonable to also understand the payer as a stakeholder here.

The payer's perspective is always going to be one of providing the highest quality, the best value to their members. Where they've had to make up for misdirected referrals is costly both to the patient and the insurance company.

Accidentally referring your patient to an orthopedic surgeon who does knees with the intention of having your patient's shoulder pain addressed. That hasn't served anyone well. Absolutely, your payer base is going to be a stakeholder in the best outcomes we can get in patient/provider matching.

I think when we're contemplating patients, providers, and the very nature of health care, we understand that burnout is happening. We understand patient frustration. We understand escalating costs.

In aggregate, it can feel overwhelming. I think one of the things that's often lost as we try and break it down into elements that we can tackle, is the particular joy that comes in the relationships that we have with patients and knowing that we've met a need.

I say that as a provider, but I also say that as a patient. Being able to make that human connection with your provider is really important and I think can really contribute to a better outcome.

I think when we talk about patient/provider matching, we're really talking about making something that could otherwise be very transactional into something that's truly very relational and very relationship driven.

I think that all of those other elements of burnout, clinical need, timeliness of care, and access in general all become spoken to when we can think about, how can we facilitate that aspect, as well? How can we ensure that there's a psychological construct that can be upheld here, as well, in helping people to find the right providers of their care?

How can we enable people to be respected as human beings, and to receive their care from other human beings, and to move that needle forward?

My hope is that as we continue to discuss things like patient/provider matching and why it's important to so many different constituents, that we can also see a certain amount of satisfaction and enjoyment come from the experience of receiving and delivering care.

People are very vulnerable when they have a health care situation. That should be respected as part of this equation.

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