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The Role Of Customer Engagement In ACO Success

Non-compliant. Non-adherent. Covered lives. Adverse events.  Medical loss ratios.  Show up at any discussion forum where health care's professionals gather and you'll likely hear these terms used (and others equally jargon-heavy) to describe the industry's customers.

In this post the other day I said words matter but actions matter more.   Sometimes, frankly, words get in the way.  This is one of those times, a time for ruminations about change, cultures, linguistics and customer engagement.  Bored yet?

It goes like this:  Language matters to engagement, engagement matters to customers and customers matter to us.  So language should matter to us, should it not?

Health care organizations are furiously thinking through Obamacare's impact and opportunities. And in the best "Back To the Future" fashion (as if it's 1995 and called Hillarycare) many aspire to become "Accountable Care Organizations," accepting financial and clinical risk for defined populations, succeeding as that population's health is maintained or improved.

It's a good strategy.  And it could work.  But it could also go expensively, comically wrong.

How?  An ACO's success depends on resolving a list of sticky issues - physician engagement, EMR functionality, compensation and governance models, negotiations with payers for acceptable premium splits, etc.  Let's assume we navigate all those rocky shoals.  Now we have 100,000 customers for whom we're responsible, financially and clinically.  Good for us.   Ahhh, but let's also be careful what we wish for.

Because our success now requires that we ENGAGE with those customers in ways and at levels that few nascent ACOs appear to understand, even dimly.  We've spent decades talking at customers, seldom caring to learn to talk with them.  I see many hospitals inordinately proud of promoting a cholesterol screening to 1,000 people and watching 30 show up, get screened and leave.   That's dumb marketing but lots of marketers get away with lots of dumb things in a fee-for-service world.

In an ACO world, that thinking kills organizations.  The bad habits of 100,000 people are now our problem for more than an evening.  Their behaviors - whether logical or inexplicable - are our burden.  And no longer just inconvenient, communication breakdowns now mean ACO life or death.

Customer engagement for an ACO mandates a huge cultural transformation, and that's where language matters.  How are cultures expressed?  In language, terminology and in symbols, in the linguistic shorthand of buzzwords and acronyms.   You want me to adopt healthier behaviors while you persist in seeing me as "the non-compliant in exam room #3?"  That's demeaning, not engaging.

As I see it, ACO success hinges on two things:  
  1. Accepting our role in one of health care's biggest change experiments.  Remember, organizations - even ACOs and their 100,000 customers - do not change.  People change.  Customers change.  And they change one at a time, at different rates, grudgingly, haltingly and usually not because somebody else wants them to. Yet change they must, or our ACO fails.
  2. Embracing that a change effort not solidly grounded in customer benefit and in a deep sense of personal engagement with the customer is also doomed to fail.  Does our jargon mask, among other things, an ambivalence about customers, a desire to maintain our sense of power in the caregiver-patient relationship?  I hope not.  I hope it's just words.  But I won't rule it out as an obstacle to ACO success.
Without organizations deeply engaged with their customers, all our legal structures and contract terms, IT systems and whatever else our lawyers dream up, are empty and sterile, expensive monuments to old thinking layered upon new challenges.

As usual, I have some ideas about customer engagement that might be helpful to your ACO efforts.  Contact me if you'd like to learn more.  (Steve Davis, Health Care Strategist -


Joy Twesigye said…
Personal behavior change is often a “heavy lift,” but even small changes in behavior and lifestyle can have dramatic effects. Even when a person wants to change his or her behavior—lose weight, exercise, quit smoking—marshaling the personal motivation and societal support to change behavior can seem impossible, especially when commercial and other social forces have influences that are counter- productive to health.

While there are many external forces impacting health over which an individual has no control, unless everyone takes some responsibility for his or her own health and well-being, the health care system will not, on its own, be able to address the volume and complexity of many diseases.

To implement this approach, we recommend focusing on methods for meaningful behavior modification. We would like to promote the introduction of financial incentives, where possible, to increase the likelihood that preventive care will occur. But we would also like to provide the tools that help consumers manage their own health and would like those tools informed by the people who use them.

In addition, we recognize that good nutrition and lifestyle are not always obvious so we believe that nutrition information combined with affordable nutrition should be pursued. Finally, access to relevant information has to be creative, interesting, and tailored to the audience.

We lay out specifics on how to Empower consumers to take personal responsibility for improving their health through education, interactive tools, and incentives at
Steph Gould said…
I think you have made a solid case re: the importance of engaging customers for ACOs to be successful. While that is critical, the culture-shift actually needs to begin to happen even farther back.

You touched on this briefly, but I think it's worth reiterating. Before providers or caregivers can effectively change the language they use to engage their customer base, empower them, and take responsibility for their care, they need to truly and AUTHENTICALLY embrace the philosophy that patients ARE customers. If they are just going through the motions because it is in their best interest to adopt another set of buzz words from the "patient-centered care" craze, patients will see right through it. The ACO will still fail.

To add even a third layer of complexity in shifting from the status quo in a way that impacts ACO success . . . practitioners will need to expand their current perspective and embrace the patient as a whole person . . .not just one isolated organ system, ailment or encounter.

This is certainly an exciting and unprecedented time in the evolution of health care delivery. I truly believe that the industry and the health of the customers it serves will be better off as we work through these challenges. Although, the road to the future won't be an easy one to travel.
Unknown said…
Changing the way your team thinks takes time, this impacts on your ability to bring about cultural change. But customer engagement can be achieved by altering the way your staff behaves.

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