January 18th, 2022 1:00pm EST
Watch the online event hosted by UpTop Health and Marcus Evans Online Events where our panel of experts will examine the healthcare customer journey through key connections between employees, ACO providers, payers and patients/members.
- Describing how journey mapping fits within large technological processes
- Aligning journey map scenarios that builds empathy and trust
- Uncovering customer engagement, big data and regulation challenges
- Enhancing the needs of the provider and patient expectations
On January 18th, 2022 an online panel event was jointly held between UpTop Health & Marcus Evans Online Events.
Moderator: Thomas Fullwood, Online Event Manager | Marcus Evans Group
Presenters: Craig Nishizaki, Head of Business | UpTop Health, Deborah Roberts, Senior UX Designer | UpTop Health, Dr. Katherine Gergen Barnett, Vice Chair of Primary Care Innovation and Transformation | Boston Medical Center, and Byron Okutsu, Former AVP, Provider Network Management | Cigna.
Thomas Fullwood: Hello. This is Tom from Marcus Evans. Thank you all for attending today’s webinar, Exploring Transformational Journey Mapping for ACOs, Providers, Payers and Other Health Organizations, brought to you in partnership with UpTop Health.
So, before we begin, I’d just to cover a few housekeeping items. As can see at the bottom of your screen are multiple application widgets you can use. All the widgets are resizable and movable, so do feel free to move them around to get the most out of your desktop space. If you have any questions during the webinar, you can submit them through the Q&A widget. We’ll try to answer as many as possible during the webinar, but if a fuller answer is needed or we run our out of time, we’ll make sure to follow up with you in a separate email after the event. Also a copy of today’s slide deck and additional help materials are available in the resource list, and we encourage you to download any resources or bookmark any links you may find useful.
For the best viewing experience, we recommend using a wired internet connection and closing any programs or browser sessions running in the background. You can also find some additional answers to some common technical issues located in the help widget at the bottom of your screen. And a reminder to look out for an email within two hours after the webinar is done with links to download the webinar slides and watch on demand.
Now, with all that being said, I’m going to hand over to our moderator for the day, Craig from UpTop. Hope you’ll all enjoy. Over to you, Craig.
Craig Nishizaki: Thank you, Tom. Well, we’d like to welcome you all to our Exploring Transformational Journey Mapping for ACOs, Providers, Payers and Other Healthcare Organizations panel discussion. We’re very excited about the speakers we have today. We have Dr. Katherine Gergen Barnett, Byron Okutsu, Deborah Roberts, and myself, and I’d to have each of the speakers give a brief introduction of themselves. We’ll start with Katherine.
Dr. Katherine Gergen Barnett: Hello, everybody. I’m so happy to be here with you. I wish I could see all of your faces, but just happy to be in this conversation. So, as Craig shared, my name is Dr. Katherine Gergen Barnett. I work at a place called Boston Medical Center, which is New England’s largest safety net hospital. I’ve been there for about 16 years. I work as a family medicine doctor, so in primary care, but with lots of different leadership hats on including at some point having run our medical clinic and being residency director and currently am serving as vice chair of primary care innovation and transformation, and also do lots of research with the community and do community engagement work. And the final piece I would just add is, during this pandemic, like many of us, picking up many different roles, have been doing a lot more public speaking on radio and television and writing opinion pieces for The Boston Globe. So, really pleased to be here with you today. Thank you.
Craig Nishizaki: Great. Well, we’re excited to have you Katherine, and we’ll have Byron introduce himself.
Byron Okutsu: Yes, good morning. I do apologize. I’ve been trying to get my camera to work and it worked earlier. So, I’ll keep continue to work on that. I’ve been in the managed care business for 30 plus years, recently retired or semi-retired because I can’t let go. And things like this opportunity are fascinating to me, but my degree is in health policy analysis from UNC Chapel Hill. I started in the 90s with a staff-model HMO and we dabbled in failed capitation agreements. I’ve worked for four hospital systems and that’s over 30 years, mind you. And each progression or each step in my career has been a transformation in that the next system has been the next step in population health and value-based care. That started with the University of Utah Healthcare. And most recently with MultiCare here in Washington, which is nine-hospital system, and then spent a bit of time with Cigna as a VP of provider network management in the Pacific Northwest. And so, I’m approaching this from two different directions, the payer and provider.
Craig Nishizaki: Great. Well, we’re excited to have you here, Byron. Deborah, how about yourself?
Deborah Roberts: Hi, everyone. I’m Deborah Roberts, the senior UX designer at UpTop Health, and I’ve worked on projects that range from designing an in-house quoting tool for a health insurance provider to improving the site structure and personalization for a leading app services company. So, through my experiences, I’ve seen the importance of balancing the needs of the customer with the needs of the business. And I find a lot of joy in helping our clients down the path that will show them the biggest impact. And I’ve found that customer journey mapping we’re talking about today is a critical exercise in helping to uncover those opportunities. And I’m excited to be a part of the discussion today.
Craig Nishizaki: Great. Well, I’m excited to have all three of you on the panel, especially since we’re going to have such a varied background with clinical health care delivery system, managed care, the business model, as well as the practice of UX. I think it’s going to be a really interesting conversation. I’m Craig Nishizaki, the head of business for UpTop Health and here’s our agenda for today. We’re going to go through an overview of health care as an experience industry talking about user experience and design thinking, and really focusing on journey mapping as Deborah mentioned.
And then, we’ll get into our panel discussion that talks about journey mapping and from each of these experts’ perspectives. And then we’ll wrap it up with the Q&A. And, as Tom said, if you have any questions, please feel free to add them to the Q&A on your interface there.
But to start, just to give you a little background on UpTop Health, UpTop Health is a user experience design and development agency. And our focus is on creating effortless digital experiences for health care payers, providers, and your customers. And UpTop Health is a division of UpTop, which was founded in 2000 as a software development and web development company. And in 2012, our CEO had an epiphany that great user experience was going to be a key differentiator for businesses. So, in 2013, he acquired a user experience agency and bringing those two practice areas together, the engineering and development, and the user experience research strategy and design allowed us to create this DNA around great UX, being the engineering of the entire experience, not just the design of the screens. Over those 20 years, we worked with clients such as Microsoft, Amazon, SAP, Disney, Starbucks, Belkin, Premera Blue Cross to name a few.
And typically we work with senior leaders that have an idea they think will have a material impact on their business. We help them articulate that vision and bring it to life. And it revolves a lot around identifying and reducing friction at key moments in the customer journey and applying design thinking and technology to reduce friction.
In 2019, our founder, our CEO experienced his second major medical event, and he had great care from his medical team and caregivers. But what he found was it was very difficult to navigate the hospital and insurance provider portals to schedule and coordinate things as a patient. And he said that health care needed to be better in realizing that our function or our background in UX, we could make it better. We launched UpTop Health in 2019.
So, when you think about health care today, health care is no longer a delivery industry. It’s now an experience industry. And what that means is that being focused on the experience is critical to providing care and outcomes. And Forrester Consulting did a study in 2018, commissioned by Adobe focused on experience-driven organizations within health care. And what they found is that experience-driven health care organizations generated tremendous results, results such as exceeding revenue growth goals by 1.6 times, seeing a 1.3X increase in customer advocacy, and improving customer satisfaction metrics by 1.9 times. And the key findings of this study were that experience-driven health care organizations focused on investments that build contextually relevant journey based on the customer’s needs. They derive insights from their customers and deliver digital experiences that lead to engagement and loyalty. They educate all their employees about their role in fulfilling that CX vision, because it’s not just the experience of that patient interacting digitally, but it’s the care they’re given, the scheduling, the coordination, the follow-up. All of those touchpoints are critical.
And then they pair rich digital experiences with strong culture of customer centricity, and they focus on user experience and design thinking as part of their culture.
So, just to give a quick definition of UX, user experience. If you think about your business organization, you have the business pillar, the technology pillar, and the design pillar. And UX sits right at the center. It’s really taking into consideration the requirements of each of those pillars and the constraints for which you’re working within and focusing on how to create the best user experience within those constraints and within those requirements, keeping the end user, whether that’s a provider, an employee, a staff member, or a patient at the center of that experience.
The challenges in health care are the complexity in terms of delivering a user experience and the customer engagement, it’s a omnichannel experience where they’re touching you physically, analog as well as digitally. There’s internal silos, the regulatory environment for which health care lives within, the cyber security concerns, the data and interoperability and transmissibility or transferability of that data, as well as the legacy systems. And unfortunately, legacy mindsets, a lot of times, are hindrance to improving that user experience.
Well, design thinking is a method and a mindset that we see health care organizations, experience-driven health care organizations applying. And it’s a method that was created by IDEO and taught by Stanford Design School as well, but more so than the method, it’s a mindset.
And the first step to design thinking is generating empathy. And to do that, there’s a number of different research methods to create this empathy for your end user, user interviews, user behavior monitoring and analytics, defining personas, and journey mapping. And today we’re going to focus on journey mapping as one of the methods. The key is to journey mapping that it’s not a set it and forget it activity. It’s a living, breathing activity because your health care journey is not linear. It’s very complex. A journey map is a visualization of the series of interactions that a person has with your company when attempting to accomplish a goal over time and across channels.
And that may change to what Katherine mentioned in her introduction during the pandemic, the way people engage with health care organizations changed and it was for no part of their own. It was out of necessity. But now, now that they’ve experienced remote and virtual care, now what? Now what? That’s kind of the new part of the journey map.
A journey map can be as simple as this with a horizontal axis and a vertical axis that’s filled in with actions, questions, happy moments, pain points, and opportunities across each of those steps or something as robust as this in terms of what it’s presented as, but as I stated earlier, the key is that it’s a living, breathing document, not just a piece of wall art.
Journey mapping helps in a number of ways, identifying gaps and issues in the customer experience, creating common goals and vision for the product internally, as you’re doing this. The exercise of creating the journey map is a cross-functional exercise and oftentimes the biggest wins, the biggest aha moments that we’ve seen are internal teams realizing what the other organization is going through to actually deliver care and see an outcome for a patient. Encouraging cross-discipline collaboration, creating empathy with and for the customer and understanding the relationship the customer has with the experience. So, these are all the benefits of journey mapping itself.
So, with that, I’d like to lead into our panel discussion. We have a series of questions that I put together and I’d like to start off with this question for Katherine, and then we’ll have the other panelists jump in as well. But Katherine, what’s your vision for health care and what are some of the digital transformation initiatives that you’ve been a part of?
Dr. Katherine Gergen Barnett: Thank you so much, Craig. And there’s so many things that you said that I would love to respond to, too, in terms of where are we now on our journey sort of going into year three of the pandemic and how does this relate to journey mapping? So, as I shared a little bit in my bio, I work at the safety net hospital and it’s really where my heart and soul have been. I’ve been sort of very lucky to both sort of be able to pivot out and think about big ACO questions, but also really be on the front lines, providing care for people from the very beginning of their life until the end of their life.
And so, my vision for health care very much aligns with that in terms of how do we keep people at the center of the care we deliver, but also be thinking about communities in which people live and their family structures, and sort of, I think a lot, especially in my patient population and the folks that I’m lucky enough to know historically, what are some of the traumas that people have experienced? What are some of their present day traumas? And really for us, Boston Medical Center, our motto that every single person would know who’s been there is exceptional care without exception.
So, really thinking about how do we ensure that we’re not just taking care of the medications for somebody, but that we’re asking and ensuring that they have enough food and that they’re in a safe place and that they’re, if they struggle with substance use disorder, et cetera, that they’re getting the care for that. So, that’s always really been our narrative.
Now I would like to take a moment to sort of overlay where we’ve had to pivot in thinking about who we are and where we come from in terms of delivery of care for the whole personal home community, social determinants of health, and thinking about digital transformation.
And again, really revisiting this key moment that all of us had March of 2020, as we are needing to go completely digital and really struggling with how do you do really good exceptional care, especially in the primary care sector. Many of us were also covering COVID floors with a population that traditionally doesn’t have access to good quality digital care, has never really used it. Many of our end users, our patients really didn’t have good internet connectivity. And we were doing a deep dive in terms of transformation saying, “Okay, well, what’s the issue here? We know that most of our patients don’t want to use video. So, what’s going on? Is it about connectivity? Is it about them not having a safe place in their home?”
I did a video visit with a father with three of his kids in the background who all had to be at home, too, doing school from home. And he was talking to me about suicidal ideation. So, how do we create safe places for people?
And then the third piece is how do we actually think about digital fluency for people? So, not just can I connect and is it safe place for me, but actually, do I know how to kind of pivot and can I bring in sort of the health care worker plus the behavioral health person plus the pharmacist?
So, the big piece for us has sort of been not only just asking those questions, but getting the data to support what our narrative needs to be. And then actually using that as policy leverage, to work with the state to talk about, “Okay, our patients need better connectivity and we need places. We need to start working in places like churches and libraries to create safe places where people can connect with free connectivity.”
And then the third thing is how do we actually create digital fluency with patients who speak all different languages and all different backgrounds? So, we are sort of on that journey, we’re on that transformative journey now. And so I actually feel it’s a perfect time to be talking about these journey maps, because as Craig said, you can sort of think about your linear line. And the fact is, is there’s all kind of aha moments and I’ll be sharing some other aha moments along the way as well, but really thinking about how do you square your transformation with what your vision is. So, thank you.
Craig Nishizaki: Yeah, that’s great. Thank you for that. And Byron, I’d love to see if you’d like to jump in from your perspective, with your experience from a different side in terms of the work that you’ve done. Can you hear us, Byron? All right. We’ll come back to Byron or you can always jump in, unless you’re on mute.
All right. Well, Deborah, I’m going to jump to another question, but I’m going to dive deep with you in a few questions a little bit more about the how-tos and stuff. But with that, I was going to ask Byron the second question, in terms of how has your organization leveraged journey mapping design thinking as part of your digital transformation efforts. But if he’s not available to talk at the moment, maybe we can have Katherine kind of add a little bit to what you had started with to give us a little deeper dive, and then we can have Deborah jump in as well with some of her experience doing design thinking and journey mapping with a payer.
Dr. Katherine Gergen Barnett: Absolutely. Craig, do you want to go to the next slide in terms of thinking about the aha moments so I can sort of use that?
Craig Nishizaki: Sure. Yeah.
Dr. Katherine Gergen Barnett: Yeah. So, lest people get sick of hearing from me. I’m excited to hear from other panelists, too. But, so I guess I just I’m really excited to hear where other people are on their journey mapping. And this really kind of continues with what I was sharing about where we are. We actually, and the digital transformation piece, we actually, akin to the sort of digital redlining. I don’t know if people have heard that term, but in Boston, it’s very clear where people, historically Black neighborhoods have been where people didn’t have access to loans from banks. And actually the housing had been so poor quality there, and then it’s perpetuated so many other inequities in terms of grocery stores and access to internet, et cetera.
So, that was not an aha moment because it’s like we’ve always known that, but then how does digital health actually overlay what we’ve always known about Boston in terms of redlining and how do those two square completely.
But the other piece that I wanted to share is, as Craig, and sort of thinking about that map that you had of marching out one way, and then in terms of the timeline and then the vertical access is really the themes for analysis. The piece that I wanted to share in terms of themes is around medical distrust. So, again, working where I work, we have mostly a very high population BIPOC patients for whom medicine has historically and present day never been or rarely been a safe place. And then you have the pandemic and the pandemic totally has exacerbated all kinds of feelings of mistrust, not just in BIPOC communities, but all communities, especially around the vaccine.
And I wish I could see everybody’s faces, because I’m just very curious where other people have been with this. But, I will say as we’re thinking about our journey mapping, and as we’re thinking about sort of going through value-based care and really kind of coming off the map with fee for service and saying, “How do we actually keep people healthy?” Well, guess what? You actually need to engage people. That very first step is, as you said, Craig is how do you engage people in health? And if you’re actually sitting in an excess of understanding that medical distrust has gotten worse than ever, before you even continue with your journey map, you need to do a deep dive on what’s happening with medical distrust.
So, that has really been for us, one of my big, big things that I’m saying, “Okay, this is not just an aha moment, but actually, we need to be working on this.” So, one of my grants that I’ve written on the PI on is getting together restorative justice circles. So, actually having people from the community with medical providers really talking about, “Okay, what kind of retribution needs to happen,” and share your stories and how people really listen now.
Let me get clear of this and then, I’m super excited to hear from you, Byron. So, we’re putting together these restorative justice circles to really talk about the historical roots in present day medical distrust, and then working, actually. We’re doing all kinds of storytelling narrative in the community, and we have a film that we’re just coming out with that I’m excited to pass along.
Craig Nishizaki: Wow!
Dr. Katherine Gergen Barnett: Maybe Marcus Evans can push it out as well, but we’re going to really be using it with trainees, like people in medicine who are just being trained and executives, and really hearing the voices of people who have kind of historically been harmed by medicine and sort of sharing some of their journey. So, in part, because there’s so many lessons, we’re all beginners on this journey map and all on the journey and just really kind of been humbled by those aha moments.
Craig Nishizaki: That amazing. Well, we’ll look forward to hearing more about that movie that’s coming out and the work that you’re doing in that area.
So, Byron, what we were just talking about is are there any aha moments or moments of truth that stand out to you from journey mapping work that’s been done at your organization, or that you’ve been a part of? And I’d like to ask you from your perspective on that and then have Deborah jump in as well, because I know from some of her work, especially on the payer side, there’s been some aha moments that we’ve discovered.
But Byron, I don’t know if you’re able to see the question, but if not, I can read it off to you again. Are there some aha moments or moments of truth that stand out to you from any journey mapping work that you’ve done in your organization in part of the work that you’ve been doing with digital transformation?
Byron Okutsu: Yeah, certainly. Yeah. I can see your questions and thank you. I think from a payer perspective, through claims and through, if we have a value-based agreement with an organization, there’s a fairly complete claim history, so you know what’s going on with them. But the notion that came up about social determinants, that hasn’t been there and I think that’s definitely an area that we got to really look at because that’s affecting their care in more ways than we can imagine.
So, looking at it from the provider perspective, digital care or telehealth. If it’s coming from the system, that’s great because that usually goes into the record and the big challenge for a system is are we capturing all of the information about the patient? So, you’ve got to make sure you’re connecting with your other partners in the network. And also getting, say, the digital care telehealth information within that record and actively work your continuity of care. And that’s easier said than done, because we can say, “Yeah, we discharge patient off to a nursing home, but then what happened?”
Another issue with the payer, they offer a lot of free or highly discounted telehealth programs that are very good, but the provider and your PCP are picking those up. So there are holes and areas that we’ve just got to work on.
And as it relates to journey mapping, okay, let’s stop, see where we are, and then what’s causing us from moving forward and where do we need to be? And I think MultiCare has done an excellent job with that. And then that they brought in an outside and partnered with an outside company that they’re now part of the same and really did a lot of education, really, and did a lot of sort of state analysis and continue to move forward. And then you’ve got to be able to bend as you go, too.
Craig Nishizaki: That’s great. Yeah. It’s interesting hearing that perspective.
Dr. Katherine Gergen Barnett: I just wanted to respond to Byron. Just, I totally agree with you in terms of the platform that health care systems has is often not adequate in terms of getting all of those, the appropriate people and the appropriate communication on. And that’s been a real frustration, I think, for us on the mapping and digital transformation and how appreciative we are of folks who are thinking big picture on this kind of work.
Craig Nishizaki: That’s great. Thanks. And Deborah, I don’t know if you want to chime in at all in terms of what you’ve seen from on the employee side, in terms of aha moments, as we’re thinking about it from the patient perspective, we’re thinking about it from the business perspective, and then there’s also some journey mapping work that you did for an insurance provider and the aha moments that they may have had along the way.
Deborah Roberts: Yeah, absolutely happy to share. So, we’re working with this insurance provider and they were exploring how they could evolve their current policy admin tool from, it was kind of a monolithic SaaS application and they were trying to move it to a more modern system that would improve their team’s workflow and communication and efficiency. And just kind of to share a little bit about our process, generally in our engagements with clients, we break down our project into four phases that are based off of design thinking.
So, for us, that’s discover, define, design, and deliver. So, in the discover phase we analyzed existing documentation and data. We did user interviews with folks who are using the tool to get a bigger picture of the problem space. And then in the defined phase, we generally run this workshop over a couple days that involve stakeholders from different parts of the business. And so, generally, we’re trying to bring together, we’ll have our main stakeholder, who’s usually a decision-maker or executive, someone from the IT side, the product owner, and then someone who’s representing the user or the customer.
We gather together this kind of cross-functional team and in the workshop, we lead the team through structured activities that helps to encourage divergent thinking where we’re encouraging participants to think big and outside of the box, and then convergent thinking where they focus in on what problem do we really want to solve right now? And the journey mapping exercise is just a really integral part of this process because it helps everyone to see the big picture and uncover questions, pain points, the emotional state of users as they’re engaging with the product and service at each interaction point.
So, going back to this project that we had, our main stakeholder was a VP and he previously hadn’t had much exposure to the day-to-day nitty-gritty details and interactions of that quoting process. So, during the journey mapping exercise, the different stakeholders and users were invited to dig into key parts of the user journey.
And then this main stakeholder was able to ask direct questions to the users about certain aspects of the flow and why they were needed. And especially with this quoting tool, there was a lot of back and forth between different users within the journey. And so, he was wondering why are all these back and forth kind of circles essentially needed.
And after the sprint, they noted that they had a much better understanding of their team’s workflow, their needs, and also the limitations of their existing tool. And then that made their following discussions and initiatives a lot more fruitful as they were trying to plan how to proceed.
And then similarly, the product owner noted that the process helped to bring team members along that were feeling maybe unsure about the upcoming changes and that now they were actually really excited about all the ideas people had to make the tool and process better.
Craig Nishizaki: Oh, that’s great. Yeah. Thank you for that. It’s helps kind of take things from a high level conceptual to the practicalities of the day to day. And it kind of leads into actually this next question that I think I’d like to start with Katherine following up on this, but the insights that you have gathered from your journey mapping and all the work that you’re doing, what have you done with those? How’s it impacted your patients, employees, partners, providers, payers, et cetera? I can start with Katherine and then have Deborah and Byron chime in as well.
Dr. Katherine Gergen Barnett: Well, first of all, I love Deborah’s description sort of the out and the in and really appreciate that. And actually, one of the pieces I think is really important and you touched upon as well, Craig, in terms of the journey map and this idea of so much of design thinking begins with empathy and sort of refocusing on that idea because I think that idea can get lost in a lot of the other ideas.
And so, how do we actually put empathy in the beginning of all of our journey maps and all of the work that we do with patients, employees, providers, payers, et cetera, and because I think we’ve lost that in a lot of parts of what we’re doing in health care and that’s a really critical part and tying that, and this does actually make a lot of difference for patients in particular, but also I want to add in that list of folks who are residents and medical students and people who are coming along the line in terms of what we’re doing for journey mapping now, and how we’re really talking about transformation of care will impact future generation of providers.
And so, how do we keep empathy and frankly emotional intelligence as the kind of key part for transformation? But I will, to circle back to this exact question to think about, for instance, the work that we recognize in terms of the digital redlining, how does that then work in terms of how we’re going to be impacting policies that come out the way that payers are going to continue to pay for telemedicine? Right now, there’s parity still between a video visit and a telephone visit. That won’t last forever. I know that won’t last forever, but how do we continue to make sure that we support our patients having access to videos in a safe and congruent way where they can really be getting care and advocating for their health and not just get cut off by the payers?
So, how do we think about actually working with the state in recognizing that our patients, what their patient experience is and putting those patient experiences and frankly, those empathetic moments out in front of employees and providers and payers so they recognize that it’s not just we’re on this road and we just need to keep delivering care and it’s business as usual. Actually, it’s not business as usual. Business has to change to accommodate people where they are.
Craig Nishizaki: That’s great. Thanks for that input. Byron, I’d love to hear your thoughts about any of the insights that your organization or organizations have worked with gathered from journey mapping and how did those impact the patients or employees, partners, providers, et cetera?
Byron Okutsu: Both payer and provider, one of the biggest challenges, I would say is making sure all your stakeholders are involved. And I love the idea of empathy in that how does it affect their everyday work? They may be coming in, as I say, oftentimes you’ll say, “Well, let’s experiment with this. And so, to add on to another job, but you really need to provide some focus and build in stakeholder communication and check-ins et cetera. And that happens with payers as well. Oftentimes, contracting doesn’t know what the population health team is doing and how they’re working with them, and then throw in utilization management prior off, and then it gets even muddier. So, that’s really key. And once you get through a lot of that, the care is only going to get better, because your coordination’s so much better.
Craig Nishizaki: That’s interesting. And actually it leads right into the next question. I’m going to put the next question on the slide up here and actually this, what you were talking about kind of builds upon that. So, what are the top three challenges that you faced in your journey mapping efforts within your organization? And Byron, I don’t know if you want to expand on what you were talking about in terms of making sure the stakeholders are all aligned. Are those internal stakeholders, or are you talking about internal and external? That would be really helpful to understand.
Byron Okutsu: Well, it kind of started internally and let’s say with a provider organization, your providers really needed to get a good understanding and get on board. It does take extra work and hopefully you’ve got staff that you manage a lot of that and use HEDIS measures as an example, or making sure that you’re covering all of your preventive measures on an annual exam. And then obviously that contracting nursing data and financial analysts that are making sure that everything is clean and that sounds kind of structural, but there really is a personal side of that because you’ve got to make sure you’re all in sync. And then that just carries over to their relationship with the payer. And problem is they’re looking at mostly the same thing, but they’ve each got a different way of doing it.
And that creates a big challenge in that if you’ve got six payers with value based or shared savings or capitated contracts, you’ve got six different methods you’ve got to try to work with the payer on. And I think that’s something the payer industry needs to really focus on. And I’m not sure what the … It’s just a big challenge to manage that. And what I’ve seen is, okay, we’re only going to limit our value-based agreement with the three payers or four payers, but not with everybody that comes to us, but what about a new payer in town that really has some good ideas? And I don’t want to work with them, but we don’t have the volume, but we don’t have the membership with that payer. So, it’s a dilemma.
Craig Nishizaki: Yeah. It sounds very complicated, very complex. Katherine, I see you’re nodding as well. What are three challenges that you faced in your journey mapping efforts within your organization? Then, I’ll ask Deborah the same question.
Dr. Katherine Gergen Barnett: Yeah. I wanted to respond also to, I was nodding vigorously around the payer conversation and in terms of the lack of congruity between one payer and the next, and just to say that there’s a group of us in Massachusetts that are working with the state to actually try to create sort of a larger fund for primary care transformation that all payers would be sort of payer blind, but it’s herding cats literally to try and get all the payers engaged in something like that. So, I would absolutely agree that I think that that is a huge challenge and I think that probably a challenge that so many of us are experiencing right now is sort of where do we need to go and also what’s the reality at the moment?
So, the discordance between all hands on deck. Oh, my gosh! Here’s Omicron. And we’re kind of buckling in for another set of reactivity versus proactivity in terms of changing our health care landscape. That is absolutely, I think something that everybody in this moment is experiencing, but I would say in terms of journey mapping, that’s been a massive challenge.
And then the third thing is Byron also touched on is sort of how do you make sure that all people are on the same page in terms of what the top priorities are and sort of getting empathetic buy-in for those top priorities?
Craig Nishizaki: Yeah, that’s great. Thank you. And Deborah, I think what’s interesting is the perspective that you bring is as the practitioner, the facilitator leading these efforts from outside-in perspective, love to hear what you’ve experienced as challenges as you’ve done journey mapping with clients.
Deborah Roberts: Yeah. Thank you, Craig. Well, I think health care is particularly complicated. There’s many interlink journeys, especially smaller ones that are part of large ones. And then there’s a personal component that you all have been talking about like social determinants of health.
So, I think just making sure in the very beginning that you’re starting at a place of empathy with research, doing the user interviews, doing qualitative research to understand the why of your problem so that you’re making sure that you’re actually understanding your users and where the problems exist.
And it’s also a great practice to kind of take smaller bite-size pieces of journeys that maybe it’s not too overwhelming. That’s one approach you can take. And then to maybe focus on a specific goal that a user is trying to accomplish. So, if the goal is too broad, you could try reframing it.
So, for example, instead of saying a patient wants to be healthy, reframe as patient looks for health and wellness providers so they can live a healthier lifestyle. So, framing it in this way kind of helps to narrow your focus. So, it’s easier to tackle.
Another complexity, I think is that there’s just so many personas. There’s the relationship between providers and patients, the relationship between payers and patients. And then there’s also the relationship between payers and providers. And as you were just talking about, that can be very different from payer to payer, provider to provider. So, there’s a lot of things that change. And so again, kind of looking at the specific goal that you’re trying to accomplish, and you can start by asking yourself which of our persona groups with this have with largest impact on? That kind of gives you a place to start.
And then, the design process is also iterative. So, you want to circle back to your other personas to evaluate how they would engage with this particular goal or flow because improvements for your smaller groups or edge cases can lead to improvements for everyone.
And then lastly, sometimes I think it’s hard to know what opportunity to focus on. The journey map is great at identifying a lot of problems sometimes and a lot of opportunities. And so, then it’s like, “Well, where do you start?” One exercise and I’ll try not to get too in the weeds here is that we do an exercise called how might we questions when we do our workshops with clients. And so, you have your cross-functional teams together and you’ve invited them to kind of dig into the journey map and flow. And while that’s happening individually, you can take the pain points identified from your journey map and create how might we questions.
And this helps to frame the opportunity and make sure your problem isn’t too narrow or too broad. So, for example, someone might share that customer service is getting a lot of calls about provider information and availability. So, then that pain point could be translated into how might we show provider availability in details? This gives you something that you can then move into ideation. And so, after we’ve had everyone generate all these how might we questions, we’ll group them by theme and an affinity map, give people the chance to vote on which question will helps get them closer to their goal for this particular initiative. And then we incorporate those top voted how might we questions back into the map. And then you’ll have the decision-maker or executive pick which ones to move forward. And we’ve found this process is really great because it’s collaborative. So, everyone feels like they’re are a part of it, but it also gives you a focus and really tying it to your kind of key business initiatives. And it’s just a great way to kind of get things moving along.
Craig Nishizaki: That’s great practical advice. I appreciate that. We’re getting toward the end of our time in terms of needing to spare some time for Q&A.
So, I had a couple more questions I was going to ask you all, but I think I’d like to ask some of these Q&A questions of you. And I guess to both Katherine and Byron, is the activity of journey mapping new to health care? Is this something that you’ve been doing for many years, and now it’s just more formalized? Love to hear your perspective on that from both of you.
Dr. Katherine Gergen Barnett: Byron, you want to go first?
Byron Okutsu: Sure. I guess that’s kind of an aha moment in that when we embark on and I’ve done this with three systems, when we embark on this process. Just out of necessity, we’ve had to look at what is our current state and then what do we want to get to? And then throw a lot of effort and some program management, et cetera. But, what we’ve done is we’ve done it on the fly. We’ve just doing it, trying to figure out on our own. Sometimes there are plenty of consultants out there that’ll come in and say, “You got to do this, this, and this.” And that’s good, too, but I think formalizing the process and bringing in either an outside firm or a partner, an ACL that’s done very well to kind of help guide you through the process I think is more effective. But, again, like I said before, it was on the fly. And now I think, now that we have more of a structured way to do it, I think that it’s a great start of a good solution.
Dr. Katherine Gergen Barnett: Yeah. And I would really echo, I think what you were saying, Byron is sort of this idea of on the fly and one of sort of prior to this, I actually say sort of this vertical access, again, of thinking about how you change through time is really not new in health care. What I really like. I apologize. That’s a horizontal access. What I really think is different is the vertical access and really thinking about the themes for analysis.
And Deborah, I really love the way you talked about qualitative research. That has been sort of verboten in medicine for so long. And it’s a huge part of what we need to be doing. And a huge part of what the research I do is qualitative, because that’s where you get the aha moments. That’s where you get real voices that represent where the journey map needs to go, rather than just thinking about this horizontal piece is how do you actually flesh it out and what’s going to make a difference? And I think that is what’s different in health care. And certainly not used globally, but with real potential to be used broadly.
Craig Nishizaki: Well, that’s great. Okay. And another question that came in that I think is really relevant is how do you bridge the gap between insurers and health care providers to ensure that digital transformation occurs across the entire system? And this, you may not be able to answer this, because that seems that’s the question of questions of all history.
Dr. Katherine Gergen Barnett: Beholden, right, right. Yeah. A challenge.
Craig Nishizaki: The pinnacle of all questions, yeah. But is there some steps that could be taken in terms of the work that you’re doing, the connecting providers and insurers in this process, because it seems like that’s a big disconnect.
Dr. Katherine Gergen Barnett: I’ll just chime in quickly.
Byron Okutsu: Yeah. Exactly what I was going to ask you, Katherine.
Dr. Katherine Gergen Barnett: Yeah, yeah, yeah. Well, look, I think, as you alluded to, Craig, if we knew that, health care would be a really different place than where we are right now, but I think part of it is on both sides. Well, for the payer side is just greater transparency. In terms of thinking about where are they? What’s their journey map? What are they thinking about? What are their biggest goals besides sort of the bottom line? Because I think that really would help for providers to understand that. I think providers often having to react to payers in all kinds of ways and even just can you send flow vent today or no? What’s getting covered today?
And then, I think for the payers to actually come spend time with providers, get in the trenches and understand, be part of that journey mapping with health care systems and really be thinking about where the provider’s aiming and how can payers support that in terms of the value base and health care kind of outcomes that we’re all hoping for.
Craig Nishizaki: That’s great. Byron, do you have anything to add to that? Or I have another Q&A question that came in.
Byron Okutsu: Yeah. Well just, yeah, quickly. It is money, but to retain the groups, to retain their members, they’ve got to do a better job of communication and getting close and transparent with their providers. I think the challenge for our provider is how many do I deal with and what kind of time do I have? And Katherine has mentioned some type of perhaps maybe some repository of HEDIS information or some type of things that’s more common. So, we don’t have to tailor it to every payer from a provider standpoint.
Craig Nishizaki: All right. I’m going to have two last questions just because we’re down to our last few minutes, but this one came in from Julia. “In conducting journey mapping, are there particular UX areas or functions that you most commonly identify as hazards to creating friction in the patient or customer experience?”
And I’ll give this one to Deborah and I think just to frame it, the some of the things that we’ve seen are when two groups come together in a merger or an acquisition and they have two separate EHR or EMR systems and depending on which clinic you’re going to, you’re having to be a part of one or the other medical record systems and they’re trying to merge that information, or the fact that when you go to a provider and your insurance payer is separate, that it’s still part of your journey, but you’re having to deal with different entities throughout your journey. Just at a high level, those are some of the areas of friction.
But Deborah, are there any other things top of mind? And we could also follow up with Julia in a more detailed response, but the question is in conducting journey mapping, are there particular UX areas or functions that you most commonly identify as hazards to creating friction in the patient or customer journey?
Deborah Roberts: Yeah. Well, I think the examples you gave, Craig, are really relevant and really good. I think, too, just going back to what you were talking about at the very beginning of this is that the health care is really an experience industry now and people come in with the same set of expectations that they want their experience to be like any other online experience or in-person experience, whether that’s an online retailer or an online financial institution. So, they come in with these expectations. And then there’s the whole personal side that we’ve kind of had been talking about throughout this conversation, the social determinants of health and all the things that are happening in our personal lives or our personal situations that are impacting how we can access care. And so, if there’s a lack of research there and understanding, there’s a lot of people that are just getting left out.
So, I think a couple things. Again, as we’ve talked about, making sure starting with research and you’re not just assuming what the problem is. Because a lot of times, we might think we know what the problem is. We might have some assumptions and they might be right, but until you actually go and talk to your users and your customer base, really don’t know the whole picture.
And then, I think again, because of the complexity and the inner workings between the payers and providers and the patient. They’re interconnected and that whole experience really should be reflected in the journey map.
There’s another process that I’ll just mention quickly. To take things a step further, you could always do a service design map. So, that way you’re looking at not just the outward facing touchpoints that your customer is experiencing, but you’re looking at the internal systems and processes and you’re actually charting that out on the map and you could look at how that’s going back and forth between the provider and payer. And that provides a way to actually try and make things more manageable because it’s such a big journey. So plotting it out really helps to see how to move things forward.
Craig Nishizaki: That’s great. Thank you, Deborah. And just to wrap things up, because we’re at the end of our time, I’d love to hear from each of you a pro tip that you have, whether it’s journey mapping or related to understanding your patient population or empathy, et cetera. So, we’ll start with Byron, we’ll go to Deborah, and then we’ll go to Katherine to wrap things up. A pro tip.
Byron Okutsu: A humble self-assessment of your organization. Get power and politics and things out of the way and have organizations like yours frankly come in and other organizations or individuals that are experienced in the field and have gone through the process. And it is evolving. It will continue to evolve. It’s not just one point in time. You’ve got to figure that stay in it, you got to keep moving.
Craig Nishizaki: All right. Thanks, Byron. Deborah, a pro tip.
Deborah Roberts: Yeah. Well, I would say definitely to start with the cross-functional team. I think that’s so important. It leads to greater insight and collaboration and really helps to move your initiative forward. And then lastly, just to make sure you revisit your journey map. Once you created it, you shouldn’t just put it on a shelf because things are always changing, your personas are changing, the world is changing. So, just revisit it to see if it needs to be revised or refreshed.
Craig Nishizaki: That’s great. Thank you. And Katherine, how about yourself? Pro tip?
Dr. Katherine Gergen Barnett: Yeah, I really, I feel like the words Byron said really echoed with what I was going to say in terms of humility and allowing yourself to really see what’s there versus what you want to see and knowing that sometimes you just have to start over and that’s okay because you’re building towards something even more effective.
Craig Nishizaki: That’s great. Well, I want to thank all three of you for your insights, your expertise, your experience, and sharing that with everyone. This has been great and I’ll turn it over to Tom for the wrap-up, but for anyone that’s interested in gathering more information about journey mapping, envisioning, design thinking, you can come to our website at uptophealth.com. We have a number of articles, resources, and webinars that we’ve put together focused on how to help the health care industry evolve and change and create more effortless experiences for patients and customers. So, with that, I’ll turn it over to Tom.
Thomas Fullwood: Brilliant. Thank you very much, Craig. And thank you all for sharing these great insights and being so generous with your time today.
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