In Malcolm Gladwell’s 2000 book, The Tipping Point, he describes the advancement of “social epidemics” where a slow and steady adoption of a new cultural phenomenon or technology innovation suddenly hits an inflection point which is followed by massive adoption seemingly overnight. The innovation is compelling, or “sticky” per Gladwell, and once enough people have it, everyone needs it to fully participate in business or culture.
In this current pandemic, we are witnessing accelerated shifts in technology adoption spurred by the societal accommodations required by the virus (fear of contagion, shelter-in-place). Contactless payment systems such as Apple Pay, Google Pay, and Venmo are seeing huge growth (the rate of consumers that now consider contactless payments as required method is almost 50% higher than before the pandemic)¹. Zoom’s explosive growth during the crisis has been well-documented as it has become the social network of the pandemic² as business meetings and family reunions all move online. Before COVID-19, about 10% of retail was online³ whereas in the month of April, online spending had increased by 50%.⁴
These are innovative technologies that are stickier than the traditional approaches. Making payments via Apple Pay or PayPal is quicker, easier, and cheaper. The costs in time and money of getting on a video conference are minuscule compared to getting on a plane. Amazon has a vastly greater selection and comparable pricing versus brick-and-mortar, and you can shop when and where you wish.
Where convenience, efficiency, and costs were the traditional drivers for the steady growth of these innovations, the pandemic’s introduction of safety as a primary driver is pushing adoption past the tipping point.
Healthcare has been way behind other consumer industries in optimizing the consumer’s online and mobile experience. Healthcare is standing on a street corner futilely hailing a cab while others monitor the progress of their personal Uber or Lyft.
Everyone’s had the experience of showing up for a scheduled appointment 15 minutes early (as directed). You spend those 15 minutes waiting in line and then filling out endless clipboards of information by hand, answering the same questions you answered during your last visit. You wait another half hour to receive financial clearance as the front-office person logs into portals and/or wades through your insurer’s voice menus. Finally, you see your doctor who orders tests or refers you to a specialist and the process starts all over again at another office that can’t find your order or referral. And all this happens while you continuously wait.
Solutions and technologies that improve this experience are available—they’re just waiting to be utilized. Patients can check-in through a mobile app and, with a text alert, walk right in to see the physician or lab tech. Patients, using self-service registration and scheduling, can be financially authorized well in advance via resources augmented by automation. Orders can be digitally transmitted to labs and specialists.
Significantly, all these advances not only improve the consumer experience, they also greatly increase the efficiency of the healthcare provider by lowering administrative costs and providing new revenue and upsell opportunities. The digitally connected consumer can be reminded about scheduling wellness visits, or even asked in a pop-up (as happened to me recently) if they would like to receive a COVID-19 antibodies test when checking in for blood work at a lab.
There are significant benefits for both the consumer and the provider, yet adoption across the industry has been slow and steady, lacking inertia in many cases. It requires investments in processes, workflows, training, patient education and governance, along with technology. The status quo works, albeit poorly, and many health systems are primarily focused on fixing that which is truly broken.
The pandemic however has changed this equation seemingly overnight.
At R1, we provide revenue cycle services for more than 750 hospitals and 27,000 physicians. Our Patient Experience (PX) solution unifies the consumer financial experience into an efficient self-serve model with online, mobile, and kiosk functionality. Through this technology and operational processes, patients can plan and pay their costs for care, register (with previously entered information defaulted), wait for financial clearance and check-in to their scheduled appointments from their homes or car, and then receive a text alert when a physician is ready to see them.
The COVID-19 pandemic provided the mandate to reassess how this solution could be utilized from the lens of patient safety and social distancing. Patients today are avoiding all but the most urgent care issues, largely because of the widespread postponement of elective procedures and the fear of a nosocomial infection of COVID-19. Our PX solution is a critical resource for hospitals to have amidst COVID-19 because it allows for a contactless healthcare financial experience that eliminates the time a patient spends in waiting rooms for scheduled visits and procedures.
This reassessment of PX during COVID-19 identified an opportunity to expand the solution in two key areas: 1) greater protection of R1’s registration employees, and 2) minimize contact for patients that did not register in advance (as usually happens for unscheduled visits -- ED and walk-ins). We tweaked the workflows to allow R1’s employees to safely perform the back-end registration processes remotely (at home or from a safe room). Patients are greeted with signage giving them instructions on how to complete their registration and check-in over the phone or through mobile which includes a new integrated chat feature. They can then wait outside the waiting room and receive an alert when they are ready to be seen. For a detailed explanation of these improvements in remote registration, read our recent blog post, Rapid Innovation: Remote Registration Ensures Patient and Staff Safety During COVID-19.
The pandemic has led to dramatic adoption of the PX solution. Before March, it was deployed at 89 of our customer check-in locations with a plan to complete a steady roll-out over the next year. Once the pandemic hit and the need for self-service escalated, we were able to compress this one-year roll-out to just two weeks. By the end of March, we had 276 sites up and running – a truly remarkable accomplishment. This included brand new surge locations setup by our customers at sites in Michigan, a region hit especially hard by the outbreak.
The adoption of this solution by our customers’ patients has been even more dramatic. Before March, under 2% of patients leveraged remote check-in. Today, 44% of our patients are completing their check-in remotely. This is growth of more than 2,000% in just over two months.
Like Zoom, Paypal, and Amazon, digital healthcare stocks are surging⁵. Consumer expectations are constantly growing and the market must keep up to remain competitive. COVID-19 is a huge catalyst, raising the bar of what an acceptable consumer experience looks like.
As health systems open for elective procedures, there will be tremendous competition to capture market share to make up for the losses of the vacuous 2020 spring. However, the fear of contagion will remain with patients, and they will be vocal and support providers with a contactless, no-waiting room experience. Most health systems recognize this, and plan to rapidly deploy this functionality if it’s not already in place.
This massive, immediate adoption will drive the tipping point for self-service. While it has been extremely “sticky” during the pandemic for safety reasons, this technology will continue post COVID-19, because — guess what — no one ever wants to sit idly in a hospital waiting room. There’s pent-up demand to go back to restaurants and concerts; however, no one will be eager to go back to clipboards and stacks of four-month old magazines.
Moving forward, in my opinion, mobile check-in will be as business critical in healthcare as it is today in airline travel. These features will no longer differentiate but will be table stakes that are required in an increasingly competitive healthcare marketplace. Amid the many societal shifts precipitated by this unprecedented pandemic, it is nice to anticipate the development of a healthcare experience that finally is closer to what we see in just about every other consumer industry. There’s no going back. And truly, it’s about time.