How can an intelligent health ecosystem create a smarter health experience?

Delivering smarter health care and well-being at scale is immensely complex, especially in an industry with multiple players and one that, until the COVID-19 pandemic, was notoriously slow to change. As digital transformation within the health care system gathers pace, smart ecosystems will need to emerge and create new pathways by which to organize and deliver health care. These ecosystems will be built on these elements:

1. Co-creation and iteration

Recognizing the complexity of having all elements work together in an ecosystem, several people we spoke with stressed the need for co-creation with users and a willingness to iterate rather than to get it right the first time. Systemic design and architecting for expected future changes in health care, such as being able to incorporate emerging fields of ‘omics data, are important. As Daniel Kraft notes, “If we build a platform in 2021, it may not be the platform that’s going to work in 2030, but we need to architect it so that it’s somewhat future-proofed.”

The health system needs to evolve from the current situation of siloed point solutions. Apps, wearables, devices and portals bring multiple digital touchpoints that can create even more noise in an already complex patient journey. Sam Marwaha, Chief Commercial Officer, Evidation Health, points out: “A world in which there are thousands of apps is not friendly to an individual. The answer to engagement lies in building better platform environments that support the individual’s health journey.” He suggests that a better solution for the industry overall is for something like a “Spotify for health care” to emerge as an enabler of the underlying platform, explaining: “It’s a clearing house, to a certain extent, for generating evidence-incorporating measures that matter to patients, validating it in the right sort of way, and then making that evidence actionable at the point of intersection between the clinician and patient.” This requires the health industry to move away from facility-centric models to evidence-supported management plans based on person-generated health data.

2. Comprehensive platforms

Different types of platforms are emerging in response to key areas of demand, such as convenience care, specific condition management, virtual telehealth, integrated virtual and physical care, and retail health.

The digital front door, or one-touch digital entry points between a consumer and a health system, is a natural fit with platforms orchestrating a network around the person. Digital front doors present a gateway to connect and stay with the patient throughout his or her journey. They also enable a more flexible clinical model — one that shifts care to the right type of provider at the right time, as organizations use AI to adjust clinical staffing models based upon need and demand surges. “Platforms are really, really, really important. But they'll fail without having the right governance,” says Rachel Dunscombe, CEO NHS Digital Academy.

3. Creative partnerships

Industry executives saw that orchestrators of smart ecosystems may well come from outside the health industry (e.g., global brands running digital platform businesses). Partnerships are already emerging between consumer, tech or electronics companies and leading health industry players that blend the technical capabilities of one partner with the service and health care expertise of another. Daniel Kraft drew an analogy with an orchestra, saying that the challenge was to, “create an orchestra with interchangeable bits … and get the big players and small players to tune up in the same key.”

4. Solid governance

Governance systems that deliver trust are seen as a critical success factor. In particular, good governance around how platforms capture, store and give access to data is necessary to establish user trust (both consumer and clinician) and for privacy and security to be maintained.

As the focus of health systems moves toward supporting wellness — anytime, anywhere — an open platform environment is required to connect and share permissioned data, at scale, within and among enterprises and systems. An open platform is one that “separates content and technology and is vendor neutral, distributed and modular.” ³ Types of platforms that are likely to become dominant in the future will include several key features of a technology architectural infrastructure, an analytics and intelligence layer, and a user engagement interface.

The patient experience moves from siloed systems with little ability to share information to a cohesive technology stack and a networked infrastructure that delivers a unified experience.

“When I think about a super-platform that supports care for life … it must have contextual intelligence to meet the customers’ expectations and care needs,” says Kristi Henderson, DNP, SVP Center for Digital Health & Innovation, Optum, United Health Group. “How we use the data and the AI applied to it must be balanced and masterfully orchestrated with human interaction and skilfully placed automation to build a trusted relationship with ongoing engagement.”

Central to this shift: Interconnected ecosystems

As health care becomes smarter, the industry will transition from siloed and transactional to one where all elements of the health care ecosystem work in concert. Technology in all of its various forms will create common platforms to provide advanced support across all tasks and insights relevant to a clinical encounter or patient journey. Ecosystems that connect all players of relevance to a patient are built upon advanced architectural integration of data and intelligent analytics of that data to create informed insights to manage care. The intuitive nature of data supports the application of AI and machine learning to truly predict the right treatment protocols, what keeps people healthy and what will nudge healthier behaviors.

Policy and regulation deliver the essential checks and balances of good governance necessary to underpin a connected ecosystem. As connectivity becomes more central to health care, regulators will continue to take a strong stance on the need for interoperable yet secure data, including ensuring that consumers have control over their health information. Gaining consumer and clinician trust is critical, particularly when it comes to the safety, validity and integrity of the data generated.

What this shift means:

Platforms form function al ecosystem(s) to deliver network effects, value and benefit in new combinations of the growing web of industry stakeholders: providers, payers, new entrants and others, such as financial institutions, housing, employment and social support services.

As a result:

A highly interconnected health ecosystem providing a superior user experience that accommodates individual preferences, uplifts the end-to-end experience and connects across the care continuum. Health, wellness and prevention are optimized through personalized therapy that is data driven.

As the health care model changes from siloed to patient-centered, digitally enabled and demand-led, there will be growing pains: persuading consumers, clinicians and those charged with governance to adjust business and clinical processes to get the right care delivered at the right time, all of the time, in ways valued by the consumer.

Kristi Henderson spoke of the importance of long-term trusted relationships that are the foundations of personalized care. Drawing upon a care team’s shared knowledge of an individual and their personal network is how N of 1 interactions can become scalable. However, as she says, “It’s common sense but it’s not done because it’s hard and takes a lot of work. It’s an intentionality that’s not built into our operating model which is based upon appointments 15 minutes apart.”

Knowing the unique customer and enabling him or her to define preferences heightens the importance of design thinking in improving the clinician and consumer user experience across health care settings. Daniel Kraft emphasizes the importance of simplification, saying, “People don’t always want to be reminded of their health or be bugged” and that, for clinicians, “No one wants to jump through a bunch of hoops to collect data … the clinician wants insights and actionable information, not just raw sleep data.”

Several people spoke of issues with user experience in health care, especially about complex health IT systems. Transforming the experience is not just an issue of end-user satisfaction. It is achieving the right balance between users customizing how they consume information and the safety net of standards.

Rachel Dunscombe describes this well:

“We can't infinitely personalize and remain safe. What I’m asking for is both standardization and variation at the same time. Standardization to a set of ways of working, for example how blood pressure or renal function are displayed. But then personalization for the clinician to match their operating practices such as how they arrange the widgets on the screen to consume that experience. It's that combination of warranted variation that gives a great experience and standardization that brings safety.”

To this end, co-design with clinicians, patient and consumer groups is a hallmark of human-centered design, designing with and for people. The best outcomes arise through a participatory co-design process, where health care consumers and workers imagine what a better experience could look like for everyone.⁴ For example, co-design can focus on elements of education, access to data, interpretation of results and predictive insights to improve well care. In addition, agile design of smart buildings and virtual services, including modular facilities, hardware, software and networks, is required to meet future demand as new technologies, innovative new care models and different ways of working come into play.

Measuring consumer centricity

Increasingly, patient experience is a central outcome for health care organizations alongside clinical effectiveness and safety. Measuring and improving patient experience are vital steps in understanding and improving the quality of care. Value for organizations arises through clinical processes, along with a robust business case that links patient experience to financial performance, brand and reputation, patient loyalty, and employee satisfaction and retention.^{5, 6, 7, 8}

Industry executives hold a strong interest in understanding experiences in the moment, as well as customer trust and loyalty. The generation of trust is important for brand equity and reputation, and for how consumers make decisions on where to seek care.

The customer experience metric, Net Promoter Score (NPS), is used by many interviewees; however, the NPS is only one measure used to gauge consumer experience. Other measures used included customer satisfaction surveys, mystery shopper research and benchmarking performance against peers.

Some organizations track whether patients are using the digital tools provided (e.g., hospital apps, remote monitoring or patient portals). This is important for clinical reasons but also for future data mining of customer activity, customer preferences and creating more finely targeted experiences for patients. Looking outside of the health industry to see how others are evolving how they look at and measure trust (such as financial services) may be one way the health industry can continue to evolve how it understands and builds on improving patient trust.

The advent of digital health at scale raises the bar on consumer engagement and loyalty. Patients value the interpersonal aspects of their health care experiences and need a reason to stay, especially in a digital health ecosystem where switching becomes easier. Digital tools make it easier for consumers to find alternatives and switch to get what they want. This raises interesting issues around the cost of switching — to what extent does exceptional service counter the attractiveness of care that may be cheaper or easier to access?

Central to this shift: trusted technology

As health systems become highly digitized and connected, integral to this is the circle of care or the personal trusted network that keeps people healthy and well. Technology is an enabler rather than the end game. It is the experience component that ultimately makes it possible to deliver better, smarter care. If experience is not thought about up front, then pockets of success are likely, when what is needed is wholesale improvement.

Other factors demand attention, such as who pays for experience — the consumer or the payer? Or should the provider regard it as a cost of doing business? Another key factor is finding the right blend of talent with the skills and capabilities to support a data-driven, consumer-centric smart ecosystem.

What this shift means:

The central role that health and wellness plays in people’s lives shows that the route to better health is through individualized and targeted treatments rather than a one-size-fits-all approach.

As a result:

Health systems invest time in bringing people together with the technologies and move from being digitally naïve to engaging and empowering consumers and clinicians through health and well-being as an everyday-lived experience. 

A vision of a better, more engaged health industry

Leading industry executives share a strongly held vision that, in the future, health care will reorient around a truly shared sense of purpose between the consumer and the health enterprise.

EY’s view is that industry transformation will be built upon innovations and interconnected ecosystems that all work in concert to make health care simpler and more seamless. This is especially true for those that succeed in gaining and sustaining consumer engagement with their health and wellness across their lifespan.

It is clear that what makes for a good health experience is highly nuanced, and the creation of trust between the consumer and health care organization is foundational. Trust has to be earned, through close and supportive relationships that drive deep engagement and are built upon great experiences. Rather than just delighting in the moment, a systematic approach to deeply understanding what matters to people is instrumental in getting the health experience right. To this end, measuring and innovating to improve the consumer and clinician experience are key to enhancing the quality of care and to capturing data for more finely targeted N of 1 care built upon activity, sentiment and preferences.

We are well on the way to creating a digital-first health experience and weaving digital into every aspect of an organization. As such, smart health ecosystems of networked platforms will level-set the health industry in a new space, completely recasting the connectivity between the consumer and health and social systems. For health care organizations, this means reimagining the value proposition around trust and experience-driven engagement in a technologically advanced environment, building a future operating model around a digital-first approach to patient and clinician experience, and enablement of the back office.

Health care will not be transformed overnight. However, opportunities to initiate disruption abound through targeting areas where a focus on experience will make a big difference for the consumer and clinician. Most important is setting sights on the far horizon. Future-proofing through design means avoiding being locked in by the constraints of the business of today. This has only been accelerated by the impact of the COVID-19 pandemic, taking years off the technology adoption timeline.

Internationally, steady progress is being made toward creating ecosystem-style infrastructures built around the timely and relevant exchange of health data. Steps are being taken toward more open and interoperable systems in Estonia,⁹ the Nordic countries¹⁰ and most recently in England.¹¹ While the health models vary, a commonly held vision is that of data that is sufficiently liquid to flow through the system. This data underpins integrated care platforms that incorporate social determinant, sensor and wearable data, along with health information into algorithms, making personalized, smart care experiences possible.

Sheryl Coughlin, PhD, EY Research Consultant and Lead Writer, contributed to this report.