Kate Grey, Vice President, Strategic Marketing Maggie Ozan-Rafferty, Chief Experience Officer

Tweets, Likes, and Comments: Leveraging Social Media as a Patient-Experience Indicator

• One of nation’s largest health care systems – Fifth-largest hospital system

– Largest not-for-profit hospital provider in Calif.

• Headquarters: San Francisco • 55,000 employees, 9,000 affiliated physicians

About Dignity Health

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• The Changing State of Patient Feedback • One health system’s story: Leveraging Online Patient

Experience Information • The Future of Patient Experience

Agenda for today

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How will you select tonight’s dinner options?

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• We’ll ask you for your input, observations and ideas throughout

• Want to tweet? #hcsm #beryl15

Social media is about dialogue

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Let’s talk about health care and change

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©2014 The Advisory Board Company • advisory.com • 29385A Source: Experian Marketing Services, “Cross-Device Video Analysis,” April 17, 2014, available at: www.experian.com; Manjoo F, “Comcast vs. the Cord Cutters,” The New York Times, February 15, 2014, available at: www.nytimes.com; Health Care Advisory Board interviews and analysis.

Paying for More Than You Use “This is the battle hymn of the cord cutter: You are paying too much for television, and you aren’t watching most of what you’re paying for.”

Farhad Manjoo, The New York Times

U.S. Households With Internet But No Cable, 2013

6.5% U.S. Adults Age 18-34 With Netflix or Hulu But No Cable, 2013

18.1%

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Revisiting a Tenuous Business Model

Most Hospitals Staying Afloat Through Cross-Subsidization Traditional Hospital Cross-Subsidy

©2014 The Advisory Board Company • advisory.com • 29385A interviews and analysis.

Source: American Hospital Association, “Trendwatch Chartbook 2014,” available at: www.aha.org; Health Care Advisory Board

149% Hospital Payment-to-Cost Ratio, Private Payer, 2012

86% Hospital Payment-to-Cost

Ratio, Medicare, 2012

Commercial Insurance • Above-cost pricing

• Robust fee-for-service volume growth

Public Payers • Steady price growth

• Only one component of our total business

Below Cost Above Cost

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Coverage Expansion and the Rise of Individual Insurance

Activist Employers and the Primacy of Value

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2

3

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The Retail Revolution & Rise of Consumerism

Four Years Post-Reform, New Paradigm Finally Becoming Clear Major Themes Reshaping Provider Strategy

Medicare Reforms and the Transition to Risk

• Employers • Insurers • Managed-care organizations All changed with ACA and insurance exchanges • By 2017, nearly 1 in 5 Americans will purchase benefits

from private exchange

Historical wholesale decision makers

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Private exchange enrollment growing

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1 2014 2015 2016 2017 2018

Public vs. Private Exchange Annual Enrollment

Public Exchange Private Exchange

Source: Private Exchange: Accenture analysis, based on data from: U.S. Census, Bureau of Labor and Statistics, Kaiser Employer Health Benefits 2012 Annual Survey. Calculations exclude post-65 retirees and individuals.

Public Exchange: Congressional Budget Office 2013 Estimate of the Effects of the Affordable Care Act on Health Insurance Coverage, CBO’s February 2013 Baseline, depicts average monthly enrollment, including spouses and dependents for individual and SHOP.

Enro

llmen

t (m

illion

s)

0

10

20

30

40

50

15

27 30 30

9

19

31

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• Private exchanges facilitate employers’ move to a defined contribution (vs. defined benefit) funding strategy

– Why? Better manage future cost trends

• More than 1 in 4 employers are considering moving to a private exchange in the next three to five years

Why employers moving to exchanges

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• Employees attracted to – Choice

– Flexibility

– Personalized product selection

– Shopping experience

Why employees like exchanges too

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• Price • Convenience • Experience

Consumers decide by assessing …

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Welcome to the Renewals Business Patient Experience Vital For Securing Purchaser Choice Year Over Year Network Selection and Ongoing Experience

Day 1 Day 365

Care Decision

Care Decision

Care Decision

Care Decision Clinical interactions represent repeated opportunities to reinforce patient preference through superior experience

Annual network selection in fluid insurance market implies consistent reevaluation of network performance

Patient Experience

©2014 The Advisory Board Company • advisory.com • 29385A Source: Health Care Advisory Board interviews and analysis.

• Think about your last Amazon experience

The Shop-Experience Cycle

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• Now in health care – MD Save

The Shop-Experience Cycle

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How we typically obtain feedback

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Patient Discharged Send Surveys Survey Responses

Prepare Results

Send to Hospitals

Analyze and Share Results

Lagging Indicator (8-10 Weeks)

What’s missing from what we measure?

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Feedback also comes from leading sources

Suggestion Box

Social media – the next feedback frontier

75 % of online users seek Healthcare Information

500M by 2015

42 % health social media users look for consumer reviews

109.1 M ALS Ice Bucket Challenge

100 K Mobile Health Apps

14,000 Tweets/Minute during Obamacare verdict

How are you managing your leading indicators?

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Internal data provides additional insights

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-3

-2

-1

0

1

2

3

Listen to patients

Skill & expertise of staff & admin

Responsiveness

Reputation

Great service

Comprehensive healthcare system

Convenience

Up-to-date technology

Leader in healthcare

Efficiency

Promotes healthiness

Compassion

Up-to-date facilities

Innovation

Internal

Consumers

Q20: How important are the following factors in your selection of a healthcare provider? Please pick the 3 most important factors.

We had a perfect storm

Surgery ER

Childbirth

Our wake-up call

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Our reaction

Marketing Patient Experience

• Deeper dive into social media policy and current practices • Informal network development

– Who? What? When? and response-time expectations

• Education for stakeholders • Assistance with problem resolution • Leveraging event reporting system as a repository • Development of initial tracking tool

Operationalize - what processes are needed?

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Improving responsiveness

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As they Happen Where

they Happen

St. Rose Dominican

Turning 1 star into 5: Shawn’s story

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We had tons of data and feedback

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Patients

Noise, Wait Times

Billing & Insurance

Ease of use, Easy to Find

Respect & Empathy

Hospital Processes & Staff Behavior

Business Units and Departments

Cleanliness Standards

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What does Big Data mean to you ?

Drowning in data

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EHR/EMR Data

Department Data

Billing Data

Financial Data

Internal – Structured 3

Avatar Surveys

Patient Letters Rounding Notes

Call Center Notes

Internal – Un-Structured 2

GOV Sites / Rankings

Social Media

External 1

Missing Link - narrative content analysis

? Is this Good or Bad ?

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Answer: Saama Sixth Sense analytics

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How have we leveraged ?

Alarms

Standouts

Processes

Performance

ROI

Culture

• Processes Improvement

• Enhanced Communication

• Culture

• Focused Learning and Development

• Proactive Identification of Hot Spots

• Increase Top and Bottom Line Impact?

A promise

Confidential Saama Technologies, Inc

Humanity holds the power to help heal.

Group Activity – Where can we go next?

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Next steps

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Before Visit

During Visit

After Visit

Next steps

• Where is the Noise • Area of Concern • False Positive ? • Areas to Improve • Action to Improve • Intervene • Operationalize Change Customer Location

Customer Channel

Action

As it Happens

Leading Indicators

• Digital Marketing Team • 27/7 Monitoring • Virtual Patient Advisory Boards • Additional mechanisms for instant feedback • Competitive Analysis using social media data • More story telling and culture building • Correlations between leading indicators and HCAHPS

Future enhancements and projects

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Social media as predictive measure of HCAHPS?

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90% of the decisions get made after visiting these websites, Is Healthcare Different ?

How would you structure the correlation? What might the variables be?

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Future use example

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No Questions asked - shipped a Playstation to replace one stolen from doorstep

Suggests local restaurants based on previous concierge interactions

Shoe shopper upgraded to Zappos VIP, so she can get free shipping to try any shoe instantly

These industries know their customers, follow their customers everywhere and learn about their habits to

provide a better experience.

Questions & discussion

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Thank you

Dr. Maggie Ozan-Rafferty Chief Experience Officer meorafferty@gmail.com

Kate Grey Vice President, Strategic Marketing kate.e.grey@gmail.com