Better, Faster, More Affordable


EDITOR’S NOTE: In 2004, Dr. Donald Storey, then the senior medical director of the Aetna Aexcel Performance Networks, conveyed unsettling news to Dr. Robert Mecklenburg and his physician colleagues at Virginia Mason Medical Center. Dr. Storey said that Virginia Mason could be excluded from an important Aetna network based on high costs for certain services. Dr. Mecklenburg and his colleagues had just collided head-on with the realities of the marketplace—that companies represented by Aetna (Starbucks, Costco, Alaska Airlines and many others) faced intense competitive pressure and needed to find high-quality, affordable care for their employees. Many doctors would have lamented this news from Aetna, but Mecklenburg, then chief of medicine at Virginia Mason, saw it as an opportunity to apply the Virginia Mason Production System (VMPS) to better align care with the needs of the marketplace. VMPS was an adaptation of the Toyota Production System, which had helped Virginia Mason eliminate waste and provide better, safer care for patients. Mecklenburg believed the system could serve the needs of companies as effectively as it served the needs of patients. Thus did Mecklenburg and others create Marketplace Collaboratives, in which teams worked to provide efficient, high-quality care at the lowest possible price. The teams addressed a variety of issues with a number of companies. This excerpt from Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience focuses on the work Virginia Mason did with Starbucks concerning back pain.


After receiving the news from Dr. Storey, Dr. Mecklenburg called then Starbucks benefits manager Annette King and asked whether he could come by and see her. She was somewhat taken aback, for she generally only heard from providers when they were seeking higher payments. The chief of medicine at a major medical center calling to request a meeting for how he might better serve her employees—now that was unheard of. “I never had anybody come and say, ‘We want you to work with us on how we care for your employees,’” says King.

King told Mecklenburg she had a real issue with back pain among her employees and asked Mecklenburg to work on a plan to improve quality and reduce cost. “I could hardly believe it,” Mecklenburg says. “Who would imagine that back pain was anything to get very excited about, and yet there it was: Large numbers of affected employees and a very high aggregate cost.”

Mecklenburg learned that the cost burdens for companies were not due to the infrequent case of pancreatic cancer or thyroid cancer that required specialized training. It was back pain and headaches!

Mecklenburg and Dr. Andrew Friedman, head of the spine clinic, pledged to apply the Virginia Mason Production System to eliminate waste and provide better, more affordable care to Starbucks employees. This represented a radical cultural shift for Virginia Mason. The hospital’s doctors were tailoring their care plan to the company’s needs, something that had been virtually unheard of in the past. Rather than trying to align the marketplace with doctors’ interests, the solution was to align providers with the interests of the marketplace.

Mecklenburg says that the message from employers was that Virginia Mason was an important supplier of care to their employees and that the hospital needed to provide quality care without delay so that the employers could maintain a healthy, productive workforce while still managing the direct and indirect costs of care.

Mecklenburg, Friedman and their colleagues set about applying Toyota-inspired methods to hunt down waste and come up with a new approach that eliminated all non-value-added steps in favor of evidence-based medicine. They scrutinized every step in the process a patient went through for back-pain care. Then they studied how each step contributed—or failed to contribute—to improvement in patient relief.

The study concluded that 85 percent of back patients suffered uncomplicated back pain that required treatment quite different from those afflicted with serious spine or disc problems. [Patients were determined to have complicated or uncomplicated back pain based on their answers to a series of screening questions.]

The Virginia Mason team was completely transparent with King and Storey. When Mecklenburg and Friedman revealed the results of their research, the results were stunning. The study showed that “90 percent of what we did was no help at all,” says Mecklenburg. “Does an appointment with an orthopedic surgeon, a neurologist, a neurosurgeon help for uncomplicated back pain? The evidence says no. Does an MRI help? No. As far as we could tell, the only thing the evidence showed [that] was worth anything was physical therapy.”

Annette King at Starbucks looked at the research and came to a quick conclusion. “If the only thing giving value is physical therapy, then why don’t we start with that?” she asked.

Thus, it was decided that every patient with back pain would be offered a same-day appointment. Dr. Friedman of the spinal clinic established a plan whereby each patient would be treated by a two-person team consisting of a physical therapist and a physician and that the team would provide psychological reassurance as well as excellent quality diagnosis and treatment. Friedman emphasized the importance of the patient’s psychological health. “There are three things that patients usually want when they come in,” says Friedman. “One is an accurate diagnosis, to know that they don’t have cancer or something terrible. They also want pain relief. And they want to know how to get back to normal function.”

Just three months after first meeting with Starbucks, Friedman was able to report that patients were receiving same-day access. He and his team had whittled down the waiting period for an appointment from an average of 31 days. Doctors and physical therapists also dramatically improved the speed at which they were returning patients to normal function. Ninety-four percent of patients were returned to work the same day or the day after. The team eliminated significant waste, particularly imaging tests that were not evidence based, thus reducing cost. And no prescription medications were needed in three-quarters of the cases, while patient satisfaction was through the roof.

Virginia Mason and Starbucks had participated in something truly special in health care. They had demonstrated an ability to change medical processes with speed and agility—and do so in a way that was directly responsive to the demands of the marketplace.

The financial question continues to nag, however. The issue is whether the health-care-payment system can change to support and encourage the kind of work Virginia Mason accomplished. Typically, fee-for-service arrangements pay for quantity of care regardless of the quality. The system, in fact, pays fairly well for a great deal of substandard care that often provides no benefit to the patient.

Mecklenburg says that when providers eliminate waste and produce reliable quality care, the cost declines. For that to work, he says, health plans must then pay for “high quality and rapid access, not poor quality, waits and delays. To the extent that health plans are paying for poor-quality care or delayed care, cost to employers and patients and even the government stays high. Customers need to buy high quality and rapid access and stop buying poor quality and poor access. If they persist in purchasing poor quality, it will remain available in the marketplace and drive up cost.”

Don Storey says the work at Virginia Mason means that “the genie is out of the bottle. If you have openness and transparency around data, you can create phenomenal improvements around efficiency and quality. You could really start taking out tons of waste. This shows you can do the right stuff for a lot less money and do it better. We know we can make health care better almost instantly.”

Working in Marketplace Collaboratives with other companies or governments, Mecklenburg and his colleagues created similar services for migraine headaches, breast nodules and shoulder, knee, and hip pain.

Says Mecklenburg: “The problem is that we squander 50 percent of our health-care dollars on medical care that does not improve the health and well-being of patients. Poor quality is the primary driver of excess cost. In the U.S., we produce, consume and pay for a great deal of great medical care; the best medical care in the world is available in the U.S. when we do it right. But we don’t always do it right. We also produce, consume and pay for hundreds of millions of dollars of ineffective and low-quality care that takes money out of the system without returning commensurate value. It is this waste that drives the price of health care beyond our reach as a nation. We are all paying the tab.”

Charles Kenney is the author of Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience, published last fall by CRC Press (, $39.95).


How to Elevate Your Health Care Customer Experience for Engaged Consumers

How to Elevate Your Health Care Customer Experience for Engaged Consumers

Health care consumers now expect the same type of seamless experience they get from Amazon and Uber

Sponsored by West Monroe Partners

Outside forces—from consumerism to health care reform, to digital evolution—have created a marketplace where individual consumers are more engaged than ever before in purchasing insurance and managing their health and wellness. For health care organizations operating in this evolving marketplace, success and competitiveness is not just about being the “best.” It is about delivering an effortless experience that meets—or, preferably, exceeds—health care consumers’ expectations.

When choosing which health care services to purchase and consume, today’s consumers will consider a host of factors that include traditional criteria such as cost, reputation, and quality of service. But they are just as likely to prioritize experience. Do they have easy access to the information they need and want? Can they connect when they want and through the channels they want? Do they receive timely and personalized communication?

What’s important to acknowledge here is that the benchmark for health care customer experience no longer comes from just the health care industry. It comes from the wider marketplace, where companies like Amazon and Uber have set a high standard for shopping and customer service experiences. Health care consumers and patients expect the same type of seamless experience when interacting with insurance and provider organizations.

The struggle to deliver on expectations

In 2016, West Monroe Partners surveyed more than 1,300 health care consumers and conducted a roundtable with health care insurance executives representing plans with member volumes ranging from less than a million to more than 15 million. The purpose of the study, No More Waiting Room: The Future of the Health Care Customer Experience, was to understand how today’s consumers interact with health care providers and payers and how communication preferences are shaping the industry. Findings point to a misalignment between consumers’ expectations and health care organizations’ confidence in delivering on those expectations.

For example: One third of health care consumers have used a mobile app to communicate with a provider in real time. 80% of consumers who have communicated real time via a mobile app prefer this method to a traditional office visit. Yet, 85% of health care executives aren’t confident that they have the right technology in place to evolve patient experience, and 54% aren’t confident they have the right processes to do so.

Start by putting health care consumers first

The health care marketplace is extraordinarily complex, with shifting economic realities, complicated products, emerging channels, and regulatory changes. Insurers and providers that are able to simplify this environment and make it easier for consumers to buy and access health care services stand to gain significant advantages—lower delivery and administration costs, greater patient and member retention, and better patient-centric decision making.

Creating a winning consumer/patient experience starts with a shift from an “inside-out” to an “outside-in” viewpoint—employing a customer experience vision that mobilizes operations and technology solutions around people rather than around traditional enterprise boundaries. Some health care organizations have begun designing from this perspective, but delivering on it is proving to be a considerable challenge. The entire organization and ecosystem—from the executive suite to the front line to the back office—must be involved in shaping consumer experience. It will also require modernizing the systems and technologies that touch consumers and engage them throughout the management of their health.

Following are several keys to adopting a consumer-centric view:

Personas and journey mapping

Developing customer personas and mapping a health care consumer’s “journey” while interacting with the organization are effective techniques for creating an “outside-in” view of operations. Personas identify the various buyers—providers, brokers, patients, prospects, and members—and reveal their feelings, motivations, and attitudes when dealing with an organization. Journey maps identify all touch points, from origination of the relationship through continuing delivery of health care services. A journey map will look at factors such as the channel of interaction, the content, and the user experience. Typically, journey mapping involves conducting interactive workshops with members/patients as well as internal stakeholders. This technique is useful for understanding the customer, the current journey, and how to design the future customer journey and experience.

It is essential that all facets of the organization—sales, marketing, network and care management teams, back office functions such as billing and call-center support, and others—participate in this exercise. Not only does this prevent interactions from being designed in “silos”, it also helps the individuals involved adopt a consumer-centric viewpoint.

Consumer data

Data is the foundation for understanding needs and behavior motivators and a key part of building strong consumer relationships. Patient and product histories, along with analytics, allow organizations to gain an inside look into how patients interact with payers and providers. Learning about and adapting to consumer preferences can boost engagement and create trust.

Health care organizations need to begin developing tools and capabilities for analyzing and assessing consumers—from their engagement with campaigns to their interactions with health care products, services, and channels. They also need to be able to translate that data into plain messages that give internal operational personnel what they need to know to improve experience.

Finally, to improve care and deliver a better experience for patients, these organizations will need to develop capabilities for sharing data effectively and securely across the health care ecosystem of pharmacy, clinical, providers, and payer organizations.

Segmentation and experience strategies

Having engaged customers helps manage costs and improve care. But the same engagement approaches don’t work for everyone. Some health care consumers prefer to pick up the phone to interact with an insurer or provider. Others prefer to do so online—and, as noted above, some prefer mobile interaction. Some are proactive about managing their own health, while others are less so. Some want lots of information, and others want information only as their interests warrant.

Engagement starts with effective segmentation of the patient population. There is no “one-size-fits-all” approach to building relationships. Developing consumer segments allows the health care organization to focus on the different needs and behaviors of a group of individuals. Each segment should have a defined relationship strategy that supports the overall brand identity but reinforces a segment-specific value proposition. From this, the organization can design engagement and experience strategies to accommodate each segment’s channel and information expectations.

Personalized communication and experience

Today, many health care organizations limit communication to e-mail, mail, and phone. These channels typically are one-sided and do little to engage customers. More significantly, this is problematic considering the rising generation of health care consumers prefers online portals, mobile channels, and messaging platforms. While the survey suggests organizations intend to rectify this, time is running short. Given the accelerating speed of technology innovation, by the time they add platforms like social media and instant messaging, they will be behind.

Omni-channel approaches, driven by customer data, will be necessary to deliver personalized messages and drive engagement. Health care organizations should be leveraging technology to develop user-friendly interfaces and self-service tools that allow patients to engage the organization through their channel of choice.


Finally, health care organizations will need a supporting infrastructure to orchestrate relationship development. An engagement architecture comprised of profile, preference, campaign automation, channel, content, and interaction-management capabilities is necessary for executing designed experience and measuring success. For most organizations, this will require a more flexible delivery environment and agile development capabilities.

Enabling sustainable change

Creating the capabilities for putting—and keeping—consumers at the center of operations is a key starting point. Once that is underway, organizations will need to start looking at their operating models to identify functional improvements that have the biggest impact on consumer experience and that allow them to react quickly to evolving trends and competition. Finally, change of this magnitude will require cultural and change management initiatives to ensure that the organization embraces customer centricity and that investments in change are sustainable.

West Monroe is a progressive business and technology consulting firm that partners with dynamic organizations to re-imagine, build, and operate their businesses at peak performance.