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Casino Loyalty Programs and the Healthcare Experience on the HCbiz Show

Vishal Argawal, co-founder and COO of “Care Cognitics,” appeared on HCBiz show, a podcast dedicated to unraveling the business of healthcare. He was interviewed by host Don Lee in Lee’s final onsite interview at the HITExpo in New Orleans. Here is their conversation about Care Cognitics’ relationship to the gambling industry and new technologies that align provider and patient needs, lightly edited for clarity:


Vishal: Hey! Thank you so much for having me.

Don: So, I’m going to give you a wide opening starting point, sort of… Could you just tell the audience what does Carecognitics does, and who they do it for??

Vishal: Yeah, so at CareCognitics, we are applying concepts from industries outside of the healthcare sphere, such as the casino industry,  in particular their loyalty concepts and gaming technologies, to help save lives–and to enable chronically-ill patients to lead a  healthier life.

Don: Ok, interesting. That’s obviously a complaint that we hear coming up a lot, that healthcare needs to look to other industries or solutions to the problems that we are facing internally. I haven’t heard of anybody coming in from the casino industry, so this is a first for me. So, what can the casino industries’ loyalty programs teach healthcare?

Vishal: Well, let me give you an example: While working in the casino industry, we realized that I can fly someone a thousand miles, get them to Vegas, have them lose money, and have them still return home happy and wanting to come back to Vegas again.  So, if I can do that for the casino industry, then why, in health care, can’t we get someone to show up at their doctor’s office for a free annual healthcare visit, which is actually good for them? That was the question we were asking ourselves. Or to look at another industry,

If Amazon can send me an alert today that says, “Hey, your dishwasher is going to run out of liquid in five days,” why can’t I get an alert from my doctor that says, “Hey there’s something wrong with your health, you should come and check it out

or something like that? Or, you know what? Did you ever miss a flight?

Don: Yes, of course I have.

Vishal: So, looking at the airline industry… Could you imagine if Southwest never sent you an alert that your flight  running late, and you showed up at the gate, and the flight was several hours delayed? What would your reaction be?

Don:  I would not be very happy. And,, I think there would be a lot of angry people at the gate there with me too.

Vishal: Yeah? Well, when was the last time you went to the doctor’s office?

Don: Oh, I’ve had bad experiences waiting at the doctor’s office, for sure.

Vishal: Were there angry people out there?

Don: Yeah, everyone tends to look pretty harried when you get into a doctor’s office waiting room.

Vishal: Has that changed, ever?

Don: No…

Vishal: No. Why?


As patients, we don’t have a lot of options.  If we need care, we kind of get to a point where we kind of have to get it the way we can,  and sometimes this is the only way it’s available.

Vishal: Yeah. Right. So, as patients, we are at the mercy of healthcare.

Don: Exactly.

Vishal: I think that has to change. Every other industry has changed. We forced the change. People forced the change. The technology is there; if Southwest can send us and alert that says, you know what, your flight is four hours late, then why can’t we get a similar alert from a physician’s office? I’m pointing out each of these things coming from an outside industry. We solve for a lot of these problems in the context of a casino. And what is very interesting to us is that the population that goes to casinos–especially in markets like New Orleans, which are outside of gaming centers like Vegas–has an average age of 52 years.  Fifty-two years old, and very digitally savvy. They all have their loyalty cards, they are playing and engaged. So, the profile is of the average casino goer is similar to the average consumer in the Medicare healthcare space.

Don: I was going to ask you if you know what that average age is. Fifty-two is probably pretty close to average I would think, right?

Vishal: Yeah, especially once you leave the destination markets like Vegas and Atlantic city. If you leave those aside and look at the frequency market, as we call it, atthose casinos, the average age is pretty high. The local people coming there love to game and gamble, and they’re an older population. And, just like in healthcare, everyone is subject to luck–which you can’t change. But, casinos have very sophisticated technology. When you walk into a casino, they know, “Don loses maximum 100 dollars a day.”

Don: Right.

Vishal: And if we detect that Don just lost 300 dollars, you would think that we are happy. The casino should be happy: “Hey, we made more money!”

Don: But you’re probably worried that I’m unhappy, because now I’m not going to come back and lose 100 bucks three more times.

Vishal: Exactly! You’re going to say, “This is an unlucky casino.” And from the casino’s viewpoint, that’s not good. That means I’ve lost you, Don.

Don: That’s interesting. I’ve never thought of it that way.

Vishal: I can’t afford to lose you, right? So, what we do through casino loyalty programs to address this in real time–not five days later, nor five months later–we see, “Oh man, Don just lost 200 dollars more. He’s probably feeling unlucky.” And someone will pop up to you and say, “Hey it’s your lucky day.” We give you a free show ticket that’s probably worth 200 dollars or more (and that, in any case, would otherwise have had empty seats.) So, we’ve just switched your experience. I can’t change your luck, but I at least made your experience pleasant. Now you’re thinking, “Well, I lost 200 dollars, but I got 300 dollars of value. Maybe it’s still my good day–still my lucky day.”

Don: So, how do you take a concept like that and take it into healthcare? Because, you know, I can compare and contrast the experience here: If I’m going to gamble, it’s because I enjoy it, and it’s this fun thing, and there’s some risk and the potential for reward, and there’s all the things that we like as people, right? But there is almost nothing I like about going to the doctor. So, you are starting in a different spot. So how do you take that–you know those concepts–and apply them in a healthcare setting, which is a situation wherein I’m going somewhere that I wish I didn’t have to go to.

Vishal: Yeah, you’re right. What we are doing is this: Just like how in the casino, I can’t change your luck, but I can change your experience. We are focusing on chronic conditions.

When it comes to chronic conditions, even a physician cannot change your chronic condition.

They can only best manage it for you. Like, if you’re a diabetic, unfortunately, you can manage it, but you can’t cure it. It’s lifelong. People come to a casino to have fun but why would they go to the doctors office? Can healthy behavior be just as positive as a casino? So just like I cannot change your luck, I cannot change your medical conditions–but at least I can make your experience more pleasant, so there isn’t a barrier to care. You hate going to the doctor partly because the experience is so poor. Do you like to wait on a phone call for at least  5 minutes before you get to the front desk for your doctor’s office? Then you have to wait until you and COME IN to have any resolution? Can you imagine if you called up Comcast or AT&T and you had to wait for as long as the doctor’s office to have help? You would be pissed. We are not used to quick resolution and the convenience we expect in other industries for the physician’s office. Ironically, this is perhaps a situation where it is even more important to reach someone and have help quickly. It is more important to treat or manage illness than get your cable turned back on. So, we are bringing in the concierge services that you are used to in an entertainment environment, like a casino, and applying them to healthcare. So, through the physician practices and providers that sign up for our service and make it available to their patients, we offer and manage concierge services to people–to those providers–so that their patients can actually call us. We offer same day appointments; we offer 7-by-24 service. We learned that from the casino industry.

Don: So how are you providing those services? You are providing access to those services for your customers who are the doctors, or do you also have clinicians that are part of your team?

Vishal: What we do is this: Our customers are the physician practices. We offer our service to the physician practice, and for the physician practice we offer in-between office visit care for chronic patients. Chronic patients are where the cost is the highest and they need the most care. And most of their problems happen in between office visits. That’s when things go wrong. We provide a service that is a combination of a technology platform and a medical assistant team that we have on our staff.

Don: These people on your team answer questions and do the little check-ins in between and stuff like that?

Vishal: Yes. 100%. Physicians sign up and our team manages the services and patients can sign up. And where our loyalty concepts come in from casino is that we offer incentives to the patients to make healthy choices, right? These incentives are very carefully crafted. You know if you offer a free gym membership to someone who is obese,chances are they are not going to use it much. But that’s what we see in healthcare–it’s a “spray and pray” approach. It is not customized.“Hey, let’s give this benefit to everybody.” Guess who ends up using those gym benefits? People who are already fit.

Don: Yeah, what’s funny is–not to go off on a tangent–but that health plan that offers a free membership is designed so the people who go to the gym self-select into that plan. They are actually building a plan for healthy people.

Vishal: Exactly. That’s always been the case. The people who aren’t already inclined to go to the gym  need different types of incentives. They need incentives that they value. In a casino, what we realized very quickly was that the best incentive costs to the casino zero dollars. Do you know what that was? To be told happy birthday on their birthdays.

Don: Oh yeah, people love that. People love to be recognized.

Vishal: That’s it–and, it didn’t cost anything.  It wasn’t, you know, a free coupon to a buffet.

Don: So, I love the concept. What is something–I mean I guess they could just say happy birthday–but what is an example that is applicable in the doctor’s office that you recommend to your people?

Vishal: Same day appointments.

Don: Same day appointments? Okay, so how do you get the doctors to do that–like they are going to have to keep space in their schedule?

Vishal: Yeah–you’re totally right. They keep designated space in their schedule.

Don: So that’s got to be a big leap for a lot of them;not to fault doctors, but it’s like the system is kind of designed to grind them into these 15-minute appointments, which itself  makes clients wait in the waiting room so that there aren’t any gaps. Everything is kind of stacked against the patients and the doctors in this scenario, so how do you get the doctors to create space in their schedules?

Vishal: So, there’s a two part answer, right? One, when we offer this service for the providers, we actually don’t charge physicians any money. We piggyback on a Medicare program for chronic conditions which allows for reimbursement of great care; it’s a chronic care program that offers incentives to the physicians. So, through our service, we are not only able to facilitate better care for their patients; we also make money for the provider’s office. They are already providing the care and able to meet requirements for treating chronic conditions. I think it’s the best alignment that we’ve seen. So that’s the business model that we follow.

In terms of offering these incentives to the patients, even in the casinos, not everybody gets all the benefits. People who have the need get those benefits. So, we “right size” these benefits to people who are really in need.

The example that I gave you: even though that is a base benefit, we ask the physicians to create some space for the patients who sign up in this program.  The physician’s office doesn’t have to do any additional work. We do that work for them. We manage their patients. We do things on their behalf, but in return we do ask of some things from the doctors to enable this–and that includes, if one of our MA’s calls in and says, “You know we need you to see this patient,” then they make time for that patient. Many a time, there’s a human touch that is missing because everyone is so burnt out. With our system, if we can’t get the same day appointment, we call back the patient and say, “Hey I’m sorry, I can’t give you that today, but it’s available tomorrow, all right?” Nine times out of 10, they are fine with that.

Don: I would be thrilled if I could see my doctor tomorrow.

Vishal: Yeah, but just getting a call that saved you the trouble of waiting 5 minutes to speak to a doctor,  just to get to a receptionist who says, “Yeah please come in four weeks”—it’s just a very broken experience that we’re trying to improve upon.

Don: I just had an experience where I had to wait two months. I’m not a chronic patient–I’m going for like my routine checkup–but I’m waiting 2-2.5 months to get my appointment. Which is madness.

Vishal: Exactly- and we are not in the business of fixing everything. We can’t be. But we do think that as a company we can make a difference, both in terms of our business model that aligns incentives between the physicians and patients, and the physician benefits that are gained, because we are helping them increase their revenue. And the patients definitely benefit from it because they’ve got a personal concierge who is looking out for them every month, seeing what their needs are and reminding them of things. And in the process, there’s a reason why we’ve seen great adoption from our patients; we’ve broken MIPS and 78-year-olds are engaging with us digitally, which we didn’t think would ever happen.

People want to be in the program because it is based on their personal needs and improves their health care experience. Physicians want to be part of it because we are not adding additional overhead or work for their staff or for themselves.

I think this is a great program for Medicare, and I think it’s driving great alignment for us. It is about organization since you already see those patients, but this way the physician practice is proactive about their care rather than reacting with bad scheduling delays.

Don: Yeah, I love how you tied the concierge approach on top of the chronic care management and the Medicare code because you’re not funded. It would have been, I imagine, a very difficult sale to go into a doctor’s office and say,“Hey, you’re going to pay us to go and offer this concierge service on your behalf, and oh, by the way, you’ve got to create a gap in your schedule every day because we are going to be sending you same day appointments–cool?” I don’t think that would have worked. So the face that you were able to piggy back that onto the 99490…there was already some demand being created. Physicians are already aware of this; they want to take advantage. I love the business model of basically saying, “Doctor, you don’t have to do much other than coordinate with us and agree to let us come in on your behalf.” You’ve got to create trust.

Vishal: Exactly.

Don:   And once they trust you–the barrier to them starting off with this service to their patients is pretty low. Right? Am I missing something?

Vishal: No, I think that is exactly right and I think you know we’ve designed our service to be exceptionally patient-centric. Everything that we do and bringing incentives onboard–you know, providing care–we didn’t have to do any of that. But we are doing that because at the end of the day what we believe is that showing value every month to those patients are critical. There is a copay involved in this right? And even though it’s a low copay, it’s still eight to ten dollars.  That’s the cost of a Netflix subscription. We consider it that way. We are competing for that 10 dollars that you may use to sign up for a Netflix so that you can be entertained every minute of the day. Can I show you enough value to stay in this program? Because it’s not just about sign up and getting the patient enrolled. It’s about getting patients to feel that, month after month, the program is really helping them.

Don: Yeah, it’s about getting them to keep spending that 8 bucks every month–and to a lot of people listening, I’m sure that doesn’t sound like very much money, but to some people that’s actually a question that they ask themselves every month, particularly those who already have an expensive chronic condition.

Vishal: Absolutely, they do.

Don: It’s like,do I want to redirect those funds to gas for my car, or is this still worth it? So yeah- that’s important.

Vishal: And we believe that:

For the population that we work with–health is important. For the Medicare population, health is a top priority. And we believe that strengthening that relationship with their primary care is the right thing to do.

There’s already trust in that relationship. It’s just that as you said at the start of the podcast–we don’t think of our physicians until we really are sick. And if we want to turn the tide of rising healthcare costs and improving the life of our members, that has to change. We feel that the change starts by strengthening that physician-patient relationship by removing barriers, by making it more personal, by making it more timely, and making it more rewarding for the patients. Incentivizing them with the right things. It’s really those 4 things that we are offering through our service and hoping that we will be able to make a meaningful difference.

Don: No, it sounds great. Now how long have you guys been at it for?

Vishal: We launched our service last March. So, it’s fairly new but we’ve got good traction. We’ve got about 2000 active patients on the platform in 4 states. We’ve got a pool of about 20,000 more Medicare patients that we are in the process of signing up.

Don: Awesome. And do you have any particular success stories you can point to? Even if it’s anecdotal, like a story you heard about this one patient. What can you share about what is happening?

Vishal: Yeah, last week one of our medical assistants just dropped a note on our internal communication channel, telling us that one of the patients had said,  “Oh my God, if that’s the kind of service I’m going to get, I’m going to get my husband to sign up with this program too.”

Don: Oh, there you go. That’s your net promoter score right there, right?

Vishal: Yeah, and you know, that’s great! You know it’s awesome. But again–there is also the other side. People who have dropped out of the program. And they’ve dropped out of the program because they didn’t get full participation from the providers.

Don: So, you basically weren’t able to deliver the whole service in that scenario, I imagine.

Vishal: Yeah because as much as we take the burden off of the providers, this is still a partnership. At the end of the day we are coordinating care. We are not providing care. The providing of care still happens at the provider side. If we want this person to come in because we’ve detected that this person is at risk, but if the physician’s office didn’t make space, or didn’t follow through for some of our care coordination, then the system breaks. So, what we are learning very quickly is that there is a profile of providers that work better with us, and a profile of providers who don’t work as well with us.

Don: Are you going to have to be really picky about who you work with ? Because otherwise, if someone signs up but there is no follow through, then it will make you look bad.

Vishal: Exactly. So as we grow as a company, that’s our learning. Trying to see who we partner with on the provider side–who is going to really make at least some level of changes, so that when we have a recommendation for a certain patient, or if we say,  “Hey, this patient needs to come in tomorrow,” you know we get that support from them.

Don: That makes sense.  Awesome. Lastly, where can people go to learn more about you guys?

Vishal: You can learn about us from You can even follow us on Twitter–and please drop us a note. We are looking to partner with family practices from about 5 primary care physicians to about 99. Again, our services don’t cost anything to the providers–we help them raise their revenue while providing coordinated care for their chronic patients.

Don: Awesome. I’ll add that, so you guys can find that nice and easy, and that’s it. Vishal, thank you so much for spending the time today–it’s really fascinating stuff.

Vishal: Thanks, Don.

You can listen to the episode HERE.

Are you a physician’s practice that wants to meet with our team? Please CONTACT US HERE.

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Applying Casino Loyalty Technology to Solve the Problems of Healthcare Technology

Applying Casino Loyalty Technology to Solve the Problems of Healthcare Technology

The Healthcare IT Expo conference in New Orleans had a theme of how to solve healthcare technology’s biggest challenges. The question? What is NOT working? What are the problems that need solving and how is technology going to solve those problems? Sunny Tara, CEO of CareCognitics, took part in a Think Tank at the event where he discussed what IS NOT working in healthcare technology. His background in building innovative technology and loyalty for casinos allows him to create a upatient-centeredntered approach to care management.

One thing that isn’t working is treating patients with a one size fits all approach.  To provide what a patient requires we must make improvements at the line level. This is where healthcare can learn from other industries. I come from the casino industry and we wouldn’t treat every customer the same so why is healthcare doing that?

We are doing the same thing with healthcare technology. We want to use the same tool for every job, even if they don’t match. For example, physicians report burnout and dissatisfaction with electronic health records (EHR). Are we trying to make the health record do something it wasn’t designed for? We want to get the maximum value out of the EHR so we try to have it measure patient satisfaction and provide information back and forth and schedule appointments and create loyalty. It is not well suited to many of the tasks we assign it.

A great EHR is critical and important when it comes to clinical care and a system of record. However, from a technology perspective, the EHR doesn’t make sense for a lot of patient focused tasks. Would I want my EHR system to be my ecommerce system? No. I would get an ecommerce system for that. We are trying to put too much on the back of the EHR when that’s not what it was designed to do. Instead we need a separate patient focused system that will build patient loyalty. Technology to improve patient care should be technology designed with patients in mind, not stretching existing technology to make it fit in every situation.

One of the key ways to find out if a technology is well suited to the job to be done is adoption. The key to adoption is one thing- providing value to the person using it. For example, in the casino industry in the early 2000’s we implemented a pretty large IT investment. We spent over 100 million dollars on the ability to order drinks from a slot machine. This is a simple technology, but when we rolled it out there was such pushback from the cocktail waitresses because they felt that this was going to take their jobs.

As soon as we implemented some pilots they changed their minds. They realized that this technology was going to help them. Rather than circling and taking orders they just were just delivering drinks and providing great service. They were able to make more tips every hour and customers were happy. The technology provided them value and that changed the dynamics. We used technology to provide a better experience to customers because their drinks were coming sooner and at the same time the cocktail waitresses were happy because they were making more money.  This is the virtuous use of technology we need to apply to healthcare where both providers and patients benefit.

When technology provides value to patients, it will have high adoption. We have been pleased to see that even among a Medicaid population, we have high adoption. If we judge the effectiveness of technology based on adoption rather than cramming patients into an assembly line of ineffective care, we can easily sort which technologies are effective and which aren’t. The purpose of our technology is to enable better patient loyalty. I cannot change your odds- but I can provide a great patient experience.

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Align with Patient Goals: Jen Horonjeff with Savvy Co-Op

Align with Patient Goals: Jen Horonjeff with Savvy Co-Op

CareCognitics caught up with Jen Horonjeff for National Health IT week to talk about patient experience.

Jen Horonjeff, PhD has been involved in extensive research about patient experience. As an expert in patient research, she started Savvy Co-op, a patient-owned co-op that works with companies and researchers to ensure that the patient perspective was better understood in healthcare.  I wanted to talk to her about Patient Experience and how their startup is working to ensure better information exchange to innovators about patient needs and improving healthcare. This week for National Health IT week we can look at some of the major problems that healthcare has with technology. A lack of involvement from patients has contributed to many of them.

Janae: What do you think about patient centered Health IT?

Jen: Technology should should solve actual problems that patients are having. The trouble is that there are so many different stakeholders in healthcare, and sometimes companies lose sight of who is the end-user or affected by the product. There may be times an insurance company is paying for product to be used, therefore is developed from their perspective, which could be meaningless or cumbersome to the patient, leading to low adherence.

Another scenario may be where the patient isn’t the end-user, but they are still affected by the technology. For example electronic health records systems may make patients feel disconnected from a provider sitting behind a computer checking boxes, instead of facing them while they talk. Involving patients in the design would have helped identify core issues and problems sooner.

Janae: What do you think about Patient Loyalty Programs?

Jen: There are a lot of programs out there that are designed to produce certain behaviors. Gamification and loyalty programs need to have aligned goals. Take the example of a patient taking their insulin. An insurance company’s goal may be to have less admissions to the emergency room and lower healthcare costs. The patient’s goal might be to go to their child’s weekly soccer game, and taking insulin might enable them to do that.

The end action might be the same–the patient is taking their medication–but it may need to be framed in a way that has an impact on the patient’s lives. Therefore loyalty programs and gamification need to identify the personal goals and priorities of the patient and be structured and anchored accordingly.

Janae: Do you think all patients know what motivates them?

Jen: There are different ways to identify priorities and motivations of patients. There may be instances where you want to ask them direct questions, and other times where you want to observe them or ask them to share other stories in order to see a more complete picture of their life,  behaviors, and challenges they face despite their motivations. Understanding motivations and barriers is a critical component that should not be overlooked. It takes time and resources, but without it your product may significantly miss the mark. Savvy helps companies connect directly with patients to ensure they get the insights they need to build better products and services.

CareCognitics cares about patient centered technology that creates value for patients.
We would love to meet with you- Find our contact form HERE.

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Patient Loyalty: the Net Promoter Score of Patient Experience

Patient Loyalty: the Net Promoter Score of Patient Experience

National Health IT Week with Sunny Tara and CareCognitics #NHITweek #IHeartHIT

Patient Loyalty is the Net Promoter Score of Patient Experience. Catching up with Sunny Tara about National Health IT Week and Casino Loyalty was great. I am impressed with the high adoption of their technology and their relentless focus on bringing value to the patient experience. They use adoption to direct if they are effective at their mission of improving Patient Loyalty using Technology.

Janae Sharp


Janae: Why is Health IT important to healthcare?

Sunny: I can’t think of any other industry where technology can play more pivotal role than in Healthcare.  You take any technology trends from 3D printing, block chains, AI/Machine learning, big data, IOT,.. some of the best examples like 3D organ printing, precision medicine/genomics, robotics for minimally invasive surgery and the list goes on are all practical implementation in Healthcare that are driven by technology.   We are witnessing digital transformation in healthcare which will change how we live and how long we live in the future.  It is truly exciting and the opportunities are endless.  At the same time, you can’t think of an industry that is more behind times when it comes to patient experience and care delivery.  You can’t get appointments for weeks, you are waiting endlessly at the physician’s office, even the airline has figured out a way to send alerts when the flight is delayed. It almost seems like you are living in a first world and third world at the same time when it comes to healthcare.  I feel technology can collide these two worlds to create a better healthcare for everyone.  Health IT is at important cross roads, does IT in the future drive innovation, growth, creating solutions that deliver value and easy to use or will it be reduced to just a governance role.  I am by no means undermining the importance of governance but it should not be the only role IT plays in the future of healthcare.

Janae: What would you tell providers about Health IT and why it is important?

Sunny: I feel, if you have to tell providers about Health IT then IT is already in a bad place.  I feel good organization should get NPS from their customers (marketing, sales, products, operation, clinicians,…) they serve.  Would they recommend them to their friends?  Would Health IT in your organization be sustainable if it was a company on its own?  It should never be about the technology or IT but always about the value technology or IT delivers to its users.  Healthcare is no different

Janae: What made you switch from Casino Technology to Healthcare Technology?

Sunny: I feel there is a lot more that healthcare can learn from the Casino industry once you past the stigma of gambling.  In Healthcare, we can’t even motivate patients to see a doctor for a free annual wellness visit and while the Casino industry has figured out a way, what it takes to fly someone a 1000 miles and even though most of them will lose money, they can’t wait to come back.  Why is that?

Just as in Casino, you cannot change the odds of winning but one can provide positive experience!  Similarly, in Healthcare, one cannot change your chronic conditions but we can change your care experience, we can provide the support and tools so the patients don’t fall off the plan and we can manage their chronic conditions better.

 Casino’s have mastered the art and got this down to a science, to create customer loyalty through positive customer experience. Our mission at CareCognitics is to apply casino loyalty principles and data science to improve the care experience of millions of people with chronic conditions.

Janae: During Health IT week- what do you think physicians should know about patient loyalty and how it impacts their practice?

Sunny: Thanks to Jeff Bezos, Warren Buffet and Jamie Dimon for bringing this front and center in Healthcare. Today the media is flooded with patient experience and patient engagement.  It has made it so much harder for physicians/providers to know what is real and what is practical.   What tools/technology are we providing physician to deliver patient experience?( I don’t’ even know if physicians have recovered from their eHR experience to give technology another chance and I don’t blame them).  How would we measure patient experience in practical way?  It is my belief that Patient loyalty is the NPS of Patient experience.  Think about it?  In your personal life have you been loyal to a brand ever that provided you with bad experience, doesn’t engage or appreciate your business and you don’t trust the quality of the product or service. If you pick any credit card or airline or any other loyalty program that you value the most, you will find three common things:

  1. The brand always provides great positive experience.
  2. The brand engages with you proactively and rewards you (recognition, experience, gift cards, reward points) for your business
  3. You trust the brand for the quality and its value proposition is transparent

Loyalty is a practical way for physician to improve profitability, differentiate their practice with positive patient experience and helps build a relationship of trust (“my doctor/his office staff cares for my well being”).


Want to hear more? Set up a meeting with CareCognitics

Find out more about #NHITWeek online. Carecognitics is a proud partner of National Health IT Week

By admin

Patient Experience Lessons from The Casino Industry

Patient Experience Lessons from The Casino Industry

Blog Originally Posted by Spencer Kubo, MD and a guest blogger on EHR and EMR HERE.

Two of the hottest topics in medicine today are patient engagement and patient experience.  It is well accepted that patients who are engaged in their medical care have better outcomes, compared to patients who “passively” receive instructions, likely due to variable adherence to doctor recommendations.  It is also becoming increasingly clear that patients who have better experiences with medical contacts will have higher levels of patient engagement. But the medical community has been slow to identify, measure, and implement the specific steps that would enhance patient levels of engagement and experience.

This lack of momentum within the medical community is not surprising to some since “traditional” interactions with medicine are now often viewed by patients as paternalistic.  Indeed, many practitioners within the medical community have trouble adopting the term “customer” and still favor the use of “patient,” viewing medical interactions as inherently different from consumer interactions.

These challenges have caused doctors and health care administrators to look outside of the medical community for better ways to improve the patient experience and engagement.  The CareCognitics team spoke to a Product Manager at Nordstrom, a company with legendary customer service and loyalty, who noted, “The most important factor in making the customer feel special is to create the sense that the sale or interaction was special to both the sales associate AND the customer.”  And in many instances, doing this creates no additional cost to Nordstrom; the very basic rules of respect and personable service are all that are needed.

In our work at CareCognitics, we’ve seen success with improving patient experience and engagement using a similar focus on making the patient feel special.  CareCognitics is a digital health company founded in 2016 that leverages casino and hospitality loyalty principles, along with data science, to improve the patient experience.  Sunny Tara and Vishal Argawal, co-founders of CareCognitics, shared some of the “secret sauce” that is already helping five clinics in Nevada and California: “We started small and focused our efforts on chronic care management, especially since these activities were well supported by chronic care management code CPT 99490 and therefore brought in additional revenue for each clinic.” Here are just a couple of the ways that Tara and Argawal were able to ameliorate patient experiences by leveraging the best practices of the hospitality industry.

Make the conversation two-way: Traditional communication with patients, outside of in-person doctor’s visits, usually occurs via phone and is restricted to business hours.  CareCognitics developed a HIPAA compliant digital platform so that patients could engage in a dialogue with the medical team using a format that was convenient to the patient’s schedule and not confined to office hours.  Tara also commented, “We were also pleasantly surprised to break many myths about digital literacy in the Medicare population – over 70% of patients were responding to texts and emails.”  People loved having a “conversation” and felt the platform provided a much more interactive experience with the doctor’s office.

“Our success is not defined by the technology we use, but rather by personalized content that is delivered to the patient every month, that reinforces the feeling that their doctor cares about their well-being.  We use technology and digital channels to strengthen the patient-physician relationship and provide personalized care at scale.” Sunny Tara

Offer encouragement and a personal touch: “Let’s face it – completing tests as part of a chronic care management (e.g. flu shots and mammograms) is not very exciting,” says Agarwal.  Each time a patient completes a test, CareCognitics sends a congratulatory note and a message on the importance of the test (e.g. dramatically reducing the chances of suffering from flu symptoms.)  And each message is branded to the physician office (rather than a 3rd party), so the patient feels the communication is with the doctor’s staff.

In addition, CareCognitics supplies a “Care Ally,” a Certified Medical Assistant (CMA) who can respond to requests for additional details, schedule changes, etc., on behalf of the physician’s office, further enhancing the personal VIP touch, similar to a VIP host in the casino industry.  All patients who enroll in the program get instant benefits like “VIP phone” access (a special priority access phone line that physician offices aren’t responsible to run), next day appointments, and interactive personalized care.

All these perks help to reinforce the relationship between the patient/customer and the physician’s office.  The patient feels “special” because there is a pervasive sense of being uniquely cared about by doctors. Many of these principles of VIP service overlap with the principles of concierge medicine, but in this program, there is no large monthly fee to the patient!  All the patient has to do is be an active participant in his or her own healthcare.

Hey, let’s not forget about the docs!

Yes, the focus of all these activities is on the patient, but physician acceptance is critical for the program to be sustainable and incorporated as an essential feature of medical treatment, and not just a fancy add-on. Physicians’ feedback has pointed out at least 4 features of this chronic care management program which are particularly attractive to physicians: engaging dialogue with patients, natively documents in the EMR, improved PQRS scores, and incremental revenue.

According to Dr. Cliff Molin, a family practitioner with PHG, physicians like the fact that patients are engaging in a dialogue with representatives of the physician practice, without taking time out away from the daily workings of the practice. The key elements of interaction are embedded into the EMR, so physicians can oversee the progress without having to access a different website. Because the program encourages completion of positive health behaviors, all the practices are reporting improved results on PQRS quality reports.  And finally, the program has brought in incremental revenue since all the care coordination activities are reimbursed by CMS at ~$42 pmpm.

Carecognitics improves physician’s ability to compete with large health systems and provide excellent care while improving payment for the work they do. Technology is leveling the playing field in improving patient care without increasing costs for physician practices.


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