Boyden's Steve Nilsen interviews David Kerwar, Chief Product Officer and Head of Consumer Digital Innovations at Mount Sinai Health System, as one the country’s leading health systems embraces digital.
Nilsen: You recently joined Mount Sinai in New York as Chief Product Officer and Head of Consumer Digital Innovations. As the title suggests, you lead efforts to create a more consumer-centric experience. What insights led to the creation of this role and what has prepared you to take it on?
Kerwar: Like many health systems, Mount Sinai is reinventing its business model to focus on taking financial risk for the care we deliver, and starting to sell solutions directly to employers, unions and consumers. We’re rapidly throttling up the portion of our $7 billion of revenue tied to risk-based contracts. We’re offering employers onsite and near-site primary care clinics, and bundled payment products to unions. We’re also launching our own health insurance products, which will target consumers buying Medicare Advantage plans – and we’re doing all of this while running a world-renowned academic medical center and providing care to 6 million consumers.
To succeed in these initiatives, Mount Sinai’s leadership knew it had to rethink the experience it was offering patients. They realized that patients are actually consumers who have choices and will simply move to our competitors if they are not satisfied. It is my team’s responsibility to ensure that they don’t do that!
Personally, this is one of the most interesting challenges I’ve taken on in my career. I have spent 18 years in healthcare, focused on leveraging technology to integrate payers and providers. I helped connect physician offices with payers and commercialize cost transparency and care coordination solutions. I also led the creation of Aetna’s Joint Ventures division with large health systems like Banner Health in Arizona. What makes this new and challenging is that we are building a true B-to-C platform in New York, a city with the most culturally, socioeconomically and clinically diverse population in the world. It’s exciting to be fashioning a consumer experience that meets each of our richly diverse consumer segments where they are.
Nilsen: It seems like your team has a broad mandate. Have you determined where to start?
Kerwar: Put simply, my team is building products and services to enable a healthcare experience that offers the same convenience, transparency and delight that consumers experience with top-notch consumer brands like Lyft and Delta Airlines.
To start, we’re prioritizing access, navigation and payments. Regarding access, we will transform how consumers book and prepare for appointments. With navigation, we will improve how they navigate the healthcare system. This includes helping them take the best actions with regard to their care plan, stay on course between visits, and get care remotely with video, text, voice and apps. On the payment side, we will create greater transparency pre-visit, enable a single and intuitive bill, and provide an omni-channel service and payment experience.
Our view is that these innovations will benefit not just the consumer, but also the health system. Done well, consumer-centricity should be a profit center, not a cost center. If we make it frictionless to find care, we should see more new patients. If we make our system easy to do business with, we should realize more of the lifetime value of the customer. If we make the payment process more intuitive and transparent, we should lower customer service costs. All of our initiatives will have a financial case that backs up the use case.
Nilsen: Can you speak to any specific solutions that your team is designing?
Kerwar: Some of them will come in the form of apps, portals or web services designed for self-service. For instance, consider a mobile-friendly, guided experience for booking care. Before the patient books, they can compare each care modality against their buying preferences, whether that’s costs, travel time, wait time, etc. However, the healthcare system is designed around the financial and operational realities of the health system, not the consumer. As such we can’t expect to create ultimate consumer-centricity simply by deploying a few apps.
In some use cases we’re deploying navigators, who will drive a technology-enabled service that guides consumers through healthcare decisions and actions. If you are a relatively healthy patient with recurring kidney pain, they will help you figure out if you should get care from your PCP, a nephrologist, urgent care or a video visit, based on your clinical profile, insurance status and preferences. If you were recently hospitalized and are trying to sort through your hospital, lab, professional bills and EOBs to figure out if you’re being ripped off, our navigators will make your problem their problem and fix it.
Ultimately we cannot expect to solve these problems by simply throwing more people in the mix, so a human-powered navigation service is not the end-state we envision. Self-service technology should eventually take away the confusion and inconvenience of healthcare, however, and this model will force us to walk a mile in our consumers’ shoes and help us design a better technology platform.
Thirty years ago, when you wanted to book a trip overseas, you would visit a travel agent who would review airline timetables, negotiate flights, communicate with hotels, etc. That’s unheard of today; you can do all of it in less than an hour online. That’s where we will bring the system – to where self-service technology helps you easily plan and navigate your journey through a vast and confusing healthcare ecosystem.
Nilsen: What functions and skill sets do you see joining your team and building the future of consumer-centric care systems?
Kerwar: That’s a great question and it is something I thought a lot about before taking this role. We are building a really balanced team that brings together the best product owners, full stack developers, architects, human-centered designers, integration engineers and consumer research experts. We are purposely hiring from both inside and outside of healthcare.
Healthcare is an incredibly complex industry, so if we just hired from consumer brands we might not find the right approach to solve the big challenges facing consumers. Meanwhile if we just hired from within healthcare, we would run the risk of rebuilding an equally broken wheel. So we feel strongly that the team should consist of a healthy blend of entrepreneurs from healthcare companies as well as consumer brands.
I was incredibly lucky to recruit the former CTO of CareDox, a care delivery and management platform for kids with chronic diseases in the K-12 public school system. He built their engagement platform, used by parents, school nurses and the larger primary care community, from the ground up. I also recruited the patient engagement lead from John Muir Health System in the Bay Area, who successfully transformed many consumer experiences for that system. Meanwhile we have some of the best product and engineering talent coming to us from leading consumer brands like Blue Apron, Equinox and care/of. It is really an honor to work with this team.
Nilsen: What are some of the things that have surprised you most since joining a provider system?
Kerwar: It’s a bit of a cliché, but I’m most impressed with the people at Mount Sinai. At past companies, I worked with people who were incredibly talented within their own trade – business development, operations, engineering, etc. At Mount Sinai, I’ve met some of the most talented clinicians who also happen to be excellent operators, informaticists, engineers, or strategy and business development leads. We have a practicing cardiologist running our informatics team. We have an emergency medicine physician who built our telehealth business. We have an internist who runs our worksite clinics and still sees patients one day a week.
It’s also a system that is actively trying to reinvent itself. Large health systems sometimes have a reputation as monolithic, fee-for-service machines that are resisting all forces to keep patients away from the hospital and in lower-cost care settings. I was expecting to run into a lot of that when I first joined, but I can honestly say that I haven’t encountered that perspective much at all.
A few years back Mount Sinai ran a campaign with the slogan “If our beds are full, it means we’ve failed.” You don’t typically run into a business that actively tries to decrease performance against a KPI that most of its competitors track! However that underscores a cultural push. Many of the people I’ve met at all levels across the system are interested in how to reinvent the industry and Mount Sinai’s place in it to achieve higher levels of clinical efficiency while becoming more consumer-centric.
Nilsen: What are some of the greatest lessons learned so far?
Kerwar: It’s still early days, but we are learning good lessons about how to create sustainable change for the consumer. It’s not just about the technology. It’s about the underlying staff, processes and culture behind that technology. My team is careful not to make an important design decision without testing it against the consumer, operational and clinical workflow we aim to improve. We do a lot of consumer research, operational immersion, pilots and A/B testing. We innovate incrementally, and we always do so hand-in-hand with the clinical and operating staff that’s going to interact with the consumer. You cannot rebuild a consumer’s experience by being an insular team – you have to be deeply imbedded on the front lines of care delivery.