In a recent Wired article, a university director of clinical engagement suggested the university would need to consider increasing their Salesforce use to help students increase their healthcare engagement. Customer Relationship Management (CRM) improves customer satisfaction, loyalty, and profitability by acquiring, developing, and maintaining effective customer relationships and interactions with stakeholders. Historically, companies outside healthcare use CRM to identify customers who generate significant revenue and tailor their offerings based on earlier interactions with those customers. Health systems could view patients with chronic diseases as long-term revenue streams with ongoing surveillance testing and procedures. Employers and health insurers looking to empower patients with potentially higher-value surveillance options will need to consider these patients’ needs to have them consider looking elsewhere. Without other tools to increase patient engagement, customer relationship management might help fill this gap in our technology deployment portfolio.
Currently, the evidence base for CRM to drive patient engagement is weak. Baashar et al. reviewed 19 studies that included some mention of CRM in healthcare from 2000 to the 2019. The review focused on Web-based CRM, implementing CRM systems and adopting CRM. One of the included studies found that implementing CRM was associated with shorter wait times, better physician allocation and higher patient satisfaction. The article did not suggest a theoretical framework to use CRM tools to increase patient engagement.
CRM may be useful for providers and payers looking to retain specific patient segments within a care delivery or contracted network, respectively. Sophisticated CRM products develop different tactics for different parts of the customer lifecycle: awareness, research, comparison, purchase and retention. Large health systems bombard patients with awareness messaging. Unfortunately, there are very few health system tools addressing any of the other phases of the lifecycle. Some communications will include a reference to a national ranking service, but those services often provide conflicting advice. Even employees searching for wellness options may not understand exactly what health products or services might best meet their specific needs. Healthcare providers and payers may believe patients are not true customers and have little choice in where they receive their care.
The COVID-19 pandemic has highlighted the importance of elective operative procedures for the financial health of most large medical centers across the country. Before considering the needs of chronic patients, health systems may have a more immediate financial imperative to address the customer relationship for surgical episodes of care. In 2012, the top four operating room procedures for Medicare patients were knee replacement, hip replacement, percutaneous coronary angioplasty and treatment for fracture or dislocation of the hip and femur. The top operating room procedure for commercial health insurance patients was knee replacement. Health systems have gobbled up primary care practices and affiliated with orthopedic surgeons to help boost their operative volumes. Most patients will defer to their primary care provider’s recommendation for an orthopedic surgeon. The patient will then defer the surgical decision and location to the orthopedic surgeon. Even if a patient has some information about the procedure’s immediate and long-term costs (e.g., rehabilitation) for one surgeon, it may be nearly impossible to get comparative information from other surgeons. From a quality perspective, few patients will have access to joint failure rates, joint infection rates, odds of being pain-free and fully functional after rehabilitation or the odds of needing a joint revision long-term. Payers have access to claims information, but very little insight into their members’ pain or functional status after a procedure beyond visits with healthcare system or refilling pain medications. Even simple CRM tactics like providing clinical and cost information before deciding to perform a procedure are likely to increase a patient’s loyalty to a physician team and the surgical facility. More sophisticated health systems and payers may consider incentives to have patients provide pain and functional status information at regular intervals after a procedure to help identify higher-performing clinical entities or support future outreach efforts.
For chronic diseases, CRM could increase a patient’s willingness to return a clinic or health system for ongoing care. Even in a value-based care arrangement, health systems that offer high-quality, low-cost methods to interact with healthcare professionals that are tailored to patient’s engagement with the health system would seem to be more likely to attract and retain patients compared to health systems that do not provide that level of tailoring. Health plans that provide more methods to engage with patients for chronic disease management and surveillance may also help patients see their ongoing care as something that can be managed separately from their acute care needs, much like many women see an gynecologist for their gender-specific needs and an internist for their other health concerns.
Even in these limited use cases, CRM will need to be tested more extensively in wider populations before considering it as an effective tool to increase patient engagement. Scalable CRM strategies seem to be most effective among patients with at least some level of Internet literacy and access to the Internet. Patient segments without Internet access or Internet proficiency are some of the hardest to engage initially and long-term. Some companies have been able to tailor their patient outreach based on patient characteristics and prior behaviors. CRM was developed with a marketing mindset focused on consumer brand loyalty. Appealing to an individual’s sense of loyalty might be most effective for procedures that individuals pay for out of their own pocket with the possibility of another procedure in the future (e.g., patient requiring a right hip replacement now and a left hip replacement in the future), individuals who purchase a health insurance policy on the individual market and Medicare Advantage beneficiaries in competitive markets. In all three cases, the CRM efforts would have to maintain the health insurance or offering at the same or better value than competitors based on publicly available metrics. To date, CRM has not been a differentiator in the healthcare marketplace. In a future where healthcare value (price and outcomes) are more easily available to consumers, CRM might provide more value to health systems or payers. Finally, long-term behavior change, the treatment to address the early stages of many chronic diseases, may require different tactics than specific tactics at different stages of a consumer’s lifecycle with a healthcare company.
It may be unfair to expect CRM to meaningfully address patient engagement. Health systems and health plans that can segment their patients and members into specific groups with their own segment-specific tactics to initiate and sustain engagement may find some CRM techniques to be helpful. CRM does not appear to enable patients to optimize their own healthcare behaviors to maximize the likelihood of achieving their own outcomes of interest. CRM may help health systems and health plans consider tracking information that is meaningful for patients. And that information could help patients understand their own role in managing their health.