Leveraging Intelligence in Value Creation Across Provider Patient Ecosystems

Leveraging Intelligence in Value Creation Across Provider Patient Ecosystems

Mohan Tanniru (College of Public Health, University of Arizona, USA)
Copyright: © 2020 |Pages: 20
DOI: 10.4018/978-1-7998-2310-0.ch003

Abstract

Value creation in healthcare calls for the design of care plans that integrate the activities of clinical and non-clinical actors of both the provider and patient ecosystems as they work towards the shared goal: ensure patient adherence outside the provider ecosystem. Given the differing institutional mechanisms that influence actor behavior, intelligence gathered through digital services has two objectives. The first objective is to use digital services to track patient adherence to care plans, so that these care plans can be adapted as needed. The second objective is to learn about the characteristics of the patient ecosystem, so that incentives can be designed to ensure that all actors are working towards the same shared goal. This chapter uses a service modeling approach to explicate the interconnected role of actors across ecosystems and develop strategies to address these two objects. Several use cases are used to illustrate this approach.
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Introduction

Organizations have been developing services not only to create value that addresses customer needs but also to gain intelligence about customer use behavior post-purchase to sustain the value created (Vargo and Lusch 2008). In fact, rapidly developing new service innovations using a mix of internal and external resources to create and sustain value is one of the basic tenets of service dominant logic (Lusch and Nambisan 2015). The gap between the value created and the value perceived by the customer, i.e. value-in-use or value-in-context, often forms the basis for successive instances of value creation and allows service systems to adapt to changing customer expectations.

Healthcare organizations (referred to here as hospitals or provider ecosystems) have an interesting challenge and an opportunity to create value for patients through care plans and to track patient use behavior (i.e. patient adherence to the care plans) to develop new instances of value creation. Like business organizations, provider ecosystems use a number of technologies to gain intelligence on patient adherence within the patient ecosystem and to analyze it before they adapt their care plans (Herzig et al. 2016). The challenge, however, is that hospitals rely on many external actors, clinical and non-clinical, in the patient ecosystem to both track patient adherence and potentially influence it. This is different from businesses that can use shared incentives as a part of their business models to ensure that all external partners are working towards the shared goal of customer value creation. Many clinical actors outside the provider ecosystem, such as pharmacies, testing labs, counseling and rehab centers, and primary care facilities, have different incentive mechanisms and are paid by different institutions. They are not all centrally controlled and coordinated by the provider ecosystem. Also, the provider ecosystems rely on non-clinical actors, such as social, community, and public health agencies, to support diverse populations with varying levels of support within the patient ecosystem. Incentives are needed to align the goals of these actors with those of the provider and the patient. Therefore, it is a major challenge to understand the role multiple actors play outside the provider ecosystem and influence their activities through incentives towards the shared goal of patient adherence to care plans.

Unlike other businesses, hospitals do have an opportunity to learn about the actors who can influence patient behavior within the patient ecosystem. Patients spend time in the provider ecosystem as patients and providers co-create value as they diagnose medical condition and design treatment plans for patients to adhere to when they leave the hospitals. While this time is often spent in addressing the clinical needs of patients, providers can use some of this time to learn about the patient ecosystem and potentially develop strategies to ensure patient adherence to these care plans. With hospitals becoming increasingly responsible for patient care outside the hospital due to changing reimbursement guidelines (e.g. bundled payments and penalties for unanticipated patient readmissions and low patient satisfaction scores), gaining intelligence about the patient ecosystem while patients are under provider care is becoming very important (Koh et al. 2016). While there are currently many digital strategies used by providers to influence care plan adherence in patient ecosystems, there is no systematic way to tailor these to the individual patient context (Health Affairs, 2013). We propose a service modeling approach to analyze the service exchanges needed to create value and develop strategies to track adherence and/or align goals of actors across ecosystems.

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