Groundhog Day: The Problem with Charging for MyChart Messages

In her 1999 stand-up special “Dress to Kill,” Eddie Izzard draws a comparison between France and Germany’s attempts to invade Russia.  The French quickly discovered it was “a bit cold” and turned around.  One-hundred and twenty or so years later, the Germans came in with a “new plan” only to find out it was the same plan and get turned away by that same cold.  Having to learn the same lesson over again is almost the defining trait of humanity.  Relearning every 120 years is expected.  No one with practical experience is left to pass on the message.  Unfortunately in less than 20 years, it seems we’ve forgotten a lesson that the trend to charge for MyChart Messages (that is gaining steam) will force us to relearn.

In the Fall of 2003, the banking industry was abuzz with the new opportunities that Health Savings Accounts (and accompanying High Deductible Healthcare Plans) would bring.  Of course they were excited; they were about to make a bunch of money creating and selling new products subsidized with tax breaks.  Whenever one of those bankers with dollar signs in their eyes was asked why all of this was a good idea for healthcare, the answer was invariably the same: “Skin in the game.”  A phrase common in “business, finance, and gambling” being used to explain the benefits to healthcare should have been seen as a red flag in retrospect.  In short, the idea was that when patients saw how much of their own money they were spending on their healthcare, they’d spend less.  These combined efforts would result in a big reduction in healthcare spending.

Turns out they were partially right.  Folks with HSAs did indeed end up spending a bit less of their own money – at least when decisions were up to them.  The United States as a whole hasn’t fared so well.  Spending on healthcare has skyrocketed in terms of both dollar per capita and percent of GDP since 2004.  For all that money our healthcare outcomes have only worsened over the same period.  Why weren’t HSAs our savior?

At the end of the day, HSA plans just weren’t addressing the reasons costs were going up.  Patients don’t get to choose whether they pay for an appendectomy or a stay in the ICU when they can’t breathe on their own.  They do get to avoid costs associated with routine check-ups, screenings, and preventative care.  That cost savings does not equal the amount needed to care for them down the road when those unchecked conditions force them into the Emergency Department.

Charging for MyChart Messages may be taking us down the exact same path.  By ensuring patients have skin in the game, doesn’t recent history tell us we’ll ensure they don’t utilize the service?  What happens then? Why would we think they’ll switch to properly utilizing less convenient services?  If this generation is anything like the last, they’ll go without care until their symptoms are so bad, they have no choice but to seek more expensive options.

Isn’t it the same plan? Feel that?  It’s starting to get a bit cold.

In order to make a new plan, let’s examine the problem we’re actually trying to solve.  Are your providers overwhelmed with MyChart Messages contributing to pajama time and burnout?  If so, they’re not alone.  Discouraging patients from sending messages to providers will discourage engagement with healthcare.  Providing your patients an easy-to-follow experience may help.  Ask yourself the following questions:

• Are the messages providers are receiving better answered by other people? 
• Are providers receiving messages that require an appointment to fully address? 
• Are providers empaneled with more patients than they can realistically cover? 
• Is it easy for your patients to understand their care options? 
• Is it easy for patients to communicate with anyone other than their provider? 
• Are post-visit instructions unclear? 
• Are patients messaging multiple people with the same question? 

Chances are some combination of the above, as well as other things that have yet to be uncovered, are the true root of message overload.  Properly investigating all the issues is no easy task.  It’s certainly more work than charging for messages, but solving these issues will fix more than just pajama time. Experience Blueprinting and other aspects of Service Design can provide the tools needed to pull this off.

Dedicated Experience Blueprint workshops allow you to bring together the clinical, technical, operational, marketing, and patient stakeholders together to not only answers these questions, but also map what systems and tools contribute to this experience.  A patient might explain that they didn’t want to message the provider, but they didn’t see another option to get their question answered.  A provider might then be able to rework patient-facing material to answer questions before they are even asked.  Or a triage nurse might suggest funneling requests to their team.  A developer might then provide a better technical solution once the problem is articulated directly from the source.  When people work together toward a well-understood common goal, amazing things happen.

Involving an outside party such as Bottle Rocket not only brings expertise with the tools and the methodologies needed to run a successful Experience Blueprint workshop, they bring together the various stakeholders together without the sense that any one group is pushing their own agenda.  Having an impartial third party facilitate these discussions and deliver actionable insights helps ensure success.  Connect with an Expert today and let’s come up with a plan that’s actually new.