Patient Relationship Management: Solutions and their Effective Application

Healthcare organizations (HCOs) striving to improve patient engagement are increasingly turning to solutions that promise more targeted patient outreach, more coordinated care management, and more potential for patient self-support in between care episodes. These solutions fall under a broad umbrella that can be described as patient relationship management, or PRM - and despite its name, it’s much more than a rebranding of customer relationship management (CRM) for healthcare.

This Market Scan Report expands on the reasons that healthcare needs PRM, describes the current and future state of the market for PRM solutions, identifies the seven classes of vendors operating in this market (see Figure 1), assesses the features available (and missing) from PRM solutions from these classes of vendors, profiles 13 leading vendors, and offers a series of recommendations to help vendors meet current and projected PRM market needs (including the challenges presented by value-based care and payer-provider convergence).

Market Dynamic

True PRM is more than just “CRM for healthcare.” It focuses on patients’ needs outside of the healthcare facility setting, in between care episodes, as they live their everyday lives. It is more than improving engagement at the hospital bedside, more than making phone calls after hospital discharge, more than launching a “portal of portals” to provide a unified engagement experience, and more than opening an Innovation Center to solve one-off problems that an HCO faces. Healthcare needs specific solutions for PRM because current engagement solutions fall short of the mark for several reasons.

Despite these needs, we expect the market for PRM solutions to grow slowly over the next 24 to 36 months. The average HCO is not taking on enough financial risk, and has too many other IT priorities, to make a significant investment in PRM. When solutions are implemented, it will be on a small scale, limited to cohorts covered under value-based care (VBC) contracts such as ACOs and MSSPs or bundled payment plans.

Large-scale adoption is unlikely to occur until at least 2020. By this time HCOs will better understand MACRA, PRM solutions will more readily integrate with clinical systems, and the convergence of payer and provider business lines will place increasing demands for a more complete view of patient data.

Market Outlook

There is no dominant vendor in the PRM market. In fact, there is no dominant set of vendors, though the CRM/ Marketing and Care Coordination sectors have been the most active - and the PHR sector has been injected with some life following the announcement of Apple’s Health Records pilot. This report identifies dozens of vendors and provides profiles for 13 representative solutions that are seeing market traction.

This report evaluates the PRM market as a whole on the maturity of functionality in five key areas:

• Patient outreach
• Care management
• Engagement and commutation
• Patient self-support
• Analysis and reporting.

Broadly speaking, engagement and care management functionality is closest to meeting the analyst's expectation of what PRM solutions should offer, while self-support functionality falls short. Finally, solutions are beginning to address the needs of patients, who appreciate the convenience that PRM solutions offer but would like to see an increased focus on giving patients digital access to their records across disparate care settings.

Key Takeaways

The PRM market is active but fragmented. Vendors approach PRM by supporting one of the seven core competencies required to support true patient relationship management: Care Coordination, CRM (both enterprise and healthcare-specific), Education, Messaging, PHR, Portal, and Revenue Cycle Management (RCM) and Practice Management (PM). Most vendors offer only some of these attributes - none currently offer all seven.

For PRM vendors, value propositions vary. Vendors with core competencies in CRM and Marketing, Messaging, and RCM can provide broad engagements across large population cohorts but struggle on their own (absent third-party partners) with deep engagements with specific population subsets. On the other hand, vendors focused on Care Coordination and Education tend to provide the opposite - deep engagements with specific use cases (e.g. disease states or surgical procedures) but not broad engagements across a larger patient population.

For all the promise of PRM, HCOs are biding their time... Uncertainty about value-based payment models, long lists of IT priorities, and M&A activity among PRM vendors will contribute to HCO hesitance to invest heavily in PRM solutions over the next 24 to 36 months. Pilot programs will remain the norm, focusing on patient populations covered under HCO’s risk-based contracts. HCOs may increasingly lean on their portals, too - especially as EHR vendors continue to pivot to PHM and offer patient self-management and support features in addition to the traditional communication features.

…And this pause will let the PRM market sort itself out. The slow pace of PRM adoption should not cause vendors to panic (too much). In fact, the pause gives them a chance to do two things. One is address feature sets that are weaknesses - such as clinical content for CRM and RCM, or broader use cases for Care Coordination and Messaging. The other is anticipate future HCO needs such as non-clinical resources, complex clinical pathways, and the creation of collaborative health records easily shared among patients, care teams, and payer and provider entities. All told, wider PRM adoption will follow as these pilots achieve proof-of-concept, as VBC models get fleshed out, and as solutions expand their feature sets and clinical integrations.

Patients want their data. Make no mistake - patients appreciate functionality allowing them to schedule appointments, email physicians, and even pay bills like they can in consumer-facing applications. By and large, though, the biggest “ask” of patients is the ability to access their records from disparate data sources in a single location. The historical struggles of PHR vendors suggests that this is quite difficult to accomplish - but the promise of Apple entering the PHR market suggests that barriers to patient data access may be starting to fall.