The Misconceptions of CRM in Healthcare ft. Craig Kartchner

Craig Kartchner (00:00):
I thought the grand vision was to get CRM in front of anyone who would interact with a patient or customer. It’s not realistic. It’s not going to happen. So again, you can’t look at it as the source for all nonclinical information that you’ve cataloged every single patient touch. So instead, you should look at it as the prompt for the next action, the thing that makes the most sense, how can we satisfy the need for any given individual?

Alan Tam (00:38):
Hello, healthcare. In today’s episode of Hello Healthcare, we’re going to be talking about a very taboo and complex term, CRM, customer relationship management. In healthcare, CRM can mean many different things. I’m joined here today with Craig Kartchner, associate vice president of marketing and consumer experiences at HonorHealth. Craig, welcome to Hello Healthcare.

Craig Kartchner (01:05):
Thanks, really happy to be here.

Alan Tam (01:06):
Craig, you’re managing the consumer experience at HonorHealth, and obviously CRM plays a big role in this. What are your thoughts in terms of how healthcare today is defining and integrating CRM into their systems?

Craig Kartchner (01:27):
First off, I have to say that I’m still trying to figure out the best way to use CRM and what makes sense for patients and all of that. So I don’t claim to know it all, but I think that healthcare has often misdefined CRM. They have borrowed too much from the origins of CRM, which was really sales. It’s developing a relationship with your sales prospects and making sure you got a certain number of touches and so on.
(01:56):
But really that interaction and that relationship that you’re managing with a CRM in the sales environment is around a product or service. It’s much more confined and defined, and the interactions are a lot fewer and less complex than you really see in healthcare. So I think if healthcare adopts it, as salespeople used to use it, they’re not going to get what they really want out of a customer relationship management tool.

Alan Tam (02:23):
So why do you think there’s this misconception of CRM in healthcare?

Craig Kartchner (02:26):
Well, I think it’s in part because there weren’t very many options for so many years, the field was dominated by Salesforce. And as is their name, Salesforce, that’s how they grew up, is serving salespeople. So now of course they have a healthcare suite and many other CRMs do, and that’s great, but it’s still only part of the story. I think the origins have forced the conversation and the use to a certain sliver of managing healthcare relationships, but they’ve left a lot of it unserved or unfulfilled.

Alan Tam (03:02):
So that makes a lot of sense, and I think that’s why a lot of CRM implementations actually fail within some of these health systems. What are some of the additional gaps that you think are applicable here that healthcare marketers typically lump in with CRM where they shouldn’t?

Craig Kartchner (03:18):
I think it’s a really good question because CRM, it’s kind of an ambiguous term and there’s some overlap with a lot of other platforms, but I think you really have to think of building an entire ecosystem and CRM is just one component. Marketing automation is often conflated with CRM. Sometimes it is the same platform, but it shouldn’t be conflated. It’s a separate platform.
(03:42):
I think even more distinct and important is your data modeling, so your data as a warehouse and then the way you analyze and model your data.

Alan Tam (03:51):
Absolutely.

Craig Kartchner (03:51):
Predictive analytics and propensity modeling, all those things, that is not a CRM. That’s not the function of a CRM. That’s something that happens that you ingest and you want access to, but that isn’t what a CRM is, likewise with some of the other tools. So some of the other patient engagement tools, appointment reminders, things like that are not CRM. They’re ways to serve your customers’ needs and engage with them. So it obviously relates to the CRM, but it’s not the same thing.

Alan Tam (04:27):
Yeah, that’s definitely an interesting perspective, and I wish more healthcare marketers view it as you do, because typically today, CRM misconceptions in healthcare can include viewing it as the kitchen sink for healthcare marketers, everything kind of goes into that. And I think that’s one of the complexities and challenges that healthcare marketers have when they’re looking for a solution. It’s like, well, does your solution do this? Does your solution do that?
(04:52):
The other thing that I find perplexing is the fact that in healthcare, CRM is often a noun and not a verb, where I need a CRM, I have a CRM, I’m done. Help me understand why are healthcare marketers not thinking about CRM as it’s intended, which is a verb and a strategy versus a tool.

Craig Kartchner (05:22):
That’s a really good distinction. I think I used to be very guilty of that exact mentality. I mean, I used to believe, I even used to describe it in presentations that CRM is like the person in court who would whisper in the king’s ear and say, “Hey, this next guy coming in the room is the lord of so-and-so,” so the king can remember, “Oh Lord Such-and-such, pleased to meet you.”
(05:50):
So it’s like you need to catalog every single interaction in your CRM and it becomes just a list of all the interactions and the response rates and stuff that you would then use to prompt the next interaction.
(06:04):
But I think to your point, if you can’t understand the need that the patient really has and be able to serve and satisfy that need, then it doesn’t really matter what you do. And that’s not always cataloged in the CRM, or the CRM doesn’t help you to take that action to be able to do the next thing that the patient needs. So it’s not that the CRM can’t be a part of that, it’s just the CRM alone isn’t going to solve it for you. You need to serve up the actions from your EMR, from other platforms. That’s what the patient needs.

Alan Tam (06:42):
So how do you convey this to a leadership team that may not have the skillset or the appetite to understand all of these requirements? How do you push for this type of tool and this type of strategy?

Craig Kartchner (06:59):
That is inordinately difficult, it really is. It is so difficult because it’s expensive to build this ecosystem, not just the CRM. To build the whole ecosystem is very expensive. But it’s really access to the data. You’ve got to convince your leaders to give you access to the data. And you look at a Walmart or other retailers, they want their vendors to have access to the data. They give them real-time access to register by register data. They know exactly what’s on the shelf, what’s in inventory, what’s being purchased at this point of sale versus this point of sale.
(07:37):
Well, in a sense, marketing departments are the vendors. We are the ones who help sell the inventory of appointments, but we don’t have the access that Coca-Cola has of the Walmart inventory. So getting access to that data is something that doesn’t always exist. Then how are we supposed to effectively sell it?

Alan Tam (07:58):
Yeah, I do find it strange in any other industry, marketing owns the entirety of the patient experience. Yet in healthcare, marketing plays such a tiny role in the entirety of the patient experience. What can marketers do to increase their presence and increase their role within the organization to help bring the light on improving the entirety of the care journey experience, especially when the patient is outside of the system?

Craig Kartchner (08:33):
Yeah, that’s a great question. I think first off, the problem you described, it’s exacerbated by the fact that we don’t have enough primary care providers. Every health system in America has a primary care provider shortage. So we are all petrified about losing additional providers. So we can’t do anything that would make their job more difficult, increase physician burnout or add steps to their workflow, anything like that, that increases the likelihood that they’ll become dissatisfied and look elsewhere. We can’t go in that realm.
(09:07):
So I think back to your question of what we can do, what I’m trying to do is two things. One, it’s truly be the expert. We do a lot of market research, and I would say to those who don’t do a lot of market research, start. Look at what you already have, HCAHPS, CG-CAHPS, things that you already have of course, but in all likelihood, you’re going to have to commission more research to really understand your patients’ pain points and what they want and need.
(09:33):
So once you’re the expert, you have the data, you can provide more value, you can be the voice for the customer because you are actually serving up data and not just opinions.

Craig Kartchner (09:47):
Oh, okay. The second thing I would say, once you’re the expert and aggressively serving up data is pitch it. It sounds so obvious, it’s the WIIFM, it’s what’s in it for me. You have to serve it up in a way that actually helps both parties, the physicians and the patients.
(10:06):
So it’s things like Dr. So-and-so or his staff, her staff, I totally respect how difficult things are right now. You are overwhelmed. You’re not staffed well enough, you don’t have enough people. I want to help you better manage your appointment inventory. So the more you share data, the more I can help you. I won’t run campaigns that are going to exacerbate your already overwhelmed schedule. So I can be more intelligent about the way I point patients and point customers in all my marketing activities.

Alan Tam (10:40):
That makes a lot of sense, especially when you compare it to retail. You’re not going to push consumers to a product that you’re sold out and you don’t have inventory on. But ultimately that requires, like you said earlier, access to that data so that you can make the right call and the right judgments to deliver that much better of a patient experience. What’s the resistance there in terms of leveraging all this data, first party data to help you drive and make those decisions?

Craig Kartchner (11:10):
I think the biggest problem is similar to what we’ve been discussing, it’s that physicians, historically, their staff at their clinics have found that when marketing and sometimes call centers, when others get involved, we can mess things up. We can send the wrong type of patient or if they give away control of online scheduling, for instance, maybe the decision trees that lead to a certain appointment type, they result in errors, they didn’t do the pre-work they needed to do or the insurance verification or other things that gum up the system.
(11:50):
So they’re worried about that, rightfully so, they have a reason to be worried, but the way we used to do marketing campaigns where it was based on a clinic opening or a service line, now we’re going to promote oncology because it’s next up or it’s heart month, we’re going to run a heart campaign. I think people know that’s antiquated, that’s not going to work. We have to market down.
(12:12):
It’s balancing supply and demand, we have to market down to that individual appointment slot. There is availability out there. It’s limited, yes, but it’s out there. It’s just that we need real-time access to see where the specific slot is, not just that, oh, this clinic needs some volume.

Alan Tam (12:34):
I appreciate that example, and I think that’s a really specific use case that you’ve highlighted that makes a ton of sense. And ultimately that delivers that better patient experience that maps back to the CRM.
(12:47):
So let’s tie this back to CRM. How does this overarchingly tie back to the CRM itself, or does it, or should it be another different type of technology or perhaps process that fundamentally ties into the CRM?

Craig Kartchner (13:05):
Well, I don’t think you meant it to segue this way, but it did because you and I have had this conversation several times, Alan, where it needs to be about always on. That example I gave of marketing that specific appointment slot, you can’t possibly do that manually.
(13:24):
My team has literally gone clinic to clinic to clinic in our system to talk to the staff who help the physicians with their scheduling to get a better understanding of the appointments, which ones are restricted and why, which ones are appropriate for which type of patient and the time slot that’s 15 minutes, 20 minutes, why, to really understand those things. But if we were to do that manually on an ongoing basis, I mean, that’s not tenable.
(13:51):
So you need the CRM to be part of your always-on automated marketing system. There are no campaigns. Campaigns might exist for brand marketing on mass media, but in terms of building volumes and associated revenue because of the patient volumes, it’s not a campaign, it’s an always on.
(14:12):
When there’s an availability, oops, slot just opened, you go to the wait list, you go to those, you look at clinical records and find out who hasn’t come in but needs to for this type of appointment, or based on a bunch of different factors using propensity modeling, who might be interested in this appointment. You market very specifically to them. It’s not a campaign.

Alan Tam (14:33):
And I’m always fascinated by that because especially in healthcare, you have Breast Cancer Awareness Month, you have cardio month, and you have Men’s Health Month. It’s just these conditions and those patients just don’t need you for that particular month. And that’s where I think always on is really critical because that’s what other industries are using and adopting.
(14:56):
What are some of the things that you guys have implemented at HonorHealth that replicates this type of experience for your patients?

Craig Kartchner (15:05):
Well, honestly, not enough. The biggest struggle is that lack of inventory and it’s matching the supply with demand. But I will say that we have turned on some features that make it more always on like wait-listing.
(15:23):
So we have much better understanding of the appointment slots that are available and which ones are restricted and so on and so forth that now we’re turning on tools to automate, put you on a wait list and if something opens up, we can automatically via text offer this slot that just opened up to you and we’re making that feedback system to our EMR real time.

Craig Kartchner (15:43):
It used to be delayed 24 hours, and so if you canceled an appointment right now, I wouldn’t know for 24 hours until the next feed. So it’s a wasted appointment if it’s same day or next day. So that’s one thing we’ve done is made that feedback real time. And then the low-hanging fruit of those on wait lists, of serving up immediately via SMS text to fill.

Alan Tam (16:09):
So it’s amazing that you’re focusing on that because you’re tackling the patient experience, especially for your existing patients. Oftentimes when I’m talking to healthcare marketers and you hear about healthcare strategies, there’s a lot of focus on acquisition and that’s where the marketing budget goes and where the marketing dollars go, but there’s been a significant lack of focus on patient retention and lifetime value. How do you look at these two strategies and initiatives in terms of funneling your energy as well as your budget dollars? Where are you guys focused on more?

Craig Kartchner (16:46):
Yeah, it is shifting, honestly. I think you’re totally right that we’ve focused almost exclusively on acquisition and not nearly enough on retention, but that is shifting. We actually have calculated, we have a formula to calculate lifetime value, I think probably a lot of health systems do. So I don’t know how much ours would differ from other calculations.
(17:08):
But we do take it into consideration when we’re budgeting different brand campaigns at the highest level, and especially in the zip codes we’re targeting where we have new facilities and where our efforts are definitely going to be more acquisition minded. But a lot of the tools we’re turning on that we’re automating right now are definitely focused on retention. It’s on thinking ahead.
(17:35):
To me, it’s inexcusable that we have a shortage of appointment availability right now, but there is a lot of healthcare out there that is, we can predict 90 days ahead, 120 days ahead, a year ahead. We know that people with certain conditions need to meet on a certain cadence. We need to do a better job of predicting. Those are existing patients, we need to retain them, do a better job of predicting what they need and getting ahead of it so they don’t encounter that wait time of three months to get into their provider and that’s something …
(18:09):
By the way, we keep skirting around CRMs. I think it’s my fault more than yours, Alan, but that’s the part that CRM can help with is providing the prompts and triggers and alerts and even assignments to different team members to handle this, take care of this, ooh, here’s an opportunity, run this, those sorts of things.

Alan Tam (18:30):
Yeah, so let’s dive deeper into that because I appreciate you bringing it back to it. So we talked a lot about what CRM doesn’t cover. You hit on some things that CRM does cover. So let’s drill down a little bit more on specifically, what should a healthcare marketer’s expectation be on CRM as a tool, as in now?

Craig Kartchner (18:52):
I think at least for now … Again, old Craig, I thought the grand vision was to get CRM in front of anyone who would interact with a patient or customer. And by the way, that would be awesome, but it’s not realistic. It’s not going to happen. So again, you can’t look at it as the source for all nonclinical information that you’ve cataloged every single patient touch or customer touch and encounter.
(19:21):
So instead, you should look at it, like I said before, as the prompt for the next action, the thing that makes the most sense, how can we satisfy the need for any given individual, and the alert to start that sequence of hopefully automated actions to fill the supply with the demand, to match those two.

Alan Tam (19:46):
That makes sense. And I think that a system like a CRM needs to have that level of intelligence. And I believe that there’s a lot of technology out there that is available today. What’s been the biggest challenge or biggest pushback that you’re hearing in terms of why healthcare marketers aren’t adopting that type of technology?

Craig Kartchner (20:12):
I think one, it’s expense because in order to build that ecosystem, it’s not just operational dollars, it’s the resource to integrate it intelligently. You’re either going to need to get our third party to do it, which is expensive, or you’re going to get your own IT teams, and we know how inundated they are, they too are suffering from staff shortages. So I think that’s one of the biggest barriers is finding the people to implement what you buy and justifying the dollars initially.
(20:44):
I think another is certainly the data access and that, again, I’m not claiming to be the expert, but I’ve been trying lately to look at things in terms of a chess game, to look at relationship building as a longer term strategy. And as one of the most critical things that I can do as a leader is forge relationships with people that are the biggest influencers or have the most authority or responsibility for any given area that I need access to serve the patients better.
(21:18):
And so it’s really mapping out who do I need to build a relationship with and what is in it for them? How can I pitch this in a way that’s going to make sense to them and engage them and excite them so that we can work together collaboratively on the patient’s behalf. That’s something that I’ve done a terrible job in my career, honestly. I’ve not done a great job, but it’s a major focus now.
Alan Tam (21:44):
Who do you believe are the key stakeholders and partners that you need to get sign-off from or support from to drive that and move that initiative forward?

Craig Kartchner (21:57):
I think there are a couple groups that … So the clinical leaders within your medical group, whatever your physician-employed group is, those clinical leaders are absolutely paramount. I would say the operations leaders, similarly. Those ops leaders, you need to be best friends with. And then I’d say two other groups, the data, so whoever is your data scientist, data analytics, data warehouse people because you’re going to need access to a lot of data and they can open those doors. And the final one is actually frontline workers, mainly at the clinics and hospitals, people who work at the front desks who are doing reg sched, who are doing patient rooming.
(22:38):
We have done a lot of rounding to specific clinics. Our call center leaders go out at least once a week, sometimes twice a week, so they’re hitting clinics, every single clinic at least a couple times a year, specifically to talk to frontline people, what is frustrating you right now? What are you hearing from patients? What types of calls are you getting? What appointments seem to be mislabeled or the template isn’t working? They really dig into those details and I think that relationship is so important to maintain.

Alan Tam (23:10):
Yeah, absolutely. And I appreciate you diving into that, which brings me back to the CRM itself in terms of when you have the implementation, when you’ve adopted the technology, what are the core metrics and KPIs that you believe are crucial to justify a CRM investment and to start thinking about ROI? What are the right metrics to use to your leadership team to continue with a CRM initiative, as an example?

Craig Kartchner (23:40):
We’ve used the ones that you’re going to be really familiar, I think all our listeners and viewers will be familiar with too. It’s the return on marketing investment and the acquisition rates, cost per acquisition and those sorts of things.
(23:51):
But one that I’m super intrigued with right now that I think I want to make a bigger part of the KPIs that I look at is percent wasted appointment, how many of our total appointments go unused? And I think that more than many other metrics I can point to is going to give us an indication, are we … You know balancing that supply and demand and the very limited supply we have? Are we being as efficient as possible with the limited supply that we have?

Alan Tam (24:24):
That’s actually a very interesting statistic, percent wasted appointments. That’s very scary. Is there actually an industry baseline around that that you’re aware of, or-

Craig Kartchner (24:36):
I mean, not that I know of. I’ll say it’s taken us months and months of work to even figure out how many appointments are available because there are so many different types of appointments and types of restrictions and blocks that your EMR or whatever scheduling system you use that it allows you to put on a block on an appointment type. So it could be same day restricted, same week restricted. There’s so many layers of restrictions on who can see it and who can’t.
(25:05):
So just figuring out what your inventory looks like is hard enough and then trying to figure out real time or as close to real time as you can, how many of those you’re actually filling, that’s a daunting task. But I think that’s exactly where we need to go from a marketing perspective, certainly, because it’s about getting patients in. But also from the patient experience, the customer experience angle, people are desperate for appointments and we need to serve them better and get them in.

Alan Tam (25:35):
I mean what you’re saying makes a ton of sense, and it goes back to what you’re saying with access to the data so that everyone can actually do their job better. What’s the resistance? What’s the resistance in granting you access to that data so that not only yourself, but these other teams can do their job better? I think I know how you’re going to answer, but I want you to answer first because I have a followup question to that.

Craig Kartchner (26:05):
Okay. I think we talked about before a little bit about sending the wrong type of patient to this appointment type or the right patient to the wrong appointment type. I think that’s part of it, but I think it’s because it is so complex and if you don’t have a really robust, clear and complete picture and you’re just getting data and you don’t have all the ancillary and background on it, you probably will misuse it or at least it’ll go wasted.
(26:31):
So I think that’s why, and I think that’s why it’s been effective to develop these relationships with the data folks and the frontline folks and the clinicians and operations people, so we are getting that background and a much better understanding of why it’s so important to have a restriction here and this block here and so on, so we won’t misuse it. We will understand the purpose of the way it’s set up and suggest efficient changes, but not gum up their works and make it more difficult for them.
Alan Tam (27:02):

So it does sound like more than half your job is just trying to educate and sell internally to get everyone else on board and to understand, because to me, it’s pretty crystal clear in terms of having the right tools, having access to the right data to get that job done so that you can deliver on your brand promise and what you’re supposed to be responsible for, which is the consumer experience.
(27:27):
What’s next? I mean, what’s next from your perspective as you look into the future at CRM, whether it’s at HonorHealth or just the healthcare industry in general?

Craig Kartchner (27:38):
We’ve talked a little bit about it already. I think it is that propensity modeling, better predicting what your patients want and need and then more real time, serving it up to them. And like we talked about, it’s that always on mentality. We said that you can’t do it manually, it has to be automated.
(27:57):
What we didn’t really get into is that you’re probably going to need machine learning or AI to help you manage that, to help you intelligently serve up the appointment slot to the right person at the right time, and that’s very difficult. So I think that’s the future is getting your platform together and then with the proper intelligence and data sets to be able to do what we just described.

Craig Kartchner (28:22):
That’s the future, I think.

Alan Tam (28:24):
Yeah, absolutely. Craig, I really enjoyed our conversation and thank you for coming on to Hello Healthcare. You’ve provided a lot of great insights and a wealth of knowledge for our audience. For those that want to continue the conversation, what’s the best way for folks to get ahold of you and pick your brain?

Craig Kartchner (28:43):
I am super active on LinkedIn, and so I’d recommend hitting me up on LinkedIn. Love to engage.

Alan Tam (28:48):
Awesome. Thank you so much. To our audience and all our listeners, thank you so much for joining us today in our conversation with Craig Kartchner on not only CRM, but also insights into how you can better gain and access data to deliver better consumer experiences. Until next time, hello.

Speaker 3 (29:08):
If you want more of the latest from healthcare’s thought leaders, subscribe using the button below, or you can visit hellohealthcare.com to get updates directly in your email.