DHW Q&A: Building Better Experiences With Nuance Communications

With Peter Durlach
Nuance Communications, Chief Strategy Officer

In this Digital Health Wire Q&A, we sat down with Nuance Communications Chief Strategy Officer Peter Durlach to discuss what it takes to create great patient experiences and the evolving role of artificial intelligence in healthcare.

Durlach was an early pioneer in voice-enabled technology before joining Nuance and establishing its healthcare business in 2006. He’s since guided Nuance’s strategy across virtual assistants, imaging AI, and patient engagement, while overseeing Microsoft’s $19.7B acquisition of the company in 2022.

Let’s kick things off with a birds eye view of Nuance’s healthcare business. Can you share a bit about the overarching strategy? 

One of the best ways to think about the Nuance platform is as a conversational AI or ambient technology stack that can be highly tuned for specific B2B problems.

The healthcare division is very focused on creating solutions that drive meaningful outcomes in one of four buckets: 1) can we improve the clinician experience; 2) can we improve financial performance; 3) can we improve clinical quality; 4) can we improve the patient experience.

Zooming in on the patient experience side, can you walk us through Nuance’s services within that bucket?

People have been talking about improving the patient experience for decades, but investment in the space didn’t really take off until a couple years before COVID and only accelerated under the moniker “digital front door.” The reason it took off is because so many new competitors are trying to siphon business away from traditional providers.

When we saw this starting to unfold, we brought over the same underlying technology that’s been providing great consumer experiences in areas like retail, banking, and airlines, then built an application layer on top of that stack that tackles common problems for every provider.

To give one example, the Access Center is more important than ever as patients forget their portal passwords or want to log in to a telehealth visit, yet the staffing shortage is making it so that none of these providers have the ability to keep up. We provide the technology that helps them improve the experience without driving up staffing costs.

How do you think about steering the direction of Nuance’s healthcare business from a roadmap and prioritization perspective?

We start by thinking about the technology platform, then figuring out what apps to build on top of it. Nearly every provider is trying to consolidate vendors, not only for themselves but for their patients.

From the patient’s point of view, it’s a terrible experience if you phone a call center on one system, then interact with a chatbot on another, then receive an SMS from a third vendor. It’s also terrible for the provider to have to build the back end to all these separate systems or deploy these patient journeys across completely disparate platforms.

We do a lot of market research with clients where we ask about their biggest pain points, and one of the things we find time and time again is that the 80-20 rule holds true. 20% of potential applications can solve 80% of the pain. We’re focusing on that 20%.

What are some of the other common pain points that you’ve seen on the provider side during your market research?

I think that one of the biggest challenges in healthcare is that a lot of places still have silos between different areas of whatever they’re calling “digital.” The website, the voice side, the SMS. These silos get in the way of a comprehensive strategy.

You can’t have the people who manage the call center thinking about workflows and technology independently from the people worried about SMS and the website. Some organizations are starting to put these silos under the same leader, but even that isn’t necessarily a slam dunk. 

Patient-centric health systems realize that all of these modalities are just different ways to communicate the same information, and it’s the connected journey that’s important.

AI has been enjoying a moment in the sun with ChatGPT and Microsoft’s investment. How do you see these types of large language models impacting healthcare? 

First, let me just say that these new models are truly breathtaking. They’re mind blowing. Does that mean they’re perfect? No. Is there a fundamental technology shift happening? 100%.

In healthcare, the bar is a lot higher because the model’s mistakes can kill people. That means we’re probably going to see non-medical decision making use cases like prior authorizations or patient engagement proliferate quickly because a mistake isn’t going to kill somebody.

On the clinical side, it’s going to be far more complicated because the downside is much greater, plus you have the FDA in the middle of it. How do these models fit into regulatory guidelines? What’s the indication for use? Can you explain the black box? I truly believe it’s transformative tech, but it won’t suddenly solve every problem without some bumps along the road.

What do you think have been the keys to success for Nuance and for anyone looking to transform the healthcare industry going forward?

The single most important thing for us might sound a little cliche, but it’s the fact that we’re laser focused on the outcomes we deliver for our clients. That’s the anchor point for everything we do.

If you’re a company that’s building something in healthcare, you need to be able to move a metric that your clients care about and that they’re willing to invest in. Once you have that metric, you shouldn’t be wasting time on anything else. 

When you ask people what problems they solve, a lot of the time they’ll show you the tech and do a demo. It’s the classic tech company thing to do. They should be thinking about the client problem, the metric they can impact, and an economically viable way to make that happen.

That focus is the biggest key to our success, and it can really help crystalize the mission of anyone else in healthcare.
For more on Nuance’s Healthcare AI Solutions & Services, head over to their website.

Accenture’s Nonnegotiable Patient Expectations

Healthcare consumerism isn’t new, but the last few years have rearranged the list of what patients are looking for in their providers more than any other time in recent memory.

To uncover what factors are currently patients’ top priorities, Accenture surveyed more than 21k US healthcare consumers since 2017, finding that loyalty is now more important and harder to come by than ever.

  • 30% of respondents switched to a new provider in 2021, up 4% since 2017.
  • Nearly 80% of patients who switched cited poor care navigation as the reason for leaving, including bad experiences with staff and inadequate digital solutions.
  • Millennials were nearly 8x more likely to switch providers than older adults (46% vs. 6%) – an important trend to keep an eye on considering that they’re in a unique position to make healthcare decisions for both their children and aging parents.

Accenture identified four focus areas for organizations looking to build patient loyalty in an increasingly competitive landscape.

  • Access: 71% cited access as the top factor in selecting a provider (availability, convenience, the ability to connect with providers through preferred channels).
  • Ease of Doing Business: People who find their providers “very easy” to work with are 9x more likely to stay. Even providers who were “somewhat easy” to work with were 3x more likely to keep patients.
  • Digital Engagement: 79% of patients who described themselves as “highly digital” were likely to stay with their providers. These patients exclusively prefer digital engagement and only fall back to traditional channels when digital methods fail.
  • Trust: Patients who trust their provider were 5x more likely to stay (84%), and almost 7x more likely to stay than those who don’t trust their providers at all.

The Takeaway

Accenture’s report underscores how important it is to lead with the patient experience when building loyalty… and just how difficult of a job that is to actually get right. Patients trust providers who make them feel heard and informed about the state of their health, but building true loyalty “not only requires the ability to meet people where they are, it also means understanding where they are going.”

Healthjoy Lands $60M for Benefits Navigation

Employees love health benefits almost as much as they hate navigating them, which is why Healthjoy closed $60M in Series D funding to simplify the process. 

The new investment brings the company’s total funding to $108M as it looks to build its platform into the leading user experience for both employees and HR departments. 

Simplicity and engagement are how Healthjoy plans to accomplish this. Its app is designed to serve as a unified front door to employee benefits, and includes all the good stuff you’d assume would make that happen: 

  • An AI-assistant named JOY that helps triage users to relevant services 
  • A 24/7 concierge team to answer any questions
  • An “automated steerage” feature that guides members to lower cost solutions

Healthjoy’s stance is that a serious lack of awareness is what causes underutilization. Many HR departments have a robust network of services, but employees can’t use what they don’t know about.

  • By housing every benefit in an employer’s package under one roof (medical, dental, vision, wellness initiatives, etc.), then serving as the engagement layer, Healthjoy is aiming to make the entire experience more seamless for everyone involved.
  • Healthjoy combines its own user metrics with partner data to create comprehensive profiles of its members, allowing it to present them with relevant benefits and nudge them towards efficient options.
  • The company also partners with virtual care providers like Teladoc and other benefit administrators to expand the solutions available to its members. It counts the ability to integrate with, as opposed to compete with, outside platforms as a key differentiator.

The Takeaway
As the health benefits space becomes more complex at the same time as many employers are growing overwhelmed with point solutions, HealthJoy’s strategy of simplifying the experience as much as possible seems to make a lot of sense. If Healthjoy can execute on its plan to drive higher engagement by connecting all utilization data within a single ecosystem, then plenty of employers would probably welcome the help in the battle for talent.

Why Healthcare Needs a Flywheel

Big tech took a week off from major healthcare acquisitions, giving us a rare chance to highlight some of the thought leadership coming out of Providence’s Digital Innovation Group.

A new blog post co-authored by Sara Vaezy and Doug Grapski – DIG THIS: Why HealthCare Needs a Flywheel – lays out how incorporating business flywheels into health system strategies can lead to lower churn, higher capacity, and a better patient experience.

Vaezy is Providence’s newly appointed CDO (she also spices things up with an awesome craft hot sauce side gig), and Grapski is the Director of Digital Strategy within the innovation group (unclear whether he likes hot sauce).

For those unfamiliar with the flywheel concept, it’s a business mechanism that pulls consumers to a platform and drives continued use, thereby adding stability and increasing momentum much like a mechanical flywheel. Notable examples include Amazon’s Prime membership and Starbucks’ loyalty program.

Despite their success in other industries, flywheels are seldomly implemented in healthcare, and most patients rarely interact with their providers outside of moments of individual need.

  • Vaezy and Grapski emphasize that a portfolio of modalities (3rd party apps, care navigation, personalized experiences) is needed to create flywheels that are effective at providing proactive healthcare experiences.
  • By integrating these tools in a single platform, health systems can begin eliminating the gap between “sick care” and “healthy care” – especially important for those in value-based arrangements.

Providence’s flywheel revolves around leveraging various data sources to deeply understand its patients as consumers with identities outside of their clinical data, allowing it to create highly personalized engagement programs.

  • This 360-degree view of its consumers lets Providence operate more like a D2C startup than a giant health system, with strong direct relationships that draw people to its services and keep it top of mind between visits.
  • Only once this flywheel is in place would the authors suggest augmenting it with non-traditional offerings such as a durable medical equipment business or concierge-level care.

The Takeaway

The consumerization of healthcare is one of the biggest trends in digital health, and it makes sense that forward-looking health systems will be borrowing plenty of plays from the consumer-tech playbook. Flywheels are the foundation of some of the most successful consumer businesses, and Providence’s digital health leaders make a strong case that it’s time for healthcare to start putting them to use.

Optum: Patient Expectations vs Reality

It’s difficult to quantify exactly what a perfect healthcare consumer experience looks like. That’s why most coverage of rising patient expectations involves pointing out differences between broken care experiences and Amazon Prime, and why it’s worth taking a closer look when a company like Optum puts out an in-depth report on the topic.

Optum surveyed over 1,000 consumers to explore how payors and providers can adapt their digital on-ramps to healthcare (online portals, websites, mobile apps) to optimize for patient satisfaction.

Highlights from the report centered around the expectation vs. reality gaps for these digital front doors, with the largest rifts found between: finding information about providers (i.e. ethnicity, gender, and licenses), ability to schedule an appointment online, and booking telehealth visits.

  • Scheduling disconnects were most acute for consumers ages 25 to 34, with 45% preferring online scheduling, but only 28% doing so today.
  • The cross-generational divide for engagement preferences has shrunk, with 44% of 55-64 year olds preferring text messages for post-appointment provider communication – just a few percentage points behind phone calls (47%) and email (49%). 
  • 52% of respondents missed a scheduled appointment in the past year, suggesting that there’s plenty of room for payors and providers to improve engagement. The most cited reason for missing an appointment was that they simply forgot (33%).

The Takeaway
The consumerization of care has been one of the biggest themes of digital health for years, and the past few weeks were no exception. Although the core idea is no longer a surprise, Optum did a great job wrapping numbers around areas where healthcare experiences are falling short, and drove home the point that removing friction for those seeking care is one of the best ways to attract and retain new patients.

Happify Health Weaves a New Path as Twill

Happify Health recently re-introduced itself to the world as Twill, the Intelligent Health Company.

While a name change and a shiny new logo probably wouldn’t warrant a full feature story, Twill’s fresh identity was tied to a complete overhaul of its business, and reflects the culmination of its five-year journey from a wellness app to a clinical-grade connected care platform.

Twill’s transformation centers around its three core pillars of a connected care experience. 

  • Untangling the complex digital health ecosystem to make the process of finding the right care more personalized and engaging
  • Weaving together evidence-based digital therapeutics, wellness coaching, and third party solutions into Sequences that help patients navigate their care journey
  • No fabric pun was stitched into the press release for this bullet, but the final pillar is about leveraging AI to intelligently guide patients to appropriate care based on their clinical needs and personal preferences

To accomplish these goals, Twill provides fully-configurable Sequences that combine its digital therapeutics with existing partner solutions to address specific clinical needs. The Sequences employ AI and behavior change techniques to steer patients towards positive outcomes at each step of their journey.

  • To give an example, a patient that joins Twill’s psoriasis Sequence would be onboarded with a questionnaire and given access to a content library for their condition. If their responses indicate that their condition is still being managed by their PCP, Twill might direct them to a dermatologist before presenting them with Almirall’s psoriasis treatment after other milestones have been reached.
  • By the end of 2022, Twill and its partners will offer Sequences for four conditions: mental health (Happify), pregnancy (Elevance), multiple sclerosis (Biogen), and psoriasis (Almirall).

The Takeaway 

Even in its past life as Happify Health, Twill’s biggest strength was its ability to blend AI and intelligent design to create real behavior change. Now, with a new brand and configurable Sequences that can weave together outside solutions as needed, Twill has a much more scalable platform that should let it quickly expand into more clinical areas as it grows beyond its wellness app roots.

Memora Raises $40M to Simplify Care Delivery

Although sky-high private valuations made a slowdown in healthcare venture activity a popular prediction for 2022, it sure doesn’t feel like that’s the case six weeks into the new year. Care automation platform Memora Health recently raised a $40M growth round to help more health systems provide proactive care from any setting.

  • Memora Health builds the technology infrastructure behind “learning health systems,” with an AI-enabled platform that automates complex care workflows and improves them over time by learning from the ongoing behavior of patients and providers.
  • The platform includes SMS-based patient messaging, reminders, and scheduling to create continuous patient touchpoints that allow providers to collaboratively manage care journeys and monitor progress.
  • Data from questionnaires and EHR integrations help triage concerns to appropriate care team members while providing patients with proactive communication about their conditions, ideally improving the efficiency of all parties involved.
  • The funding will help Memora meet commercial demand and drive new partnerships with health systems beyond the organizations it already works with, which include Mayo Clinic, Edward Elmhurst Health, and Penn Medicine.

The Takeaway

Memora is solving one of the most pressing challenges facing health systems by automating components of the care journey and allowing time-constrained providers to practice at the top of their license. In doing so, the company is simultaneously pushing the transition from episodic to continuous and always-on care, which seems like a pretty solid combination of goals to build around in the current healthcare landscape.

Babylon Acquires Patient Engagement Platform DayToDay

Value-based care enabler Babylon is wasting no time making M&A moves in 2022, announcing patient engagement platform DayToDay as its second acquisition in as many weeks. 

Just days after kicking off its US expansion by acquiring health kiosk manufacturer Higi, Babylon is bolstering its remote care capabilities with DayToDay’s digital-first programs supporting patients through major health events such as surgeries, childbirth, and the diagnosis of chronic conditions.

  • DayToDay supports patients during crucial recovery periods that often extend beyond a hospital stay. It provides targeted education resources and clinical support from a personal care team, a strategy that it reports is able to keep rehospitalization rates below 4% (vs. a 15% industry average).
  • Babylon works with providers, employers, and payors to offer members digital-first healthcare through the devices they already own. Its AI platform powers its Babylon 360 value-based solution as well its Babylon Cloud Services data analytics suite.
  • The combination of DayToDay’s patient engagement services with Babylon’s existing offerings should enable better care delivery for both the hospital setting and the home, widening the impact that Babylon can have across the care continuum.

The Takeaway

Babylon’s goal is to “make high-quality healthcare accessible and affordable for every person on Earth,” a mission that’s as big as the company’s appetite for acquisitions that could help make it happen. The Higi acquisition was a strong entry point into US healthcare, and DayToDay’s patient engagement services strengthen Babylon’s value-based care portfolio as it establishes itself internationally.

Phreesia Acquires Insignia Health

Patient engagement company Phreesia recently announced its acquisition of Insignia Health to help patients become more active participants in their care journeys.

  • Phreesia provides services focused on “putting tools in the hands of patients to take on tasks,” ranging from scheduling to self-reporting social determinants of health. Each service is designed to make care more efficient through patient activation.
  • Insignia Health holds the worldwide license for the PAM patient activation measure, which allows clinicians to quickly understand a patient’s ability to self-manage their healthcare. PAM is backed by over 700 peer-review studies and is the only measure of patient activation used by the NHS and CMS.
  • PAM levels include “disengaged and overwhelmed,” “becoming aware but still struggling,” “taking action and gaining control,” and “maintaining behaviors and pushing forward.” Knowing a patient’s level allows care teams to cater treatment plans to individual needs.
  • The acquisition expands PAM’s reach through Phreesia’s existing partner network. Insignia Health founder Chris Delaney stated that “the number of patients we can reach in a single week through Phreesia’s platform would otherwise take us months.”  

The Takeaway

Improving outcomes through individualized care is a top priority for any patient engagement company, and the Insignia Health acquisition gives Phreesia the license to the “gold-standard” of patient activation measures.

Owning PAM could generate additional revenue for Phreesia through licensing, but might also lead to Phreesia cutting back on the number of competitors that have access to PAM in order to strengthen its competitive positioning.

Suki Raises $55M to Bring Voice to Visits

Although some physicians might love the time-consuming administrative tasks that help make a successful patient visit, Suki recently raised a $55M Series C round to help develop AI-enabled voice tools for those that don’t.

As of the latest funding, the company has raised a total of $95M to support the development of Suki Assistant, its voice-first digital assistant, and Suki Speech Service, its platform designed to improve the accuracy and experience of voice solutions.

  • Suki uses natural language processing to create patient notes and streamline administrative tasks, such as retrieving information from the EHR or ICD-10 coding. 
  • The digital assistant supports doctors “in any clinical setting, as well as any specialty,”  and can be configured with personalized commands to adapt to unique workflows.
  • Early research shows that the assistant lowers average time per note by 76%, while decreasing claim denials by 19% through the creation of detailed documentation.
  • Voice is quickly entering the healthcare spotlight, with Notable raising a $100M Series B in September and Microsoft acquiring Nuance for nearly $20B earlier this year.

The Takeaway

The accuracy of voice recognition has crossed a threshold that allows it to be effective in a growing number of consumer products, as well as in healthcare. These tools can now understand a speaker’s intent regardless of most accents or phrasing, leading to wider adoption within previously difficult use cases.

In a roundabout way, Suki is taking a tech-heavy approach to making technology less visible, removing it from between the doctor and the patient so that more attention can be given to providing clinical care. Taking advantage of voice is a natural way to accomplish this, giving Suki a good shot at reducing burnout by allowing more time for physicians to actually practice medicine.

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-- The Digital Health Wire team