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Why Decision Engines are the Future of Health Management

Paul Griffiths

Healthcare is undergoing a dynamic growth in size.  As merges and acquisitions are increasingly permissible in today’s environment, the audacious size of health systems will collide with the efficacy of their mission.  As larger systems move away from operating uniformly sized hospitals and toward increasing their breadth of continuum of care, organizations need to rethink how to create opportunities to provide excellence at scale without becoming overly perfunctory in delivery of that excellence.

While a strong network of care affords consumers a variety of access points, a great patient experience requires a decision engine designed to route consumers to the best option possible.  What is uncomfortable for healthcare systems is that “best” is no longer a clinical definition, rather “best” is what is defined by the consumer.

Imagine the challenge of a consumer who doesn’t understand the difference in models of care and is confused by where to go.  They start with fundamental questions to resolve, such as:

  • What are my closest options (work? home?) to receive the exact care I want?
  • Where should I start dealing with this medical condition my son has?  ER? Primary Care?
  • What if I want a second opinion? Can I get that within the same office or do I have to go to another office or even another system?

If we understand the context, we can answer these questions; you just need to aggregate knowledge – where to receive care, for a specific patient’s journey, and with the specific care they need.  This is the basis for a decision engine.

Decision engines can come in a multitude of flavors – from chatbots, to robust personalization, to integrated digital/web/email journeys.  Or they can be as simple as making a doctor’s appointment with your primary care doctor as a follow up, post-exam.

Decision engines are, by nature, self-learning and self-growing.  As consumers engage with them, they can begin to help them traverse the growing system with ease and answer complex queries.
Real-time appointment setting, both in the physical world and online, gives us a good reference point.  We can offer a range of solutions to better understand the consumer’s needs.  

Do they need to:

  1. Receive a second opinion from a specialist.
  2. See a new primary care doctor.
  3. Get in line for the urgent care facility.
  4.  Start a virtual visit right now.

As 25% of in-person appointments are informational only and can be effectively triaged, ensuring physicians can focus on higher acuity cases, practicing “at the top of their degree” and seeing the patients who need them the most, is the benefit of the patient, the physician, and the provider.  

Most importantly, through effective rules around triage, real-time appointment data, and access to consumer’s information, decision engines will answer the ultimate question: 

When can I be seen next, by a doctor of my choosing, who can meet my specific needs, according to my schedule?

This operational promise of access will be a competitive advantage for the entire system.


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