Consumerism in Healthcare and its Impact on Independent Physician Practices


Host Carol Flagg talks with Sarah Hughes, Director of Product Management, CareCloud. Sarah drives the strategy and development of CareCloud's patient experience management technology and on this episode discusses the rise of consumerism in healthcare from the small practice position.


Carol Flagg: This is HealthcareNOW Radio's InterviewsNOW. Thanks for listening in. I'm Carol Flagg, your host for today's episode. You can follow our show at #InterviewsNOW and join the conversation and follow HealthcareNOW radio on Twitter @HCNOWradio.

In this fast-paced, ever-changing landscape we call health care delivery, who can we trust to tell us the good, the bad and what's happening now? We're here to help you sort out these issues with thought leaders in the know. On this episode, we talk with Sarah Hughes, Director of Product Management at CareCloud. At the company, Sarah drives the strategy and development of CareCloud's patient experience management technology. We'll be discussing consumerism health care from a small practice position, and Sarah, thanks for joining me today.

Sarah Hughes: Thank you, Carol. I'm really excited to be here.

Carol Flagg: Yeah, we're excited to have you on here. Remind our audience, CareCloud out of Miami, correct?

Sarah Hughes: Yes, CareCloud out of Miami, Florida. Sunny Miami.

Carol Flagg: Sunny Miami, always a party, always fun. I love that city. Before we get started, please share with me and our audience a little a bit about your background and how you got into health care.

Sarah Hughes: Yeah, absolutely. I am, like you said, the Director of Product Management here at CareCloud. I lead our Breeze product, which is our patient experience management solution. I've been at CareCloud for a little bit of over four years. I've been in the healthcare industry about 10 years. I thought I was going to go down the medical school route, decided that was not for me and that I am much more interested in technology and the tech side of things.I would say my passion really lies with technology and how to build products that make people's lives easier.

Carol Flagg: Great, well, it sounds like you found the right sweet spot there.

Sarah Hughes: Absolutely.

Carol Flagg: Yeah, yeah. Consumerism health care, that is obviously a hot topic in our industry today, has been for the last few years. We hear a lot about it, news media, we hear a lot about at the conferences we go to. MGMA, MGMA [inaudible] and what not. Consumers in health care, what does this really mean, though? Specifically, what does this mean for the independent physician practice?

Sarah Hughes: Healthcare is really different in 2018 than it was 20 years ago, or even 10 years ago. If you think about our typical day, we wake up and we ask Alexa for the weather and the traffic. We listen to Spotify on our way to work. We buy our groceries on Instacart. We track our workouts on our Fitbits. We order dinner with Uber Eats. We watch TV on Netflix. Every part of our daily experience has been not only modernized but personalized, as well.

But when we have a doctor's appointment, we step into the office, we get handed a clipboard and we're asked to sit in a waiting room that looks 20 or 30 years old. So, consumerism health care is really about modernizing that patient-provider relationship and really just elevating it to the 21st century. There's no reason that our interactions with our health care provider's so antiquated and outdated. The point of all these apps that we use every day is to make our lives more convenient, so visiting a doctor, that's already a painful experience. Modernizing that experience is a no-brainer. All of us, we're all patients. So, our expectations today are really different than they were many years ago.

Carol Flagg: It's so interesting. I think that, I don't know what the numbers are, but you would think in today's technology-driven world, app-driven world or whatnot, that to walk into a doctor's office and still get a clipboard to fill out paperwork does seem just hard to believe. And some of it's generational, too, I'm sure

Sarah Hughes: Yeah, absolutely. It used to be, if you think about it, it used to be that patients kind of stuck with their family doctor throughout the majority of their lives. But today, it's all about which doctor has the highest reviews online, and which doctor was a reputable website, and which office feels clean and open and modern? I think that physicians are starting to understand that, as well.

When I talk to our customers, they're now talking to me about how they're going to remodel their office space, and how to get rid of paper, and how to make their patients feel more at home. So, I think from a technology standpoint, that's really where the tech that we're building is now being focused on. It's that patient experience.

Carol Flagg: That patient experience that you talk about, are there greater barriers to getting to that technological level that we're expecting from a small physician practice than, perhaps, larger medical clinics or hospitals? One would think, intuitively, that maybe it is. [crosstalk]

Sarah Hughes: Yeah, I think there's definitely barriers there because ... I've had the opportunity of visiting many medical practices across the country, across different specialties. One of the common themes that I see across the board is a lot of these guys are using very outdated technology that was built 20 or 30 years ago. So, that's already a barrier to delivering this excellent patient experience. How can that technology keep up?

As a product person, I'm pretty excited to be able to say that I get to work with the latest and greatest when it comes to technology, and that's what we really want to make sure comes through with that Breeze application vision.

Carol Flagg: Yeah. To create that consumer experience that we've all sort of become used to you mentioned, and there are more, a long list of things that we all do every single day to make our lives a little easier, more immediate, create this environment of a digital world around us. These physician practices ... What are you seeing, technology aside, what else are you seeing? Obviously, if you're a physician practice, you have a website. You're on Healthgrades and in other things that are like that, where individuals can use that rating system that we've all become used to-

Sarah Hughes: That's right.

Carol Flagg: What else are they doing to become more, let's say, consumer-friendly?

Sarah Hughes: Yeah, and you made a couple of really good points. You look at medical practice websites these days and some of them are just beautiful. It's a different world now. It's all about patient acquisition and retention, and the best way to do that is to make your online reputation, as a physician, solid. How do you do that? You keep your patients happy and then you make sure that those happy patients are speaking up about it.

Those are some of the things that Breeze enables practices to do; modernize their patients' experience and gather that feedback. And with the same token, keeping their staff happy, as well, because they're not spending their time on these menial tasks. They're actually spending their time making sure that their patients are happy.

I think that physician practice are trying to be more consumer-friendly and trying to modernize their office, but it's difficult sometimes because what ends up happening is that they have all of these different point solutions being used. They use one service to allow their patients to schedule appointments online, they have another service to gather post-visit surveys, a third service to send out appointment reminders, and a fourth service to try and collect patient payments. It's just too many things to pay for, too many things to manage, and it's a really disjointed experience for their patients.

Because Breeze is a platform, we're kind of able to look at one problem at a time and expand our product to address it. That's why we kind of feel comfortable telling our customers, "Hey, get rid of all those point solutions. This is what you can use instead."

Carol Flagg: I think that's a really interesting point. I was sort of having this conversation the other day with somebody when you talk about online reviews and people today ... or Twitter or Facebook ... Wherever they are sharing their story about their experience at their doctor's office, it does seem to be sort of a bookend of issues, meaning that usually, it's not about the care. It's not about the clinical side of it.

What they're perhaps expressing their discontent over is, certainly, the start of the process, the going into the office, what they have to do, the wait, the paperwork or whatever. And then the end of the process when they get the bill, we live in the world of high deductible plans. So, it seems as if it's the start and the end of the medical process that seems to be most frustrating for the patient.

Sarah Hughes: Absolutely. I think about what physicians have to think about today and there's so many things going through their mind. They're thinking, "Is my staff happy? Am I documenting fast enough? Could I be seeing more patients per day? Are my patients happy? Is their experience at my front desk a good one? Are they having trouble parking?" These are the things that they think about. It's not just that patient-provider experience where they want to focus. They can only focus on so many things at once, which is kind of why we wanted to make sure that Breeze was able to take away these extraneous concerns so that the physician can just practice medicine.

I can't tell you how many times I've heard physicians tell me that they wished they can spend more time with the patient and less time with their face in the computer. That's what Breeze is really for, to kind of take care of all of those task, to allow patients to schedule their own appointments, to fill out their own forms ahead of time at home, to make their own payments, to give their providers feedback, even to make retail purchases if the practice has retail offering. That way, the experience between the provider and the patient can be more focused and meaningful.

Carol Flagg: Certainly, I've been around ... We started our first ... [inaudible] is our network site dealing with the adoption of certified EHR technology and that issue of doctors feeling, perhaps, as if they spend way too much time on a keyboard has been sort of one of those barriers that have been the talk about for years now. Certainly, it's hard to understand or perhaps figure out how to make that patient experience more engaging.

There are doctors, obviously ... I've been to doctors where they actually have their EHR in front of them and they're very engaging and perhaps that's case to case. But that's one of the barriers, for sure, creating that consumer-friendly kind of experience. You mentioned staffing, you mentioned resources, certainly bandwidth, and, again, from a small practice provider standpoint. And, certainly, resource and cost, right?

Sarah Hughes: Definitely. Those are all huge factors when we're trying to kind of overcome this.

Carol Flagg: I'm sure those are the things that you talk about every day with your clients.

Sarah Hughes: Yeah, these are the problems we're trying to solve. That's why we got out and we try to build these products.

Carol Flagg: Right, right. If you're just tuning in, you're listening to InterviewsNOW and our guest today is Sarah Hughes of CareCloud and we're talking about consumerism health care from the small practice position.

Let's talk a little bit more about Breeze and the product that's been in the market for about a year now, this patient experience management platform. What are the things that you've been learning about as you go out and implement this platform. What are things that you learned from your clients and your doctors that you work with, and what has most surprised you?

Sarah Hughes: It's really interesting because when we first launched this product, we were really trying to solve a couple of issues. We really wanted to make practices more efficient. We wanted to make practices more profitable, and we wanted to make them more modern. When we talk about efficiency, it's obviously one of the most important things to a thriving medical practice. But by giving that/back time to that front office staff so that they can focus on the patients' in-office experience versus spending their time on the phone doing data entry or asking for payment, the practice becomes that much more efficient.

When we're talking about profitability, which is, arguably, more important than efficiency to a medical practice, the payment collection piece being at the forefront of the Breeze product, that was an easy call when we partnered with First Data and Clover. We know that today, patient responsibility at a typical medical practice could be upwards of 20%. It used to be that patient responsibility was only 3 to 5%, so if a practice missed on collecting the patient's responsibility, it wasn't really that big of a deal. But when you're talking about 20%, practices can no longer afford to not collect that money from their patients.

When I go on site and see how our customers are using Breeze, sometimes I'll sit with the front desk staff behind the glass and sometimes I'll sit in the waiting room with the patient. What I found just absolutely fascinating was how few front office staff actually asked patients to pay off their balances, to the point where-

Carol Flagg: Oh, really?

Sarah Hughes: Yeah, to the point where I would actually ask them, "Hey, why are you not asking this patient to pay his balance. It says here, I can see it, that he owes $300." They would tell me that they don't really want to have these awkward payment conversations with their patients.

The beautiful thing that we saw was that if an app asked a patient to make a payment, and it explained why their balance was $300 and it made it really easy for them to use their thumb and pay with Apple Pay or create a payment plan if they need to, they would pay it. They were just used to if a machine asks you to pay and tells you this is why you owe this much, patients would pay it. That's what our clients were seeing and that's what kind of excites them about this product, you know?

Carol Flagg: I think that, for the average practice out there, and correct me if I'm wrong, but I don't think they see themselves as a bank or a credit card company. But, in essence, they are, right?

Sarah Hughes: Yeah, that's absolutely true. They really don't view themselves as having an obligation to collect money from their patient, which is, frankly, fascinating because, like I said, the responsibility of the patient to pay is just continuously going up year after year.

Carol Flagg: The financial side of this ... What else has surprised you in this last year?

Sarah Hughes: I think one of the things that was really surprising ... Patient experience management, it's a new category for us at CareCloud. The most surprising thing for me was how easy it was to relate to these patients because we're so used to building products for doctors and for front office staff, so we're used to their questions and their feedback and their expectations. But, patients ... We're all patients. So, as consumers of an app trying to a specific experience better and, in this case, the experience of visiting my doctor, it's really simple what we want.

We want an app that's easy to use. We want an experience that's enjoyable, and we want to be able to interact as little or as much as we want to with our doctor through the app. So, I just found it really refreshing how relatable these patient problems really were.

Carol Flagg: The word app. I take it ... I've not seen the product but it seems like it is very app-driven, right? So, you know, that experience where you can just tap it on your phone or it's attached to an iPad and you run a credit card through, and then you sign. You get an email for your payment. These are the kind of things you're talking about, right?

Sarah Hughes: That's exactly right. Yeah. We built two different apps. One for the patient, and one for the practice, because we know we have two different constituencies to deal with. For the patient application, we just try to make it really easy to schedule an appointment, really easy to make a payment, really easy to understand your bill, to fill out your forms ahead of time so you're not sitting there in the waiting room for 40 or 45 minutes. So, just try to make it a little bit easier on that patient before their appointment.

Carol Flagg: Yeah. So, these are some of the problems that you're looking to solve, the making it easier to be a consumer in the health care system, financially, book appointments, all of that. What else does it solve? What else are you looking to help make the provider's life easier?

Sarah Hughes: Yeah, and I think that's a great question. I know for practice staff, we know that a lot of their time is spent on the phone scheduling and rescheduling appointments. A lot of their time is spent keying in all that information that patient wrote on the clipboard into the system for their doctors to see. We knew that we could get rid of a lot of those tasks just by building them in Breeze for the patients to do themselves.

The great thing is the patient doesn't mind doing these things. Patients prefer to schedule their own appointments on their own time. They prefer to enter their information in digitally and at home before they get to the appointment so they don't have to wait around. So, the value is really twofold. It's not just about making the practice more efficient and profitable, which are two of our goals but making the patient happy with their experience of visiting their provider. Because, we know when patients are happy, they'll come back. They'll refer their provider and they'll leave a positive review.

Carol Flagg: Yeah, yeah. It's so interesting, this issue of reviews. It's certainly ... I know you guys are involved the [inaudible] area, as well, and the [inaudible] scores being published in October. Reviews ... They're taking on a more important role in health care decisions, right? It's still true, right, that most ... Usually, in a household, the health care decisions are made usually by the woman, or partner who is ... one partner responsible for making these decisions. Today, it seems hard to believe, I think, that ... For years ago, obviously, people relied on referrals. You know, "Do you know a good doctor who does this?" You ask your friends. You ask your coworkers. Whatever. Now, this review issue, again, just part of this whole consumerism health care, that you would look for a good doctor like you would a good restaurant, right?

Sarah Hughes: Absolutely. Can you imagine going to a different city today and trying to find a place to go to dinner and not using something like Yelp, or not trying to find reviews online before going to some restaurant. That's the world we live in today, and that's why, when we first started talking, we were talking about consumerism and health care. That's really what it is. People are dependent on what other people think of the experiences that your about to interact with, and it's so important for physicians to make sure that the entire patient experience, not just the 10 or 12 minutes that they're there in the office with the patient, but the entire experience is really, really just wonderful for that patient.

That's what we have to help them with as health IT company because that's really not their job to be able to do all of those things. Their job is to practice medicine and to grow their business. So, we want to help them with all those other things that they need in order to keep their patients happy.

Carol Flagg: Yeah. That idea of the patient experience, of course, is very subjective and very personal, obviously. My experience and what's important to me, perhaps, could be different than what's important to you or my neighbor and whatnot. You add in these issues of staff impacts that experience, as we're talking about right now, technology, it impacts that experience. But, how do you actually see technology overall, Breeze included, but overall, the world of health IT that you live in for delivering -

Sarah Hughes: [crosstalk]

Carol Flagg: ... value [crosstalk] for the practice and the patients?

Sarah Hughes: Yeah, that's a really good question. From a technology standpoint, these tech practices that they were normally built primarily to focus on provider-payer workloads, right? The original idea of an EHR or practice management systems is really just built to submit claims, at the end of the day. That was the idea, getting reimbursed for services rendered.

But our health care system is evolving and patients are now taking on a much bigger share of that reimbursement money. So, the paradigm is changing and we're starting to see a new era where healthcare is really just organized around the patient and what their experience is. So, technology has to move in the same direction. It's not just about getting reimbursed and submitting a claim. It's about making sure that those patients come back because you actually need them to be able to sustain your business, not just from a patient [inaudible] perspective, but from a patient responsibility and obligation perspective, as well.

Carol Flagg: And this proliferation of high deductible health plans, to me, that's a big part of this. I suppose, back in the HMO days, the PPO days where, perhaps, I went in and I paid a $25 copay, and I was basically done, right? Perhaps, what your expectation level is ... The doctor care and compassion aside, and just the experience of walking in the door and that sort of thing, perhaps, is different than when you're faced with a bill that's 2, 3, 4, or thousands of dollars, depending on what the medical condition might be.

Sarah Hughes: Yeah. Patient payments is one of the largest drivers for technology to be moving into this consumerism in healthcare direction. It's because of patient payments. That business alone is a multibillion-dollar business. So, it's our job to kind of make it easier for patients to be able to pay.

Imagine ... I still get statements in the mail from some of my doctors. I don't even ... I just leave them there for months and it's not because I don't want to pay it. If I could do it online or if I could do it through my phone, I would have same-day payment kind of deal. It's just so antiquated, some of these experiences, that we really just ... It's up to technology to kind of progress that into what patient expectations are today. And like I said, we're all patients. It's just consumer, regular consumer, expectation.

Carol Flagg: Yeah, we've all had an experience where we get that bill with the explanation of benefits, EOB, and trying to figure out what it all means.

Sarah Hughes: And it's all gibberish.

Carol Flagg: It's really difficult to understand what that means, because those bills that we get aren't ... They don't talk in a retail kind of experience, right? You get your credit card statement and you understand every word of that credit card statement.

Sarah Hughes: Exactly. 

Carol Flagg: And every [crosstalk]-

Sarah Hughes: And you could read it [crosstalk]-

Carol Flagg: Right, you read a lot, you understand every word and every [inaudible]. Well, let's talk a little bit before as we sort of close out our conversation. Tell me where CareCloud's going to be next. What conferences are you going to be at coming up and displaying Breeze and just talking with providers? Where are you going to be?

Sarah Hughes: We'll definitely be at MGMA this year, and we're actually having our first ever CareCloud user conference this year, as well.

Carol Flagg: Oh [crosstalk]-

Sarah Hughes: Yeah, we're pretty excited about that.

Carol Flagg: Is that in Miami, obviously? No?

Sarah Hughes: It will definitely be in sunny Miami.

Carol Flagg: Yeah, yeah, yeah, yeah, yeah, yeah. So, your first user conference. That's exciting.

Sarah Hughes: Yeah. There'll be a lot of talk about Breeze at our user conference and, like I said, we'll be at MGMA this year, as well.

Carol Flagg: Yeah. When is the user conference?

Sarah Hughes: It is September 7th, weekend.

Carol Flagg: Oh, nice, nice. Yeah. I'm finding more and more as I talk to health IT vendors that these user conferences are really becoming just part and parcel to their events schedule. There's so much value -

Sarah Hughes: It's really important to show our customers how much we appreciate their loyalty, and to show them, "Here's our vision and here's our strategy and look where we're going for the next five years." It's really important to bring them in the fold with those kinds of things.

Carol Flagg: Right, and where's MGMA this year? Is it Boston?

Sarah Hughes: It's in Boston, yeah. It'll be in Boston.

Carol Flagg: Yeah, that's my hometown. So, Sarah -

Sarah Hughes: Oh, nice. 

Carol Flagg: Yeah. Before we wind down, any final thoughts on our topic, consumerism health ... It's a big topic and it sounds like you guys are really sort of taken a bite out of this idea from the small practice position and these independent practices.

Sarah Hughes: Yeah, we're so excited about this new platform. We know that it's going so much to offer, you know, these physician practices. We want to be able to help them make that patient experience just absolutely wonderful. We know that it really is this app that's really the one-stop shop for that patient-provider experience.

Carol Flagg: Yeah. Do you have anything else coming down the pipe, product-wise?  Or, is it all your-

Sarah Hughes: Yeah, we're continually adding to the platform. There's now, actually, an offering on Breeze for our customers with the retail items in their practice for patients to actually browse and make purchases right from the app. So, if they sell any cosmetic, dermatologist [crosstalk]-

Carol Flagg: Oh, yeah. Sure.

Sarah Hughes: Yeah, they're able to just put that on their online store with Breeze and have their patients kind of browse at home and make those purchases. We're exploring new methods of payment to add to the platform. Like I said, the payment piece is so important for patients, just to give them more options to pay their bills. We're looking to add Telemedicine functionality. This is going to be the super app of the provider-patient experience.

Carol Flagg: I love that. The super app pf the provider-patient experience. That's a great tagline.

Sarah Hughes: I like it, too.

Carol Flagg: Sarah, I want to thank you so much for your time today.

Sarah Hughes: Thank you so much, Carol. I really, really appreciate it. It's been fun.

Carol Flagg: Yeah, it has been fun. You coined the super app of patient-provider ... Remember that. You can learn more about Sarah Hughes and CareCloud at and be sure to follow Sarah on Twitter @Sarah_Maria12 and the company @CareCloud. As always, we thank you, listeners, for tuning in today. For more information about InterviewsNOW, visit our show's program page on Until next time, if it's happening in health care and it's now, it's on InterviewsNOW.


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