Episode 13: Guiding Patients Through the Digital Healthcare Journey

Kevin Madden, Assistant Vice President of Web Experience at Providence, joins Digital Clinic this week to discuss the future of digital healthcare marketing. In this insightful episode, Kevin shares Providence’s approach to creating personalized, localized web experiences that guide patients through their healthcare journey. He emphasizes the importance of leveraging user-generated content, such as reviews and videos, to build trust and engage patients.  

Kevin also explores the impact of AI and semantic search on healthcare marketing, highlighting the need for providers to adapt their strategies to better serve patients. Throughout the conversation, he shares his thoughts on the ever-changing digital world and how healthcare providers can optimize their web experiences to improve patient acquisition and engagement. 

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Digital Marketing for Healthcare

Aaron: Welcome to the Digital Clinic, the podcast that goes deep on critical digital marketing trends, strategies, and tactics for the healthcare and medical device industries. Each episode brings you expert guests sharing the knowledge, insights, and advice that healthcare marketers need to be successful in this complex and rapidly evolving digital landscape. I’m Aaron Burnett, CEO of Wheelhouse Digital Marketing Group, and with me today is Kevin Madden, AVP of Web Experience at Providence. Kevin, thanks very much for being with me. 

Kevin: Oh, thanks so much for having me here. It’s great to be back in this beautiful office you have. 
 
Aaron: Yeah, I think it’ll be a great conversation. 

Kevin: Looking forward to it. 

Aaron: Can you describe your span of responsibility and influence? What’s involved in your job? 

Kevin: So I oversee patient website experience at Providence, which does include our websites. There’s also some purview over our apps, our other digital infrastructure, including the EHR, which is my charge, which is a pretty standard thing and definitely a lot of responsibility, and deciding where the right place for the patient is at a given time. We see the website as our consumer facing website. This is for acquisitions. This is for storytelling. This is for ingress into the system. But, we also draw a pretty clear line. Once you’re a patient, you need access to your providers, you need access to your medical records, and that’s a whole different sphere where we can personalize and target messages. Managing that handoff and transition between different experiences and the app goes just as far if not further than MyChart and giving customized experiences. I’ll generally focus on the intake portion of the journey and leave the other portions to very capable teams but to deliver prime quality traffic into those realms. Roles also include patient acquisition, so digital scheduling, online scheduling, online intake, registration, seminars, all of that fun stuff falls under my umbrella as well. 

Aaron: And you’ve been in this role, how long now? 

Kevin: I’m new to this role about six months, but I’ve been working within the web strategy team for almost six years now. 

Aaron: Sure. I know that you are always thinking strategically and you likely had a strategic approach before you landed in this role. I’ll ask you maybe an unfair question six months into the job. What is your strategic vision? What are you working toward for the system overall? Is there a unifying concept toward which you’re working? 

Kevin: No, if anything, it’s the opposite of unification. As a large health system, trying to serve many regions, many divisions, and even I’ll go as far as to say many different cultures, harmonizing them has been very difficult and trying to aggregate everybody into unified experiences causes us to boil down to the lowest common denominator in most cases, and that pertains to local search, too. As Google has really advanced their local preference, WebMD is becoming less and less relevant, even in the concept of global search, results are diminishing. Each market now needs its own cancer content. It needs its own orthopedic institute, it needs these footholds in the local markets to attract a local audience. A broad, multi-state website just isn’t able to do that very effectively.  

Aaron: Ah, okay. So the notion and the approach that would have said, keep the generally applicable content at sort of a brand level, and then subordinate the local content to the local site and local search, which was a valid and high performing strategy for a long time. Now, it doesn’t work in the same way.  

Kevin: Well, it’s a very efficient way to build a website, but it’s not the most productive way to build a website from a patient’s experience. Patients generally don’t care what’s going on outside of their state or what other insurances are accepted outside of their market, or often cases, for most types of care, willing to travel very far. We wanted to really constrain those experiences and be more personalized and much more direct with our patients than representing ourselves as a big corporate brand. 

Personalized Healthcare & The Patient Experience

Aaron: Right. Okay. How do you deal with the risk of duplicate content? If all of these individual sites are creating content that in many instances would certainly overlap and in some instances might end up being very close approximations of one another? 

Kevin: Well, we see duplicate content as a factor only for content we’re trying to rank for. Most of the time, the things we’re trying to rank for are facts about our businesses: what insurances, what services, and where are they at? Through Google My Business and local listings, we’ve been able to really compartmentalize each location to its own set of facts, and those facts are what we rank on The other items, more broadly, the “Our Story” type content, that convincing content, it’s not something we’re trying to rank for, so we actually forget that and put our facts first and see that is where all of our SEO fodder is. 

Aaron: Okay. So if someone’s looking for information on a particular condition or a particular form of treatment, that’s not necessarily something you’re trying to rank for. You’re trying to rank when they’re looking for care, and they want to find out something about Providence, or one of its brands. 

Kevin: Very much so. I mean, the research process takes place in so many forums, even more so than ever, like YouTube now, and that’s where we want to make brand introductions and raise brand awareness, that upper funnel type search. When it comes to the patient saying, “Where am I going to get this resolved? Where am I going to see a provider? Where am I going to get care?” that’s where that pin on the map means more than anything else, and that’s where our angle of approach comes in.  

Aaron: Okay. You were talking about what you’ve learned about the journeys of folks who come to your website and now websites, and how you need to create a different context to cater to their experiences and their needs, and that is resulting in disaggregation of web experience. So how have digital experiences changed? How have user experiences and the needs of users changed in the Providence system, and how does that contribute to the vision that you have now? 

Kevin: Let’s see, I’m thinking that through. I’d say one of the biggest learnings we’ve had over the last few years is that no matter how hard we’ve tried, we haven’t been able to make people do things that they don’t want to do. It’s not like E-commerce, where somebody might try on some healthcare and return it if it doesn’t fit, or there’s a special financing incentive and generous return policy, or things like that. It takes a pretty high commitment, so generally, when people come to our site, they’re looking to complete an action. As we’ve evolved in scheduling, lead capture, seminar registration, and a lot of other capture and intake methods, we found we have to do a better job of screening people and qualifying them and getting them to the right place. The biggest next evolution for us is going to be our website’s ability to guide patients to their next step. Too much of it right now is find a location, find a service, find a clinic, find an offering, and guess – pick up the phone, call, see if it’ll take you. What we don’t do is get more context from users, ask them one or two qualifying questions to help triangulate where they need to go, whether they have an image already or a diagnosis or referral. All of these things need different behaviors, and those are patients that need to be steered.

Where we’ve been really successful is just by asking one or two preliminary questions, rather than saying, “Schedule an appointment,” or “Fill out a form and we’ll get back to you.” Saying, “Do you have a primary care doctor? Have you been referred? Are you a referring provider?” These little things can give us what we need to know to tell the patient what to do next. As soon as they’re given a prompt or a cue, your next step is maybe an orthopedic specialist before you see a surgeon or maybe a primary care doctor or maybe you just need to go to a same day care clinic. As soon as we can give the patient that prompt, they now have a task to complete, and they will do so at what are unprecedented rates for our website.  

Aaron: What gave you the insight, what data gave you the insight, that enabled you to begin to make these pivots these changes? 

Kevin: Appointment cancellations and re-bookings. Early on, when we started scheduling, we saw success as a scheduled event and then a completed event. We also saw, generally, 30-40% cancellation and reschedule rates, and we were seeing those patients elsewhere, just not where they intended to book. We knew that there was more force behind patients trying to get in than we could align to the right path to get in. They were putting too much pressure on our intake methods, when they were often unqualified, or just weren’t in the right place.  

Improving Healthcare in Search

Aaron: Yeah, okay. That’s very interesting. It sounds like you have tested this new guided approach and that you’re seeing very significant performance gains. Do you have a sense for the sort of gain that you’re seeing? 

Kevin: We do. I guess the first thing to talk about there is success wasn’t measured by how many people get through because often, in cases like with a surgical center or women’s health clinic, people are able to do that anyway. The success is measured in how many people can we deflect, how many people are in the wrong place, and if we can get them to express care or primary care or the right level of specialty for where they’re at in their journey, we’ll be a lot more successful. We’ve seen almost 30% deflection rates with success behind them, and that’s how we’ve known we’re doing the right thing. 

Aaron: That’s a very interesting KPI, deflection as a KPI. 

Kevin: Yeah, because people are going to push through no matter what. 

Aaron: Sure. Interesting. Obviously, search is changing, has changed considerably, even in the past week. How are you thinking about user journeys before they get to one of your sites? 

Kevin: So we’re still foregoing the highest parts of the funnel, the WebMD, Mayo Clinic, even Cleveland Clinic does a very good job there, type spaces and allow that to happen. We’ll approach those audiences either through video content or through advertisements on these platforms for positive brand impressions, but that’s all loading them up for later steps in their journey. This is where reputation becomes so important to us. The review stars, whether on our first-party reviews or third-party reviews, are something we manage in extensive detail. We solicit reviews in multiple places, and we syndicate our reviews to channels that will take them. We’ve got some partnerships that will allow us to read and perceive and respond to reviews on just about any platform. We want to make sure when the patient flips over from, “What’s happening to me?” to “How do I seek care for this?” that we’re consistently at the top-rated providers in their consideration set.

AI in Healthcare

Aaron: Okay, that’s great. Let’s switch to a topic that’s in the zeitgeist this week, and that is AI in search. This week, Google hosted Google I/O, they announced that their search generative experience was going to be rolled out to everyone within a week, and we’re now seeing that. It’s now called AI Overviews. Certainly, AI Overviews, where they’re present, changed the structure and nature of search results. What’s your reaction to Google rolling out AI Overviews? This is yet another instance in which lots of people are being maybe hyperbolic, maybe calling it as they see it, and saying, “This changes everything. This is the end of search. This is an unfair advantage for Google,” or “This changes nothing.” Where do you fall there? 

Kevin: I think it’s just another evolution or a step forward in semantic search. We’re really starting to see now how Google can take an entity and pull relationships from it and actually give those back to the patient. Before, it would be clouded by search results, and you wouldn’t understand necessarily why you’re getting what you are, but now the ability to see that Google is considering reviews across third-party websites and incorporating user comments into that to formulate an opinion and perspective in the search results is actually very gratifying. Because the things we’ve been working, reputation, getting the facts about our business right, and being very precise about what it is we do and what insurances we accept, all of that comes together to give us a lot more long tail potential and actually convinced the user, with fewer steps in their journey, that we are the right place to seek care. 

Aaron: It’s early days. Do you have any data that gives you a sense for the extent to which AI-driven search results are not or are not impacting your search visibility? 

Kevin: We seem to be improving, largely because of the long tail that gets added through our reputation and user comments and user feedback and postings about us throughout the social space. As Google’s considering those, and they do seem to favor their own reviews more than others, which is just again, an evolution of something they’ve been doing, they’re now exposing it to patients, and that’s been a big boom for us. We’ve seen impressions go up pretty considerably, and what is a continuation of our strategy, we don’t necessarily need those people to come visit the website to see that as successful. More often than not, Google serves as a surrogate for our website, and now they’re serving as a surrogate for our website and third-party websites. It kind of limits the patient’s ability to perceive and consider the competition when we do rank well, so it’s been it’s been very favorable. Our engagement rates are up as well as our impressions.  

Aaron: Interesting. So Google’s not breaking out, they’re not giving any data in Search Console with regard to where AI Overviews are or are not being served, so as a consequence, you’re using overall impression data and click through rate data as sort of a proxy, an indicator, of any positive or negative change since they rolled out AI Overviews. 

Kevin: We are. One thing we did a long time ago was we created custom tracking parameters in our URLs for GMB placements, which do score the impressions in SGE. We’re able to differentiate what is a web result from a map pin, and because of the prominence of the map pins, and we’re seeing our links in those, we are able to measure the incrementality there.  

Aaron: That’s clever.  

Kevin: It was necessary to justify the program early on. 

Aaron: Sure, yeah. That’s very smart. We were talking earlier about the rise of AI and implications of AI operationally, in the healthcare context. What’s your perspective on that? What are you seeing that’s working, that has promise, and what might you dismiss? 

Kevin: I mean, where I’ve seen AI as most effective are in individual workflows and task completion. We haven’t gotten close to finding a true automated process, but AI can really facilitate. We’ve done a lot with document conversion and formatting and structuring, making documents consistent, and we’ve been able to alleviate what has otherwise been low-level labor. Beyond that, we’re testing AI for use of creative generation, which is a good way to spin up a lot of variants, but without a lot of separation amongst them, so limited application there. I’d say the folks who are most successful with AI are the ones where you can’t tell they’re using it, and that’s an individual task completion. Data analysis has been pretty interesting too, as we have very, very large datasets that we can feed in for some high-level takeaways and some paths of further inquiry, but we haven’t found AI to be a silver bullet for much yet. 

Aaron: Yeah. Obviously, the healthcare space has been an environment in which there were stringent privacy regulations. In the last 18-20 months, those privacy regulations have become even more restrictive, with the expansion of HIPAA coverage. To what extent has that impacted the insights and the data that you need to do your job effectively and to formulate strategy? 

Kevin: I’d say the most profound changes were in the tools that we use. There was a time when everybody was using Google Analytics and AdWords remarketing and a lot of other platforms which had a lot of reach and are pretty standard in other marketplaces. But, our compliance reviews quickly found that those were not sustainable, and even goes far as out of compliance. The process to change tool sets we did lose a bit along the way, but really we’ve always tried to balance the desire to automate marketing with the need to not freak people out or scare them. We know a lot about these patients, and we have a duty to not leverage that against the patients, especially in marketing purposes. I think, ultimately, it makes for better patient experience without the level of advertising and targeting and badgering that they might get from a pharmaceutical company. That said, we do have limited reach to reach out to customers after the fact, to target them, to follow them in their journey, so we have to do a better job of capturing them when we have them. 

Aaron: That makes sense. That’s a good answer. The strategy that you’re employing at Providence, and the process of consolidation, through acquisition and through consolidation of web properties, and now disaggregation because you’ve realized that data or an experience that is more relevant to a local market is much more valuable to a patient or prospective patient, do you think that that’s a universally applicable insight and experience? Do you think other healthcare systems are likely to be going through the same process, or is that peculiar to Providence, its history and actions over the last few years? 

Kevin: It’ll be a similar experience at some health systems. Generally, and I don’t want to name anybody here, but some healthcare systems operate with a very corporate structure and have a single, more unified culture, largely because they don’t have the history and the community that we’ve had. A lot of that comes with a lot of identity, a lot of purpose, a lot of differentiation, even between the markets, and we want to preserve that as a value proposition to our customers. It’s not to say others don’t have the same problems, but I think we’re unique in terms of our geography and the unique histories of the different ministries and the regions.

Leveraging Video Content and Reviews 

Aaron: Given everything that is happening with search engines, with AI, with the changing nature of digital marketing, what do you see as the future of digital marketing in healthcare? 

Kevin: I think the future really has us working towards an evolution in our ability to tell stories and communicate more effectively with our patients because of the standardization EHRs and EMRs, a lot of acquisitions, a lot of scheduling, a lot of patient education is becoming standardized. While it might seem, initially, onerous to folks coming from E-commerce land where we’re trying to squeeze every point out of checkouts, you start to realize and can see that there are steps that you have to take for patient safety, and there are steps you have to take to ensure patient routing, and to relieve clinical burden and overhead, and managing misguided patients. All of those are becoming the undifferentiated part of healthcare. It’s getting easier and easier to understand where doctors are available and when access is available and even to become a patient because of these digital tools.

What’s getting harder is the differentiation of healthcare providers and healthcare systems. That often leads people to the review space, and there’s any number of websites whose sole businesses to collect and provide reviews for providers. Yelp for healthcare, there’s WebMD, there’s Vitals, there’s Healthgrades, there’s Doctor.com, the list actually goes on and on of aggregators in the space, and that’s because there is so much audience, and being able to control that narrative to guide patients, especially very satisfied patients, to leave feedback is one big step in the future. Video is the other big part of that that I think is being missed, and that goes back to storytelling especially. Video search and video research is still a very untapped space in healthcare. It’s largely left to self-help gurus and charlatans right now, so there’s a very big need for healthcare at large to step into that space and provide quality, clinically verified information. 

Aaron: I think that’s very insightful. You mentioned that prospective patients seek out third-party reviews. They’re looking for trust signals. How do you think about and how do you manage those trust signals to ensure that they are trusted and that they’re not simply seen as being manipulated by providers, either at a corporate level or individual level? 

Kevin: I mean, what I can say is, with any healthcare system, you’re going to please most of the people most of the time, but there’s always going to be negative sentiment and feedback, too. We actually look at that as an opportunity to engage with those patients and bring them back in. You might call it service recovery, but what we want to do is we want to give air to those reviews, but we also want to respond to them and fix the issues and ideally lead to subsequent reviews where people don’t have those issues. There’s an evolution that’s happening in the story, even in the reviews, that we’re working hard to provide the best experience possible. 

Aaron: Yeah, I think that’s very smart. 

Kevin: I mean, we’re delighted that 90% of our reviews are five star reviews, too. That was something we were very pleased to see, prior to solicitation, and we might get one review per location per month. You don’t have to encourage somebody to leave a negative review, but changing that conversation has been instrumental in driving a much more positive outlook and perspective on our caregivers. 

Patient-Centered Healthcare Marketing

Aaron: I can imagine that’s true. I asked you about user journeys before they reach a Providence web property, and so thinking about that overall top funnel process and the way that they might get initial information, maybe discover a potential form of treatment, maybe drill down to potential providers, all of that can happen before they ever touch a Providence web asset. When you think of that experience, I know you mentioned video as an untapped opportunity, how do you think of video and how do you envision using video to facilitate that discovery process at the top of the funnel? 

Kevin: Well, let’s dig into the discovery process first because that’s where there’s a lot of give and take that we have to allow to happen. For most patients, the first stop on their journey is going to be their insurance provider, and that is where we see our first competitor. We need to one, enrich and supplement those insurance carriers with as much data as we can about our providers – specialties, areas of interest, clinical expertise, the list goes on and on about the data we have about our providers that we need those carriers to have – but even when a patient selects the provider from their carrier, there’s a high likelihood they’re going to go and do a Google search for that provider’s name. In fact, almost half the traffic that comes to our website, well over a million visitors a month, come on proper name searches for providers. They discovered these providers elsewhere, and they’re doing additional research, and the onus really comes to us to be the last step that they need in their journey, and that includes third-party platforms and consideration platforms because once somebody goes on to ZocDoc, they’re back in the marketplace again, and they’re considering competitors and non-affiliated physicians in the same breath as our own.

We want to be the last stop in terms of rich information about our providers, in terms of having up to date insurance information, service information, but also aggregating our third-party reviews. We want to be the Rotten Tomatoes of doctors, and pull in all of the third-party sentiment and aggregate that into a score, too, where patients can then say, “I don’t need to go anywhere else. All the information I need is right here.” So, we allow for that interplay, we know that it happens, but we also want to influence it as much as possible. Not through manipulation, though, but much more through getting quality data syndicated ubiquitously. 

Aaron: Right. That’s very smart. 

Kevin: After that, even if a patient is aligned or considering a doctor, we know that they’re going to be searching for that doctor. They’re going to do so on social media, they’re going to do so on YouTube, so we do several things. One is we want to encourage our providers, even if they’re short little one or two minute videos that they film on their phone, to tell patients about themselves, to show patients that they care, what their bedside manner is like, to get a sense for who that provider is because that’s the kind of connection that, once you make it, is very difficult to break. 

Aaron: So as an organization, if you now have a hundreds or thousands of physicians who are now creating shorts, they don’t know anything about how to publish video and certainly not how to optimize video, do you also have a program or an approach that optimizes and promotes that video to ensure that it is prominently figured in search results? 

Kevin: A little less so. When it comes to providers, their personal reviews, their online presence, that’s bigger than their relationship with Providence. We want to give them a lot of leeway to express themselves, who they are, their own manner and care styles, and we see that as advantageous to the patients. What we don’t want to do is try and harmonize everybody into this very rigid and formal presentation. We want the doctors’ personalities to come through. 

Aaron: I’m thinking not so much about the content of the video, which I agree is an expression and an extension of the personality of the physician, but in optimizing the video, ensuring that it has an optimized transcription and that it’s appropriately tagged and titled and all of those sorts of things that do contribute to more prominence in search.  

Kevin: Sure, and there’s general social media guidelines which we provide to our providers that does allow them to do this, but like I said before, their name is going to be the most important thing and often what people are searching for, so making sure there’s a verified account associated with that, that’s tied back to Providence, ideally, if not, that is to the discretion of the physician, but we do give them recommendations on titling and transcription and otherwise. It’s pretty standard fare, I’d say. 

Aaron: Right. Well, as you described, if the search is on their name, then they have an incredible advantage in terms of ranking. 

Kevin: Very much so. 

Aaron: Do you see longer form video being an opportunity as well? 

Kevin: We do for our more nuanced storytelling, especially when we want to capture the greater breadth of the patient journey. Because when you have cancer, you don’t just get cancer surgery. There’s a process with imaging, there’s mental health aspects and therapeutic aspects, and post op recovery, and we want to tell that story in its entirety. It’s very difficult to do with content. It’s much easier to do with video, so long format comes in when we’re positioning our institutes, especially, or our hospitals.  

Aaron: That makes sense. Anything else we should talk about?  

Kevin: If you want to go any further into the deflection idea, I think there’s some pretty interesting things there. You really can’t force a patient to do something they don’t want to do, and we’ve tried things like when somebody searches for “flu shot,” we’ll inject “urgent care” into our search results because urgent care has flu shots, too, but it’s not always intuitive to patients, if you’re trying to coerce their behavior. What we’ve seen as very successful is giving them prompts and very clear, compelling guidance that this is their next step, that if you want a flu shot today, you can get that at an urgent care location or you can schedule with your provider. Microcopy has become critically important in steering patients and helping them move to their next step. Otherwise, they’re just guessing. 

Aaron: Yeah. So the difference between guiding and directing patients, it sounds like the approach which was directing, previously, didn’t really work well. But if you give them information and guide them and allow them to choose in a controlled context, that works much better. 

Kevin: Much better. One of the things that I’ve seen, this is kind of the early promise of AI, is that there’s going to be tools and platforms that will tell patients where to go based on who has the most access or what’s the most financially beneficial for the health system, and that patients can be coerced and manipulated, and we are finding that’s not the case at all. 

Aaron: Where have you seen instances, what information, what signals do you have that tell you that people are resistant to being directed? 

Kevin: Performance metrics, initially. We went through a lot of this when we first launched our virtual care offering, which is a telemedicine app-based service. We launched it prior to COVID, so there was very little demand. We tried to position it as competitive to other services; you go to a primary care clinic, and it says, “Get a video visit,” or something like that. People weren’t necessarily seeing the analog in those care options, but when we started to say something like, “Primary care wait times are over two weeks, you can see a provider today online,” it was much much more effective. Patients need more context to understand services are analogous to each other, and then they need a directive to push them to the next step. What you can’t do, and we’ve tried this with search – location and provider search – is give them the results you want them to have because they’re just going to think your tool is broken and abandoned. We saw that in our uptake rates, our scheduling rates, etc. It’s give the patients what they think they want, and then help them understand whether that’s right. 

Aaron: You have so much insight on patient needs, preferences, and reactions to their experience on the site. It sounds like you must do quite a lot of qualitative research? 

Kevin: We do a bit. A lot of the feedback comes through our providers of patient experiences, and they’re very inquisitive, “How did you find us, how does this work?” and they’ll test and evaluate our tools quite a bit. But really, behavioral analytics tell us more about patient behavior and how they’re interacting with our site than any survey will. I feel like as we’ve gone down the road of user testing, the whole industry has kind of been overrun by professional users, who are very helpful, but they want to be helpful and try very hard to give you feedback on things that a regular patient might not even consider. 

Aaron: Interesting. Okay. Thank you.