Hospitals are getting more competitive to win patients. Here's how one of NYC's largest health systems is building new tech to stay relevant.

• New York's Mount Sinai Health System is making a bet that a revamped home page and a chat feature to answer questions and book appointments will help it appeal to patients in the competitive New York market.
• The effort is led by Mount Sinai's Chief Product Officer David Kerwar, who drew inspiration from applications like Lyft as a way to provide estimates for booking different types of visits: from virtual video conversations, to urgent care, to a trip to the emergency room.
• The move to make it easier for patients to access Mount Sinai's health system - as well as entice new patients to get their care there - is happening as the war for funneling in patients is heating up.
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David Kerwar is on a mission to make it easier for you to book a doctor's appointment.

That should be a simple task. But for many, it requires looking up a list from your insurer to find out who's in network, calling around to doctor's offices to see who might have availability, then waiting weeks to get an appointment. Even then, it can be hard to know if you're seeing the right kind of doctor. And you might not know the cost of your visit until you get a bill in the mail weeks later.

"My theory is that the days of traditional primary care - where I make an appointment and I go wait in the waiting room for two hours and I, you know, hopefully get seen, I tried to take a half day off for a wellness visit - are quickly coming to an end," Kerwar said.

Kerwar joined Mount Sinai Health System a year ago as chief product officer, coming over from health insurer Aetna. His job has been to revamp how the company uses technology to attract new patients and communicate with existing ones. That includes making it easier for patients to book appointments at Mount Sinai.

Academic medical centers like Mount Sinai used to be able to rely on reputations for providing cutting edge medical treatments and top quality care to drawn in patients. But as people increasingly demand convenience and cost information, too, major hospitals are being forced to adapt.

Places like urgent care, emergency rooms that aren't connected to hospitals, and clinics in retail pharmacies like CVS Health all tout their convenience to win patients. Technology as well has started playing an increasing role in how people get their healthcare, with startups promising to make the experience easier and cheaper.

To do that, Kerwar and his team built out a way for patients to directly book visits through Mount Sinai's website, replacing an older interface that relied on Zocdoc. Patients can choose what kind of visit they might want, including primary care, a virtual visit on the phone, a text-message chat, urgent care, or an emergency room visit. Patients can chat with a Mount Sinai worker if they're not sure what kind of visit they need.

Unlike the online appointment-booking website Zocdoc, Mount Sinai plans to give patients an idea of how much a visit will cost. Because the health system has information about insurance coverage, patients can get an estimate long they'll have to wait. Through the website, patients can book appointments, check in on refills, and one day see a log of their visits.

You'll still be able to book an appointment with some Mount Sinai doctors on Zocdoc's own website. Zocdoc has said it plans to add cost estimates to its website in the future.

Kerwar said he was inspired by Lyft and Uber, which show cost estimates based on what type of ride you'd like. But early on, he realized that wasn't enough: It's hard to know what kind of visit you might need, which is where the chatting feature can come in handy.

Mount Sinai started to roll out some of the features of the website to some primary care and obstetrics practices in May. Kerwar hopes to launch an app and a chat feature later in the year, and some day have a chat feature in which people can text "4SINAI" to get help with booking appointments and other matters. Also in the plans: smart speaker capabilities, like the kind Amazon's Alexa is now working on with some health systems.

Read more: Amazon's Alexa can now schedule doctor's appointments and give you updates on your prescription drug shipments

Mount Sinai runs eight hospitals in the New York City area and in 2018 had operating revenue of $2.9 billion. It's one of the largest employers in the area.

It's embracing a number of strategies to draw in patients and meet their demands for convenient care. The organization has partnered with companies like urgent care operator CityMD, opened up its own urgent care locations, is affiliated with CVS's MinuteClinics in New York, and is working with insurance startup Bright Health and primary-care startup One Medical.

The push to win over patients with convenience and price is happening at a time when patients are more on the hook than ever before for the cost of their medical care. In 2018, nearly half of Americans under 65 with private health insurance had high-deductible plans, up from about 25% in 2010. Those plans require a person to spend thousands out of his or her own pocket before their health insurance starts covering their care.

Read more: Meet the woman overseeing a key piece of CVS Health's plan to change how Americans get healthcare

Appealing to patients directly

Kerwar said the move to start marketing more directly to consumers started after Mount Sinai completed its merger with Continuum Health Partners in 2013. Farther downtown in NYC from the health system's main hospital on the Upper East Side, Mount Sinai has opened up more primary care practices.

The team has also started contracting directly with employers. Employers, which are a big source of health insurance coverage in the US, are increasingly starting to work more directly with health systems, rather than having health insurance plans manage those relationships. The goal is to keep employees healthy while cutting down on the cost.

Read more: A failed deal with Boeing taught a $23 billion health system 5 key lessons about how to work with big companies to shake up healthcare

The new arrangements required a big investment of resources from Mount Sinai. Kerwar said that the team realized they'd have to build it out themselves, rather than rely solely on tools or software from outside companies.

"I think at the board level, there was a realization that in that world where you're not just going and negotiating contract with a national insurance carrier and then they're just going to send as many patients and that's how you're going to keep your business going," Kerwar said. "But if you're actually going to sell a solution to a consumer, to an employer or take risk with a payer that we needed to offer a much better consumer experience."

The 'digital front door'

That included a revamp of how Mount Sinai connects with patients when they aren't in the office.

Kerwar calls the program Mount Sinai's "digital front door."

"A lot of what the digital front door is about is not just saying, hey, if you need primary care, you make an appointment in our office and we can help to see you in the next two weeks," Kerwar said. "We say make a relationship with you and we can help triage you to the most efficient care setting, the fastest and most convenient care settings."

Through Mount Sinai, you can message with a team that'll direct you to what kind of visit you might need. That could mean a text-message or video conversation between you and a doctor or a trip to a nearby urgent care facility.

"If you can get well and you just need to be texting with a physician, we're not going to force you to sit in our waiting room for two hours," Kerwar said.

But since it's happening through Mount Sinai, say a visit that's happening via texting does actually require an in-person visit, the Mount Sinai team can direct you to another one of the health system's "front doors," capturing that business as well.

• Read more:
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• The largest healthcare company in the US is sounding the alarm on a new kind of emergency room that charges 20 times more than a regular doctor visit
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