The Dawn of Consumerism
Key trends and strategies for healthcare consumerism
By: David V. Gallegos, SVP, Consulting Services, Change Healthcare Consulting
Reducing costs and improving quality are the two prevailing objectives behind most healthcare initiatives. However, one leg of the proverbial stool that doesn’t get much attention are the efforts to improve the patient experience. Healthcare in the United States has historically been funded by employers and the government, and because of that health plans and providers have treated the employers and government agencies as the ‘customer’. This approach meant the needs of the patient were addressed through the perspective of the funding entities.
Thus, a paternalistic system was created. Employers picked the health plans that patients could choose from. Health plans picked the providers patients could select. And providers determined the care patients were given. Up until recently, patients had little to no input on their care plan. Limited data was available to make informed decisions so patients had no option but to trust their employer, health plan, and providers. As information has become more available and patients continue to bear more of the cost burden, a fundamental shift is taking place: the consumer is gaining more control of their care.
Information Technology is empowering the consumer and disrupting the healthcare system as we know it. IT is transforming healthcare from the paternal system where care is delivered to the patient, to a customer-centric approach where care is provided in collaboration with the patient.
Consumers are actively demanding better access and more information so they can make informed decisions. High costs and general inconvenience are creating this revolution. They want healthcare to work like Netflix and Amazon, where personalized algorithms help guide them through their course of treatment and wellness regimen. They demand immediate, easy, and convenient access to caregivers. And they want content that is useful and relevant. It is only after they understand the benefits and risks, and have read provider reviews, that they seek the care they decide is most suitable for them.
Organizations that respond to the growing trend of consumerism in healthcare will be better positioned to thrive in this ever-changing market. But becoming consumer-centric takes more than implementing a new system or setting up a new portal. Consumerism in healthcare starts with the culture of the organization. For an organization to put its customer’s first, the staff must have the customer at the center of their focus. The customer experience must be a top priority, ensuring all products, services, and innovations are focused on the best interest of the customer.
To achieve the highest in patient satisfaction, organizations must ensure they address three key aspects of the customer experience:
Markets only work when there is a clear understanding of the cost for the product or service being provided. Healthcare has been historically opaque. Most patients never know the full cost of the service until after the care has been delivered. Patients also have little insight into the quality of care they are given. Additionally, relative outcome data based on the physician or hospital is hard to come by. Finally, and most importantly, patients need to better understand the implications of recommended care, especially if the outcomes are likely to have a negative impact on their quality of life.
- Normal Value Equation: Value = quality/cost
- Healthcare Value Equation: Value = (quality/cost) + quality of life improvement
Cost and quality transparency tools are becoming more widely available. Organizations like the Leapfrog Group and the National Committee for Quality Assurance (NCQA) are pushing payers and providers to make cost and quality data more available. Healthcare organizations that want to satisfy consumer needs must provide as much transparency as possible in terms of cost, quality, and expected outcomes.
2) Immediate Access to Care
Patients also want immediate access to care. In most areas in the United States, getting immediate access to care requires a trip to the emergency room, but that is changing. Urgent Care centers are becoming more popular in most metropolitan areas and clinics are opening in many large retail stores (Walmart, CVS, etc.). Telemedicine is also being used more widely. After more than 20 years in the market, telemedicine is finally being leveraged for immediate physician consults for minor injuries, illness, and prescription refills. Telemedicine no longer needs expensive proprietary equipment. Now most virtual visits can be made through a cell phone.
Other innovative approaches are being used to provide immediate access to care. A Texas community is using paramedics to provide in-home and telephone-based support. They focus on patients who frequently call 911 and patient populations that are at risk for potentially preventable admissions or readmissions. These programs have significantly reduced 911 calls, the number of preventable emergency department visits and hospital admissions, and the number of overnight observational admissions. Several other communities have re-initiated the “house call” so that sick patients don’t have to leave their bed to be treated.
A 2014 study analyzed the Veterans Health Administration's Home-Based Primary Care Program and found a 24% reduction in total healthcare costs. This was done by increasing primary care (at home) and reducing hospital stays. Embracing services like these create customer loyalty, improve health and well-being, and save on costs in the long run.
3) Precision Medicine
Another growing trend in consumerism is Precision Medicine. There is nothing more customer-centric than customizing treatment to each individual patient. Analytics can now be used to leverage family history, claims data, prior diagnosis, lab and pharmacy data, and even genomic information to customize treatment and pharmaceuticals for the individual. Computer programs can now track the progress of these custom interventions and adjust them as the individual’s response to treatment varies.
There are many interrelated aspects to a person’s health. Treating a patient based on their individual uniqueness has the opportunity to revolutionize healthcare. Health should be more than the absence of disease; it should include the absence of suffering. By treating the whole person, and addressing their medical, behavioral, social, and financial well-being, caregivers have a better chance to improve the patient’s overall quality of life.
Today we have the power to take a holistic approach to address a patient’s comorbidities. Providers can leverage technology to design and manage customized treatment plans for every patient by using analytics, integrating data from wearables for remote monitoring/tracking, and deploying health coaches to help keep individuals motivated to achieve their health goals. This shift to customer-centric care gives healthcare organizations the strategy and opportunity to improve outcomes, reduce costs, and improve patient satisfaction.
A New Era
Empowering the consumer (patient) is an important part of the healthcare industry’s evolution. Dusk has come for the paternalistic industry we’re used to, where doctors and institutions (the suppliers) dictate the care provided to the patient. A new day has arrived where consumers can take charge of their healthcare. They will look to health plans to be their advocates, and to providers to be their partners. They’ll still need guidance and coaching given the complexity of this industry, but through the use of technology and analytics, they will be armed with the tools they need to make informed decisions for themselves and their families.
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