Healthcare consumerism is already reshaping the ways care is delivered, received and paid for. Despite its many promises, payers, providers and patients still have much to prepare for as the U.S. transitions to a completely new chapter in healthcare.
“With providers treating patients more like consumers, I think it will require a big change in how healthcare professionals market their services, deliver their services and charge for their services,” said Jeff Ries, vice president of strategic investing at Healthbox.
“It’s all about those providers making the necessary changes to their technology, their processes and their behaviors to create more of a brand to actively go out and market to these consumers who are starting to shop around. It’s becoming more of a retail business; a more competitive environment.”
Watch David Chou, vice president and principal analyst of Constellation Research, talk with HIMSSTV about how value-based care is meeting challenges in the age of consumerism.
So how is healthcare consumerism already coming into fruition? One example that people are already becoming highly familiar with is the existence of high deductible healthcare plans. These typically have lower premiums than other health insurance plans, but require more out of pocket expenses to start.
“Consumerism in healthcare has already arrived financially. With high deductible health plans, consumers are being forced to be responsible for their own healthcare and take a role in it,” said Ries.
Digital health innovations like wearables are helping pave the way for patients to take more ownership over their health outcomes. However, the challenge of turning data into information that is easily accessible to consumers persists.
“We’re starting to see a lot of different data sources emerging – not just from the EMR but demographic, social and genomic data. At the same time, we’re seeing organizations like HIMSS take a leading role in trying to create interoperability to drive these,” he said.
Patients, or consumers with these plans, may eventually become ‘smarter shoppers,’ one survey indicated, but they still have much to learn. Researchers surveyed 1,637 patients that were enrolled in a high-deductible health plan for at least a year. Of this total, 42 percent of respondents had at least one chronic health issue. Additionally, only 14 percent were comparing prices and quality in seeking healthcare services.
Chronic health conditions require significant out of pocket costs. Such a common scenario emphasizes the importance of patients being educated on new payment models and how their care can be financed, in addition to where and how care is delivered; especially as consumers assume more ownership over their outcomes, Ries explained. “For example, if you have an earache, you don’t necessarily go to the emergency department, because it’s expensive and the severity of your problem doesn’t necessarily mean you need to go to an emergency department,” said Ries.
Another growing challenge providers are wrestling with is fighting administrative burden, and the shift to healthcare consumerism isn’t necessarily helping with that challenge.
“Historically, providers have gotten revenue from two sources: third parties like government or the more traditional, commercial payers – and then patients, with copays. Over the past few years, we’ve seen the shift to a more consumer model, especially with the rise of high-deductible plans becoming a bigger portion of these net revenue sources for providers,” said Ries.
“I think what we’re seeing there is providers have, historically, then set up their technology and processes to obtain the revenue from government and/or commercial payers, but now they’re being forced to collect money from you and me, they don’t necessarily have the right technology, processes or tools in place to do that,” Ries said. “So it’s causing a lot of administrative burden for them, having to spend extra time having to call patients and get them to actually pay their bills.”
Most of this is done either by the phone or mail, Ries added. According to one estimate, for every 10 U.S. physicians providing care, almost seven additional people are engaged in billing-related activities.
“It’s not a seamless process. It’s timely and costly, so with that I think we’re starting to see more of that debt piling up for provider organizations because they don’t have ways to collect revenue from patients effectively or efficiently.”
That’s where healthcare innovation comes in. “What I’m seeing in the market is numerous technology solutions that help providers by allowing patients access to online portals for payment and scheduling,” said Ries. Ultimately, these solutions should provide more ways to help meet the patient where they are, he said.
As a consumer-centric focus in healthcare grows, so does the demand for outpatient care services, which have experienced a steady uptick over the last two decades. This is due not only to advancing technology, but changing payment models; Healthbox’s report Redefining Care Delivery notes that adult inpatient discharges are expected to decline at least 2 percent over the upcoming decade in the U.S., with a 15 percent growth in outpatient volumes expected.
“With healthcare consumerism, it’s all about meeting the patient where they are, whether its allowing them to get a flu shot while buying groceries or allowing a patient to receive care in their home and allowing the provider to have the full medical history in front of them when they’re seeing a patient,” said Ries.
In addition to telehealth services, popular ridesharing companies are partnering with healthcare providers to solve the transportation challenge facing many patients, Ries said. “Providers are implementing transportation services to pick up the patient such as ridesharing so they can bring them to the hospital or doctor’s office. This way, the doctor can see them, and after they’re done, make sure they get home safely,” Ries said.
Along with the increase in outpatient care settings, providers are challenged with increasing competition. “Fee-for-service companies don’t want to lose that volume. Fiscally, it could hurt those kinds of organizations if they don’t create some kind of joint venture with some of these various outpatient retail settings out there,” said Ries.
“For organizations taking more risk with their populations, these various kinds of care settings help ensure the continuity of care,” he added. “For fee-for-service companies, it creates a threat because there are more competitors in their market vying to provide health services to their patient population, which could ultimately drive down volume for them.”
According to Healthbox reports on internal and external innovation, in 2017 alone, more than 325,000 health-oriented applications were available to consumers – with $5.8 billion invested in digital health funding, Ries explained. “Consumers have more access than ever to remote monitoring devices, behavioral health solutions and telemedicine services that allow them to remain more independent from the health system in its traditional form.”
One variable the success of healthcare consumerism is dependent on is behavior change across the board – and that’s possibly the biggest challenge left to tackle. “It is going to be a challenge because it is a behavior change for providers; it’s not something they’re taught in medical school. I think many provider organizations understand that, and are trying to wrap what the doctor does with these other services and technology solutions to allow the doctor to really focus on the clinical side, but improving that experience for the patient as a whole.”
The future of healthcare consumerism is dependent on strategic alignment, powered by strong partnerships and collaboration. “Creating alignment among all stakeholders is where we want to go and I see the market headed that way,” said Ries. “The more innovative companies are creating the tools, technologies and processes to help us achieve this alignment.
“Ultimately, it will improve quality of care for patients and reduce costs – which is what I think we’re all rooting for.”
Healthbox, a HIMSS Innovation Company and healthcare advisory firm, drives innovation from the inside and out, helping organizations build internal innovation programs, assess the potential of employee-led projects and look to the market to find solutions to implement or invest in.