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The Dawn of Consumerism: Key trends and strategies for healthcare consumerism

David V. Gallegos, February 27, 2018

A new day has arrived where consumers can take charge of their healthcare-- demanding greater transparency and information access. As they bear more of the cost burden, patients look to health plans to be their advocates and providers to be their partners.

Reducing costs and improving quality are the two prevailing objectives behind most healthcare initiatives. However, a rising trend are the efforts to improve the patient experience. In the 8th Annual Industry Pulse Report, a recent national survey of healthcare leaders, we gain perspective about what’s being done today to improve engagement and help turn passive patients into active healthcare consumers.

Historically, healthcare in the United States has been funded by employers and the government, and because of that health plans and providers have treated themas 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.

Up until recently, patients had little to no input on their care plan. Limited data was available to make informed decisions so patients had 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. Organizations that respond to the growing trend of consumerism in healthcare will be better positioned to thrive in this ever-changing market.

To achieve the highest satisfaction, organizations must ensure they address three key aspects of the customer experience:

  1. Transparency

 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 may 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 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.

    3) 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. 

    Treating a patient based on their individual uniqueness has the opportunity to revolutionize healthcare. 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. 

    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.


    © 2018 Change Healthcare Operations, LLC. All rights reserved.

David V. Gallegos

SVP, Consulting Services, Change Healthcare Consulting

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