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Retail Medicine a Big Shift for 2014

 |  By John Commins  
   January 06, 2014

With the growth in high-deductible health plans accelerating, "the healthcare business model is starting to turn from wholesale to retail," says the managing director of PwC's Health Research Institute. That means insurers must be ready to offer new products in a different way.

For all the talk about the Affordable Care Act, population health, value-based reimbursements and Accountable Care Organizations, arguably the biggest "curve bender" for healthcare costs will be growth of the high-deductible health plans that force patients to become smarter consumers.

Savvy healthcare consumers bearing higher deductibles and co-pays will bring with them a list of expectations that come from the retail sector, including price transparency, access, convenience, and value.

"The big shift for 2014 is that the healthcare business model is starting to turn from wholesale to retail," says Ceci Connolly, managing director of PwC's Health Research Institute. "Instead of insurance companies selling to one large employer for thousands of employees, you now have individuals going online one-by-one and shopping. That means creating different products and creating different product plans. It means education and outreach and advertising that is very different."

The growth in high-deductible health plans is accelerating. Connolly points to annual PwC surveys of about 1,000 employers and coverage options for employees. In 2012 13% of the companies said they were offering only high-deductible plans for employees. That figure grew to 17% in 2013 and 44% in 2014 and 2015.

"That is major," Connolly says. "The consumers just by virtue of the fact that they are spending more of their own money are beginning to take a much harder look at what they get for their healthcare dollars. They're also bringing their expectations from their other shopping experiences to healthcare. So they are saying, if I can do my banking in my pajamas at midnight on my couch why can't I make my doctor's appointment then or why can't I get my lab results on my smartphone? Consumers are starting to demand better pricing or at least transparency in pricing and 'what am I getting for my money?'"

The shift toward retail medicine means that traditional healthcare providers will have to rethink their roles and business models in the new healthcare economy, and perhaps look at how other industries have adapted to fundamental changes in the way they do business, Connolly says.

"This is not going to happen overnight. This is a tough nut to crack, but we have been through this with the banking industry and the travel and hospitality industry so we know the pattern and we can see that when you start getting this consumer pressure, that is when things start shifting," she says.

"So much is going on in the remote monitoring space as well as with the big box retailers that we saw embrace the flu shot trend a few years ago. These players are thinking to themselves about many other opportunities beyond just a flu shot," Connolly says.

"We are seeing that consumers are willing to not necessarily go to the hospital or even their primary care doctor now because they are thinking about price point in the high-deductible plan and they think to themselves this is pretty basic, it is more of a commodity. So maybe for an X-ray or lab work they can find alternative care venues that are much cheaper."

Connolly says some traditional healthcare providers have seen the writing on the walls.

"There are some that have picked up on this very quickly and are putting logical pricing information right out in the public because they feel very good and confident about their value. There are some that are clearly struggling with this idea," she says.


See Also: Kill Your Chargemaster


"Part of it with the hospitals and health systems is the arcane chargemaster. They are still grappling with what do to with that. People don't realize hospitals negotiate discounts for larger purchasers. All of that is true, but there is going to have to be some real simplification here and some very savvy communication for the average consumer."

In the meantime, we should expect a bumpy period as healthcare transitions away from mostly fee-for-service and toward value-based payment models and population health management.

"This is going to be the difficult challenging transition period for everybody involved, for consumers, insurance companies, providers, all of us," Connolly says. "The mile marker I sometimes look to when is we moved from pensions to 401(k)s and that was about a decade until we had the vast majority of Americans in 401(k)s. We are already a year or two into this shift and things today happen a little faster but it's hard to say."

So what are traditional healthcare providers supposed to do in the next few years to weather the transition?

"We often advise the smaller- to medium-sized systems in particular to look for the smart partnerships and relationships and alliances," Connolly says.

"Can you affiliate with a larger entity that takes some of your more complex cases or that maybe has capital available to help you invest? Maybe you partner with a retail entity in your region and you share in the most basic care. It's really starting to head in that direction with population health, thinking about value and looking honestly outside of your own four walls for the smart partnerships."

Connolly recalls meeting with a group of primary care physicians recently who expressed unease about their role in the changing healthcare delivery landscape.

"I said to them, we want to be heading into a world where you are doing fewer procedures over and over again, but there is going to be a care team in the community and you are going to be the ones to direct the other players. That is where more physicians need to orient themselves in the future. They'll no longer do every single procedure. Patients are going to do a lot of it in their own homes but they will still look to the doctor as a trusted advisor."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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