5 Things the Trend Toward Healthcare Consumerism Won’t Change
One of the strangest things about the evolution of modern healthcare is that fact that we act as if healthcare consumerism were a new thing. It most assuredly is not. It's just that the industry has been insulated from the direct demands of consumers — through private health insurance, through government entitlement programs and so on — for so long that we've forgotten our patients do have power. They have the power to choose providers. They always have. They always should.
The advent of patient-centered care, at its core, is really just a recognition by the industry that the human being receiving care — the patient or healthcare consumer — is who matters most in the exchange. The consumer is the one with the most skin in the game: stakes can't get much higher than one's very life and well-being.
Healthcare consumers have always had 5 basic expectations that aren't going to change, regardless of how we choose to model the marketplace or how much we shift our distribution paradigms. Let's take a look at what those expectations are, and how the industry can orient itself to meet them under a value-based reimbursement care model.
1. A patient-consumer expects to be healed.
First and foremost. If there were no clear benefit to treatment, a patient wouldn't come to a provider for it. Clinicians need to know what they're doing. But it's not enough for a doctor to have the experience to heal — especially now that there has been such a surge toward hospital ownership of physician groups. There is now more pressure than ever before on hospitals and healthcare organizations to manage spending to empower their providers to heal cost-effectively while meeting patient demand
A healthcare organization needs to hire and retain competent support staff that reflects its brand equities and commitment to care. It needs to invest in care delivery technologies that balance efficiency and cost-savings with clinical effectiveness. It needs to invest in its facilities' physical space, ensuring a confidence-inspiring appearance, infection-reducing cleanliness and easy navigability for healthcare consumers, their families and providers.
A healthcare organization needs to invest in community health: follow-up services, interoperability initiatives, public health advocacy, eHealth and mHealth, preventative health services, patient outreach and engagement efforts. Healing doesn't begin and end at the hospital's doors — it's a long, ongoing process to which we need pay more attention.
How might a healthcare organization effectively engage patients, and activate positive behaviors, once they’ve left its premises? Since patients spend most of their lives outside the healthcare system, it can be challenging to influence preventative and wellness behaviors that support the healing process. PatientBond is an innovative platform for automating patient communications (e.g., text/SMS, phone calls, email, etc.) to extend healthcare providers’ reach to patients.
What helps differentiate PatientBond from other platforms is that it customizes messaging to patients based on psychographic segmentation. Specifically, messages are worded to appeal to patients’ “health and wellness personalities,” so that they resonate on a deep-seated level, motivating behavior change. PatientBond addresses such things as medication adherence, health education, appointment reminders, bill paying and many other activities.
2. A patient-consumer expects to be treated with dignity and respect.
In any business, customers demand to be treated with respect and kindness. Healthcare entities often act as if they are immune to bad word of mouth. Healthcare is a necessity, some may think. They need us.
Yes, constituent consumers do need care. But the industry also needs them, now more than ever. On the ward, it's very easy for this concept to become elusive. Providers are under intense time constraints, often needing to explain advanced concepts to patient-consumers and to their families in a truncated amount of time — sometimes with a life hanging in the balance. And it must be done in a way that is both compassionate and meaningfully informative.
But how do providers do that when they are so often dealing with consumers who have little understanding of the service or treatment we know they need? And how do providers allay their patients' very reasonable fears about purchase advisors and providers being one and the same? To many people, the concept of a doctor telling one what treatment he or she needs is akin to a financial advisor with a position in a stock telling his or her customers to buy it.
Value-based care is placing even more pressure on healthcare organizations to reinforce the clinical care they are providing with personable care. Moreover, it's incentivizing providers to give personalized care.
Already, we've seen family care doctors experimenting with personalized care by offering flat-fee, subscription-based direct primary care, or so-called "concierge medicine." The idea is that, by doing away with health insurance billing (and all its attendant rigmarole), doctors can offer affordable care and attain a more efficient workflow. It's a novel idea. And it’s a compliant model under the Affordable Care Act — patients who opt for direct primary care are exempted from the requirement to carry health insurance. Other models of concierge care accept insurance, but the patients’ fees go toward additional services not covered by insurance. Concierge care, however, is often perceived as “rich people care,” assuming very expensive fees. This isn’t really the case anymore, as such care is being democratized with costs comparable to monthly cable or satellite TV bills.
That doesn't mean that concierge medicine is a complete solution — yet. Specialty care is still an issue. Not enough specialized doctors offer a similar model of care for there to be a realistic hope of offering broad consumer options for any health contingency. And concierge medicine typically covers office visits, home visits or follow-up care, but often does not come with any sort of prescription coverage.
This naturally begs the question: should health care systems be offering subscription-based models? In effect, hospital chains could be capturing subscription share and self-insuring their patient populations.
3. When patient-consumers seek care, they need that care now.
No consumer likes to hear that he or she has to wait for delivery of a good or service. Amazon has built its entire business off the concept of convenience and near-instantaneous gratification: a consumer can order and have a product delivered (in some cases, the same day) without having to make a move off the couch.
And we're talking about perfectly healthy people, here. People who are usually able-bodied enough to move off the couch. Why, then, do we have a healthcare system that forces the sick and lame to bring themselves to the point of sale? Why did doctors stop making house calls? Granted, house calls for advanced care like emergency surgery and ICU recovery wouldn't work. And, yes, triage is a necessity in many cases. Naturally. But we have a healthcare system that delays elective care, while simultaneously banking on it. Why should a patient-consumer with a bad knee have to wait 3 months or more for a scheduled knee replacement surgery? No doctor could afford 3 months of non-productivity, and patients wonder why they are expected do so.
Why do we expect primary care patients — most of whom have work and family obligations to attend to during the daytime — only to be sick between the hours of 9 am and 5 pm, weekdays, and never on holidays or Wednesday afternoons? We have already seen an increasing number of retail clinics open, and thrive, on the premise of on-demand, pay-as-you-go minor care.
The reality of providing care - with all of its logistics, talent supply issues and resource limitations – is much more complex than healthcare consumers understand. Regardless, consumers have expectations and healthcare providers need to understand these wants and needs to innovate and educate.
4. Patient-consumers expect value.
No consumer likes to feel as if he or she has wasted money. If a consumer feels ripped off by a retail business, he or she isn't likely to shop there again. Why, then, would a consumer pay a healthcare system or insurance provider thousands of dollars each year for care that doesn't live up to expectations?
For decades, choices have been limited through HMOs, PPOs, skinny networks, system mergers and acquisitions. But consumers have never fully lost the ability to choose their providers. Now, they sense weakness in that care delivery model. And they're asserting their purchasing power, backed by the voice of our largest single consumer — the federal government.
Consumers under the value-based system will reward health systems and doctors that they perceive as providing good value, by demonstrating their loyalty. That loyalty should, theoretically, translate into improved compliance rates, lower readmission rates and free reputational advertising.
Conversely, consumers will penalize providers who do not give the perception of good value. They won't be as beholden to network constraints in the near future. They'll place pressure on their insurance carriers to cover the hospitals and doctors who provide excellent value. They'll leave the practices of those who do not. Much of this may be years off, but the tide is building.
5. Patient-consumers expect easy-to-understand, convenient billing.
Part and parcel with price transparency and value, consumers demand bills that are easy to interpret. Patients expect not to be nickeled and dimed down to the last bandage and the last ounce of saline, and they demand to be able to quickly review and pay a bill.
With all of the internal data that hospitals have been collecting, they should have a good idea what the quantity of each supply used will be for a standard course of care. They should know, for example, that a simple incision and drainage procedure in the emergency room will require an average of 3 gauze pads, an 11-blade, one sponge, one bottle of saline, 5 stitches, etc.
Of course, there will be variation, but if hospitals would approach supply utilization from a statistical analysis standpoint — the way insurance companies generate actuarial tables — they could bill by standard supply packet and do away with extensive line item tracking. Many hospitals may already be doing this to a certain degree, and some hospitals may be doing it better than others. However, if billing-by-packet were to become the norm, hospitals could come a long way toward meeting consumers' demands for simple billing.
And, on the reimbursement side, all providers should be fielding simple e-portals or apps that would allow patients to pay their bills quickly, conveniently and hassle-free. That's not an expectation derived from 21st Century healthcare consumerism — it's just common sense.