By Jane Sarasohn-Kahn, MA (Econ.), MHSA | HIMSS Social Media Ambassador
As the annual HIMSS17 conference approaches, there are several uncertainties shaping U.S. health care and, ultimately, the health IT market: a new Administration with unclear healthcare and health-tech objectives; changing provider payment regimes; a shifting employer-sponsored plan environment; and, growing discontent among clinicians, among other driving forces.
Against these uncertainties, there’s one certainty with which the health IT community must deal: the patient as an increasingly cost-conscious, demanding and empowered health consumer. In fact, consumers’ challenges with the healthcare system create opportunities for health IT companies. If health-tech companies understand, appreciate and respect patients-as-consumers, they can conceive, design, and grow products and services that help drive individual and population health, inspire positive retail-style experiences, and boost healthcare providers’ business models.
Consumers as payors. Consumers spend one in five dollars of their household budgets on healthcare in America. This fiscal reality is motivating more U.S. health citizens to seek information and control for their health care. Personal health technologies will play a growing part in peoples’ self-care increasingly prescribed by clinicians taking on financial risk.
A plurality of Americans, 4 in 10, is dissatisfied with the healthcare costs they face. The level of dissatisfaction varies by a consumer’s type of health insurance. Overall, 42% of people are dissatisfied with costs. Underneath that statistic is the fact that 48% of privately insured people are dissatisfied with their healthcare costs.
The growing burden of healthcare costs on Americans and their families sets the stage for the new retail health landscape in the U.S. Growing consumer out-of-pocket costs are exposing people to first-dollar payments that health plans won’t cover until deductibles are met. This puts the patient-consumer into the role of shopping for healthcare services and products, or simply opting out of seeking care. Fully one-half of people dissatisfied with their healthcare costs have delayed getting care due to cost: not a happy prospect for providers taking on more financial risk for performance.
One known aspect about President Trump’s views on health care, supported by prospective Secretary of Health and Human Services Dr. Tom Price, is an interest in growing the number of health savings accounts adopted by patient-consumers. An expanding consumer-directed healthcare landscape exposing greater consumer skin-in-the-game raises the stakes for consumer-directed health IT that supports cost and quality transparency and retail-style transactions and experiences.
Growing chronic care burden. Two articles published in JAMA in December 2016 analyze the growth of chronic disease and related costs. The original investigation article, US Spending on Personal Health Care and Public Health, 1996-2013, quantifies how US spending on different health conditions has changed over time and by demographic changes in the nation’s population. Greatest spending was on diabetes, followed by heart disease and low back and neck pain.
The second article is a response to the first by Dr. Ezekiel Emanuel, titled, How Can the United States Spend Its Health Care Dollars Better? In Dr. Emanuel’s response, he writes that, “By 2020, health care spending in the United States is expected to surpass the national economy of Germany, at which point the US health care system will be the fourth largest economy in the world.” This begs the question asked in the title – how can the US spend its health care dollars better?
The chronic conditions receiving highest spending are largely amenable to consumer lifestyle and behavior changes. Social determinants of health largely influence these conditions. Consider the health impacts of smoking, poor nutrition, lack of exercise, substance abuse, lack of clean water (think: Flint, Michigan), and unsafe neighborhoods, and you begin to understand the major impact of the social determinants of health on morbidity and, ultimately, mortality. Health IT can help nudge and support patients’ lifestyle changes, complemented by high-touch tactics underpinned by knowledge bolstered through artificial intelligence and machine learning that mash-up health care and public datasets.
The health disparity of information access. Among many health disparities which mar healthcare quality in the United States, add health and healthcare information access. Access to health care is dependent on a health consumer’s access to information about available health care services, their location, price, and if the patient is very fortunate to glean, quality. As people take on more responsibility for managing their health care utilization and financing in America, their access to information that is easy-to-find, clear, comprehensive and current is critical to personal and public health outcomes.
Consumers are, sadly, quite dissatisfied with the state of their health care information, discovered through a survey supported by Robert Wood Johnson Foundation and Oliver Wyman, and conducted by the Altarum Institute. Results of this study were published in the report, Right Place, Right Time: Health Information and Vulnerable Populations.
Vulnerable U.S. health citizens are health information-compromised. This group of people tends to be uninsured, Spanish-speaking, caregiving, and enrolled in Medicaid. The lack of health/care information access jeopardizes care access and quality, putting people at-risk for worse health outcomes, eventual higher costs, and greater burden of disease compared with people who enjoy health information access. Health consumers want financial transparency; simpler, direct language; mobile-friendly formats; and, respect.
The new retail health: patients as consumers. Patients who feel disrespected by providers are less likely to trust health care information or follow medical advice, the study also learned. This feeling of disrespect was found to be linked to medication non-adherence – with costly results to the healthcare system and individual health outcomes.
This Rodney Dangerfield feeling of “can’t get respect” leads to health consumers being three times less likely to trust information provided by their doctors. Furthermore, patients who feel disrespected by providers are twice as likely to be non-adherent to medication regimens. For example, people with diabetes (PWD) who do not feel respected are one-third more likely to have poorly-controlled diabetes compared with PWDs who feel respect from their providers.
User-centered design is mandatory for the consumer-facing health information economy. Health information portals tend to be poorly utilized because they lack good design informed by patients’ values, digital literacy, and life-flows. Empathy is part of this ethos. The RWJF/Oliver Wyman/Altarum report notes that, “Good patient-provider relationships are not just part of good bedside manner…positive patient-provider relationships should be considered a medical priority, and should be encouraged through training, education and, potentially, compensation changes.” That’s on the healthcare supply side.
On the demand side, patient-consumers want a retail experience in healthcare. Surescripts recently published the 2016 Connected Care and the Patient Experience report, learning that consumers: want their medical information delivered electronically, easily accessible and shareable; and, are dissatisfied with the time and effort they spend on dealing with their medical information and waiting times in health care offices.
Most patients (52%) now expect the ability to conduct remote visits with doctors, which would facilitate receiving prescriptions remotely from doctors making life easier and time-saving.
Patients, facing greater price transparency, first-dollar out-of-pocket payments, and more self-service/DIY workflows in daily life expect retail-style service from all aspects of healthcare: in the doctor’s office, at the hospital, in the pharmacy, and from the insurance company.
The growing cadre of health consumers seeks convenient, value-priced, mobile and virtual care. This transition has already begun. The health IT opportunity is to meet peoples’ demands for retail health experiences. By doing so, the industry can help the legacy healthcare system – hospitals, providers, pharma, and health plans -- stay relevant and valued by consumers.