As our industry transitions from a volume-based to a value-based model, one of the most significant opportunities before us is the consumerization of healthcare. As membership in health insurance exchanges expands and employers rethink their role in providing health insurance, we are likely to see individuals progressively take more and more control of their own healthcare decisions. Part of this change is driven by the transfer of financial risk and responsibility to individuals, exemplified by the growth of high-deductible plans. All of this means that we must treat our patients more and more like healthcare consumers.
Patient Centered Care Models now are transforming into Consumer Engagement Strategies that expand beyond Patient Satisfaction and into customer experience design. This places focus on creating very intentional experiences at key points in the consumer’s healthcare journey. With that focus, healthcare organizations like Englewood, Colo.-based Catholic Health Initiatives, the nation’s second-largest nonprofit health system, can drive long-term behavioral change that will lead to improved health and wellness outcomes.
For a sector that has traditionally never felt the need for treating patients like consumers (after all, the consumer never really paid for any healthcare services directly -- it was always an insurer), this imposes a sudden and dramatic need to change the fundamental approach to the delivery of healthcare. The reason is simple: consumers expect and demand value when they pay out of their pockets for any service.
Digital health and patient engagement
There has been much talk about the use of new technologies, especially digital health, for better engaging with patients. San Francisco-based venture capital firm Rock Health highlights some key aspects in its 2015 survey of digital health adoption. While the survey points out that the need for consumer engagement in healthcare has never been greater, nearly half of Americans have only used one or none of the five major digital health categories. In other words, adoption rates are low. Other research, published earlier this year, suggests that healthcare organizations are not good at engaging patients through digital means, which runs counter to the rapidly increasing use of digital and mobile technologies in the broader consumer markets.
The news is not all bad, though. Digital health adoption rates are high in several areas. Patients now conduct research online for healthcare information, from drug prices to diagnostic and treatment advice. Telehealth is making steady progress, as is the emergence of new wearable devices that help consumers better manage their health. At CHI, we are moving aggressively into these key areas as the healthcare environment continues to shift dramatically under the Affordable Care Act.
"The healthcare industry has already started adopting population health management strategies in anticipation of a future where value-based care is the norm"
Emerging world of healthcare consumerism
There are some things that will define a day-in-the-life of a patient-provider relationship in the future.
Here are just a few:
■ Healthcare will move steadily away from acute care settings and into the homes of healthcare consumers. This will be driven by several factors, including the high costs of patient care inside a hospital setting.
■ Patient encounters with physicians, nurse practitioners or physician assistants will no longer be episodic, occurring at irregular intervals. They will be 24x7. People shop online at Amazon at all hours of the day. Healthcare will be no different.
■ The quality of the patient experience will matter more than ever. When a consumer pays out-of-pocket for a service, she will expect a high level of service quality.
Along with the emergence of consumerism, new healthcare-service providers are emerging from non-traditional sectors (such as Uber which is being employed to deliver flu shots) and new relationships between existing players (such as Walgreens and Providence Health). There will be some setbacks as well, as we have seen in the case of lab test startup The ranos; however, the markets are inexorably moving toward a future that clearly belongs to the healthcare consumer.
A final, and important, enabler in this journey is the use of advanced “big data” analytics to understand patients, to risk-profile patient populations for appropriate and timely interventions, and to manage the quality of outcomes. The healthcare industry has already started adopting population health management strategies in anticipation of a future where value-based care is the norm. In the Sep-tember 2015 issue of Health Leaders magazine, Kevin Lofton, the CEO of Catholic Health Initiatives, de-scribes our organization’s transition from volume- to value-based care. The organization, which operates in nineteen states and includes one hundred and two hospitals and hundreds of other healthcare facilities spanning the continuum of care, has been making significant investments in value-based care models over the past few years, starting with a section of our own employees who have enrolled in managed care programs. By focusing on high-risk individuals and by delivering care through clinically integrated networks, we have been able to reduce emergency department visits and average hospital length of stay by ten percent.
The emerging role of the CIO
As Information Technology (IT) goes from being an enabler to a competitive differentiator and a revenue generator, the CIO is increasingly being called upon to perform the role of business strategist.
Healthcare organizations have spent billions of dollars over the past years implementing electronic health records (EHR); however it is just the starting point. CIOs additionally must drive transformative IT strategies that provide a superior digital experience to consumers at the front end, while ensuring a robust always-on IT infrastructure that enables seamless data exchange and robust analytics throughout the consumer relationship and care continuum.
Much has been written about the new Internet of Things (IoT) phenomenon, and we must recognize the potential of new wearable technology in personalized medicine and population health management. While many of the new devices are currently lifestyle-grade, they will eventually mature to clinical grade, and data from these devices can be integrated with traditional electronic medical record data for improved insights on patients.
A final word on healthcare consumerism: healthcare is unlike other consumer-oriented sectors, such as retail sales and consumer banking. HIPAA and FDA regulations impose certain limitations on our ability to use personal health data and to “market” healthcare services the way other consumer sectors track consumer behavior and market based on that behavior today. This distinction between healthcare and traditional commercial consumer sectors poses a unique and unprecedented challenge for healthcare consumerization.
The successful CIO in the consumer-driven healthcare environment of the future will be an essential enabler of an enterprise’s success. She must be able to integrate a deep understanding of technology and critical business insights that can ultimately lead to increases in quality of service, revenue and overall profitability.