In the United States, both payor and provider healthcare companies are facing a myriad of critical, urgent challenges as the managed care industry transforms from volume-based to value-based systems.
A primary force in this transformation is a consumer-focused emerging payments model, where renumeration results from improving health instead of treating illness. There is also a tsunami of other forces at work, such as increasing regulatory uncertainty, and new market disruptors like CVS and Walmart, who are becoming key players in healthcare delivery – not to mention an enormous, almost unmanageable amount of available patient and beneficiary data now available to payors and providers.
However, among the most pressing challenges today in the digital healthcare landscape is the consumerization of the industry and the emergence of the educated patient and beneficiary who demand more from their healthcare interactions.
Healthcare companies are working diligently to figure out how to embrace direct engagement, as it is part of the critical path to value delivery for payors and their beneficiaries, as well as providers and their patients. In fact, for visionary payors and providers, mastering consumerization – and addressing today’s savvy, informed, discerning consumers – is no longer a matter of “if,” but “when.” It is something that many other industries, such as retail and banking, have already tackled, and it’s time healthcare catches up.
This “patient-as-a-consumer” phenomenon is so pivotal in the digital transformation of healthcare that we are kicking off our four-part series on healthcare’s digital future with this topic.
Can healthcare look like this someday?
Imagine this scenario: a young boy named Mike has severe asthma, a condition that has often landed him in the emergency room. Now let’s imagine that Mike’s health insurance company has access to pollen-count predictive technology and data about the susceptible levels that could cause medical emergencies for Mike. When there is a prediction of a dangerously high pollen level, Mike’s pediatrician gets a real-time notification from the insurance company. Next, Mike’s mom gets a text alert with information from his pediatrician’s office about the high probability of an asthma attack that could land Mike in the hospital. Now, Mike’s mom can pack his inhaler in his backpack so he has it during recess, and a potential asthma emergency on the playground – and a visit to the ER – can be averted.
Is this kind of real-time digital healthcare landscape really possible? Can healthcare providers transform the way they engage to meet evolving consumer demands while improving cost management and population health?
The answer is yes, if they are willing to reimagine their value-delivery chain to embrace today’s digitally-transformed reality.
Enter the consumerization of healthcare
As mentioned earlier, retailers like Amazon, Walmart, CVS Health, and Target are rapidly becoming disruptive players in the healthcare industry. In fact, a pwc study notes that 40% of the consumers surveyed said they’d trust large retailers for health services. Another 38% said they would trust a digitally enabled company, such as Google or Amazon. Meanwhile, trust percentages for the incumbents are only 37% for insurers and only 34% for providers. This is evidence that consumer perception has already shifted, even ahead of the delivery of comparable services.
In another recent report by Healthcore, researchers found that visits to retail clinics in the past five years among the commercially insured Blue Cross Blue Shield members in the study have doubled.
Why the big jump in the popularity of retailers? These companies have created such a consumer-centric, personalized, and intuitive buying experience that people now expect to interact with the healthcare system the same way. So when they are offered affordable healthcare options from retailers that already know them intimately, it makes sense that these customers are willing to try them out.
So, what does this mean to traditional healthcare providers? It’s time to shift the way they do business.
To deliver a retail-like healthcare experience, providers are now being called upon to give consumers more control over the care they get so they can choose the options that best meet their individual needs. This is true not only for the quality of care, but also from a cost perspective, where consumers want the best value for their money, especially when it comes to things like premiums, services, and prescription drugs. For example, the Healthcore report found that out-of-pocket costs for an upper respiratory condition cost US$35 for a retail clinic visit, as compared to US$377 for an emergency room visit.
An article by McKinsey & Company analysts describes the consumerization of healthcare this way: “In the not-distant future, financially accountable tech-enabled consumers may avail themselves of a range of discrete digital health services from a variety of providers. As a result, they would be able to create their own health-management ecosystems, acting as stewards of their care and controlling not just where they access it but also how and from whom, as well as the price they pay.”
Technology-enabled customer engagement makes this all possible
A related McKinsey article on how healthcare systems can become digital-health leaders recommends a comprehensive and integrated approach to transformation. The article notes that providers should be ready to make “bold changes to their business and operation models to compete in the digital healthcare landscape.”
The technology that retailers invented to gain share of wallet in their brutally competitive industry, where disruption and obsolescence is commonplace, provides instructive examples for healthcare payors and providers. For instance, retailers use customer engagement and commerce solutions that form the cornerstone of their consumerization efforts.
Consider Salvatore Ferragamo S.P.A, the luxury goods company, for example. One key to the retailer’s success is the ability of shop managers to access integrated customer information directly and provide contextually relevant shopping experiences to their customers. Because of its customer-centric efforts, Ferragamo is now is able to offer better promotions tailored to individual tastes, preferernces, and past purchase behavior – a technique that parallels the desired state in healthcare.
Healthcare consumerization is already a reality today
To effectively embrace consumerization, healthcare companies must adopt a patient-centric approach that serves people like never before. Think back to Mike and his asthma condition – for him, consumer-centric technology can help him achieve better ongoing health, while saving his family unneeded angst and expensive emergency room and related costs.
This kind of consumerization is already available for healthcare providers through technologies like customer engagement and e-commerce solutions. These patient-centric solutions can help providers rapidly process massive volumes of health data, analyze it in real time, and suggest contextually relevant points of engagement that improve population health and save lives.
To fully support this approach, providers can also include in-memory technology in their strategy and integrate siloed data from multiple sources – primary care doctor, hospitals, health and medical devices, to name a few. Utilizing this powerful technology allows providers to create context-based interactions that will help them deliver a higher quality, more personalized level of care that is efficient and effective for them, and crucial to their patients.