The benefits of aligning with the consumer viewpoint
The COVID-19 crisis has accelerated the imperative for consumerism in healthcare. More than ever, patients and members are concerned for their safety, their care and their financial well-being.
That puts the onus on healthcare leaders to deliver accessible services that meet consumers' specific care needs — and at a price they can afford. If they don't, competitors — old and new — will seize the opportunity for themselves. This is a major challenge, but it also presents an opportunity for healthcare organizations to step up, deliver innovative solutions and drive lasting change.
The case for consumerism: Improve engagement and lower the cost of care
The total cost of care has been a mounting pressure in the health industry. And costs are anticipated to grow by 5.5 percent per year for much of the next decade.1 Now, the economic turmoil resulting from COVID-19 has made this issue an urgent priority. More consumers than ever are delaying or forgoing care, with 32 percent saying they will adjust their spending because of COVID-19 while another 30 percent either have skipped or plan to skip an elective procedure.2 Healthcare leaders can design products and leverage delivery channels to keep consumers engaged with affordable, quality solutions that protect them from financial harm. If consumers can't find solutions within your organization that meet their ability to pay, they may turn to your competition. Or they may simply opt out and allow their conditions to go undiagnosed.
Additionally, healthcare leaders can help engage, retain and even grow their consumer base by reassuring them about their safety, guiding them to appropriate care channels and offering sensible, upfront financial information. Ninety-two percent of consumers say they would rather go to another clinic if they couldn't know the cost of their care before receiving the bill.3 Health plans and providers can work together to offer accurate cost estimation and win consumer trust.
The case for consumerism: Deliver quality care and outcomes
Consumers want to be healthy. But they often find the healthcare environment confusing, indifferent and cost-prohibitive. A coordinated, consumer-centric approach can eliminate these barriers and surround each member or patient with a personalized health ecosystem.
The key to designing care around your populations is to understand the consumer on financial, clinical and social levels. These segmentation efforts can start by blending the claims and clinical data your organization already possesses. The next level of insight comes from adding demographic and psychographic data, along with information on consumer health finances and purchasing behaviors. It's also important to factor in social determinants of health (SDOH) such as employment status, education, transportation, dietary habits and more. After all, it has been estimated that 80 percent of health outcomes are dictated by these SDOH.4
Digital care channels can also be leveraged to collect even more information, and strategic partners can be tapped for further data and analytics capabilities. All of this information can help you identify the consumers who most need support, coverage and care.
The case for consumerism: Remain ahead of the competition
In the aftershock of COVID-19, many consumers pivoted to telehealth, virtual health and in-home care solutions as a stopgap for in-person care. However, though this market shift occurred out of near-term necessity, there's a good chance it could solidify into permanent transformation. And while many traditional healthcare organizations responded admirably to meet this sudden demand, new market entrants have poured billions of dollars of private equity into the market and are continually innovating solutions to go a step further.
Virtual care solutions are gaining in popularity — but they're only part of the puzzle. Leaders can blend remote services with existing on-site care programs to create a thoughtful, targeted health experience. Work with your consumers as collaborators to figure out how they wish to engage, what barriers they feel they face and what you can do to make it easier for them to get care and health information on their own terms.
Each member of the C-Suite can help design a more consumer-centric health care system.
Explore Health Care Beyond Crisis and our C-Suite insight series Navigating Forward for a deeper look at the unique challenges facing CEOs, CFOs and CMOs, and the specific actions they can take to address them.
SOURCES
1 Centers for Medicare & Medicaid Services. CMS Office of the Actuary Releases 2018-2027 Projections of National Health Expenditures. Newsroom page. Centers for Medicare & Medicaid Services website. https://www.cms.gov/newsroom/press-releases/cms-office-actuary-releases-2018-2027-projections-national-health-expenditures#:~:text=National%20health%20expenditure%20growth%20is,%26%20Medicaid%20Services%20(CMS). Accessed September 25, 2020.
2 PwC. The COVID-19 pandemic is influencing consumer health behavior. Are the changes here to stay? Research and Insights page. PwC website. https://www.pwc.com/us/en/library/covid-19/covid-19-consumer-behavior.html. Accessed September 22, 2020.
3 Advisory Board. What Do Consumers Want from Primary Care? Research page. Advisory Board website. https://www.advisory.com/-/media/Advisory-com/Research/MPLC/Research-Study/2014/What-Do-Consumers-Want-from-Primary-Care/28878_Research_Brief_PDF061614%20(2).pdf#page=16. Accessed September 22, 2020.
4 Aroditis A. Leveraging Social Determinants of Health Data to Improve Accountable Care Delivery and Gain a Complete Picture of Patients’ Needs. Resource Center page. HIMSS website. https://www.himss.org/resources-leveraging-social-determinants-health-data-improve-accountable-care-delivery-and-gain. Accessed September 21, 2020.