Consumers vs. patients: Healthcare's biggest misunderstanding

One of the most noted transformations in the current healthcare landscape revolves around patients and their growing involvement in their care. Patients have become so engaged and informed that the industry is largely starting to refer to them as consumers. But the two aren't synonyms, and the labels aren't interchangeable.

Patients are to squares as consumers are to rectangles. To illustrate, here's a quick geometry refresher. By definition, a square is a rectangle, but a rectangle is not a square. A square is a subset, of sorts, of the rectangle. In healthcare, the same principle can be applied to patients and consumers. A patient is also a healthcare consumer, but a consumer is not necessarily a patient.

"People use patient and consumer interchangeably," says Jeff Margolis, chairman and CEO of Welltok, developers of a consumer-facing health optimization platform. "You're strategically doomed if you use them interchangeably because they're not the same."

Mr. Margolis delineates patients and consumers in one simple way: Patients, he says, receive care, while consumers make choices. Engaged patients adhere to or comply with a treatment regimen given to them by healthcare professionals, while engaged consumers are accountable for their overall health status and the costs of achieving that health status, he elaborates.

Understanding these differences can help transform health IT systems and how these systems are designed to serve patients and consumers, Mr. Margolis says.

As healthcare IT systems currently exist, there are insufficiencies in the way patients and consumers alike can utilize platforms. The platforms today were built for very specific purposes. Important purposes, yes, Mr. Margolis says, but the clinical information and benefits information they currently offer have little practical usability for consumers because they were never designed to be consumer platforms.

"If you expose data directly to a consumer out of a clinical system (which most people call patient portals) you might say they're necessary, but they're insufficient because all they can tell you is information about you crossing the lines of service of those particular provider organizations," Mr. Margolis says. "It's not a whole picture of you. It's largely just the sick care picture of you."

These insufficiencies hold true for member portals that health plans offer, Mr. Margolis says. Such member portals display benefits, deductibles, claims paid on a patient's behalf and other data points along the same lines, none of which really speak to the patient's or the consumer's health needs. Mr. Margolis adds that such systems were built as business-to-business systems, "to produce transactions that are reimbursable" and to transfer this information among business entities.

What's more, only about 15 percent of people in the population are in a patient state at any given time, Mr. Margolis estimates. The other 85 percent of the population are in consumer mode, where other influences besides clinical data are the drivers of overall health status.

Yes, some patients need to monitor clinical and biometric data on a daily basis, such as type 2 diabetics who monitor their glucose. That clinical data has everyday use and value, but there's no reason that data has to be stored in a clincial EHR, Mr. Margolis says. "Most times, you don't need a doctor or hospital-based system to do that monitoring. You just need the data from whatever device is doing the monitoring exposed directly to the consumer in a manner that integrates with the consumer's life".

So what does a consumer need in terms of a consumer-facing IT platform?

"Take the spectrum of consumer-facing activities: health and wellness, fitness, nutrition, education about how the health system works, social support and communities, rewards and incentives that go along with participating in those activities," Mr. Margolis says, which is the strategy behind Welltok's CaféWell HHHealth Optimization Platform.

The consumer-facing platform aligns consumer actions and behaviors with incentives and rewards and coordinates with population health managers, who Mr. Margolis says is anyone who helps people manage their total healthcare costs, such as at-risk providers, health plans and other organizations.

Consumers have specific needs, ones that can't necessarily be serviced by business-centric platforms. Instead, platforms such as CaféWell should "curate the ecosystem for the consumer" in a personalized, data-driven environment that is complementary to both traditional EHR platforms or insurance benefits platforms, Mr. Margolis suggests.

And with the ever-growing emphasis on population health and the commitment to engage consumers in their well-being, platforms need to offer them access to adequate and effective tools. Population health can't be the key to reducing overall healthcare costs if consumers are relatively ill-equipped [as compared to medical professionals or benefits managers] to start making those changes.

The patient vs. consumer conversation is a new one, as many are still adjusting to thinking of patients as consumers and the gatekeepers to their own health. Given the inevitable shift toward population health management, there is an opportunity for IT solutions to step in and offer consumers what they need.

"There needs to be recognition that there's a third type of enterprise platform in healthcare — consumer platforms," Mr. Margolis says. "I'd love for people to stop setting up the 'either/or' on consumers…and come up with the 'and.' The clinical information comes from [one platform], the benefits come from [another platform] and the information that consumers need to navigate a year in the life comes from [another]. If the consumer-level can easily integrate the information from those other platforms and swizzle in the vast amount of additional consumer data available, everybody becomes more efficient."

More articles on health IT:

Global telehealth market to grow 19 percent from 2014 to 2019
Patient portal enrollment at Virginia Mason tops 100,000 users
A history of EHRs: 10 things to know

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