Borrowing from the principles embodied in the U.S. Constitution’s “We The People”, the U.S. Healthcare Industry is facing unprecedented transformation driven by a similar principle, “We The Patients”. Successful healthcare providers are finding ways to leverage existing assets to meet the high expectations of empowered patient/consumers.
Three words, “We The People” carry extraordinary significance in the American lexicon. Framing the preamble to the Constitution, these words establish the enduring principle on which our country was founded an on which it continues to flourish.
Reflecting on the just-passed Independence Day holiday, it would be appropriate to observe that the unprecedented transformation currently underway in the U.S. Healthcare Industry might be framed “We the Patients”. The imbalance of power between the healthcare establishment and its patients is giving way. Tomorrow’s winners in the Provider community will excel in three critical areas; Consumerism, Convenience and Technology.
Several significant trends are converging to force radical change to the way healthcare services are delivered and consumed in the United States. Driven by demographic, social, economic and regulatory pressures, healthcare providers are being forced to abandon traditional business models. But the search for workable, meaningful change can be overwhelming. Important lessons for the future of healthcare can be gleaned from the behavior of innovators and upstarts who have already begun reshaping healthcare for the next ¾ of the 21st century.
The Fading Dominance of the Primary Care Physician
For generations, healthcare in American was guided by the patient’s relationship with her primary care physician (PCP). Typically, the PCP’s deep familiarity with the patient – often developed over years of preventive and curative care for the patient and her family, was the basis for most patients’ healthcare decisions and purchases. In an era when relationships were paramount, information was closely held and the patient’s out of pocket costs were manageable, this system was established as the ideal model for the delivery of quality care.
That’s changing. The erosion of the PCP model is most evident in the attitudes of Millennials, the 83 million Americans born between 1981 and 1996. According to a national poll of 1,200 randomly selected adults conducted in July, 2018 by Kaiser Family Foundation, 45 percent of 18- to 29-year olds had no primary care provider, compared with 28 percent of patients age 30-49. Older patients between the ages of 50 and 64, and those 65 and older came in at 18 percent and 12 percent, respectively.
In an article from Kaiser Health News, Dr. Ateev Mehrotta, an internist and associate professor in the Department of Health Care Policy at Harvard Medical School is quoted, saying “These trends are more evident among millennials, but not unique to them. I think people’s expectations have changed. Convenience [is prized] in almost every aspect of our lives.” Dr. Mehrotta goes on to point out that speed matters too. Younger patients are unwilling to wait a few days to see a doctor for an acute problem. “Now, people say ‘That’s crazy, why would I wait that long?’.”
From a care perspective, this shift in patient behavior can have some negative implications such as increased costs due to higher utilization as patients seek care they otherwise wouldn’t have, missed or incorrect diagnoses and inappropriate treatments due to poor care coordination. Nevertheless, the fact remains that for more and more of us – convenience wins.
The Growing Dominance of Patients-as-Consumers
Along with millennials’ preference for convenience, growing out-of-pocket costs for care are also influencing patient behavior. According to the nonprofit TransAmerica Center for Health Studies’ 2018 Consumer Study 62% of respondents said that healthcare costs are a major stress, second only to personal finance (72%). One study found that 40% of prospective patients avoid or delay care because of concerns about the cost.
According to new TransUnion Healthcare analysis, patient out-of-pocket costs rose 12% in 2018 across all care settings with the majority (64%) facing costs of $500 or more. In the analysis, TransUnion Healthcare president Dave Wojczynski states that, “…patients are now making decisions about where they receive care based on costs – not just the quality of care they may receive. This means price transparency is critical for healthcare providers who are not only competing for patients, but also want to secure timely payments from them.”
Another trend driving healthcare consumerism is the younger generation’s comfort with technology. According to survey results published in 2018 by The Advisory Board, 67 percent of millennials reported that they would consider a virtual visit if in-person care was not available on the same day. 47 percent said they would consider a virtual visit if it was less expensive than an in-person visit. However, it’s important to note that 62 percent of baby boomers would consider virtual for same day service. To save money, 32 percent would consider going online.
To sum up, higher patient out-of-pocket costs and a growing willingness to choose alternative treatment settings are turning patients into customers. This notion may offend some purists, but please note: the “We The Patient” principle doesn’t diminish the more important social contract between patient and caregiver. It does, however, add an inescapable new set of expectations to the healthcare industry’s current operating model. And with disruptive new players like Haven Healthcare, CVS Health and others threatening to steal market share, ignoring these trends will likely prove to be perilous.
Leveraging Technology to Stay Relevant in the Modern Healthcare Economy
For traditional healthcare providers, these circumstances demand new ways of doing business and new tools to keep up with (if not ahead of) rapidly evolving patient/consumer expectations. But there is good news on this seemingly murky landscape, the building blocks for a consumer-centered enterprise are already in place for most hospitals and health systems - with Electronic Health Record system companies like Epic, Cerner, Athena and AllScripts for comprehensive clinical management; existing point solution providers like TransUnion and Experian for patient revenue cycle management; larger-scope technology and services players such as Parallon, Optum, nThrive, and Waystar; and specialty patient financing and payment processing companies such as CareCredit and First Data, Global Payments, PayPal, Square, Total System Services and Worldpay.
Leveraging these systems, providers can support robust telehealth delivery, achieve price transparency, offer affordable payment options and engage digitally – enabling satisfying self-service wherever and whenever a patient chooses it. By doing so, providers can also reduce costs through operating efficiencies and improve staff and physician satisfaction. And because data is gathered at every patient touchpoint, system analytics can be mined for business intelligence to drive continual improvement thereby honing provider competitiveness.
The tricky part of this proposition is blending all of these disparate systems into a single, seamless whole. One that adapts to every setting in the ecosystem and is flexible enough to incorporate new and emerging solutions while maintaining strong user engagement.
Fortunately, that technology exists. Loyale Patient Financial Manager and the Loyale Affordability Workbench are the healthcare industry’s most widely deployed patient financial engagement solution. Combined with a hospital’s patient clinical portal, Loyale’s platform-enabled integrated solutions give patients and providers the tools they demand, so patients can get the care they need the way they prefer, and providers can achieve their goals for growth and patient satisfaction.
Just as the baby boom generation set the tone for cultural and market transformation through the 1980s, today’s millennials are now driving innovation. Motivated by high personal out-of-pocket costs and relative indifference to the traditional primary care provider model, they bring a willingness to consider care delivery alternatives that make care more convenient, more affordable and more accessible digitally. Like the boomers before them, they’re driving fundamental change that attracts innovators and upstarts who see gaps in the marketplace and rush to fill them. Traditional providers can meet this challenge, but those who delay could find themselves at a profound competitive disadvantage.