Patients’ ability to choose can affect your practice.
Consumerism in health care is best defined as individuals proactively using trustworthy, relevant information and appropriate technology to make better-informed decisions about their health care options in the broadest sense, both within and outside the clinical setting.1
Health care consumerism recognizes the importance of a patient or a family member in the continuum of the health care journey. As what becomes important to the patient becomes more evident, the concept continues to evolve.
The origins of consumerism can be tied to the push for health care insurance in the 1930s, with the patient having input into how their care would be paid for. The protest over provision of care for those with HIV/AIDS in the 1980s showed that patients, not government or payers, should drive how health care is provided to a population.2
This article examines what is driving the current consumerism movement and explores evolution in the provision of health care and the health care system as a platform for how a practice can thrive. No discussion of health care consumerism would be complete without addressing legitimate concerns over the use of the term, both in possibly marginalizing the concept of the patient as well as placing the burden of the health system’s shortfalls on the patient rather than the system.
A consumer-focused system needs to address cost and experience.3 When systems, practices, or individual providers try to address what is important for the patient or consumer, the foundational assumption—even if flawed—is that the quality of care will not differ among providers and that, with quality being a fixed variable, value is mostly cost dependent.
Markets and consumers have always been focused on the cost of goods and services in places such as grocery stores and restaurants because the responsibility for payment rested solely on the consumer.
For years, health care consumers have had little or no responsibility for payment as generous employer- or government-supplied insurance products covered most of the cost of care.
As the cost of these insurance programs became unsustainable, cost of care shifted toward the patient. When patients became sensitive to cost, they predictably became consumers in the traditional sense.
Some consumers choose high-deductible health plans where lower premiums are balanced by higher co-pays or deductibles. These plans drive consumerism in 2 ways. Ostensibly they can promote personal responsibility for care.
Making better lifestyle decisions and using preventive care would hopefully decrease not only overall health care spending but also out-of-pocket costs. Unfortunately, it often means that the overall health care spending is unchanged, but the consumer pays more of the health care costs.
Data from 2018 showed that patient financial responsibility increased 11% in 2017. The impact of this increased spending has led to more than 10% of patients struggling with this financial responsibility.3
Value-based care, the essence of consumerism, is more than just cost control. Although traditionally value has been related to only 2 variables—quality and cost—the definition of value is now in line with the Institute for
Healthcare Improvement’s Triple Aim. This improves health while lowering per capita cost and also places value on the patient experience.4 The Washington Health Alliance defines the element of patient experience at each step of the health care journey from insurance product enrollment to before, during, and after each visit.5 Value, the cornerstone of consumerism, has a different formula.
Practitioners would be well served to understand the dynamic environment of consumerism and health care at this time, as well as anticipated changes, and how they will share responsibility and also benefit from the changes.
Although today’s health care system is characterized as a high-cost system with quality and safety performance less than what would be expected at the price, it has identified and is acting on several opportunities both at the payer and provider level.6,7
Responsibility for cost should shift back to the health care system and by proxy to the provider. Despite introductions in payment reform, much of the nation’s health care dollar is still spent on volume as opposed to value. An acceleration to value-based programs that pay at either an episode (bundle) or population (accountable care organization) is inevitable.
Physicians will need to learn that these modern systems thrive not when an individual tries to manage the complexity of care, but when well-crafted teams design programs that promote healing (surgery) as well as prevention and wellness.
For physicians to succeed in this paradigm, they need to be prepared to lead teams and share the financial risks and gains that would occur with well-coordinated care.
Providers must rapidly embrace
evidence-based care and discontinue reliance on unproven expensive technology. In addition to financially incentivizing evidence-based care, incentives for low-value, volume-based care must be removed.
It is no longer enough to worry about the other health care systems or practices in your market. The most formidable competition will come from those who have already succeeded in a consumer-based world, such as companies that have proved facile in technology-driven service and artificial intelligence to guide effective marketing and targeting.
These strategies are not only an opportunity for revenue generation but also a key part of disease prevention and management, especially of costly chronic conditions, pushing these entities toward success in a risk-based environment.
For example, Best Buy, known for being more resilient than most retail electronic giants, is active in patient monitoring, a key component of the hospital-at-home movement that is a favorable space with respect to cost
and engagement.
The COVID-19 pandemic quickly changed the way consumers think about health and health care. A team from management consulting firm McKinsey & Company lists 5 areas that are important to consumers.8 Let’s look at these 5 through the lens of pregnancy care:
We screen for depression and domestic violence. Can we do better about evaluating environmental factors such as food security and toxic exposures?
Quality data are hard to come by in obstetrics, which makes consumer choice a more blinded process. Items such as readmissions might not carry the same negative connotation as they do on the medical/surgical side. This makes a clinician focus on the patient experience.
This is critical in obstetrics as most patients are experiencing a normal life cycle process, so the engagement process needs to be altered based upon the needs of the patient as pregnancy and health status progresses.
Can your patients access care quickly? Does your office have a way of handling tests such as carrier and aneuploidy screening that are sent to third-party laboratories? More importantly, are patients who develop complications such as gestational diabetes or hypertension given appropriate referral for follow-up?
This is the area that COVID-19 most quickly accelerated. Although many visits were transitioned to a telehealth platform, now is the time to establish the appropriate cadence for in-person and virtual visits. It also is important to expand the option of asynchronous care for patients whose lives are most disrupted by half-day, low-value visits to a provider.
Patients often do not have a choice in their current episode of care (eg, an ambulance transport to the emergency department). But remember: They may have a choice in their next. Consumerism must give patients a voice in how their health care dollars are spent, but it should not be an excuse to accelerate cost shifting or move the responsibility of lowering the cost of care to the patient. Patients deserve the same—if not more—attention to value that other consumers have grown to expect.
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