Health Care Consumerism | Nexsen Pruet, PLLC


Over the previous a number of years, there was an elevated concentrate on the rise of well being care consumerism. Well being care consumerism refers to sufferers taking a larger function within the managing and paying for one’s well being. A rise in well being care consumerism might end in sufferers turning into extra knowledgeable relating to the prices and high quality of their well being care providers which might have an effect on customers’ selections about how and the place to obtain their well being care. Well being care leaders are being attentive to the change, with a 2019 survey of nationwide well being care leaders displaying that 69 % of the well being care leaders record consumerism as a high precedence[1]. 

Whereas we will not be at a degree the place sufferers are evaluating the price and high quality of their suppliers on an app as in the event that they had been shopping for a automobile or an equipment, we’re seeing a sustained development of well being care customers having extra entry to information about their well being care choices and a stronger want to make use of that information to make extra knowledgeable selections about their well being care. Latest research point out that customers have gotten extra assured about purchasing for medical health insurance on-line and are doing extra analysis on their well being care suppliers[2]. 

Some components which are accelerating this development in well being care consumerism are: modifications in know-how, elevated use of telehealth and its integration with digital well being information (EHR), worth transparency, use of patient-centric communications and affected person portals by suppliers, and modifications in well being profit designs. 

Adjustments in know-how embrace the speedy improvement and deployment of wearable know-how that enables people to observe their well being and wellness whereas they’re at dwelling or the workplace. This new know-how comes within the type of apps for smartphones, smartwatches, health trackers, and different gadgets that observe numerous well being metrics from numerous steps taken through the day to high quality of sleep. This well being know-how has precipitated many individuals to grow to be extra engaged of their private well being and is offering sufferers with information that may be built-in into their medical document and shared with their treating physicians.  In a latest research, over 57% of sufferers indicated that they thought that information offered by usable know-how could possibly be helpful in conversations with their suppliers about their well being[3]. 

In the course of the previous 18 months, there was a major enhance in using telehealth primarily due to the COVID-19 pandemic.  In October 2020, utilization of telehealth elevated by 3000%, in comparison with the earlier October in 2019[4]. When telehealth know-how is built-in into the sufferers’ EHR, sufferers may have larger entry to their well being information, invoice information, care info and simpler communication with their well being care suppliers. Sufferers seem to have embraced telehealth and it’s anticipated it should proceed for use so long as the insurance coverage corporations reimburse it post-COVID. If suppliers don’t assist using telehealth, customers might look to suppliers who do use telehealth for his or her well being care wants. 

Over the previous two years, two federal guidelines have been carried out that require hospitals and insurance coverage corporations to publicly share their pricing info on their web sites. The coverage behind their transparency necessities is to permit well being care customers to grow to be extra engaged in evaluating their well being care decisions. It stays to be seen whether or not the required pricing info disclosures on hospitals and insurance coverage corporations’ web sites shall be virtually useful to customers, however it’s anticipated that third get together corporations will mixture this pricing information and make it accessible to the general public in a extra user-friendly format that enables customers to check hospitals and insurance coverage corporations to at least one one other. In July, President Biden issued an Government Order that’s designed to advertise competitors within the American financial system by decreasing client costs and rising staff’ wages. This Government Order particularly addresses considerations about the price of prescribed drugs, the consolidation of well being care suppliers, and promotes worth transparency in well being care and the power of Individuals to decide on the kind of well being care insurance coverage that greatest serves their wants via comparability of worth and protection of plans. That is one other instance of the concentrate on pricing transparency and its objective of offering well being care customers with extra info that may assist them make higher well being care selections. Some suppliers are already embracing the transparency and providing pricing instruments to let sufferers know the way a lot their process or care will price beforehand. As sufferers grow to be extra comfy discussing and analyzing the price of healthcare, understanding price of care beforehand might have an effect on selections about which well being care suppliers they select. 

To satisfy calls for and higher serve affected person preferences, well being care suppliers have begun to make use of social media methods and patient-centric portals with sufferers. Seventy p.c of c-suite well being care leaders have stated that they’re bulking up their employees and coaching them particularly to reinforce these affected person experiences[5]. These methods give a affected person actual time entry to their medical information and communication entry to their physicians. Well being care suppliers are additionally utilizing patient-friendly apps for scheduling and different interactions with the apply. Using these portals of patient-centric apps has been properly obtained by sufferers and people who use these instruments are in a greater place to make extra knowledgeable selections about their well being care. Using these patient-centric methods can definitely differentiate suppliers who use them from those that don’t. 

As extra insurance coverage corporations supply greater deductible plans or plans with much less advantages and extra out-of-pocket duty, insureds are dealing with the truth that they’re going to be accountable for extra of their well being care price. In accordance with a report from the Kalorama Basis, affected person monetary duty prices have elevated by 10% since 2020 and it’s projected to proceed to go up by 9.9% per 12 months via 2026[6]. With rather more pores and skin within the sport and extra info accessible about the price of well being care, knowledgeable sufferers are paying extra consideration to well being care prices. A survey from October 2020 discovered that 80% of sufferers said that they give the impression of being up the value of a medical service earlier than accessing such care and that price is a significant factor of the place to obtain care[7]. The development of worth transparency might impression particular procedures like colonoscopies or different elective surgical procedures and imaging providers when a affected person can analysis and evaluate suppliers. The underside line is that suppliers will should be ready to debate prices with their sufferers as the value transparency development will probably proceed.  Moreover, as we transfer from a volume-based care system to a extra value-based system, suppliers shall be paid in several methods by payors. Affected person satisfaction and affected person suggestions might impression potential reimbursement, so suppliers are exploring methods to remain in contact with what sufferers are considering and making an attempt to enhance the general affected person expertise. Sufferers may also be monitoring supplier high quality information as they handle sure affected person populations. This high quality information is also a think about the place customers determine to go for well being care. 

As we benefit from the one-click comfort of on-line buying in retail, it seems inevitable that sufferers will search the same kind of expertise when trying to find well being care providers. Many well being care providers (emergency care and sophisticated illness administration) are too complicated and unpredictable to have the ability to simply clarify and predict the price and end result of. Nonetheless, progressive suppliers try to enhance the general affected person expertise by speaking with sufferers in new methods equivalent to textual content, e-mail or social media, via post-visit suggestions about all elements of their go to and through the use of buyer relationship administration (CRM) software program to handle affected person interplay. 

Whereas your subsequent go to to the physician’s workplace will not be as handy or customer-friendly as utilizing Amazon or your favourite app, it seems to be like well being care consumerism is a development that isn’t going away and can proceed to have an effect on the well being care system. Well being care suppliers will should be ready for a extra knowledgeable client who has the power to make selections on the place to obtain their well being care primarily based on price, high quality and different components, together with comfort and the general affected person expertise.

[1] “69% of Healthcare C-suite Say Enhancing the Client Expertise is a Prime Precedence,” Sage Development Companions, July 9, 2019
[2] “Mega-trends in Healthcare Consumerism: A 5 Yr Examine,”
[3] “How COVID-19 Reshaped Well being Care Consumerism,” Fred Pennic, January 31, 21, NRC Well being
[4] “Telehealth Utilization Rises with Improve of COVID-19 Circumstances,” Well being Leaders, January 07, 2021
[5] “Utilizing Affected person Navigation to Help Healthcare Consumerism Developments,” Affected person Satisfaction Information, July 10, 2019
[6] “U.S. Out-Of-Pocket Healthcare Spending Swells to $491 Billion, Up 10%,” Kalorama Basis , August 2, 2021
[7] “Over Half of Sufferers Fearful About Out-of-Pocket Healthcare Prices,” Affected person Engagement HIT, October 29, 2020