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Benefit cuts and increasing prices are creating medical debt and bankruptcies. Some consumers respond by avoiding healthcare or abandoning coverage. Their alternative? They don’t pay providers.
As providers struggle to make progress in value-based healthcare and its transition to financial risk, they are not paying enough attention to this rising trend: healthcare consumerism. The tech industry is pulsing with excitement to bring mobile apps and services to consumers. They believe consumers may be the force of change, disrupting exclusive historical roles of providers in directing healthcare services.
Mary Meeker’s highly anticipated 2018 Internet Trends Report documents how the shift of healthcare costs from employers and health plans to consumers is driving technology development to bring consumers what they want. And what do they want? They are demanding cost transparency, their own digital health records customization to their interests, demand-based shopping for healthcare providers and services, and decision tools. Consumers want cost control, and they are done waiting for providers to give it to them.
Let’s look at some of the latest ventures now offering alternatives to the bundled solutions provided by most healthcare organizations:
Providers face big challenges in responding to consumers
Providers have been merging, acquiring, and building ever-bigger healthcare enterprises. First to gain market share against competitive providers, and then to achieve leverage in payer negotiations, healthcare is big business. Ask providers why, and they point to economies of scale for purchasing electronic medical records and technology and forming accountable care organizations.
We now know that large healthcare complexes have driven costs rise even higher. Provider health systems have become bureaucratic. It is harder for them to change. Price transparency, shared decision making, and shared data have taken a back burner to operations and population health.
Providers have miscalculated the power of their direct customers-consumers-and the employers paying for the shared cost of their coverage. Big business such as JP Morgan Chase, Berkshire Hathaway, and Amazon are already taking action. Efforts to repeal the ACA thrust the cost of healthcare into consumers’ personal politics. Aided by the coming of “healthcare age” of millennials, with willingness to challenge traditional systems, and the retirement of boomers with meager savings and debt, both younger and older groups are poised for making change.
Healthcare affordability is now a consumer issue
Affordability of healthcare was once considered an employer and health plan issue. Now, however, affordability of healthcare is affecting benefits, availability of coverage, and consumers’ ability to pay. Driving about half the annual increase in costs is medical technology, according to repeated examinations of annual increases in U.S. healthcare costs. That is worth an examination because at higher costs than other countries, it is not improving our health.
What exactly is “medical technology”? The term refers to new or improved surgical, medical or diagnostic techniques; advances in equipment; new drugs; and even technology purchased by providers to improve care, such as EMRs. Already on the radar screen for consumers are these technologies:
The surge in adoption has been facilitated by the fee-for-service reimbursement that allows costs to be passed on to health plans and consumers. Consumer messaging by healthcare organizations highlights best doctors and the latest new technologies. Pharmaceutical companies have redirected marketing away from providers and toward consumers, emphasizing the latest therapies, less side effects, and more flexibility.
Patients are being burned by this approach. Benefit cuts and increasing prices are creating the record medical debt and bankruptcies. Some consumers respond by avoiding healthcare, and a growing number are abandoning coverage altogether. Their alternative? They don’t pay providers.
How can providers re-orient to consumers?
A patient seeking treatment for atrial fibrillation, for example, has various choices of medical technology, including new drugs and procedures. Each has high consequences. The cost and effects of each drug differ dramatically. Ablation has outcome issues under scrutiny, and serious risks. The goal for providers is to make those differences clear through summary of research data.
2. Support physicians in efforts to help patients. Physicians need to guide the process of decisions and provide the data associated with results and any biases in the research. Organizations must support provider processes, allocate sufficient time, and centrally compile consumer-directed cost and research data.
Most physicians feel responsible for their patients’ health. They will need to transition from only treating patients to providing guidance and education as well as treatment. That will involve training in leadership and understanding of consumer trends.
3. Create communication channels for consumers. Consumers have challenged provider bureaucracies for obtaining medical records, cost information, and clinical information. There is rarely someone directly responsible for responding to complaints. Tools in use for customer satisfaction are not enough to raise issues for identifying consumer value.
Providers should create new avenues for consumer communication, making it easy to find answers. Areas of potential conflict-access to medical records, billing, the front office staff, and the physician-patient experience should be examined.
4. Collaborate with technology solutions for consumers. Technology solutions coming from the industry will require provider cooperation and involvement. Providers should help consumers connect with key applications and respond to questions. Special efforts to connect to scheduling, on-demand prescriptions, and consumer-oriented technology will need decision and engagement and require provider cooperation.
Failure of providers to act on these fronts will create consequences for them that could be irreversible. Consumers who can’t get relief will sideline health systems when they can and seek less costly or intrusive services. Physicians caught between demanding patients and recalcitrant organizations may leave. Sick patients who are stuck in the system will create financial disaster for themselves and for their providers.
Turning a big ship is hard and incremental. Whether providers have enough time to regain the loss of confidence in their operations is not clear. But they may be the torchbearers of this new wave of consumer power if they take the initiative now.
Theresa Hush is the CEO and cofounder of Roji Health Intelligence. As an expert at creating consensus for desired change through education and collaboration, Hush helps healthcare organizations take actions that will direct their future through meaningful technology and programs.