Health Care Consumerism | Nexsen Pruet, PLLC


Over the previous a number of years, there was an elevated deal with the rise of well being care consumerism. Well being care consumerism refers to sufferers taking a larger position within the managing and paying for one’s well being. A rise in well being care consumerism might lead to sufferers turning into extra knowledgeable relating to the prices and high quality of their well being care companies which might have an effect on shoppers’ 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 exhibiting that 69 % of the well being care leaders checklist consumerism as a high precedence[1]. 

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

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

Modifications in expertise embody the fast growth and deployment of wearable expertise that enables people to watch their well being and wellness whereas they’re at house or the workplace. This new expertise comes within the type of apps for smartphones, smartwatches, health trackers, and different gadgets that monitor varied well being metrics from plenty of steps taken through the day to high quality of sleep. This well being expertise has precipitated many individuals to turn out to be extra engaged of their private well being and is offering sufferers with knowledge that may be built-in into their medical report and shared with their treating physicians.  In a latest examine, over 57% of sufferers indicated that they thought that knowledge supplied by usable expertise might be helpful in conversations with their suppliers about their well being[3]. 

Throughout the previous 18 months, there was a big 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 expertise is built-in into the sufferers’ EHR, sufferers could have larger entry to their well being knowledge, invoice data, 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, shoppers 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 shoppers to turn out to be extra engaged in evaluating their well being care selections. It stays to be seen whether or not the required pricing info disclosures on hospitals and insurance coverage corporations’ web sites will likely be virtually useful to shoppers, however it’s anticipated that third social gathering corporations will combination this pricing knowledge and make it out there to the general public in a extra user-friendly format that enables shoppers to match hospitals and insurance coverage corporations to 1 one other. In July, President Biden issued an Government Order that’s designed to advertise competitors within the American economic system by decreasing shopper costs and rising staff’ wages. This Government Order particularly addresses issues about the price of pharmaceuticals, the consolidation of well being care suppliers, and promotes worth transparency in well being care and the flexibility of Individuals to decide on the kind of well being care insurance coverage that finest serves their wants by comparability of worth and protection of plans. That is one other instance of the deal with pricing transparency and its aim of offering well being care shoppers 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 turn out to be extra snug discussing and analyzing the price of healthcare, figuring out 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 % of c-suite well being care leaders have mentioned that they’re bulking up their workers and coaching them particularly to reinforce these affected person experiences[5]. These methods give a affected person actual time entry to their medical data and communication entry to their physicians. Well being care suppliers are additionally utilizing patient-friendly apps for scheduling and different interactions with the follow. Using these portals of patient-centric apps has been properly obtained by sufferers and those 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 provide larger deductible plans or plans with much less advantages and extra out-of-pocket duty, insureds are dealing with the fact that they will be chargeable 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 by 2026[6]. With way more pores and skin within the sport and extra info out there 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 worth 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 companies when a affected person can analysis and evaluate suppliers. The underside line is that suppliers will must be ready to debate prices with their sufferers as the worth transparency development will probably proceed.  Moreover, as we transfer from a volume-based care system to a extra value-based system, suppliers will likely 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 knowledge as they handle sure affected person populations. This high quality knowledge may be a think about the place shoppers determine to go for well being care. 

As we benefit from the one-click comfort of on-line procuring in retail, it seems inevitable that sufferers will search an identical sort of expertise when looking for well being care companies. Many well being care companies (emergency care and complicated illness administration) are too complicated and unpredictable to have the ability to simply clarify and predict the fee and end result of. Nonetheless, progressive suppliers try to enhance the general affected person expertise by speaking with sufferers in new methods comparable to textual content, electronic mail or social media, by post-visit suggestions about all facets 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 is probably not as handy or customer-friendly as utilizing Amazon or your favourite app, it appears to be like like well being care consumerism is a development that’s not going away and can proceed to have an effect on the well being care system. Well being care suppliers will must be ready for a extra knowledgeable shopper who has the flexibility to make selections on the place to obtain their well being care based mostly on price, high quality and different components, together with comfort and the general affected person expertise.

[1] “69% of Healthcare C-suite Say Bettering the Client Expertise is a Prime Precedence,” Sage Progress Companions, July 9, 2019
[2] “Mega-trends in Healthcare Consumerism: A 5 12 months 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 Instances,” Well being Leaders, January 07, 2021
[5] “Utilizing Affected person Navigation to Assist Healthcare Consumerism Traits,” 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 Anxious About Out-of-Pocket Healthcare Prices,” Affected person Engagement HIT, October 29, 2020


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