The main aim of this document is to provide an overview of healthcare consumerism, its growth drivers and challenges / barriers providers and payers face while adopting it. The document provides insights on how providers and payers can tackle the rising wave of consumerism in healthcare industry. The document also provides some real-life examples on market trends which emphasize the need to brace consumerism in healthcare
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The Future of Healthcare in Consumerism World
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27 October, 2017| Author : Hemangi Hanote, Varun Agarwal, Tanay Agarwal| Healthcare
Business Analyst
The Future of Healthcare in the
Consumerism World
CitiusTech Thought
Leadership
2. 2
Objective
The main aim of this document is to provide an overview of healthcare consumerism, its growth
drivers and challenges / barriers providers and payers face while adopting it
The document provides insights on how providers and payers can tackle the rising wave of
consumerism in healthcare industry
The document also provides some real-life examples on market trends which emphasize the need
to brace consumerism in healthcare
At the end of this document readers shall be able to:
• Recognize the current market trends on consumerism prevailing in the healthcare sector
• Identify areas where they can gain competitive advantage by acting early
• Understand the process of adopting consumerism in healthcare
3. 3
Agenda
Introduction to Healthcare Consumerism
Key Drivers of Consumerism
Key Challenges
Consumer Access Points
Current Market Trends
Opportunities to Leverage
Technology Enablers
5 Step Approach to Consumerism
References
4. 4
Introduction to Healthcare Consumerism
What is Healthcare Consumerism?
Consumers are taking an increasingly active role in healthcare decision making. Healthcare
Consumerism is defined as the actions individuals take to become better informed and more directly
and proactively involved in decisions and behaviors that affect their health, insurance coverage, and
health care. These actions may include:
Researching for information about health concerns and compare treatment options
Taking deliberate steps to monitor and improve their health
Cooperating with physicians to make treatment decisions
Sharing information with doctors
Taking cost and quality aspects into consideration in their decision making
Adhering to recommended treatment plans
Key Stakeholders
Providers PayersConsumers/Patients
5. 5
Key Drivers for Consumerism
Regulatory reforms
(ex. ACA)
Market for private HIX solutions deployed by U.S. employers will
grow at a CAGR of 41.9% between 2016 and 2020 – Frost & Sullivan
Growth in
co-pays - Individuals
as biggest payers
>35% of total healthcare payments were out of pocket in 2015 and
the trend is only increasing – HIMSS
Shift to
value-based care
models
Healthcare transformation task force is working on a plan to shift 75%
of members’ contracts to VBPs by 2020
Focus on wellness
and prevention
91% of consumers want to be more proactive in managing their
health – A Xerox survey
More expectations -
Access to digital tools
/ info
By 2022, 20% population with chronic health conditions will rely on
virtual health assistants
6. 6
Key ChallengesConsumerExpectations
More for less
Quality vs. Price
On demand access
Information and care
Continuous engagement
Communication and loyalty
Self help / timely resolution
Automation and integrated
customer service
Customized care
Tailored solutions
Key Technology Considerations
User Experience
Data security and privacy
Integration and Interoperability
Scalability / Cloud
HIPAA / PHI compliance
Enterprise Mobility
CRM / Web enablement
Internet of Things
Enterprise BI and Analytics
Providing a simple and effective consumer experience is hard! It needs organization to connect
various disparate data sources and work across many different technologies.
7. 7
Consumer Access Points
47%
15%
27% 27%
34%
37% 38%
50%
19%
48%
35%
23%
Retail Clinics Urgent Care
Centers
Freestanding
Imaging Sites
Virtual Visits
Not Available Limited Access Significant Usage
Patient Engagement initiatives
Source: Kaufman Hall 2017 Healthcare Consumerism Survey
Enhancing access with a variety of entry points is a must for legacy healthcare providers
to enrich consumer experience.
Availability of Innovative MethodsTraditional Methods for Consumer Access
4%
11%
13%
18%
23%
6%
34%
30%
26%
42%
69%
43%
48%
41%
27%
Online Patient Portal
Message between
Patient and Providers
Extended hours of
dignostic services
Extended hours of
primary care
Virtual Visits
Its Available
We are working on it
Not available and not working
It’s available
8. 8
Current Market Trends (1/3)
Retail Clinics
A retail clinic is a category of walk-in clinic located in retail stores, supermarkets and pharmacies
that treat uncomplicated minor illnesses and provide preventative health care services
Memorial Hermann has partnered with RediClinic to provide 22+ retail clinics in Houston
area
RediClinic operates quick-care clinics in grocery stores, to offer convenient, low-cost
access to consumers who need minor care
Enhancing access to quick care at convenient location at right time through retail clinics,
providers are taking the right step in transitioning to customer-centric model .
Renton-based provider has teamed up with Walgreens to offer 25 walk-in clinics
The clinics will bridge the gap between hospital-based urgent care and coordinated
primary care
Retail health clinic offers transparent pricing, no pre-appointment and extended hours
Arizona's largest healthcare provider
Partner with Safeway grocery stores to open retail-based clinics at 3 different locations
All 3 locations will have a nurse practitioner on site and will be open 365 days per year
The objective is to provide patients with the same level of care as in an emergency
department but with less waiting time and cost
Banner
Health
Providence
Health
Memorial
Hermann
Source: Banner Health | Providence Health | Memorial Hermann
9. 9
Current Market Trends (2/3)
Patient Engagement Initiatives
A concept that combines a patient's knowledge, skills, ability and willingness to manage his own health
and care with interventions designed to increase activation and promote positive patient behavior
The project provides a way for providers to share patient-centric information directly
with the patients
Instigates communication and engagement between patient and provider by making
physician notes available via a secure online portal
Patients feel more empowered in their healthcare, and have reported that having
access to their notes would influence their decision to choose the provider
Physician-led integrated health system based out of Pennsylvania
Its ProvenCare model offers money-back guarantees for care experiences that don’t
meet patients’ expectations. The patients decide how much they get back—no questions
asked. In six months just 74 patients asked for their money back, totaling about $80,000
It has launched an innovative CRM program in collaboration with GH’s Fresh Food
Pharmacy which brings medical, dietary and social care to families struggling with food
insecurity and diabetes. 50% of nearby Shamokin city residents are diabetic and 30%
don’t know where their next meal is coming from. When diabetic patients order insulin
from a Geisinger pharmacy, they also get a week’s worth of tasty, diabetic-safe food
delivered.
OpenNotes
Geisinger
Source: Open Notes | Geisinger
10. 10
Current Market Trends (3/3)
Healthcare consumerism and digital patient engagement are becoming the new norm to meet
the challenge of the patient-consumer’s service expectation, convenience and value.
Leading insurance company, serving approximately 46.7 million people
Teamed up with the Financial Planning Association for a public education campaign
dedicated to helping patients navigate the financial aspects of their health benefits
"Find a Doctor & Estimate Costs" tool provides members with cost and quality data
The tool provides searching doctor by location, cost estimates for procedures, the
amount members would have to pay and read and write doctor reviews
Members can also check quality data of doctors and compare doctors side-by-side
Pardee is a non-for profit hospital managed by UNC healthcare
They have customized search on their portal wherein patient can select the doctor by
selecting up to 14 personality characteristics
Algorithms also list doctors based on compatibility, distance and location
The largest integrated health system in New York state
Developed a mobile app that offer instant feedback options for patients
Any “unsatisfied” result trigger, alerts to appropriate physician / staff who then attend to
patient need within 15 minutes
Satisfied patients prompted to identify staff people for recognition as well
Aetna
BlueCross
BlueShield
Pardee
Health Care
Northwell
Health
Source: Aetna| BCBS | Pardee Health Care | Northwell Health
11. 11
Opportunities to Leverage
360-degree customer view
Consumer analytics
Segmentation analytics
Real-Time patient
Feedback system
Staff operated feedback
system
Enterprise application
framework to support
apps across care
continuum
Build Advance Virtual
Care
Multichannel Navigation
Platform
Application integration
and interoperability using
EAI platforms
Data integration support
for care coordination and
patient engagement use
cases
Uncover points of
frictions between
patient and provider
Discover digitalization /
transformation
opportunities
Integrated search, price
estimation and
scheduling
Externally embedded provider
search
Automated price estimates
Hospital locator and way finding
inside hospital
Online scheduling
Integrate portals and apps
Consumer-driven personalized
healthcare plans
Bargain-base pricing
Simplified billing & payments
eHealth Platform /
Mobile Support
Data Intelligence
and Analytics
Device / Data
Source
Interoperability
Consumer
Journey Mapping
/ UX
Consumerism
Purchasing Ease
Reconfigure
Access Channels
12. 12
Technology Enablers
E-visits
Personal analytics
Patient Portals
Digital care coordination
Omnichannel experience
Digital care records
Virtual health
Telehealth
Remote patient monitoring
system
Patient Wearables
Real-time health systems
Sensors and host boards
IoT enabled medical
devices (including OS,
firmware, drivers)
EHRs / EMRs
CRM
ERP
EDW
Cognitive HIS / RIS
Consumer Ecosystem
Devices IT Systems
Consumerism Platform
Intelligence
Population Health
Management
Precision Medicines
Genomics
Real-time Analytics
Key Enablers
User Experience
Artificial Intelligence & Machine
Learning
Integration and Interoperability
Scalability / Cloud
Enterprise Mobility
CRM / Web enablement
Internet of Things
Enterprise BI and Analytics
13. 13
5 Step Approach to Consumerism
Establish vision
and governance
Discovery and
current state
assessments
Strategic blue
print and gap
assessment
Reprioritization
Execution blue
print and kickoff
Clearly
articulated
strategy around
consumerism
with key
outcome
expectations
An empowered
team structure
to drive
integrated
consumer
centric initiatives
Current state
assessment
through interviews
and focus group
discussions,
discovery
workshops, asset
inventory
exercises,
document reviews
and observation
and analysis
Current state
customer journey
maps
Draw a
strategic
blueprint that
is aligned to
the vision
with a
detailed gap
analysis
Rethink the
initiatives
based on
current state
assessment
Reprioritize the
initiatives after
detailed
considerations on
multiple dimensions
- investment vs.
returns; impact vs.
complexity; tactical
vs. strategic etc.
Consider impacts
like change
management,
process re-
engineering and
enterprise
architectural
adjustments
Finalize the phases
and sprints for
prioritized initiatives
Come up with clearly
articulated key
success factors for
each of the
initiatives
Define fail fast and
fail safe
expectations;
leverage tools and
methodologies like
design thinking,
rapid prototyping
and journey
mapping
14. 14
Summary
Consumerism will reshape the healthcare industry in the coming years
The age of consumerism will be even more profound in 2018-2020 as more choices and
information will be available to the consumers for decision making due to advancement of
technology
Use of alternative care options for example retail clinics will grow substantially in the few years
The key to survive for healthcare organizations is loyalty
Healthcare organizations who will be able to understand, guide and engage consumers will have
a significant opportunity to make difference and earn the loyalty
Healthcare organization should also think about the role of new healthcare technologies in
understanding consumerism to gain competitive advantages
15. 15
References
The Reality of Consumerism on healthcare
https://www.td.org/Publications/Blogs/Healthcare-Blog/2016/07/The-Reality-of-Consumerism-on-Healthcare
2017 state of consumerism in healthcare
https://www.kaufmanhall.com/sites/default/files/2017-State-of-Consumerism-in-Healthcare.pdf
HFMA report on Health Care 2020 - Part 2: Consumerism
http://www.hfma.org/Content.aspx?id=49983
Banner Health opens 3 clinics at Arizona grocery stores
http://www.beckershospitalreview.com/facilities-management/banner-health-opens-3-clinics-at-arizona-
grocery-stores.html
Providence to own healthcare clinics
http://www.modernhealthcare.com/article/20150820/NEWS/150819875
Memorial Hermann Medical Group RediClinics
http://mhmg.memorialhermann.org/doctors-specialties/rediclinic/
A $10 Million Victory for Patients
https://gopvi.org/blog/a-10-million-victory-for-patients
Pardee Hospital & Northwell Health
http://www.himssconference.org/sites/himssconference/files/pdf/INV5.pdf
Blue Cross Blue Shield
https://www.fiorente.tv/heath-care-consumerism/
Geisinger Health System
http://www.pressganey.com/docs/default-source/industry-edge/issue-3/breaking-new-ground-in-the-era-of-
health-care-consumerism.pdf?sfvrsn=2
Aetna
http://investor.aetna.com/phoenix.zhtml?c=110617&p=irol-newsArticle_Print&ID=909224
16. 16
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Author:
Hemangi Hanote
Varun Agarwal
Tanay Agarwal
Healthcare Business Analyst
thoughtleaders@citiustech.com