This year things will be different for the New Health Consumer…or maybe not quite yet…

Improvements are undoubtedly in progress to make it easier for American consumers of healthcare insurance, traditional healthcare services, and wellness in 2017…say compared to 2010. But much remains unchanged. The New Health Consumer in the U.S. can now take a more active role in managing her health than even 7 years ago. However, I DO NOT predict 2017 to be the year of the New Health Consumer, especially when compared to dramatic shifts in recent years for book lovers, music lovers, travelers, students researching whatever, aspiring bullies, voyeurs, among many others. It’s just too early; disruptive healthcare forces are just beginning to bite. And let’s face it: like education, healthcare is complicated (more on that in future posts). There are many reasons healthcare consumes 17% of our national income — more than twice the global average according to the WHO — and shows no signs of slowing down. With that disclaimer out of the way, following are some of the most obvious improvements in progress that will help the New Health Consumer.

Retail healthcare. In its many forms, retail healthcare is adapting to shifts in hospital and office-based healthcare. CVS, Walgreens, Wal-Mart, Theranos (v2.0) and the mushrooming urgent care center industry have prompted traditional hospital-based organizations to respond in kind. However, only after the consumer aggregates more power will retail initiatives move beyond niche to mainstream healthcare.

Web-based Appointment Scheduling. It may seem strange to highlight this very specific activity, but it’s been a work in progress for many years, and there are a lot of healthcare activities related to it. Unfortunately, this capability is still very centered on organizations, rather than on the consumer (or patient).

Telehealth expansion. Much has changed in the past few years to initiate insurance-based reimbursement for telehealth services. American Well, Teladoc, Doctor on Demand, among others, have responded by offering services that help to connect clinicians and patients for new ways of healthcare engagement. The next generation of these services has the potential for broad-reaching impact on healthcare delivery for some obvious and some not-so-obvious reasons (again, more on this in future posts).

Connected devices. In his recent book, “The Patient will See you Now,” Eric Topol walks through a long list of self-diagnosing devices available to consumers today, with many under development. This trend will continue as technologies mature, younger consumers experiment, and mainstream healthcare organizations and clinicians embrace rather than dispute their utility.

Pricing Transparency & Value-Based Care. Arguably, much of the foundation is being laid to make it easier for consumers to begin comparison shopping for certain types of services. It’s difficult to read an issue of Healthcare Financial Management, the most popular trade journal for hospital CFOs, without seeing references to transparency. But let’s be honest: until a critical mass of decisions are influenced by price, the industry is not really motivated to sustain this investment.

Here’s where things might get controversial: when I focus on those parts of the health consumer experience that have a LONG way to go. They are not being ignored; quite the opposite. However, these areas involve complex changes that (1) significantly disrupt the way things are done, (2) take years to implement, and (3) often involve executive and/or board-level risk.

The feedback loop. Healthcare organizations do, in fact, survey their customers to get feedback on services delivered. However, this data is not yet consistently actionable, primarily because customer feedback hasn’t yet resulted in significant changes in organizational performance. Contrast this with hotels, restaurants, or even tradespeople on Angies List, where persistent negative ratings can significantly disrupt their businesses. There are many reasons why the healthcare feedback loop is disconnected (getting back to that complexity thing), but suffice it to say that this area is the first area healthcare organizations should solidify as they prepare for a consumer-empowered future.

Support for assuming complete control over personal health. Over the past 25 years, there have been plenty of efforts to leverage healthcare organizational foundations (data, electronic medical records) relevant to consumers. Consumer-driven industries understand the importance and central priority of customer-facing processes and infrastructure. Healthcare organizations must find ways to empower, or at least actively support, their customers’ efforts to manage their own healthcare, which we all need to encompass more than infrequent visits to the doctor, or even-less-frequent overnight hospital stays. This will be as important as (in the near term) or more important than (in the long term) the industry-defined metrics that are being used to drive quality improvements in healthcare. On a recent flight from east to west, a young hospitalist suggested to me that consumer-centric healthcare may conflict with evidence-based medicine…I’m not sure I agree but that’s yet another topic for a future post.

The cost of everything in healthcare. It’s still crazy expensive for everything and broad price ranges for routine (but expensive) services do not mirror anything we see in other industries. I won’t spend much time on this but it’s a basic issue. Our healthcare expenses are unsustainable, and not much happening in healthcare today promises to make it more sustainable. Sustainability requires active participation of all the current key stakeholders — government agencies, health plans, and healthcare organizations — but also the active participation of outside-industry disrupters and of course, empowered consumers.

The role of catastrophic health insurance. I won’t cite statistics here — do I really need to? — but the New Health Consumer (and maybe her employer if she’s lucky) pays many multiples on insurance than on actual healthcare services, month after month, year after year. If the amounts were relatively small — as for most life or property insurance — then it might not be as important. But health insurance, even with high annual deductibles, is expensive! This is another important part of the unsustainable story.

Population Health (and its future focus on the last mile to the Patient). Virtually every health plan, hospital and larger physician group is thinking about ways to “manage” population health, rather than fix serious problems when it’s arguably too late. This has been the holy grail in healthcare for decades but there are three problems with current approaches: (1) arguably, the technology and analytical infrastructure is only beginning to support the ambition, (2) expensive vertical integration strategies (hospitals and physicians jointly owned) are seen as critical first steps, but are arguably as focused on managing competition, as they are on improving population health, and (3) the role of the patient (or consumer) is usually the last challenge tackled, even though it should arguably be tackled first.

The overall experience. Everyone I know, and I mean literally everyone, has 10 bad-experience stories in healthcare for every good one. The good news for most of us coping with our health is that we’ve managed to block out the bad experiences to focus instead on the good. While it’s very important for all of us to retain confidence in the physicians and hospitals in our communities, we also are witnessing a slow-motion collapse because of the industry’s lack of sustainability. It’s really only a matter of time (not in 2017!) before key groups of healthcare customers, say a collection of New Health Consumers, get together somehow to demand changes in their experiences. I have no doubt healthcare organizations — health plans, hospitals and clinicians — will respond to the challenge when it’s clear they have no choice. But not before.

So what am I doing about all this? My family is aggressively leveraging as many of the new consumer-friendly improvements as we can. We are just beginning to leverage telehealth, we are using retail healthcare at times, we are just beginning to consider ways of centralized documentation of our healthcare lives. As importantly, I continue to dedicate my work life to helping consumers and organizations embrace changes that we all need for a sustainable healthcare future.