Consumerism

Consumerism is a perennial buzzword in healthcare. But it's a tricky and somewhat controversial trend to define, as some argue recasting patients as mere consumers of healthcare extracts some humanity from the equation of delivering medical care.

During the first day of HIMSS' annual healthcare conference, speakers at the executive summit attempted to put some context around the term, and delineate how hospitals can weave consumerism into their operations to try to provide better patient experience and care.

Even before COVID-19, the healthcare landscape had started evolving from a provider-oriented world, with decisions being made around the physician, to a consumer-centric one, based on the health needs of unique individuals. As such, it's important to approach consumerism from a clinical — not a clinician — perspective, panelists said.

That means keeping the entire patient experience top of mind, instead of just the experience the doctor is used to providing.

The biggest question hospitals should be asking themselves is, "How do we think about meeting the primary care needs of those patients as consumers?" Tom Kiesau, lead of Chartis Digital at the Chartis Group, said on a Monday panel.

For many physicians, it's a "battle" with management to define the difference between a patient and a consumer, but "they're two sides of the same coin," said Tarun Kapoor, SVP and chief digital transformation officer at Virtua Health, a nonprofit system in southern New Jersey.

One way to think of it is a person is a consumer if they're shopping between locations to get a flu shot, but they become a patient when they're forming a deeper, more longitudinal relationship with a physician or provider. The "key component for us, for all of us, is the integration of those journeys," Kapoor said. "Those folks who can figure out how to integrate it seamlessly will win the day."

Integrating this seamlessly is easier said than done, however.

As provider competition ramped up over the past decade or so, hospitals began to see consumer-focused amenities like same-day scheduling or concierge programs as a way to boost online ratings and cement patient loyalty, without sacrificing the bottom line. Consumerism was top of many executives' minds even before the COVID-19 pandemic caused demand for digital health products to soar.

But despite consumerism growing in importance, few hospitals have fully committed to the trend, according to a Kaufman Hall survey of health systems conducted last year.

The vast majority of systems that participated in the survey didn't meet the benchmark to be defined as best-in-class for delivery system redesign, pricing and digital infrastructure. Just 7% did, Kaufman Hall found.

That's despite consumerism being an important avenue to stay competitive, both with peers and with industry disruptors like big tech companies and payers interested in elbowing into direct care delivery, as consumers raise their expectations for their medical experience.

But there are strategies hospitals can pursue to reorient themselves around the consumer experience, including giving potential patients multiple access points into their organization, like chatbots, scheduling tools and telehealth visits, panelists said.

"I think the whole healthcare paradigm of the last few years is, patients come to us. We don't come to them," said Nick Patel, chief digital officer at South Carolina nonprofit Prisma Health. "That whole paradigm is shifting."

Management should try to identify the key components of the patient's journey, to zero in on the use cases that hospitals have to solve before targeting them with technology. That's key to avoid a clutter of point solutions, while ensuring doctors and medical workers feel confident a new digital health tool won't take up more of their time and contribute to 'click fatigue' or burnout, which is growing in severity as COVID-19 barrels into its third year, panelists noted.

Hospital executives also need to prioritize things like governance and interoperability, while focusing intensely on what they're trying to provide as an organization. Some problems are better solved by hiring additional staff members, instead of throwing a point solution at it, but the shift to consumerism for most organizations does necessitate adding adaptable and scalable technology at the end of the day.

However, speakers noted it's important not to exacerbate disparities by only increasing access for consumers with technological know-how and access.

Many barriers, including a lack of devices, tech literacy or reliable internet coverage, make it difficult for patients to access virtual care services — especially those living in low-income, minority and rural communities.

Roughly 19 million Americans, or 6% of the population, don't have access to fixed broadband service at threshold speeds, according to the Federal Communications Commission. In rural areas, almost a quarter of the population lack access to the service. That makes effort to reach these underserved populations with technology difficult, stymieing uptake of virtual care at a time when the deep medical inequities in the U.S. are particularly stark.

"The biggest thing I'm always sensitive to is, there's already a healthcare divide in America. You layer technology on top, you worsen that barrier," Patel said. "At the end of the day, we need to make sure that the patient's at the center."

Executives need to be sure they're retaining access for all facets of their patient mix, and that — despite being pushed by consumerism — they're not modernizing beyond the reach of every U.S. consumer. That means retaining services like call centers and capacity at walk-in clinics.

"Not everyone is going to be excited by a digital route. Some people just want to talk to someone," Nassar Nizami, chief information officer and chief digital officer at regional system Jefferson Health, said.

Dive Brief:

• An online tool that allows patients in markets across the country to compare prices for hundreds of hospital services before getting treatment has launched in its beta development stage.
• Turquoise Health's platform uses cost data from machine-readable files made public by hospitals as part of compliance with a federal price transparency rule that went into effect in January 2021.
• The San Diego-based startup's platform includes a scorecard that lets users assess price transparency compliance with the CMS requirements for nearly 6,000 hospitals, Turquoise Health said Monday. Hospitals receive a score based on an algorithm-driven five-star rating system.

Dive Insight:

Noncompliance has been an issue with the government's price transparency rule, which is designed to make it easier for consumers to comparison shop for medical services with the aim of lowering healthcare costs in the U.S. The nation's hospital lobby mounted legal challenges but ultimately failed to block requirements that they reveal rates negotiated with insurers for services provided to patients.

Under the new rule, hospitals also must publish price data, including expected out-of-pocket costs, for services such as an MRI or knee replacement that can be scheduled in advance, in an easily understandable format to facilitate shopping across different hospitals.

Several studies, including a report published in May in JAMA Network Open, have found low compliance with the price transparency rule. A recent analysis by the nonprofit group PatientRightsAdvocate.org showed that just 14.3% of the 1,000 hospitals it examined were complying with transparency requirements, and about 38% of hospitals posted a "sufficient amount of negotiated rates" on their websites.

In November, the CMS finalized plans to increase penalties for hospitals that don't post their prices online to as much as $2 million a year for larger facilities. The agency said its analysis showed sub-optimal compliance with the price transparency requirements.

The CMS said it would also require machine-readable files with pricing information to be accessible to automated searches and direct downloads. That requirement was seen as needed to prevent hospitals from using hard-to-access files to keep information opaque.

Turquoise Health said its beta scorecard identifies transparent providers as well as those with areas for improvement. The system's search results for hospitals covered under the federal rule show name, location, type, bed count and a transparency score based on the completeness of the hospital's machine-readable file.

Launched in 2020, Turquoise generates revenue by selling a suite of software to payers and providers to support price transparency compliance. The company expects hospitals will use its price transparency scoring system to assess compliance and compare their machine-readable file attributes to similar facilities. Hospitals that score four or five stars are eligible to become verified by Turquoise through a free program.

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By Perficient

With the widespread saturation of digital, consumerism has reached critical mass in healthcare. Consumers expect technology to work intuitively, regardless of its underlying complexity. And in healthcare – an industry that tends to segment consumers into patient or member experience silos – consumers increasingly expect a seamless, holistic, digital health journey.

Today, entire industries such as healthcare, banking, insurance, and business-to-business (B2B) sales are being rewired around customers and end users. Experiences in these sectors are becoming more consumer-like: channel-less, mobile, more visually oriented, and replete with easy-to-use features that maximize personalization, touch interactivity, and natural language search.

If your organization hasn't already begun to embrace consumerism, how can you start? Here are five tips.

Tip 1: Mine Your Inspiration

Savvy healthcare innovators leverage the power of consumerization by first observing what works in domains outside of their own, and then adapting those successes to address their own challenges. They look for adjacent innovations with the potential for broader application, adopting features from one market to create a new product or improve an existing one.

You can get started by mapping the customer journey, uncovering pain points and opportunities across their interactions with your brand. Then widen your inquiry to learn from your customers as they interact with brands well outside your industry. How do they address problems like the ones you're attempting to solve? How do they interact with those to whom they are the most loyal? Say you want to promote healthy choices amongst your patients or members. What might you learn from studying emerging innovations used by virtual personal trainers, e-learning platforms, or even credit card companies?

Steve Jobs said it best: "Figure out what the consumer needs before they do." Know your consumers, anticipate their needs, and deliver in inspired, meaningful ways.

Tip 2: Rally Your Success Team

Once you have an idea for the consumerized experiences you want to create, it's time to rally others, starting with a message of the value it adds for patients, members, and your business.

Whether provider or payor, it's critical to engage multiple areas of your organization. Providers need to think about the entire patient care experience, not just the marketing-led version. Likewise, payors need to rethink all elements of interaction – from portal, to mobile, to authorizations, and claims. Use precursors, analogies, and success stories to prove how adjacent solutions might be applicable and adapted.

And consider this as well: if you enable a "consumerized" interaction at a specific point in a patient/member experience, what insights can you gain for other points along their journey? And how can others in your organization benefit from those deepened understandings?

Identify early adopters who can help secure early wins and gain a foothold among broader audiences. These steps are key to socializing your vision and paving the way for investment and adoption. By understanding the drivers of consumerization, switched-on innovation leaders can more fully reap the benefits in today's consumer age.

Tip 3: Power Up With AI

Artificial intelligence (AI) is here to stay, and organizations that want to maintain their competitive edge realize that embracing AI is a must. According to Forrester, 31% of companies want to use AI to significantly improve their customer experience.¹ However, that's only scratching the surface of AI's full potential. With an increasing number of experiences powered by AI, such as voice search and virtual agents, it's reshaping how consumers behave and make decisions. This puts the impetus on leaders to continuously identify innovative opportunities that meet consumers' ever-evolving expectations.

Tip 4: Empower, Transparently

Today's healthcare consumers demand a greater say in their care. Healthcare companies need to recognize the new decision-making power that consumers have and figure out effective ways to engage with them. The key is to get to know your consumers and then design points of engagement (e.g., portals, apps, communications and content strategy, etc.) that focus on meeting patient/member needs.

As consumers gain access to more information, including service providers, procedures, and – yes, at times – even pricing, the less loyal they become to any one company or brand. It might seem like healthcare would be immune to that trend, but it's not. A common mistake is to create patient-facing solutions that address a business need, rather than a patient need, which leads to poor user adoption. Consumer needs simply must come first.

Tip 5: Enable a Sure Foundation

To meet consumer expectations, you must engage consumers wherever and whenever they may be. Websites, portals, mobile apps, chatbots, telehealth, and personalized communications are the tip of the iceberg. Consumers crave even more: virtual devices, wearables, IoT, gamification, wayfinding – a holistic health journey.

These great experiences can't run without data, and they surely can't run at optimal capacity without a well-formulated integration plan. The "shiny objects" that delight your consumers must be supported by mature platforms and infrastructure, which then support the data assets and analytics capabilities that empower innovation. Think of it as addressing the full iceberg – all the exciting, customer-facing elements visible above the waterline, stabilized and powered by the vital foundation hidden below. Collaboration and interoperability net all the pieces together.

Why Now?

Creating a great healthcare experience reaps rewards well beyond patient or member satisfaction. It boosts consumers' access to care while driving down operating costs and improving your bottom line.

Simultaneously, it can help instill trust and build your brand reputation, leading individuals to consolidate their care with your organization. Importantly, it underscores healthcare systems' organizational mission to keep people and communities healthy.

Nine of the 10 largest healthcare providers and the five largest healthcare plans in the US count on Perficient, an award-winning global digital consultancy that is transforming how the world's leading brands connect with customers and grow their business. Learn more at perficient.com/healthcare.

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¹ Gownder, J., Joseph, L., & Lu, G. (2018, November 01). AI And Automation Aren't Quick Wins - Invest Anyway. Retrieved August 04, 2020, from https://go.forrester.com/blogs/ai-and-automation-arent-quick-wins-invest-anyway/

Dive Brief:

• Virtual care company Teladoc has partnered with Amazon to launch its telehealth service on the ecommerce behemoth's Alexa technology, in what represents a major expansion of Teladoc's consumer reach.
• Beginning Monday, the command, "Alexa, I want to talk to a doctor" on supported Echo devices will take customers to a Teladoc call center. The service will be as low as $0 for consumers with insurance, and cost $75 a visit for the uninsured.
• The voice-activated service is for general medical care, and will initially be available via audio on supported Echo devices, including the Echo Dot and Echo Show. Teladoc and Amazon expect to add functionality for video visits soon, though a spokesperson declined to provide an exact timeline.

Dive Insight:

The partnership announced on Monday integrating Teladoc's virtual-first care with Amazon's Echo devices is part of Teladoc's ongoing strategy to meet consumers where they are.

A spokesperson said Teladoc isn't providing any detail on expected customers, visits or revenue affiliated with this launch. But partnering with Amazon — one of the biggest household names in the U.S., with a chokehold on the smart speaker industry (and a new rival in virtual care delivery) — will likely help Teladoc reach a significant number of new customers.

Amazon's Echo devices are the most prevalent smart speaker in U.S. households, and Amazon's share of the market is growing. In 2020, Amazon made up more than half of the U.S. smart speaker market share by brand, and that proportion grew to almost 70% in 2021, according to one market research firm.

"Teladoc Health's collaboration with Amazon is yet another step in breaking down barriers to healthcare access," said Donna Boyer, Teladoc's chief product officer, in a statement on the partnership.

Under the new voice functionality, consumers can ask Alexa to speak with a doctor and will be connected to a Teladoc call center for a screening call. A Teladoc representative will verify the customer's recent medical history and insurance information. The representative will inform the caller whether their insurance is covering the appointment and, if yes, they will be provided the cost of any copay.

Users will then get a call back on their Echo devices from a Teladoc doctor. The service is for non-emergency needs, like talking through symptoms of a cold, the companies said.

Teladoc and Amazon make interesting bedfellows for the partnership, given the two are direct competitors in virtual-first primary care delivery.

Earlier this month, Amazon announced it was expanding its virtual care program Amazon Care to employers nationwide in response to growing demand, sending stock in publicly traded telehealth vendors like Teladoc and Amwell slipping. The three-year-old program, which includes in-person care delivery in some U.S. cities, vies directly with Teladoc for employer clients to provide virtual care to their employee population, though Teladoc also brings in a large slice of its revenue through deals with health insurers.

Analysts have also noted the program is not likely to be a near-term threat to major vendors with a large suite of services like Teladoc, Amwell or Included Health just yet, though Amazon's deep pockets, logistics infrastructure and consumer reach could make it eventually competitive with existing telehealth players and retail chains like CVS Health and Walgreens, which operate their own medical clinics, alike.

Despite consistent revenue gains, Teladoc's stock has struggled recently amid fears of a COVID-19 digital health bubble, and under pressure from big tech giants in virtual care. The New York-based vendor has focused on building out its services in lucrative areas, such as mental health, that brings consumers in the door and introduce them to Teladoc's other offerings — something this new partnership is likely to help with.

Teladoc's stock spiked following the news, and was up more than 7% as of Monday's close.

Dive Brief:

• When U.S. patients envision their future medical care, the majority see telehealth playing a role. But when presented with the choice between an in-person or video visit for nonemergent care, most prefer a traditional in-office visit, according to new research analyzing consumer telehealth preferences.
• The survey conducted by the nonprofit Rand Corporation published in JAMA on Wednesday found those who leaned toward in-person care were more willing to pay for their preferred visit modality, while those who preferred video visits were more sensitive to out-of-pocket costs.
• Of the respondents who had used telehealth at least once since last March, only 2.3% said they were unwilling to use telehealth in the future, suggesting the method's continued importance in hybrid models of care even after the pandemic — though it's unlikely to be most patients' first choice, researchers said.

Dive Insight:

Telehealth use skyrocketed starting last year as patients sought out digital avenues to medical care, put off from doctor's offices and other care sites over state-mandated lockdowns and fears of coronavirus transmission.

But virtual care's long-term role in U.S. healthcare post-COVID-19 is still being defined. Most experts agree it will hang around in some form or another after being normalized over the past year-and-a-half, though it is unclear what modalities will be permitted by Washington, how much it will be reimbursed and how much patient demand will remain.

The new study conducted in March suggests it's important to be aware of patient preferences in answering these questions that could determine the future of the $145 billion industry.

The survey of more than 2,000 U.S. adults found almost 67% of participants preferred at least some video visits in the future. That jibes with previous research finding generally high levels of satisfaction with telehealth encounters — even as some early evidence suggests telehealth use is decreasing as COVID-19 cases fall. Telehealth use is stabilizing at about 38 times higher than before the pandemic, according to McKinsey.

However, when faced with a choice between an in-person or video visit when the appointment could be conducted either way, more than half of respondents (53%) preferred an in-person encounter.

Researchers then asked people with a preference for either modality which option they preferred if their preferred option had an out-of-pocket cost of $30 or the other modality had an out-of-pocket cost of $10.

Among those who preferred an in-person visit when out-of-pocket costs were not a factor, almost half still preferred in-person care and 24% switched to a video visit when told the in-person visit would be more expensive.

Among those who initially preferred a video visit, only 19% still preferred a video visit and 62% switched to an in-person visit when told the video visit would be more expensive.

Researchers said that difference in perceived value could have many potential explanations. Patients may prefer telehealth for certain circumstances, like to receive care for minor acute conditions, but may not think video visits have the same value as in-person care overall. Patients might think that in-person visits allow for easier referrals for diagnostic testing or other needed followup care.

Alternatively, some patients might think in-person care has benefits that even the highest quality virtual care visits can't match, such as rapport with a clinician or the ritual of attending a doctor's office, that outweigh the additional travel and time costs associated with in-person care.

A little over 33% of participants didn't see any role for video visits in their medical care. Those respondents tended to be older, lower income, in rural areas and have lower levels of education.

Though much has been said about telehealth's ability to expand access to care for underserved populations and HHS has made expanding virtual care a key prong of its health equity strategy, the findings suggest these populations may be the least likely to demand virtual care. Such efforts may not be taking the preferences of these populations into account, researchers said.

Dive Brief:

• The long-term shift from hospital-based care toward more treatment delivered in the home and ambulatory centers picked up pace during the COVID-19 pandemic and is expected to continue to gain momentum, pressuring revenue growth and margins in the hospital sector, according to new research from Moody's Investors Service.
• Reimbursement changes, risk-sharing, investment in outpatient services including ambulatory surgery centers, advances in drugs and medical devices and greater use of at-home acute care services are among the forces driving the movement away from more expensive hospital inpatient care.
• Medicare telehealth visits increased 63-fold during 2020, Moody's said, citing HHS data. Although hospitals are reporting that telehealth use is receding as more patients return to in-person physician visits, it will likely remain above pre-COVID levels, the ratings agency said.

Dive Insight:

The pandemic brought a surge in telehealth use and a drop in emergency room visits, accelerating a move to outpatient and home care that had been underway for several years. Before COVID-19, hospital admission rates already were trending flat, and outpatient revenues consistently outpaced inpatient revenues, according to Moody's data.

As patient volumes slumped during the pandemic amid people's reluctance to seek care in hospitals, for-profit operators such as Tenet have been notable for expanding their ambulatory services. Tenet, which has been building its outpatient business through its United Surgical Partners unit, reported a 9% rise in outpatient visits during the fourth quarter, even as total admissions declined 4% from the year before. HCA Healthcare saw patient volumes increase in most categories during the period except for inpatient services.

Underscoring the shift to outpatient services, jobs in ambulatory care have increased steadily during the pandemic. In the latest data from the Bureau of Labor Statistics, the home health services sector added 20,000 positions in February alone. Overall, healthcare employment was down 2% from two years ago.

Moody's noted that in particular, a number of providers are focused on expanding in-home acute care admissions. For example, Mayo Clinic and Kaiser Permanente in May 2021 invested in Medically Home, a service that helps health systems develop complex care-at-home models that would allow some providers to reduce inpatient beds while others, such as academic centers, increase inpatient capacity as needed. Mayo and Kaiser are among more than a dozen systems that launched the Advanced Care at Home Coalition in October 2021.

Reimbursement changes and risk-sharing models also will support the larger shift to outpatient care, Moody's said. The decision by CMS to remove certain orthopaedic and cardiac procedures from its inpatient-only list will help drive more treatment to hospital-based outpatient departments or ambulatory surgery, the report said. CMS' penalties for excessive readmissions are another incentive to keep patients out of the hospital.

At the same time, new drugs and at-home heart monitors are expected to reduce hospitalizations for heart failure, while new orthopaedic technologies are reducing time spent in the hospital.

Hospitals such as academic medical centers with a strong focus on highly complex cases requiring greater levels of specialty care will be better able to sustain demand for inpatient services than hospitals that offer mostly secondary care, Moody's said. However, hospitals may see greater demand for inpatient services in the near term due to the number of higher-acuity patients who delayed care during the pandemic.

Hospitals in markets with strong population growth, such as Florida, Texas, Arizona, Utah and Idaho, in general will continue to see stronger overall volume trends, including on the inpatient side, the report noted.