Framing the issue:
• Because they have more financial responsibility for health care, individuals are starting to behave like consumers when making health care decisions.
• Many consumers are not satisfied with their health care experiences.
• Consumers want more information, more convenience and a higher degree of service than many health systems currently provide.
• Forward-thinking health systems are working to become consumer-savvy.
Many health systems were still looking squint-eyed at retail clinics in 2007, when Memorial Hermann health system partnered with RediClinic to provide basic health services in grocery stores. That decision proved pivotal in how leaders of the largest health system in southeast Texas saw the future of their business.
“Many of our own employees, including senior executives, took notice,” says David James, M.D., CEO of Memorial Hermann Medical Group. “When they wanted a health care service, and couldn’t get fast access to their doctor, guess where they often went? RediClinic.”
Since then, Memorial Hermann has been making a major pivot toward consumers, rethinking all aspects of how it attracts and interacts with the individuals who use its services and exploring additional retail opportunities and affiliations.
“The new front door is through consumer-driven health and nontraditional relationships,” James says.
Consumers at the center
Memorial Hermann is one of many health systems that recognize that the words “consumers” and “patients” are not synonyms. A health system’s patients are people who have been treated there in the past; consumers are those who may — or may not — choose to seek care there in the future.
“For all too long, we have made decisions about our services as to what’s most convenient for our physicians and other caregivers,” says David Pate, M.D., president and CEO of St. Luke’s Health System in Boise, Idaho. “And if you look at what is happening, consumers are starting to tell us that they need to be considered.”
He gets a firsthand perspective on consumers from his daughters, one of whom changed her children’s pediatrician in favor of a competitor who provided online access to their medical records. “They are millennials, and they are not like me or my parents,” he says. “They don’t understand how we might call a doctor and fully accept that it might be a couple of weeks before we could get an appointment. They just don’t understand that and, frankly, expect better service and options that meet their needs.”
To learn more broadly what consumers want from St. Luke’s, the health system has recruited more than 1,000 patients who have agreed to share their opinions and give feedback. Patients are grouped into panels representing a demographic or geographic segment of the population, depending on what the health system is trying to learn.
Meanwhile, St. Luke’s is experimenting with a variety of consumer-friendly concepts. In September, two clinics started offering extended hours — 8 a.m. to 8 p.m. seven days a week, including most holidays. The clinics offer urgent care services, walk-in access for routine care and scheduled appointments.
A Web portal allows patients to see their medical records online, communicate with their physicians using secure email and request an appointment online. One-step electronic scheduling is next, Pate says.
And St. Luke’s revamped its billing system, which had been a big source of complaints. In the new system, patients are notified by email when their bill is ready to view online; bills for all family members can be consolidated; bills are electronically matched to the insurer’s explanation of benefits; and patients can pay — and set up payment plans — online.
“I don’t want to go back to seeing a physician who is on paper charts, and I don’t want to go to another system where I’m going to get all those paper bills,” Pate says. “I believe a growing number of consumers feel the same way. We are building system loyalty because people can see that we are doing these things that really meet their needs.”
What consumers expect
At Kaiser Foundation Health Plan, the point person for consumerism is Christine Paige, senior vice president for marketing and digital services. She believes Zappos, Uber and other consumer-oriented, digitally enabled organizations have forever changed the way consumers expect to be treated. “In all those consumer situations, I have a range of choices presented to me, I understand the relative cost of each and if I make a selection, I have visibility into everything all the way through to delivery,” she says. “That has really changed the consumer mindset in terms of expectations.”
For one thing, consumers expect a level of service-on-demand and an ease-of-access experience that many traditional health care organizations currently are not prepared to deliver. For another, consumers expect to have access to information, be able to understand information provided and use that information to make decisions.
“The third dimension, not to be underrated at all, is sensitivity to cost,” Paige says. “As people are absorbing more [health care] costs themselves, this is extremely important and something that all of us in the industry have to be thinking about.”
Kaiser Permanente, with 38 hospitals and more than 600 outpatient sites in eight states and the District of Columbia, continues to fine-tune its consumer strategy, which has been building for more than a decade.
It was one of the first large systems to introduce an online portal that allows patients to schedule appointments and manage prescriptions, communicate with physicians by email and see test results. Today, more than 68 percent of its patients have signed up for electronic access. And it launched a consumer brand — Total Health — that has been supported by the multifaceted Thrive campaign since 2004.
“That has been a tremendous effort to get people to think about this organization as a health advocate that is focused on prevention, great care and a whole host of services that are very appealing to consumers,” Paige says.
Those consumer-oriented moves positioned the health system well when it sharply increased marketing directly to consumers two years ago. Kaiser Permanente is participating in public insurance exchanges in every market in which it operates, as well as several private exchanges.
Memorial Hermann, with 12 hospitals in the Houston area, is one of the rare health systems that is expanding its inpatient capacity and even building an entirely new hospital. The local economy is booming and the metro area is growing by 100,000 residents a year, but the health system is not relying on its high profile for its future success.
“The competition in this town for those people is coming from all directions — from telemedicine and all kinds of freestanding ERs and urgent cares,” James says. “They are on every street corner.”
That is why Memorial Hermann is focusing on what James calls nontraditional relationships with consumers. For starters, he approaches the term “medical home” in two distinct ways. First, the traditional medical home serves patients who need an ongoing relationship with a primary care provider for chronic disease management or help with complex medical conditions. For everybody else, the “virtual medical home” enabled by an integrated electronic health record and patient portal, can be accessed at any Memorial Hermann facility — or via the Web.
“The new medical home is not just a patient-centered medical home, it’s a consumer-driven medical home,” James says. “Instead of our placing the patient in the center of what we have, when we have it, the patient is telling us, ‘No, I’m going to put myself in the center of what I want, when I want it and where I want it.’ ”
James finds that many patients, particularly millennials, want primary care, but they don’t want to declare a PCP. Rather, they want a service — a flu shot, a physical, a mammogram — at a time and place that fits into a frenetically busy schedule. “They might get some of their care done after hours near their home and some of their care during their lunchtime near where they work, or anywhere in between,” he says.
So in 2012, Memorial Hermann piloted a Convenient Care Center concept: adult/pediatric primary care practice, urgent care, imaging and laboratory services, sports medicine and rehabilitation open 12 hours a day, seven days a week, as well as a 24-hour emergency department — all under one roof in a high-traffic location.
The first Convenient Care Center “took off like gangbusters,” James says, convincing Memorial Hermann that it had a consumer hit on its hands. Three such centers are open now with six in the pipeline.
James considers the centers to be the “big box” version of Memorial Hermann’s outpatient facilities that are complemented by freestanding urgent care clinics, retail sites and medical offices.
“It used to be that the hospital was the hub and there were medical office buildings out there as spokes,” he says. “But these Convenient Care Centers provide care all the way up to and including emergency care, so we are looking at placement of [smaller retail and office sites] as spokes around them.”
— Lola Butcher is a contributing writer to H&HN.
Why is consumerism in health care coming to the fore now? Christine Paige, senior vice president for marketing and digital services at Kaiser Foundation Health Plan, gives three reasons:
1 | More individuals are buying their own health coverage.
“Group retiree benefits are fading away, so many new Medicare beneficiaries are buying coverage as individuals. People on private exchanges are buying coverage as individual consumers. And, of course, people in the public exchanges are doing the same. So, we are seeing a real shift in the industry.”
2 | Individuals with employer-sponsored coverage have a lot of money at risk.
“With employees being given much more financial responsibility for sharing in the cost of the health care services they consume, they actually start to behave more like consumers.”
3 | The digital revolution has changed consumer expectations.
Anyone who shops on Amazon and its ilk expects to see a range of options, ratings based on other shoppers’ experiences, an easy-to-understand comparison of prices and features, and the ability to track a transaction from the moment of purchase until delivery. “That level of service and individual control over the process has really changed peoples’ expectations, and they bring that to every aspect of life. Health care is far back in the line of industries that have understood that they need to respond to those shifting expectations.”
What consumers don’t like about health care
f you see a patient grinning at a medical clinic, know that it may be a fake smile. That’s the No. 1 takeaway from a survey of more than 2,300 U.S. residents conducted by Strategy&.
“When people are asked to rank their experience with their health care system, it is not a high outcome,” says Jaime Estupiñán, a New York-based partner in the firm’s health practice. “It’s important to have that in mind — the consumer, for the most part, is not that satisfied.”
John Santa, M.D., medical director at Consumer Reports Health, thinks he knows why. Until recently, consumers have had no information with which to evaluate their health care experience.
“When we survey consumers, they really don’t know the benefits and risks of the health care they’re getting. They don’t know about how health care organizations are performing [in comparison with one another], and they don’t know what anything costs,” he says. “The industry has kept them, frankly, at a child or adolescent stage.”
Emerging transparency about health care — quality and safety performance, costs, financial relationships and more — is helping consumers to mature. And like teenagers learning to assert their autonomy, health care consumers are finding a lot to complain about.
Being treated like a child. While some hospitals give patients access to their physician notes, admit when they make mistakes and provide good estimates about what medical services will cost before they are incurred, those practices are not the norm.
Being denied safe care. The vast range of performance on safety measures shows that some hospitals are simply safer than others. “It amazes me that … many straggling hospitals do not prioritize their safety data and do not get their act together,” Santa says. “That data is right there, and the ways to improve it are well-established and should be the top priority, but it’s clearly not.”
Being denied the assistance of a family member during a hospitalization. The Institute for Patient- and Family-Centered Care has revealed that many hospitals still have restrictive visiting policies that leave inpatients vulnerable to avoidable problems. “We are telling families that you need to stay with your family member 24/7 in a hospital, because it is a complex place, lots of things are going on and there is lots to remember,” Santa says. “I was shocked when I found out how many hospitals are telling family members — despite the patient’s saying, ‘I want my daughter here’ — that they have to go home.”
Being denied access to available information. Many hospitals collect and analyze quality and clinical outcome data that are used for benchmarking and improvement initiatives, but not shared with consumers. “If hospitals really want to demonstrate to consumers that they’re on their side, they will make it possible for them to see the same data that [hospital executives] are seeing,” Santa says. “When buyer and seller have the same data, that’s a perfect market.”
Consumers in charge: How health care delivery must change
David Pate, M.D., president and CEO of St. Luke’s Health System in Boise, Idaho, writes a blog called “Dr. Pate’s Prescription for Change: St. Luke’s Health System’s Journey to Transform Health Care.”
He isn’t afraid to peer into the crystal ball to predict how consumerism will influence health care delivery in the foreseeable future.
Patients will expect round-the-clock access to their medical records. “Just as very few people would consider not having a cellphone today, it will be: ‘What do you mean you have my medical records on paper?’ ” he says. “And they will be available online for patients to access.”
Secure email communication between physicians and patients will become routine. Physician worries that email communication will become a time-sink — or that dangerously ill patients will miss timely treatment while waiting for the doctor to respond to a message — are unfounded. “That is not the experience of those who have already done this,” he says.
“Office visits” will not require face-to-face contact. Video communication — think Skype or FaceTime using a secure connection — and photographs will make life easier for consumers and more efficient for physicians. Why take your arm to the doctor’s office if sending a photograph of the rash provides the same information?
Extended clinic hours will become commonplace. “As we move to a pay-for-value rather than a pay-for-volume system, we can’t afford for everybody to go to the ER for minor things,” Pate says. “I think physicians will adapt to it.”
Team-based care will become routine, allowing patients to be seen by the team member — say, a nurse practitioner or a nutritionist or a health coach or a physician — who corresponds to the consumer’s need in a given situation.
One-size-fits-all educational materials will be replaced by a tailored approach that engages an individual patient in the most effective way.
“How is it that you learn? Would you like to listen to a CD as you drive to work? Would you like to watch a DVD? Do you want a link to a website?” he says. “And we’ll provide information that can be easily shared with the family.”
Communication with patients will become more honest and more realistic. Consumerism requires that patients’ goals and preferences be honored, which means that discussions about end-of-life care start early. It also means an end to paternalistic “here’s what you need to do” treatment plans.
“If I tell the patient that he or she needs to exercise, and they’re willing to do so, we need to have a discussion: ‘What kind of exercise would you be most successful at? What do you think you could keep up? Let’s tailor the exercise to something that you’ll actually like,’ ” Pate says.
About Dr. Pate’s Blog
“Dr. Pate’s Prescription for Change” blog is written for St. Luke’s employees, physicians, board members, the community and donors. Pate says he’s always looking for more ways to reach out to his employees and the public, who are eager to know more about senior leadership’s vision and strategy for St. Luke’s. The blog also provides greater transparency to the public. “After all, the community owns us. While not everyone will agree with everything I write in this blog, I hope that everyone will appreciate this,” Pate says.
Five steps to becoming more consumer-friendly
Jaime Estupiñán, a partner on the health market team for Strategy& (formerly Booz & Co.), offers five things that health care executives should do right now.
Get a view of the consumers that your health system can serve — and what they value. A Medicare beneficiary with chronic conditions is different from a young mom who brings her kids in for an annual check-up. Don’t wait until patients show up to decide what kind of experience will serve them. Figure out what they want and be prepared to deliver when they arrive.
Determine your consumer experience strategy and execute it. Some health systems want their patients to feel that they have received the best care money can buy. Others want patients to view the health system as a partner for life through the continuum of care. And others want patients to feel that they received no-frills care that did not waste their money.
Identify how to track your progress. “Making sure you have measures in place — measures of things that are dependent on consumer choice or that impact consumer experience — is important,” Estupiñán says.
Appoint a consumer champion. “Do you have somebody on point looking across the board to make sure that the consumer experience and the way you are thinking about the consumer is consistent across the different boundaries of your organization?” he asks.
Allocate resources to support your consumer experience strategy. Evaluate each investment decision in terms of how it supports consumers.
ABOUT THE SERIES
This is the first in Hospitals & Health Networks’ five-part series on the rise of the health care consumer. Over the course of 2015, we’ll examine the distinction between patients and consumers; how retailers, Internet giants and other consumer-friendly businesses are disrupting the health care system; the emergence of new payment models; and the growing sophistication of Americans when it comes to understanding — and demanding — information about provider prices, quality and customer service.
The second installment of The New Health Care Consumer will run in April.