“Patient” is generally the right label for a person seeking treatment. When people have a chronic disease, cancer, a broken leg or a mysterious rash, they are patients seeking professionals who can explain, diagnose and treat. The actions of the provider and the health care system are based on understanding the needs of someone with the label of patient.
A “consumer,” on the other hand, is a person who makes choices and, based on those choices, acquires goods and services for his or her personal needs.
While clinicians do not usually label a person a “consumer,” patients are also consumers: They make choices whether to seek care, where to seek care and whether they will comply with a care regimen. They are constantly making choices about the services of health care.
More than ever before, those who deliver care must interact with people as consumers and patients.
Under fee-for-service payment, attracting consumers helps fill beds and clinics. Under value-based reimbursement, attracting consumers helps them choose care settings that are part of an integrated system; it also motivates consumers to seek programs and services that manage health and appropriate utilization. Regardless of the form of reimbursement, assisting people in making good choices improves the quality, efficiency and safety of care.
Moreover, people are beginning to more forcibly exert their health care consumer muscle. High-deductible health plans raise the level of a person’s financial accountability for health and health care, and patients will make care choices based on cost, just as cost factors into their choice of vacations. As we increase the amount and veracity of information about the quality of care, people will make choices based on desired quality. As we raise the level of consciousness about health and health behaviors, people will make lifestyle choices that reflect cultural norms.
Many health care providers have launched programs designed to make health care more consumer oriented. These providers understand that consumer choices about care have financial consequences to the organization and are the foundation of maintaining health.
Components of a consumer strategy
Providers have learned (just as their retail, financial services and culinary counterparts have) that a consumer strategy must be multifaceted: It must address, for example, culture, processes and information technology. Although their strategies may vary, providers tend to focus on several key dimensions of service — physical and digital access, overall patient experience, providing transparency in both price and quality.
Strategies that address these three critical components of consumer engagement — access, experience and transparency — employ a combination of digital and nondigital initiatives.
All consumers want easy, no-hassle access to services, but convenience can mean different things to different people — grabbing a same-day appointment, stopping at a provider-branded retail clinic on the way home from work or having a virtual consultation with a physician.
For example, New York–Presbyterian has seen notable success with the launch of its NYP OnDemand, a telehealth initiative that enables patients, doctors and other health care providers to engage in a broad range of web-based health care transactions. Available on the health system’s website and through its mobile application, NYP OnDemand services include virtual visits, digital emergency and urgent care, and interhospital digital consults.
The platform has enabled NYP to provide emergency and urgent care in a more cost-effective manner and expand access to experts in the faculty practices at the health system’s two affiliated medical schools — Columbia University Medical Center and Weill Cornell Medical College. Additionally, through its Digital Second Opinion service, rather than traveling to New York to consult with experts from Columbia or Weill Cornell, patients across the country can pay a one-time fee to receive a second opinion in 80 medical specialties from a New York–Presbyterian physician.
In Texas, Memorial Hermann’s consumer access strategy includes numerous quick-care clinics in grocery stores via its partnership with RediClinic, several strategically placed convenient care and urgent care centers, and a network of breast imaging centers via a partnership with the University of Texas MD Anderson Cancer Center, among other initiatives. With so many convenient care options to choose from, the health system also provides around-the-clock access to a triage nurse who can advise consumers on the most appropriate care venue based on a particular condition or need.
It has been said that a health care system is the ultimate service delivery organization. Given the life-and-death decisions that need to be made — not to mention the anxiety, confusion and fear that often accompany being an inpatient — never is the relationship and trust between an organization and its customer more important.
Consumers judge their experience based on a small number of processes. Was it easy to get an appointment? Did my providers take the time to talk to me about my issues? Did I have to wait too long to get my blood drawn? Providers need to streamline these processes just as the retail industry has leveraged the internet to ease purchasing.
Memorial Hermann continues to advance its patient portal and mobile device capabilities under the brand name Everyday Well to transform processes that are fragmented or not patient-friendly. For example, patients can now view clean, concise statements and pay their bills online through the portal — an initiative that has led to a significant increase in self-service payments, thereby reducing the overall cost to collect.
In addition to first-rate processes, improving consumer orientation requires an understanding of a consumer’s “journey.” Becoming pregnant and starting a family or undergoing cancer treatment are journeys that have a continuity, consist of multiple states with needs that can be different at each state, and have a desired destination. Effective consumer strategies focus on defining those journeys and supporting them.
Consumers are diverse. A consumer’s religion, ethnicity, priorities and desired level of engagement vary. While providers cannot hope to cater to all potential combinations, they can understand the variation and design approaches to services and information that recognize that diversity. As we know, patients are much more likely to become engaged in their care if clinical interventions are organized and individual preferences are taken into consideration.
Providing the information necessary for patients to evaluate their choices for care is paramount in consumer engagement.
For example, it can be nearly impossible for health care consumers faced with high-deductible health plans to get an accurate estimate of what their out-of-pocket expenses will be before they receive a bill. In fact, patients rarely know the real cost of care until after they have received it.
We thus see a proliferation of tools such as online cost estimators, websites, consumer hotlines and rankings that offer greater transparency into price and quality. Like many managed care companies, United Healthcare has made it easier for people to comparison shop for health care based on quality and cost. Today, its well-designed mobile and online resources provide members with cost estimates that are customized to an individual’s location and health plan.
Help from IT
Information technology’s incorporation into all facets of a consumer’s life has raised the bar: Consumers expect the same convenience and value from health care as they receive from other services.
A provider’s consumer applications and infrastructure should have several foundational capabilities:
A longitudinal record that gathers a consumer’s medical data from a wide range of sources: This requires the integration and normalization of data from multiple electronic health records, payer claims, social and behavioral data, environmental data, and information provided by the patient.
A plan from the consumer and his or her care team working together to develop health goals: The plan will encompass traditional medical care (the rehab needed to recover from surgery), lifestyle plans (losing weight) and community resource needs (counseling to reduce stress and ensure access to food banks).
Mechanisms that enable consumers and providers to track a person’s progress toward health goals: These mechanisms include providing access to data that indicate laboratory trends, personal devices that monitor health status, alerts (such as elevated pollen counts), and appointment or screening test reminders.
Capabilities that support virtual interactions between the person, communities and providers: These capabilities include telehealth visits, consumer access to communities that can support consumers' efforts to manage their health, and customer relationship management systems that support provider outreach to consumers.
The information technology platform that delivers these capabilities to a consumer should have several overarching characteristics:
The platform should enable the services and information to be tailored to the relationship a person has with a provider organization. A person can be a potential customer who is seeking to identify a specialist, someone under the care of specific providers, an employee or a member of the provider’s sponsored health plan. Someone can have more than one relationship with the organization. Consumer-facing technology has to recognize these roles and adapt the capabilities offered based on the role. For example, someone interacting with the technology in the role of an insurance plan beneficiary will be interested in the status of his or her health savings account, while someone in the role of patient will be interested in test results.
The platform should support contextual awareness. When someone interacts with the technology, the computer tailors the interaction based on what it has learned from previous interactions and what it knows about the consumer’s preferences, as well as his or her ethnic, education and gender identity. The technology presents shortcuts to frequently used features, displays data in accordance with observed preferences and presents new information on medical advances based on previous search patterns.
The platform should enable the incorporation of third-party applications. Consumer-oriented health IT has seen an extraordinary infusion of venture capital and private equity funds. While not all of these efforts will bear fruit, there has been and will continue to be an amazing level of innovation. The IT platform needs to support the integration of these innovations into the core consumer experience.
Thriving in the years ahead
The health care landscape will continue to mature as payers and providers embark on consumer-centric journeys that are shaped by best practices found in other industries such as retail and banking. As we know from market leaders like Amazon, engaging customers in meaningful interactions that uncover consumer preferences, buying habits and other useful insights is key to enabling an exceptional, personalized experience and creating a culture committed to superior service outcomes.
The patient-centered organizations that will thrive in the years ahead recognize that the traditional provider-centric delivery system must be complemented by one that seeks out, understands and responds to the consumer’s perspective. Moreover, they recognize that their consumer engagement strategies must be supported by a technological sophistication that is just beginning to emerge in health care.
Indeed, the industry is challenged to move beyond the transactional use of technology to create a personalized experience based on knowledge and relationships. This experience, however, must be as much high-touch as it is high-tech — providers cannot lose sight of the importance of care and compassion as they demonstrate their ability to know their customers intimately.
Good health is about good health care delivery, and it is about people making good health and care choices.
John Glaser, Ph.D., is the senior vice president of population health with Cerner in Kansas City, Mo. He is also a regular contributor to H&HN Daily.
The opinions expressed by the author do not necessarily reflect the policy of the American Hospital Association.