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The Consumerization of Healthcare

Achieving a patient-centric transformation within the healthcare industry.

Superior user experience and instant access to information. This is what consumers today have come to expect from businesses.

Some industries, such as banking and retail, have excelled in this cultural shift and transformed their business models to provide convenient, on-the-go services such as online shopping and mobile deposits. The success of these consumer-centric industries has raised expectations for all types of businesses, including healthcare. Consumerization has become imperative for businesses in today's always connected society that expects access to everything anytime, anywhere.

Modern technology and its applications in daily life have been the primary drivers behind consumerization. In healthcare, modern technology is maturing as organizations heavily rely on interconnected devices. In theory, the mass amounts of aggregated information that comes from these devices could be used to create a patient-centric healthcare model. Unfortunately, given the breadth and depth of the industry, healthcare may be the most difficult to transform.

The healthcare sector is a very diverse landscape with patients, payers, providers, medical devices and pharmaceutical companies all running independently, in different silos with interactions that are still in their infancy and based on traditional business models .

Multiple inconveniences are created for patients due to the disconnect among healthcare's multiple arms. For example, according to a 2014 survey by Merritt Hawkins & Associates, the average wait time to see a family practitioner is 20.3 days. Additionally, the demand for care will continue to increase as the population ages, which will eventually outpace the availability of care by 2025. The Association of American Medical Colleges projects that this will create a primary care shortage of more than 150,000 physicians.

The Patient-Centric Healthcare System

Today's patient is increasingly likely to seek answers to medical questions online prior to seeking professional help. As a result of this increased knowledge, they are more likely to seek alternative care in emergency rooms or urgent care facilities, resulting in $31 billion of unnecessary spending each year, rather than wait 20 days for a primary care physician (PCP).

SEE ALSO: The Next Level of Patient Engagement

Creating a patient-centric healthcare system has a variety of requirements for each sector. One universal need is the ability to seamlessly share information across all parties, thus streamlining and connecting each unit that works with patients.

Broken down, this would help physicians provide more effective and efficient care, pharmaceutical companies would work more directly with patients and payers save time and money since patients are receiving more strategic care.

Creating customer centricity requires systemic changes in how patients think about healthcare; it also requires changes to how we think about the center of coordination. The center is a difficult topic to debate. Patient information should be owned by the patient and yet we do not have direct access to our own records from all our providers.

As we become older or are faced with one or multiple conditions, our providers grow in number and keeping the knowledge base transparent across providers becomes increasing difficult.

Finally, the topic of a coordination center becomes even more difficult when you add how most of us seek out care, namely when something bad happens. We fall, have an accident, or wake up feeling ill; typically we are not aware that we will need a doctor until an acute event and when it does happen, we cannot wait 20 days.

Stacy's Story

What if instead of seeking a healthcare provider first, patients sought the advice of a healthcare payer. To demonstrate how this would look in practice, let's look at an example.

Patient A, or Stacy, is experiencing some shoulder pain after a recent round of golf. Stacy enlists her insurer's care coordinator instantly by video chat and after a quick exchange, eliminates the desire to go to the ER or a specialist and instead visit her PCP. She calls her PCP and schedules an appointment the next week.

Upon checking in at her appointment, Stacy receives a text from her insurance representative letting her know that she is available to help in any way following the appointment.

When she's checking out, she receives another text, or even video exchange, asking about the diagnosis. Stacy relays the doctor's message; the care coordinator could even help expedite the submission of claim information with the provider's office, yet regardless, the payer provides a recommendation:

"Request a sample of the prescription from the doctor and we will overnight the rest to you directly. Also, given you should wear an arm brace, I am emailing you three braces to choose from. Let me know which you prefer and it can be shipped with the prescription. You'll receive both first thing tomorrow."

What has this done for Stacy? She now gets to go home and let her insurance provider coordinate the care recommendation.

The payer is also benefitting by serving as the retailer, which saves them money and adds to their bottom line (controversial thinking here, given the robust medical supply chain network that exists but the same could be said for the taxi and limousine service when Uber came onto the scene).

Two weeks later Stacy is still experiencing pain. She calls her care coordinator again, who provides a list of orthopedic specialists within her network, schedules the appointment, and sends the salient details of Stacy's first PCP visit, saving her an additional, unnecessary, trip to the PCP.

This helps Stacy get the care she needs faster. The insurance company once again benefits by eliminating a claim from the PCP visit. The physician benefits by freeing up time in her schedule to see patients who need attention more suitable to her skills and the specialist saves time reviewing and is able to make a much more accurate diagnosis and treatment plan.

This is a small snippet of healthcare consumerization. Everyone benefits, and the long term impact would include reduced wait time to see a physician, fewer unnecessary visits to urgent care and emergency rooms, and less healthcare spending across the board.

How Can This Actually Work?

The initial reaction to this concept is likely, "Sure, sounds great, but that's impractical." While a valid opinion, this is already in the works with some organizations and technology.

Accountable Care Organizations (ACOs) are groups of doctors, hospitals, healthcare payers and other providers who come together voluntarily to provide coordinated, high-quality care to their patients. The goal of this is to avoid duplication of services and medical errors, as well as provide timely and effective care. By succeeding in both delivering high quality care and spending healthcare dollars more wisely, ACOs share in the overall savings.

The key to this success stems from the initial database sharing setup. Each ACO will combine entities that have different needs and goals, with each variant combination requiring differentiated technology. If this isn't fully understood on the back-end, and the cloud infrastructure and interoperability isn't built to meet these needs, then all parties involved will struggle unnecessarily to meet their outlined goals, and ultimately the patient does not receive improved care and experiences.

Once established, the open and interoperable systems share data between all parties. This saves time and money and provides patients with faster and more efficient care. By connecting and making services available, both payer and provider can find, transmit, track and report against all data, as opposed to these each being separate tasks, completed individually. A critical factor in this exchange is the shift to the payer as the center of the coordination of care. A payer has the ability to enhance the experience of its members and has the knowledge, as well.

With the ACO relationship, providers can have access to payer systems, such as mature correspondence packages, that can enable richer and clearer discharge instructions that can directly improve readmission rates.

These changes are available today; what seems to be holding some entities back is linking the strategic objective to tactical projects that have the patient at the center of the model with the payer at the center of the coordination of care.

To reach a point of healthcare consumerization, the industry as a whole needs to take a holistic approach to providing a complete, connected user experience. This not only helps the consumer, but also helps the insurance company and doctors - Insurance will only pay for what the patient actually needs, and doctors will only see the patients that actually need their attention.

Adam Nelson leads the Healthcare and Life Sciences Solution Offerings group at NTT DATA. The group's focus is productizing service capabilities to bring predictable and relevant industry solutions and benefits to our clients. He is a guest lecturer at Miami University's Center for Business Excellence.

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