The friction that exists for patients in our healthcare industry isn’t new. As other industries have evolved and consumers have become increasingly savvy, its presence has been more apparent. In this piece, we’ll focus on the friction that exists between patients and the industry in terms of access, care delivery, payment and coverage.
My new book, Healthcare Evolution: Helping Providers Get Paid in an Era of Uncertainty, addresses this friction and provides strategies for what can be done to improve the overall healthcare experience for patients. When the following areas become frictionless, we’ll have a more productive and affordable healthcare system:
Access to care, costs and medical information. Many patients want the ability to easily view — on their own terms — information regarding places to obtain care, coverage, their costs, the clinical results, medications, appointment reminders and other relevant details. As patients become more knowledgeable, there’s an expectation these services will be provided, and if they're not, they’ll vote with their feet and seek care elsewhere. Per a 2018 survey, 50% of respondents said they’d leave their current doctor for a better digital experience, and 59% said they expect healthcare digital consumer experiences to be similar to retail experiences.1 Hospitals and health systems need to deliver a meaningful online experience. Offering a positive online experience via a “digital front door” can help patients feel more engaged and drive better health, as well as frictionless payment.
Payment. Healthcare costs can be confusing. Patients often have no idea what their estimated out-of-pocket costs will be in advance of service. Transparency has been such a tumultuous issue that HHS issued a rule requiring providers and payers to disclose their negotiated rates. The American Hospital Association (AHA) sued to block implementation, lost and plan to appeal.2 To make matters worse, providers and payers don’t always work together to educate patients, manage their costs and ensure quality care is delivered and paid equitably. As a result, care is often over-utilized, and the cost of care is often unaffordable, and someone — patient, provider, payer, government, employer or a combination of them — is stuck with the tab. Having transparent, actionable cost information readily available is especially important to the younger generation. Per a recent TransUnion Healthcare survey, 65% of Gen Z and 60% of Millennial respondents are more likely to consider a provider based on costs. One way to remedy cost confusion is to have an online patient self-estimation and payment platform. Putting an automated, tailored payment platform in place can improve price transparency and collection efforts.
Delivery. The delivery of care in the US is highly inefficient. The U.S. “sick care” system is wasteful, to the tune of hundreds of billions per a JAMA study.3 Patients aren’t educated on when and where to obtain care, and regulations (such as the Emergency Medical Treatment and Active Labor Act (EMTALA)) complicate transitioning to more appropriate levels of care. Treatment often happens for too long at the wrong place; and many times there aren’t incentives in place to provide the right care, at the right time, in the right place. All of this creates a “sick-care” system where affordable and quality healthcare becomes harder to achieve. While value-based care models may help address some of these inefficiencies, adoption is slow. What's needed to drive the needle forward is more sweeping industry change, patient education and incentives. We must create a system where we’re managing health, not solely managing sick care. We’re in this together, so let’s fix it together boldly.