Insight

How Healthcare Executives Can Harness the Consumer Health Movement

Executives should immediately update their customer journey maps to include how consumers are taking advantage of healthcare ecosystems, especially those outside the provider’s solution platform. For example, patients will soon expect to book an appointment with a healthcare provider in response to an alert from a wearable device that will automatically transmit updated vitals to their physician in real time. Within the same experience, the patient might call an Uber to take them to a clinic or doctor’s office, then to the pharmacy and then back home. New systems will send health data to a network of other physicians, caregivers and the individual’s family based on the permission granted by the patient. Identifying a range of scenarios to map the end-to-end patient journey offers the opportunity to provide better care, strategically differentiate and fill gaps in underserved market opportunities.

Traditional approaches that view the patient experience through the lens of the provider will not be competitive. Every executive team must view its transformation effort through the desired consumer experience versus the provider’s operations and systems. A customer-centric approach will reveal areas of opportunity and needed investment in new processes and technologies.

Executives need to shift cultures and mindsets and build skill sets to acknowledge the business impact from the empowered consumer. This means healthcare brand managers will need to assess their reputations with far more rigor while considering data and insights from customer measures of satisfaction and quality along with social media activity and third-party sources.

Given consumers are known for freely expressing their opinions, brand managers will need to avoid reacting to news in favor of having standard processes in place to investigate and reform any systemic roots associated with positive and negative consumer experiences or ratings.

How to justify investments in the consumer movement?

Mounting evidence of how individuals behave is underscoring the need for investments in consumer health. For example, in the U.S., more consumers are actively making decisions between competing insurance companies, particularly in public health exchanges established by the Affordable Care Act (ACA).

This move has been even more significant in the Medicare and Medicare shift to private options, competing managed care organizations (MCOs). Although employer-offered multi-carrier private exchanges have not moved as quickly as anticipated, they are still enrolling millions of employees each year.

Other evidence points to the need to update a data exchange strategy. The steady rise of consumerization in all service industries—with the ubiquity of mobile devices and increased availability of medical information—emphasizes the need to make services more accessible. Consumers expect ease-of-use when they seek trusted advice and education from providers.

All of this gets challenging when it comes to data, which is growing at unprecedented rates in both volume and variety. Executives should establish a position toward consumer data sharing, especially since electronic heath record (EHR) adoption rates have exploded in the U.S. and globally.  

Data and analytics leaders in healthcare organizations should also evaluate Apple’s FHIR-based health API, which enables iOS to function as a personal health record (PHR). Dozens of providers have adopted Apple’s Health API, which represents millions of patients. Other consumer-oriented digital tools, including GoodRx and Blink Health, help patients and caregivers reduce drug costs (whether or not they have insurance). In some cases, purchasing drugs outside of insurance actually saves the consumer money.

More evidence of consumerization comes from consumer-direct health plans (CDHPs) with relatively high deductibles as a way to lower benefit costs and encourage cost-effective care utilization among beneficiaries. For example, a benefits survey from the Kaiser Family Foundation shows CDHP enrollment at 29 percent versus just 20 percent in 2013.

Since these plans operate on high-deductible, low premium models, payers should design them with tools to help consumers spend wisely on services that will be most efficient and useful. Health savings accounts offer another way to actively save for services. Payers should consider letting consumers integrate these types of accounts into their CDHPs, helping them to save money specifically for healthcare expenses.

Using technology to become more competitive

Technology can become a competitive differentiator by seizing the economics of connections. Given the rise in new platforms and ecosystems, executives should consider the following:

• View consumers as partners not users. Consumer collaboration is rapidly emerging in a variety of ways, hence customer satisfaction (and their ideas) should be continuously monitored through surveys or experience ratings. Features that enable data exchange through the consumer’s personal technologies and third-party developers along with access to external communities—where consumers can interact with people like them—should also be considered.


• Invest in the consumer’s rising appetite for self-service. Secure API management and HIPAA-compliant communications can make available insurance policies, appointment times and medical records. Existing consumer-facing applications can be upgraded to support the culture surrounding the consumer health movement. For example, patients expect to be able to enroll in virtual care condition management programs, manage their information, connect with fellow consumers like them through communities, evaluate their treatment options and research their prescribed drugs.


• Rethink data management strategies. Healthcare technology managers will need to manage, secure and govern the volume and variety of data emanating from new healthcare ecosystems (everything from pharmacy apps to Fitbit devices). Data models must expand to go beyond patients to embrace other users, such as caregivers. Additional new insights are arising from the social and economic factors related to health. All of these actions will enable the organization to engage more satisfactorily and efficiently with consumers.


• Use analytics to enhance the employee experience. IT managers should consider enabling systems, especially those that support frontline, consumer-facing staff with real-time analytics, branching workflows, scripts and other actions to better optimize resources. Investments in sophisticated big data analytics will help the organization move from basic descriptive analytics toward the promise of predictive insights, enabling them to receive alerts about potential events before they happen.


• Strike partnerships with the digital juggernauts. As some experts often say, “the digital giants have awoken, and they are coming after healthcare.” Since its first round of funding in 2009, Alphabet’s venture arm, Google Ventures (GV), has backed nearly 60 health-related enterprises ranging from genetics to telemedicine. Google is aggressively using its skills in structured data and AI to enter the space recognizing that about one-third of the world’s data is generated from the healthcare industry. Google’s moves, along with those from Apple and Amazon, are also using AI and machine learning to garner insight from health data. These newest entrants should not be seen as competitors, rather as partners and allies.

Given the ineffectiveness of previous attempts to influence control, many may push back on the consumer health movement. This time however, mounds of evidence suggest major structural shifts in the industry are coming given advances in consumer connectivity and high expectations to use personal technology to access just about everything.

Given the industry’s traditional slow adoption of digital services, there is an opportunity to not just participate in the emerging ecosystem but use the consumer health movement to lead. CVS Health’s Aetna acquisition underscores the retailer’s seismic commitment to offer consumers a super-efficient, convenient means to access healthcare services across its 10,000 locations. Oscar Health and its partnership with Cleveland Clinic offers another compelling reason to invest in consumer health.

Healthcare executives across the industry should carefully consider how they can team with and benefit from the investments being made by Google, Apple, Uber, Amazon and even Facebook as these players make sizable investments with the aim of making big profits from the consumer healthcare movement.