With the continuing surge in healthcare costs and patients gaining greater control over medical budgets has led to a paradigm shift in healthcare — from a provider-driven industry to a consumer-driven one. In the past healthcare in the US ran on a business-to-business model where patients were incidental to healthcare and the hospital’s primary customer was the insurance company. But with patients having an increasing say over their healthcare dollars and legislation like the Affordable Care Act, health insurers have begun to sell directly to consumers through the marketplaces or insurance exchanges.
Under the Affordable Care Act (also known as Obamacare), patients can compare and shop for insurance plans on marketplaces based on their individual needs and competitive value. This has brought tremendous transparency into the system as consumers now have the power to compare plan metrics like premiums, co-pays, and direct payments. This in turn has made patients active participants invested in their healthcare, ensured an enhanced customer experience for them, and increased technology usage for interacting with the healthcare system.
Consumer driven healthcare (CDH) is aimed at restructuring healthcare around the patient or the consumer. It is based on the premise that if the consumer is made more aware and involved in her healthcare budget, she will not only actively participate but also lead a healthier lifestyle. This will ultimately bring down skyrocketing healthcare spend, particularly those that are unnecessary. CDH products like Health Savings Account (HSA) are being actively accepted by both consumers and employers. For instance, the number of people with HSA coverage rose to over 13.5 million in 2013, from 11.4 million in 2011.
The increased demand for CDH calls for integrating health IT systems and customer service with quality data, clinical decision support and comprehensive patient engagement strategies for an enhanced customer experience. It also requires clinics, hospitals and doctors to up their game and focus on customer satisfaction, improve safety and quality, and support patients in managing their own health.
However, consumer-driven healthcare is not without barriers. Critics argue that while it may reduce unnecessary hospital visits, it may also decrease necessary care especially for people from weaker economic backgrounds. When a patient is suffering from a life-threatening disease, he is not looking for a bargain and many will have to take a financial hit to pay up for expensive drugs and treatments given the blunt cost sharing provisions. Also, the lack of information may prevent patients from making decisions that are appropriate for them.
But it is hard to ignore that consumers now have multiple gateways to becoming smart buyers of healthcare services based on their choice and need. The way forward for Consumer Driven Healthcare lies in “managed consumerism” with the right balance of managed competition between providers, as well as patient focus.
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Publish Date: September 23, 2015 5:00 AM
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