Healthcare Consumers

Healthcare Finance 3.0

Reimagining healthcare finance post Covid19.

I have been participating in some Zoom meetings to hear how others are reimagining healthcare post Covid19. There is broad consensus that use of Telehealth will not diminish because consumers are using it now. In fact, 80% of physician visits are now Telehealth visits.

Most are still questioning the longevity of current Telehealth reimbursement. When first conceived, Telehealth use was supposed to help reduce the cost of healthcare and with current reimbursement levels, it’s not achieving that objective. Convenience and limitations of the technology may be driving up cost.

When costs go up, everyone starts talking about the need for more value based care arrangements even though structural issues makes it hard for many healthcare organizations to make those arrangements work.

So the question that remains to be answered is how do we develop a more sustainable model?

Healthcare Consumerism vs. Accountable Care Organizations [ACO]

We have competing ideas at play in the healthcare industry.

On one hand, we want everyone to behave as healthcare consumers. That means we want every American to carefully select the healthcare services they need based on quality metrics and cost so that they get the best outcome possible.

On the other hand, we want to narrow their choices and limit their options so that we can control their spending and achieve defined outcomes of quality.

There are elements in both strategies that could work if we combined them in different manner.

Ideation

Ideation is not about having the perfect idea but rather generating fresh ideas to solve a problem. Asking questions helps to get the process started:

1/ Who should control the purse strings?

2/ Is the Healthcare Consumer capable of making informed decisions?

3/ Can we better empower the healthcare consumer?

4/ Is it possible to offer choice and control costs?

5/ Who should define a quality outcome?

Developing a Sustainable Model

If we answer the questions from different perspectives, new ideas and needs emerge. 

For instance, if we start from the healthcare consumer perspective:

1/ The consumer could control the purse strings even if they are not paying for the service out of pocket.

2/ The consumer could make informed choices if we laid out a healthcare roadmap for them.

3/ The consumer could be informed of all the options for events on their healthcare roadmap.

4/ The consumer could be better empowered to choose their physicians and control costs.

5/ The consumer knows how they want to feel and move post service and is in the best position to assess whether or not they got their expected outcome. 

The expected outcomes needs to be established with their physician. Atul Gwande MD talks about physicians understanding all the options but also understanding the limits of medical interventions so that healthcare consumers develop reasonable expectations.

Healthcare Roadmap

Based on the answers, we’re missing the healthcare roadmap that gives consumers actionable information based on their genetic profile and lifestyle. 

Various companies are collecting information on their current health status, pre-determinants of health, genetic and risk profile but so far there is no repository for the information.

Professional economists believe the government should maintain a single repository of this type of information so that it is safeguarded and continuously used to better understand the needs and cost of healthcare.

Coverage

As an industry, we usually talk about “medical necessity” as a way to define coverage even though there are always issues in defining necessity and limiting care. 

Most consumers don’t read all the fine print in their policy and likely don’t understand the concept of medical necessity. To empower the healthcare consumer, policies need to be easier for them to understand what’s covered and what’s not.

Different nomenclature such as uncontrollable event versus controllable event could help.

1/ Uncontrollable events are those predicted in their healthcare roadmap. 

Everyone has some sort of flaw whether genetic or lifestyle that leads to an increased cost. So financially shielding healthcare consumers from all uncontrollable events seems fair to all. Incentivizing healthcare consumers for sustained behavior change may help lower the cost of their roadmap and the total cost of care.

2/ Controllable events are the services healthcare consumers want and can plan for in advance of the event.

Thinking about events enables us to think more holistically about everything that might be needed and that could enhance the healthcare consumer experience. Controllable events could be either paid out of pocket or financed through a supplemental plan. 

Direct to Consumer

Other industries are reconfiguring to enable more direct to consumer sales. There is a role for it in healthcare as well to fulfill the miscellaneous needs of healthcare consumers. 

Direct to healthcare consumer platforms are providing the same level of service and transparency as direct to consumer services. Prices are coming down for over-the-counter drugs and medical supplies. 

The expenses could be paid either out-of-pocket or a pre-tax account [aka: HSA account].

Think Global

Why you should start thinking globally now.

Covid19 is making the US healthcare industry cross the chasm to consumer driven healthcare. 

Previously imposed ideas of what we thought were possible in healthcare and other aspects of life are being challenged every day. No one is accepting a lower standard of care or service but rather realizing that there are pros and cons to delivering service online.

Based on my own experience and insights from others, we should all start thinking about the global potential.

Global Markets

Everyone has the potential to prosper in a global economy. The cost of doing business is decreasing in developed countries and increasing in developing countries.

Retired healthcare providers have rejoined the workforce and are supplementing care via telehealth services. We’ve created a new way for them to participate on their terms while increasing the supply of medical expertise to the market. 

It’s an important proof point to acknowledge because many countries have been fretting about how to meet the demands of aging populations. Designing services that continue to empower physicians and other healthcare providers will enable us to meet the growing global demand.

The cost of providing telehealth and virtual services is substantially lower than a bricks and mortar service. Providers don’t need receptionists, schedulers, coders and billing staff. We’ve had the ability to automate all of these functions for years but many providers were scared to let go of the past and venture into the future. 

Reimbursement and Wages

Reimbursement for telehealth services is reportedly about 30% lower than an in office visit now. That may change post Covid19 pandemic. There is a lot of concern about the potential of over utilization. 

One prominent Oncologist who is using telehealth services to have end of life discussions with his patients shared that it’s harder for him to gage the patient’s reaction and to offer comfort. Consequently, he’s scheduling a follow on discussion a few days after the initial discussion to answer questions. 

Telehealth is enabling him to enhance his service by doing more timely follow up with the patient. Some might think that is an example of over utilization whereas others will think that is an example of good service and patient care. 

Establishing a standard of care and appropriate reimbursement is going to be tricky because there are a lot of variables to be considered. As a benchmark, payment for online services outside the healthcare industry have decreased by more than 30% and are constrained by the consumer’s ability to pay in light of the economic impact.

Health tech companies shouldn’t expect to receive a premium now given the amount of consumer technology being researched and used in the delivery of care. It will be hard to justify. Plus consumer technology is raising the bar for health tech companies. Dated, poorly designed and restrictive interfaces are not going to be accepted by healthcare consumers in the near future.

Credentials

There is an increasing need to establish global standards for healthcare professionals to facilitate a global healthcare marketplace. 

While some US physicians have been tossing around the idea of unionization to address their working conditions and pay, they might be better off fighting for a new organization that establishes global credentials. Technology is going to empower them in new and better ways to work on their terms if they embrace it.

Infrastructure

There is political discussions happening now around infrastructure as a way to stimulate the economy after the Covid19 shutdown. Governments should be investing in infrastructure because roads and bridges effect everyone’s ability to live productively.

The definition of infrastructure needs to evolve. Good roads and bridges represent how we functioned in the old economy but less important to how we will function in the near future. Internet access and reliable connectivity is quickly becoming more important for our ability to work and live.

Coverage is still spotty or limited in older parts of major cities, rural areas and other countries. Hopefully, political leaders are considering that as they plan the next round of stimulus funding so that everyone has equal and affordable access to opportunity and healthcare.

[Re]Building Trust

Why healthcare companies should be re[building] trust now.

Trust is more important than many leaders realize. I’ve been thinking about it in light of the 2019 allegations of wrongdoing in healthcare report and corresponding settlements being chalked up to the cost of doing business. 

The impact of wrongdoing whether it’s excessive charges, abusive billing practices and the mistreatment of patients and their data is likely having a much bigger impact than most healthcare executives realize. 

Healthcare Consumers

Healthcare companies undermined the trust Americans have in the system at a time when we are asking for more and need more data and engagement from patients and healthcare consumers. Granted there are other factors that have contributed to the mistrust felt more broadly but healthcare companies will need to rebuild that trust in order to transition into value based care models.

Employees

Employees of these companies are likely impacted too. The wrongdoing is not accidental but rather a function of the business practices that likely don’t align with the company’s stated values

How do employees reconcile what they believe versus what they do? They can’t reconcile it. The wrongdoing is likely contributing to the anxiety felt by the employees working within those companies. The impact of the stress and anxiety will only get worse until there is better alignment in the values and the work performed.

Profits

Did you know that companies with high levels of trust outperform their competitors by as much as three [3] times? Healthcare companies have relied too heavily on having a captive consumer. When people are sick, they surrender to the process to get better and deal with the fallout after the fact. 

That’s not going to work going forward. New approaches to medicine and healthcare services require participation from all consumers – not just patients. How is your company going to convince consumers to trust your organization and the process when there is no immediate need?

Trust

What is trust? The one common theme that I have found to describe trust is that trust happens when you’re willing to accept the risk of vulnerability or in other words, the risk of being harmed in some way. The perceived risk has to be lower than the probability of being harmed.

How do you convince someone to take the risk on your organization or you? Trust is earned by repeating actions that conveys trust. 

The book Trillion Dollar Coach, written about Bill Campbell’s work with leading Silicon Valley companies and executives, identifies five [5] key elements of trust:

  1. Keep your word: The commitment and/or fulfillment of one’s promises. Be accountable for mistakes, apologize and make amends when things go wrong.
  2. Loyalty: A strong feeling of support or allegiance. Establish clear boundaries and when you’re unclear about what’s okay and not okay, ask rather than ask for forgiveness after the fact.
  3. Integrity: The quality of being honest and having strong moral principles. Have the courage to practice your values and do what is right versus what is easy, fast and fun.
  4. Ability: The possession of the means or skill to do something. Avoid overpromising and underdelivering.
  5. Discretion: The quality of behaving or speaking in such a way as to avoid causing offense or revealing private information.

Trust can’t be won with one large gesture. It has to be built over time with actions that are consistent with the key elements of trust. Just remember – trust can be undermined faster than it is earned.

Be generous

Best advice from Dare to Lead for developing trust within an organization is for everyone to extend the most generous interpretation possible to the intentions, words, and actions of others.

Even if you believe that you are trustworthy, most only trust a handful of people. Chances are your assumptions about a situation, interaction or person are wrong. Default to truth but when in doubt, look for the data and trust the facts.

Trust

Transparency is the key to consumer engagement in healthcare. Why? In one word – trust. 

Yesterday I participated in a film being made by a US physician who’s trying to wrap his brain around the patient – physician relationship. The film is being presented at a US Public Health event later this year. I’ll be sure to share the link.

Trust is one of the themes that has come up in several interviews that he’s had with both patients [aka: healthcare consumers] and professionals. Reportedly, no one knows who to trust when it comes to healthcare.

Trust has been eroded in both Canada and the US but for slightly different reasons. 

In Canada, the lack of choice and ability to actively participate in treatment decisions is eroding patient trust. Canadian physicians have no financial incentive to invest the extra time needed to educate their patients. 

In the US, the lack of pricing information and network participation is eroding patient trust. American physicians need to educate and almost sell their patient on their plan but patient trust has been undermined with various out-of-network and billing strategies.

When I ask people if the 80/20 rule [80% right thing done] applies in healthcare – most don’t agree. The responses are pretty dismal.

Trust is clearly a problem. Transparency will help to re-establish trust.