What Consumer-Driven Healthcare Really Means

Achieving online patient engagement is widely perceived to be one of the biggest hurdles faced by healthcare organizations. Putting up a patient portal and giving patients a password is not so hard, but getting patients to use it? Hospitals and healthcare organizations have enough of a challenge getting their employees and affiliated doctors to use online tools. Patients are outside their control, so how are they supposed to meet the patient engagement performance targets baked into Meaningful Use, Stage 2?

It's called marketing, folks. This is where you influence consumers by grabbing their attention by whatever means available, make them an attractive offer that they will perceive as being in their own best interest, and hold onto them by offering superior convenience and overall service. The regulatory requirement to get a small fraction of your patients to engage online should be the least of your motivations for pursuing patient engagement, both online and off. Because they're not just patients anymore, they're consumers. Increasingly, they are also customers, and any good business knows how to attract and retain customers.

One of the themes of this week's eHealth Initiative conference in Orlando, a gathering of health IT proponents including providers, payers, and vendors, was that healthcare is shifting from a business-to-business to a business-to-consumer model. That's why the first event was a keynote speech by Target medical director Joshua Riff, who oversees Target's in-store clinics as well as programs for keeping the retailer's employees healthy.

[Here's how technology in healthcare is changing: Read 3 Trends Are Reshaping Healthcare IT. ] 

When healthcare organizations talk about becoming more patient centric, that sounds like a noble aspiration to begin with. However, it's also a business imperative. For a long time, the US system of employer-sponsored healthcare was built around a business-to-business model, where patients were incidental to the delivery of healthcare. A hospital's primary customer was an insurance company, and the insurance company's primary customer was the employer. Or the customer was a government program like Medicare or Medicaid, with the bill going to taxpayers. This pattern of indirect funding has come to be seen as one of the flaws in the system, leading to higher costs because patients feel entitled to whatever care their provider recommends, at whatever cost.

The trend toward individuals taking more control over and responsibility for their healthcare expenses has been gaining momentum for decades, but it is accelerating because of legislation like the Affordable Care Act, as well as pressure from employers seeking to contain the cost of health insurance. Health insurers are selling directly to individuals through the Obamacare insurance exchanges. More employers are having their employees and retirees select their plan from a menu of choices offered through a private exchange. People shopping for the best price often find their way into a high-deductible plan, meaning that a bigger portion of the bill for any given healthcare service will be paid by the individual. The very deliberate intent of this structure is to make consumers more price sensitive, making it ever more important that healthcare organizations sell consumers on the value that they offer.

"We're forcing them, unwillingly in some cases, to accept more financial risk in return for their care," said Sam Ho, chief medical officer and executive vice president at UnitedHealthcare and the new chairperson of the board for the eHealth Initiative. The restructuring under way is radical and the implications for health information technology are equally profound, he said. "We're changing the entire customer service model." Health IT systems need to be able to integrate that customer model with quality data, clinical decision support, and patient-engagement strategies to produce a better overall customer experience.

Like the patients, provider organizations are taking on more risk when they participate in the Medicare Accountable Care Organizations created under Obamacare, which is a model of population health management widely perceived as the template for the healthcare system of the future. ACOs are healthcare networks in which providers are compensated based on how well they care for an entire population of patients, as measured by the outcomes of care provided, rather than by how many patients they see or how many procedures they perform. The federal government is also phasing in a system of penalties to be deducted from Medicare reimbursements for excessive hospital readmissions, with the idea being to encourage hospitals to get the job right the first time and do a better job of follow-up to make sure patients are complying with doctor's orders.

There are commercial ACOs as well. In the Medicare program, the provider's goal is to achieve "shared savings" to be split with the government by beating benchmark measures of health quality compared with cost.

One important enabling technology for ACOs is the patient portal and other techniques for patient engagement. To improve health outcomes, providers want to get patients more involved in their own care. Further, with the incentives aligned for providing care at a lower cost, you want to encourage preventative health measures that will eliminate the need for a hospitalization. New modes of patient interaction such as video consultations, which might not always be reimbursed under the traditional fee for service model, can also make sense once the goal is to deliver the best results for the lowest cost.

One of the salient features of the Medicare program is that participating hospitals and healthcare networks are assigned a pool of Medicare recipients to care for -- patients who have used their services in the past -- but the patients are not required to get care only from within the ACO.

"We're trying to reap a health improvement, but patient engagement doesn't mean patient accountability," said William A. Spooner, CIO at Sharp HealthCare in San Diego, who spoke on an eHI panel about technologies to support population health. Under Obamacare rules, providers and payers are not allowed to discriminate against the person who smokes, never exercises, and is in poor health for those reasons. The most you can do is try to motivate them toward better habits. Similarly, Sharp's Medicare ACO can analyze all the data it has gathered about a patient and use it to formulate a care plan, but it can't prevent the patient from going to a hospital or physician outside of its network that might not follow that plan.

That is one reason Sharp has put a lot of energy into developing its patient portal, and into making it a pleasant online consumer experience and customer relationship management system, as well as a patient engagement tool. Part of its purpose is to keep patients in network, as a consumer choice, even when they are not compelled to do so.

"Given I can't make them accountable, I've got to be able to attract them. I have to show them we're the most viable provider in town, so they want to come to us," Spooner said. Obviously, there are lots of other things a healthcare provider needs to get right, from a high standard of professionalism to the maintenance of the waiting room, to win the loyalty of a whole population of patients. But in terms of what an IT organization can do to steer things in the right direction, focusing on the patient engagement experience becomes pretty important. In the online world, marketing and service delivery are one and the same.

Healthcare providers must look beyond Meaningful Use regulations and start asking: Is my site as useful as Amazon? Also in the Patient Engagement issue of InformationWeek Healthcare: IT executives need to stay well informed about the strengths and limitations of comparative effectiveness research. (Free registration required.)