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Is 2019 the Year Healthcare Becomes Consumer Friendly?

Allison Inserro
The year 2019 will finally be when the healthcare industry, particularly payers and providers, finally begins to catch up to other industries in terms of giving the consumer what they want.
The year 2019 will finally be when the healthcare industry, particularly payers and providers, finally begins to catch up to other industries in terms of giving the consumer what they want. Really.

No matter whether you call this trend consumer engagement, consumer centricity, or something else, various forces are combining to make this a reality, even though the topic has been discussed and studied ad nauseum. To complete the transformation to value-based care, payers and other parts of the healthcare industry have to be able to influence the member, patient, or consumer, no matter what label or name they’re given, according to recent interviews looking to the year ahead.
It’s the first time Tom Wicka, chief executive officer of NovuHealth, said he sees the payer marketplace ready to move on these ideas, he said in a recent interview with The American Journal of Managed Care® (AJMC®). Plans recognize that if they don’t, it will have negative repercussions for the future

“It seems to be the clay is kind of removed from their eyes,” Wicka said of the payer community. NovuHealth is a healthcare consumer engagement company that offers rewards and incentive programs to enrollees in government health plans—Medicaid and Medicare Advantage—in an effort to both improve health and health plan performance.

Wicka said it’s a matter of economic self-interest as plans realize that “if we don’t really engage our members, getting them to take the behaviors that we require them to take for better health, for better fiscal performance, we could find ourselves out of this marketplace in a few years.”
Likewise, Gurpreet Singh, health services leader at PwC, likens the focus on consumers to “creating the Southwest Airlines of healthcare.” A recent report by PwC looking at forces that will have the most influence in 2019 says “a health industry increasingly pressured to do more with less will take lessons from emerging companies that have figured out how to deliver value to the uninsured and underinsured—traditionally deemed unprofitable—and turn a profit.

In an interview with AJMC®, Singh said from a “value discipline standpoint,” the Southwest model stands out as one of operational efficiency, followed by customer intimacy. Translated to healthcare, this will involve the twin tasks of lowering the cost of care and delivering it in the most effective way, and then developing the capabilities—by both providers and payers—to enhance patient and consumer experience.

About 75% of PwC’s payers and providers are investing in digital capabilities and creating the position of “chief experience officer,” he said. The report said consumer-wooing methods used by other industries will broaden into healthcare by the end of 2019, even if a “Southwest”-type entity is not created outright.

These so-called “surprise and delight” customer-experience moments will allow a plan or provider to engage with the patient on a consistent basis, Singh said. He described what this might look like with his own personal example of avoiding the emergency room when his son broke his wrist at camp during a workday. They were seen quickly and efficiently, getting a cast and all, within a short timeframe at an urgent care center specializing in orthopedics.

The PwC report said combining improved customer experiences with a “lower-cost value line is an important growth strategy in a healthcare ecosystem in which average deductibles have tripled over the last decade and are now almost $1300 for an individual with employer-based insurance, making healthcare costs a difficult financial decision even for the insured.”

Wicka and Singh also discussed other predictions they expect to see this year, including holding the line on the Affordable Care Act (ACA), social determinants of health (SDOH), digital therapeutics, and private equity deals in healthcare.

Affordable Care Act
Neither Wicka or Singh, nor AJMC®'s co-editors-in-chief, A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at the University of Michigan, and Michael E. Chernew, PhD, director of the Healthcare Markets and Regulation Lab at Harvard Medical School, believe that the December 2018 ruling by a federal judge in Texas declaring the ACA unconstitutional would stand.

The blue-state plaintiffs in the case, led by California, have already filed a notice to appeal the decision to the US Court of Appeals 5th Circuit.

Undoing the ACA would also mean changes to Medicare Advantage rates and payment reform models, Chernew noted on a recent AJMC® Managed Care Cast podcast.

In his opinion, Fendrick said that while the law is imperfect, the ACA has many popular features, such as allowing young adults to stay on their parents’ health plans until age 26, not to mention the protections from higher premiums due to preexisting conditions.

While Wicka said he usually steers clear of discussing politics and policy, he said no matter what happens, “there’s going to be no stopping…the continued trend for pay for performance and more privatization of Medicaid.”

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