HFMA’s first Healthcare Consumerism Symposium shed light on major trends that are disrupting the industry, and strategies that providers should be considering to keep up.

Shifting consumer behaviors and expectations are influencing the business of health care, with patients increasingly avoiding or abandoning care, and even the best care experiences being at risk of adverse effects from financial issues.

That was part of the discussion at HFMA’s inaugural Healthcare Consumerism Symposium, which took place Nov. 2-3 in Chicago. The event was sponsored by Simplee.

In an opening “fireside chat,” Joseph J. Fifer, FHFMA, CPA, president and CEO of HFMA, and David Johnson, CEO of 4sight Health, discussed the importance of prioritizing consumerism and customer engagement as part of billing-and-collections processes.

HFMA focuses on consumerism because the industry has been slow to adopt a consumerism orientation, Fifer said, and that’s especially important now that consumers are paying more out of pocket for their care. High-deductible health plans and concerns about affordability are leading some consumers to delay or even forgo care. And healthcare stakeholders are just beginning to realize how much the financial experience affects overall patient satisfaction.

Everyone in the industry talks about being consumer-centric, Fifer said, but in some cases, it’s more talk than action. As much as patients want to honor their obligations, current billing and payment systems often don’t make it easy or convenient for them to do so. For example, Fifer cited the lack of prearrival estimates and of price transparency mechanisms in general, as well as the absence of affordable payment options and timely assistance for many patients.

On a systemic level, the fee-for-service structure rewards transactions and volume, Fifer said, rendering the customer experience secondary. But the industry may be nearing a tipping point. Value-based care requires the ability to engage patients, and providing an optimal financial experience is a foundational step in achieving such engagement. The crux of the consumerism challenge is moving from dealing with a captive user (the patient who traditionally had few choices) to actively working to acquire, engage, and retain the user (the patient as a consumer with many choices).

The healthcare industry in this effort can learn from early-mover peers and new entrants. The industry can adapt to new consumer norms by implementing tools such as real-time surveys, multi-language platforms, and installment plans for payments.

Looking outside health care also is advisable, Fifer said. The following examples came up in discussion:
  • The airline industry, which transformed from a regulated, low-margin business to a business configured for self-service
  • Car companies, which embraced mobility and new customer norms (e.g., reduced ownership)
  • Retail, which implemented transparent pricing and mobile-first designs

As part of the transformation, the healthcare revenue cycle needs to change, Fifer and Johnson noted. That effort starts with a change in vision. Instead of simply striving to lower costs, healthcare organizations should be looking to empower consumers by complementing clinical care with true financial care.

Key metrics to track performance in this respect include net-promoter scores, which measure loyalty; revenue cycle-specific measures of patient satisfaction, with real-time monitoring; and engagement by patients, specifically the adoption of self-service options. Additionally, revenue cycle departments should become more cross-functional, working closely with marketing and patient experience teams.

For a blueprint and exemplars, healthcare organizations can look to HFMA’s Patient Financial Communications Best Practices and Adopters. By implementing the Patient Financial Communications Best Practices, Adopter organizations have demonstrated success in helping patients understand the cost of services they receive, their insurance coverage, and their individual payment responsibility. They have a record of bringing consistency, clarity, and transparency to patient financial communications.

When these practices become more widespread, the industry will be on the right track.

“We can do better with the everyday patient experience,” Fifer said. He added that optimizing that experience is simply “the right thing to do.”

The Age of the Consumer

As more of the financial responsibility for paying for health care falls to consumers, expectations of better outcomes only become greater, said Kate McCarthy, a senior analyst serving CIOs at Forrester.

McCarthy contended that health care will have to shift its operational focus from connecting departments and providers to embracing strategies that truly affect a person’s life from a customer-focused perspective.

“We have to make the customer experience an organizationwide obsession,” McCarthy said.

“What if we could prescribe lifestyle changes and social interventions for prediabetics? What if we could give them ways to finance their care? What if we started treating [patients] the way retail treats us every day?”

In 1996, hospitals experienced a major shift—there was more outpatient than inpatient volume. Looking back, McCarthy said, the scale of change happening today would have been difficult to envision.

In the next five to 10 years, Forrester predicts that virtual care will outpace outpatient care. This shift is driving the change from a business model to a consumer model, and it is happening quickly, McCarthy said.

What is the impact on health care? “Customers are going to become more aware of what we do, and how it affects them,” she said.

In the future, health care will be measured on three important experience outcomes:
  • Effectiveness. Do we understand our product (i.e., health care) and what we are delivering?
  • Ease. Are our products easy for a customer to use and to get value out of them? McCarthy illustrated this point by asking attendees to consider the last time they or someone they love had a healthcare experience: “How easy was it to understand the billing process?”
  • Emotional impact. Although this is the hardest positive experience outcome to achieve, it is by far the most important aspect of winning consumer loyalty and trust, McCarthy explained.

Looking at the strategic approach of successful digital companies, it is apparent that many are clearly focused on simplifying and improving the customer experience. McCarthy highlighted the hotel industry, which she said understands the concept, noting that it hardwires training and culture within organizations about the importance of the customer experience. “Everyone in the organization needs to own the experience,” she said. “The customer experience is about differentiating brands, but you have to train your people.” She also emphasized the need to measure performance.

Successful organizations build loyalty by building what customers most want. Patient experience is delivered through a process of simplifying and clarifying communication, producing journey maps to understand a customer’s experience, and creating programs and solutions that empower customers to improve their lives through better health, McCarthy said.

Free thought leadership paper: For more insight on patient satisfaction in relation to healthcare financial services, download "No Immunity to Patient Experience Obsession," authored by Forrester Consulting and commissioned by Simplee. 

From Consumerism to ‘Prosumerism’

In the next decade, we will also see a dramatic shift in who we characterize as healthcare providers, said Rubin Pillay, MD, PhD, assistant dean for global health innovation at the University of Alabama School of Medicine.

Pillay recounted a personal experience that underscores the impact of this change on health care. About a year ago, Pillay was invited to present on healthcare technology at a meeting in Destin, Fla. While at dinner, he felt a sudden pain in the left side of his chest. “I am a prediabetic. I have a cholesterol problem. I am mildly hypertensive. Like all physicians, I am in denial about my own health care and not very compliant,” he said.

In those seconds, he decided to try an EKG app he was experimenting with on his cell phone. Within 30 seconds, the app offered a diagnosis and instructions on next steps. The EKG was forwarded to his cardiologist, with whom he ended up having a brief conversation. Although the EKG results did not signify that he was having a heart attack, he was instructed to schedule an appointment with the cardiologist to evaluate the episode further.

“That day I saved the insurance company $5,000,” he said. “I freed up the ED in the small town of Destin. That day not only made me a consumer, but a producer of my own care. That is the future of health care.”

Because technology is creating so many new and powerful healthcare tools, it is literally shifting roles from the traditional provider to the technology-enabled consumer.

“Your patients are moving from being informed purchasers to actually empowered competitors,” Pillay said. “How do you compete in a healthcare environment where your customer is now your competitor?”

Pillay pointed to three main factors driving this trend:
  • Availability of technological solutions
  • Capacity problems due to shortages in the healthcare workforce
  • Biomedical research advances

The Growth of Knowledge

“We have become so good at generating biomedical knowledge, it is introducing complexity as it relates to patient care,” Pillay said. Consider that in 2015 there were 40,000 peer-reviewed articles just on oncology, he observed. Keeping up with the sheer volume of medical information has become physically impossible for specialists. Even the top medical institutions struggle in deciding what findings should provide the basis for efforts to improve healthcare outcomes.

Because of this trend and the need for continuous advancement in medicine, the single technology that will have the greatest impact on health care is artificial intelligence, Pillay said.

“We are seeing artificial intelligence making a difference in a whole host of other areas apart from oncology,” he said. “You can see its application in infectious diseases, breast cancer detection, cardiovascular risk prevention. Artificial intelligence can make sense of those 40,000 articles in a better way than the average human can do.”

The medical specialties and subspecialties that will be dramatically impacted first include dermatology, pathology, and radiology.

The Capacity Problem for Health Care

Two opposing trends will drive significant change in health care: an aging population coupled with a shortage of providers.

“As we age, the demand for health care will continue to go up. This exacerbates the provider-patient ratio,” Pillay said.

Today, if you need to see a family practitioner in Boston, the wait is 66 days. If you have to see a cardiologist in Washington, D.C., the wait is 32 days. All over, wait times are continuing to increase. Do we train more providers or are we going to have to create more technological solutions?

“Today, you can download dermatology apps that let you take a photo of the affected area, upload the image, and receive a diagnosis and next-step instructions. It is clinically validated,” Pillay said.

There are tremendous developments in alternative care, from telemedicine to a “cardiologist in your pocket” to remote monitoring of chronic conditions such as diabetes.

DxtER is a device from Basil Leaf Technologies created to diagnose illnesses by consumers without any medical training. This machine was created as part of a $10 million Qualcomm XPRIZE competition, and it incorporates algorithms for diagnosing 34 health conditions. These include diabetes, atrial fibrillation, chronic obstructive pulmonary disease, urinary tract infection, sleep apnea, leukocytosis, pertussis, stroke, tuberculosis, and pneumonia.

Consider that the map of the human genome took 13 years and almost $3 billion to first produce. Ten years later, you can do the same thing for $1,000 at home. That is “exponentiality,” Pillay said. “To survive in the future, we have to understand this concept of technology improving at an exponential pace.”

New web-based platforms are helping patients turn to each other for information. Consider the website Patients Like Me. “They trust their peers probably more than they trust their providers,” Pillay said. “We will see an explosion of peer-to-peer information sites.”

Think about the power of 5,000 patients around the globe communicating about what works when it comes to management of disease—it is a living clinical trial. That is real consumerism. Patients are getting and sharing information about providers, treatments, and costs, and they are leveraging their own experience, Pillay said.

Health care is now entering an era of prosumerism, defined as patients who produce their own care. “Technology is enabling Mom to be the next general practitioner,” Pillay said.

Consider too that the nation has entered a platform economy. The largest transportation company doesn’t own any vehicles or employ any drivers.

Health care will not be immune to this disruption. The biggest healthcare providers of the future will not own a hospital bed or employ a single physician. The changes are being driven by this trend of dececentralization from hospitals to patients, Pillay said.

Health care needs to embrace technological innovation, Pillay said, and adapt to meet the needs of consumers and the societal challenges that are influencing the industry.