In commenting on the new IMS Pharma Letter, we highlight the emergence and widespread build up of the consumer’s role in prevention, care and outcomes. Consumer centricity is being driven by the rise of CDHP (consumer directed health plans), but it’s quite different from these insurance products, with their high deductibles and variable co-pays.
Consumers are learning and experiencing more about consumer-directed health plans (CDHP) as they enter the exchanges, even though CDHP has been around for fifteen years or more. Most new health insurance products have a deductible that must be met, so consumers must pay for services and treatments until they reach that goal. NOTE: the ACA (Obamacare) mandates that no individual pay more than $6350 in total out-of-pocket costs in Y2014). If they have not paid the sum, they will pay more of their own money for the care.
Consumer centricity in health care means that control for choice of service and for outcomes will shift to the consumers and they will become the ultimate arbiters in their health and health care. It’s a value-based concept that drives this shift in decision-making. IT supports the data so that the consumer can decide where, when, why and who to choose for care based upon personal preferences and goals, total costs, incentives to engage and time to get to the outcome preferred.
When they don’t have a good experience, they change vendors, even in health care.
Consumers already use their friends (real and social) for lifestyle and treatment choices, even more than their doctors. In a 2009 survey, three out of four people in the United States go online to plan a trip and 62% prefer to bank online. (US Travel Association , PWC).
Consumers are comfortable using technology to give them choice and control for decisions that are meaningful to them.They use transparency indicators online and peer-to-peer information in social media to choose their insurance plan, physicians, hospitals, treatments (including drugs) and lifestyles (eating healthier, getting regular exercise and sleep).
The rise of health information technology (IT) including the new wearables, will accelerate the shift of control to the consumer. Health care systems that are ready to share the information on total cost of care and quality outcomes will succeed.
The question of whether consumers will use more technology to make choices becomes clearer by considering the graphic. Consumers report that they choose their health care provider primarily on the experience. If the experience is poor, they leave. The technology will show them the alternative providers, costs, and locations so that they can make a change that best suits them. [Pictures above and below are from PwC]
It’s a message delivered to DIA (Drug Information Association–a conference of developers and researchers in drug production) in a conference in 2010 and again in a peer-reviewed article for their distribution. Building quality indicators into the development and uses of new and existing drugs will be imperative in the consumer-centric economy. In effect, including quality metrics in drug pricing and distribution has now reached a tipping point for decision-makers, including the CEO of her health care, the person – patient- consumer who is making the choice. The decisions will not be based solely on cost.
But it’s not just a drug manufacturer’s commitment to building quality metrics into their products. The Apple Watch and other wearable accessories will actually become central to this decision-making by the consumers.
The watch, combined with Apple Pay, will deliver the information on potential costs and comparison of outcomes at exactly the moment the consumer must make the decision, whether in the grocery store (what local foods are available), the physician’s office (where is the lowest cost lab for these tests), the pharmacy (cost of drug versus potential side effects), or the hospital (which one delivers the best outcome and also includes my doctor on staff).
Technology and wearable tech will drive the shift so that consumers will be able to see both their benefits (including potential out-of-pocket costs if they have not met their deductibles) and their choices of care, putting the data on their arm, their phone, their iPad, their Google glass. They will ask more questions on the total costs of procedures and thoroughly question the $117,000 bills that they receive after a “simple procedure.”
The definition of value will become more sophisticated, moving from cost/rewards to interfacing with lifestyle decisions. The trophies will go to those who embrace the rise of the knowledge consumer and respond accurately and openly to the questions.
Consumer centricity is the curation of the information I want, when I want it, how I want it and from whom. It’s an outgrowth of the iTunes/iPhone phenomenon of curating the music (and games, books, etc)c I want rather than buying the whole album. It will change the marketplace of health care to a broader choice of all products that meet the individual’s needs at the moment. Questions of health care are morphing into questions of health value. In the end, the winners will be those who can deliver better health.