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Engaging ‘Consumers’ pro-actively, before they become ‘Patients’: How a pro-active rather than reactive approach can help solve the healthcare crisis

By Anurag Gupta | June 05, 2014 | 4 Comments

Consumers not Patients

Some of the often heard phrases at healthcare events and conferences: ‘Healthcare needs reform’. ‘The system is broken’. ‘It is unsustainable in long term’. ‘We are edging towards a cliff’.  ‘The demographic time bomb is ticking’…

A closer look atmost simple market dynamics reveals that most efforts have so far focussed only on supply side (healthcare providers) rather than demand side (patients). Various eHealth initiatives across countries in EU (most notably the NPfIT program in England (See Market Insight: Changes in England’s National Health Service Create New Market Opportunities)), US government’s HITECH ACA program for spurring EHR adoption, Singapore government’s National EHR, Australian government’s PCEHR programme etc have all almost entirely targeted the providers market, aka the supply side market! We have so far almost completely missed proactively managing the demand side dynamics or in other words; cranking the levers that can reduce or at least manage demand for healthcare services from the patients. That neglected area can finally be targeted now..

  • Economists propose that to change behaviour; align the right set of incentives. Incentivising healthy behaviour is one such way to reduce demand for healthcare services. Simple lifestyle choices can have big impact on our vital health stats. Unfortunately no such incentives exist now.
  • If employers start motivating healthy behaviours (for ex: say a healthy body metabolic rate), it can have a positive impact considering we spend a significant portion of our life at our workplace. The recently appointed NHS chief Simon Stevens in an interview with the Telegraph also urged employers to reward healthy living within their employees.
  • Online user groups can create a strong ‘pull effect’ similar to Social Media Platforms. Language learning Sites like Duolingo not only create customised learning plan for users but the online platform also help users track their progress and compete in a friendly fashion with one others.
  • Targeting preventive care can help by nipping the problem in the bud . There is an on-going debate in the industry about the utility of regular health screenings, but one thing is for sure: prevention is better than cure. A properly regulated screening test directed to consumers within the right age group can help avoid a lot of complications later on (think initiatives similar to Breast Cancer Screenings). In the UK, the Ministry of Transport (MoT) mandates proactive diagnostic check of all transport vehicles every year for any possible problems.  The Department of Health now is considering similar ‘Health’ MoTs instead directed towards health screening for a select age group
  • Wearables, Quantified Self and Internet of Things are helping too. Applications of IoT can be helpful in not only monitoring patients in their homes (through sensor lead tracking) but also in keeping consumers healthy (through the quantified self-movement which involves tracking data through wearables like Fitbit, Jawbone etc). Mobile phones and apps have created similar consumer side push.  (See: Market Insight: Disruptive Change Is in the Making for Health Apps)
  • Stimulus by health insurers can be critical to derive adoption. PruHealth Vitality program in UK run by Prudential Insurance rewards healthy behaviour through a point based system which also keeps members motivated and engaged. UnitedHealth in the US has an initiative called the UnitedHealth Personal Rewards program which engages members through financial incentives.
  • Rewarding outcomes rather than episodes is gaining traction. The growth of patient centered integrated care models across Europe, population health in US are also creating a significant push towards engaging patients

Over time it will be possible to proactively manage ‘demand’ for healthcare services and partly tame the healthcare crisis. The healthcare ‘problem’ cannot be solved by handling the supply side dynamics alone !

What do you think ?

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  • Good Morning,

    I have said elsewhere that systems of people perform in a manner that they were structured and rewarded to perform. Poor structure begets poor incentives and poor incentives beget poor performance. The problem in the U.S. healthcare system is that it has been built around hospitals or teaching institutions, rather than around families and communities. While sources of revenue drive market forces, the inability or unwillingness of consumers to adhere to physician directives about medications, behaviors and screening, suggests a possible SERIOUS problem with health literacy. This confounding reality is amplified by the un-noticed exchange of a Registered Nurse in private physicians’ offices for a Nurse Assistant or a Referral Manager – typically with very limited clinical skills. The loss of the patient educator in primary care means that the patient must somehow fend for himself or herself in determining what is the right path for diet, ingesting medicines and exercise. The idea of coaching consumers into improved health behaviors seems uncharacteristic in a society which is committed to pulling the petals off of a rose, searching for its scent. I am encouraged by the ever rising GPD in health care. By designing innovations through the Center for Medicaid and Medicare Innovation, like the Camden Health Provider’s Model, incentives are being restructured and the outcome data are impressive – and for some, quite scary. The Camden health reform solution is searching for the low-hanging of the costs associated with “frequent fliers in hospitals and ED services”. It is also searching for community-level disconnects between mental and physical health systems. The use of community health workers or patient navigators is empowering community advocates to connect homeless individuals with housing resources, and techniques that will exchange old behaviors (like emergency room use) for new behaviors (like primary care clinics’ embrace). Sadly, the Medicaid system has earned a disproportionately negative reputation because of the bureaucracy which enshrouds the processing of paper and its very small checks – checks that sometimes do not cover the cost of a service. The policy argument is wrapped in the balance of a decline in the disproportionate share payments for reductions in the uninsured. We trust this hydraulic will bring the economic balance that is needed. By building apps that focus on informing – “coaching” – patients how to act in their own best interests, such advice and direction will demonstrate the importance of “patients first” in the quadratic equation of care delivery. Finally, I just think the entire movement around electronic medical records has been fascinating. What does the system do with the information that a patient is at risk for diabetes? Who makes the house call and sets up the strategies for linking assets to encourage and promote health and wellness. On the last day, when differences get measured by improved health outcomes or closing the health status gap, I suspect that the profitability of a particular system will NOT be the first unit of measure.

    Paul B. Simms

    • Anurag Gupta says:

      Paul, thank you for your detailed insights. You raise great points. Community workers have a major role to play in healthcare (think: China’s Bare Foot doctors). Their role is so important but still undervalued. Hopefully, we will see concrete action by the policy makers.

  • Tony Kane says:

    Great blog. Agree with the point about insurers getting into the prevention business – Axa in France just announced a tie-up with Withings to promote activity tracking. Clearly it’s a vested interest but it’s a win-win for everyone.

    • Anurag Gupta says:

      Thank you for your comment Tony. Health Insurers are exploring many unconventional partnerships, piloting new technologies and also stretching the old boundries of core insurance. Would be interesting to see further developments here.