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Consumerism in Healthcare 2016 and Beyond

By: | Tags: , , , , | Comments: 0 | October 26th, 2015

Part 1

There are many trends emerging today in healthcare that seem to be gathering momentum. Some may credit changes to the Affordable Care Act of 2010 (ACA), some may credit changes in demographics, some the advancement in technology, while others the success of increasing consumer engagement.

Regarding changes due to the ACA; yes, the ACA has disrupted some elements in healthcare, but in the totality of its context, the ACA seems to have brought about more challenges than solutions. It is self-evident that a lot of work remains and what we do know for sure is approximately 30 million Americans, nearly 10 percent of our population, do not have health insurance even today. We also recognize that the cost of healthcare has been material to the economy and for the government. For example, we know that Medicaid spending is up about 14% nationwide AND is up 18% in the 29 states that expanded Medicaid.

Reports show that the problem in non-Medicaid enrollment, or exchange driven signup, are below expectations because of high out-of-pocked costs, high deductibles, and restricted selection of providers participating in the ACA-approved plans. We are noting that many subscribers to ACA plans are paying for insurance, but still not using it, due to a high deductible. Many have become frustrated by paying a monthly premium AND paying a large out-of-pocket cost, which continues to discourage the investment in health insurance.

The US Department of Health and Human Services (HHS) recently announced that they expected 10 million enrollees in 2016; but that was weeks after it had projected 14 million, and four years after it predicted 25 million or more, would join the program. To be fair, some of the shortfall had to with the extension through most of 2017 of non-ACA qualified employer sponsored health plans (I am the beneficiary of one such extension). These predictions, I believe, also assumed that individuals would cancel insurance on one plan, to be forced onto a completely different plan, almost always having a higher cost if not a significantly higher cost.

The demographic changes are real and expanding. There are many consumers today, from baby boomers and older, that are finally getting in to smart phones, iPads and searching on Google. Like me, the 70 million baby-boomers that lived during the technology transformation, from no cell phones and no personal computers, to phones (that function as both), analog to digital to streaming videos, and from the paper street map to Siri-driven iPhone anytime, anywhere navigation. This yielding, all to the second wave of over 75 million echo boomers or millennial generations are, living today without land-line phones, shedding cable TV for streaming video, and have no concept of anything analog. All are driving forces behind the technology revolution in healthcare. At this point it seems evident that the government should just let market dynamics and consumerism drive the next phase of technology innovations in healthcare.

The US Government has recently unveiled the new Meaningful Use-3 (MU-3) rules for 2017 and beyond, and we have to wonder why? In the next blog I will discuss this more and pay special attention to a recently released survey by the Deloitte Center for Health Solutions on “Healthcare Consumer Engagement.”

One of today’s big trends will be new healthcare consumers are resisting the traditional and routine office visit and the interaction between providers. Consumers are wondering why it takes so much time and energy to see a doctor for many routine questions and chronic issues. 21st Century healthcare needs to move from “volume to value.” Today we have a system based on encounters that was effectively developed a century ago. A system in which information was “horded by doctors” and doctors dealt with acute care vs. today’s chronic care. We have lived through these 100 years with rising life expectancies from age 47 in 1900 to 82 in 2015 and possibly 88 by 2050 . How can we expect the same system to work in that rather tectonic shift in life expectancies and the major changes in individual wellness objectives?

We need a new model and we need a new way of using technology. We need a new way for healthcare consumers to interact with their care team, and that means better use of technology, and better systems for payment. The market is making that shift today. One expensive example is concierge medicine; and although expensive, it concentrates on the consumer, uses non-traditional ways to communicate and uses technology more effectively. It’s time for a change, and while it may hurt, it is better than the disease that is static.

– Noel J. Guillama, President

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