Patient understanding crucial to success in consumer-driven healthcare

Understanding what drives patient choices is crucial to succeeding in a consumer-driven healthcare industry, according to a new report by the Healthcare Financial Management Association.

The report, Health Care 2020: Consumerism, is the second in a series of four reports by HFMA meant to guide organizations in their strategic planning  and improvement efforts. It highlights two key trends, increased patient cost-sharing and a shift toward outcomes-based payment, that are changing how healthcare organizations operate.

"So much of our billing system have been set up to be more wholesale. But now with health exchanges, hdhp's and higher costs it has gone more retail," said Rick Gundling, HFMA vice president, healthcare financial practices. "People want to understand how things work. It's really responding to the consumer paying more out of their pocket and wanting greater transparency."

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Gundling said employers and consumers in general are seeing greater out of pocket costs, baby boomers are aging, and millennials are bringing their view of customer service to healthcare. The key findings of the report all point to the need for changes in how systems engage with patients.

Appealing to consumers is key for both population health management  and value-based payment. In meeting their needs and expectations, patients are more likely to stay in their health system.

But the report also claims health plans and providers will be held responsible more and more for providing patients what they need to take command of their health, and their success could hinge on whether they are doing so. Price transparency tools are one example. As more and more consumers shift to high-deductible plans, those plans are making transparency tools available to prepare patients for what bills might lie ahead. After all, sticker shock can negatively impact patient satisfaction. However, the report says those tools are only as good as the plans' understanding of its members.

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"Those plans that attain such an understanding have developed innovative member engagement strategies and have significantly higher rates of patients who shop for care, thereby lowering costs for both the patient and the plan," the report said.

The report also said health plans and providers that truly succeed will be the ones that put the effort into understanding the needs and wants of all the population segments they serve, and use the knowledge to steer their operation into the future. This requires actively listening to consumers.

Generating actionable consumer insights is challenging for many plans and providers because there's a lot in the decisionmaking for consumers. It's a complex system involving employers, providers, health plans, and even the government.

"It's getting to the consumer themselves to get the information. Some do patient focus groups, some do surveys and make changes based on that, asking the right questions. Also, sometimes what makes the environment better for patients is different from a patient standpoint versus the clinician standpoint. Organization leaders have to marry the two and then act on it," Gundling said.

[Also: Hospitals say best patient engagement programs start simply, target conversations]

According to the report, some healthcare organizations are looking, and trying to learn from, the techniques and analytics used by "customer-facing" businesses such as consumer packaged-goods companies and retailers to glean insights about their target customers.

Some organizations are broadening their use of tools such as patient satisfaction surveys by finding ways to capture and share informal feedback from patients, doing everything from discussing patient comments regularly in department meetings to actually having patients participate on care-and business-process reengineering teams, the report read.

Gundling said a number of consumer-centric practices that are just starting to catch on now will be the norm in five years. Healthcare organizations will have incorporated many of the same tools as other industries: focus groups, patient experience professionals on staff, patient surveys throughout the care experience, patient access to touch screens for things like meals or real-time help, and other changes to just boost patient experience.

He also said it's important to remember that perceived quality is connected to care access, especially a patient's ability to text, skype or use other means to quickly communicate with a health professional for quick issues, questions, and non-life threatening problems.

"That really improves the patient experience. Having fast access to answers to questions and care."

That kind of knowledge and understanding of what drives consumer choice and loyalty, and the actions and systemic improvements that come with it, will be crucial to the success of health plans and providers.

"Consumers are demanding a better experience -- which providers, health plans, and physicians will have to deliver to remain competitive," the group said.

Twitter: @BethJSanborn