And as a consequence, it’s hard behavior to learn and to take up when you’re an adult. So all of those factors, I think, have an impact. But I’m a big fan of the more transparent we are about what goes into those decisions, about what does constitute quality, the more likely we’re going to bring them along with us and increase their trust in the market.
Consumer Expectations Have Changed
So all of this is happening around health care costs in an environment where consumers’ expectations are changing about all of the kinds of services that they purchase. And they expect health care to work a lot more like the other consumer goods and services that they deal with than they currently do.
So when people find out what I do, I can’t tell you, and this was back, of course, when I was actually having real conversations with new people. But how often I get questions like, “Well, if I can do X, if I can see all my banking information in one place, why can’t I see all my health care records in one place? If I can get my dog’s whole veterinary record, why can’t I get my whole health record? If I can schedule my hairdresser appointment online, why can’t I schedule my provider appointments online?”
And you think of it, think of the ways in which our expectations have changed over that same ten years of the graph I showed you earlier about all of the goods and services we work with and people are expecting health care to work like those they expect it to be convenient.They expect it to be connected and interconnected. Expect it to be personal and engaging. And they expect it to be effective. And those expectations color their judgment of the quality of the care that they get and their expectations about how convenient and digital the services that they receive should be.
Democratization of Information Impacts Expectations
And that, along with all of these digital tools in other aspects of their lives, we’ve seen a democratization of information. And that, too, affects expectations. So everybody’s a creator. You’re not just watching a performance, theatrical…sports…and waiting for the next day to read the pundits evaluation of it. People are providing commentary in the moment.
And Twitter and other social media tools are getting interactions. They’re getting likes. They’re relying on expertise a little bit less because they can get access to a lot of that information. It’s not protected in silos. In the same way, experts aren’t the only source of information. You can also potentially read the journal article or do a lot of research on your own. You can get evaluations from your peers. And while there are potential problems with that, I think we’ve seen some of those play out both in vaccination hesitancy, and certainly in our politics, there are also some benefits to it. And we need to figure out how to provide trusted information that gives people access to this, just, deep stuff and then help them understand whether they’ve interpreted it correctly and not.
What Does Health Care Consumer Partnership & Participation Look Like?
And so as they enter into this world, they’re expecting, in their health care endeavors, more partnership and more participation than they’ve had in the past. And this has an impact on the strategies that are effective for them in working with health care.
And as I talk about what partnership and participation look like, I have to say I am on the board of the Society for Participatory Medicine. I do have a book out that’s entitled Participatory Health Care. You can tell this is an area that I am a champion of. And that’s where I think it really does matter to consumers health, that we help them understand what it means to participate in their own health and give them the tools to do so. And frankly, train providers to understand what that care looks like and provide that kind of care.
So it means a lot more shared decision-making. It’s not, “I recommend you do X,” but, “Let’s explore what your options are and what the benefits and detriments are of each of them.” And there are certainly curriculums around shared decision-making and training for doctors. But maybe we need to think about developing those kinds of training tools for consumers as well, or for our employees.
Health Care Consumer Goals, Wishes, Lifestyle Choices
Patient goals, wishes, and lifestyle choices are respected. I’m on an HL7 committee that’s looking at advanced directives and, you know, one of the problems with advanced directives is that there’s a huge issue with getting, even if you do have one as a consumer and expressed your wishes, making sure that that’s actually available at the point of care when critical decisions are being made. And until we solve some of those problems behind the scenes, that are indeed systemic problems, we’re going to have a hard time really listening to and understanding what people’s goals are for their care.
Coaching and Education
In addition, they’re looking for more coaching and education rather than having an authority figure to tell them what to do. And again, this changes over time. It changes based on age. It changes based on severity of illness.
I remember interviewing a woman who was somebody I really admire in terms of her decisiveness and her taking charge of almost any situation. And I interviewed her about an experience she had with, again, grandma syndrome, where if you don’t know about this, it’s a situation where you get paralyzed. And she’d been diagnosed at a doctor’s office and he said, you know, I’d advise you to go to the hospital right now because you’re going to end up there anyway. But he didn’t insist. And she was like, “Well, of course, I need to take make arrangements for my children. I need to take care of a variety of things.”
But by the time she got home, she couldn’t even lift her two-year-old, she couldn’t climb the stairs, and she realized and I realized interviewing her that it was a moment where she needed the doctor to be sensitive. He had information she did not about what the course of that illness was. And she needed to be further educated about what kinds of choices might make sense.
So, in that moment, she needed a more decisive provider than she would at almost any other point in our lives. And that’s a sensitivity skill that, again, we can train people, we can train people, physicians, and motivational interviewing. We can train their staff to recognize some of these things so that we can respond to people where they are in the moment.
Digital Tools Are Expected
And people expect digital tools, access to digital tools, being able to do things outside of normal business hours. And, actually, they’re beginning to vote with their feet for the kind of care they want. And that includes digital care. Accenture has been studying the digital health market for at least since 2008 with serving a set of consumers every year and in 2020. Well, there wasn’t it was not all good news by any means, and it was their 2019 survey that was published in 2020. So this wasn’t affected by the pandemic yet, but they found that for the first time, 25% of people said that they would change providers for a better digital experience. 50 percent said a negative digital experience with their provider affected their whole perception of the care received, and 40% said a positive digital interaction had a positive halo effect in all of their care.
Care and Treatment is a Collaboration
So we’re starting to see these behaviors emerging in terms of really having those expectations about convenience and frictionless care and participation affect the choices of providers that people make. And when we think about the cost control strategies that we talked about earlier and that are the ones that as employers we’ve tended to use to reduce costs, many of them are focused on controlling consumer behaviors more than educating and partnering with them.
Cost Control Strategies
So narrow network strategies reduce the choices of how many providers that you can see. But they may also break long-established physician-patient relationships, and the trust that’s part of that with some negative impacts.
Pre-authorization requirements, again, intended to reduce the cost of care or make sure that care is really necessary. But it adds a lot of friction to the process, and it uses providers’ time, expensive time, and not necessarily in productive ways.
We’ve talked about high deductible plans and some of those perverse incentives that they introduce. And this whole idea that trust is lacking in their cost control measures are really aimed at getting the person the best and most effective care rather than just the least cost care.
Strategies That Match Expectations