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Has the Consumer Been Lost in Value-Based Population Health?

by Janice Young | May 26, 2017

Among the many recent American Health Care Act (AHCA) sound bites was one congressman pointing out that healthcare cost is the real issue at hand. If healthcare costs can be brought down, the issue of premium increases and access will lessen. The recommendation is that the consumer must become a more discerning purchaser of healthcare and do more shopping and cost comparisons.

The “shopping” metaphor doesn’t work all that well. There are many reasons, but the shortlist includes the following:

  • Consumers don’t purchase healthcare like they purchase washing machines.
  • There is still no universally available, credible cost and quality information.
  • Use of price transparency tools – where they even exist – is low and not sustained.
  • There is little competition in many regions of the country.
  • Health plans often limit consumer choice.

Above all, the concept assumes that the consumer is the dominant decision maker. In healthcare, that’s simply not true.

When bringing the consumer into healthcare discussions, other metaphors work better. Ideally, consumers are partner in their healthcare, with collaborative relationships with their providers – looking at the same data, having enough information to understand the pros and cons of various options, weighing cost and quality decisions. If you remember, the early description of consumer involvement was the “consumer-directed” health plan: Consumers at the helm of their healthcare journeys and responsible for managing the course of their benefits, health, and care decisions.

Although the dominant term now is consumer engagement, the market has taken a step back from the original idea of collaboration. Industry conversations of initiatives and technology solutions reveals that engagement is most frequently defined now as consumer compliance with provider directives.  Consumer engagement in 2017 is largely something “done” to consumers.

A lot of the work and discussion on value-based health, population health, and provider-payer convergence focuses less on the consumer than on the new relationships, incentives, and business models between providers and payers. Consumers are referenced, but are frequently on the side lines. While the information may be patient-centric, their perspectives, their involvement in healthcare decisions, and their interactions rarely are.

Health Affairs noted this missing link in a recent article, The Case of Patient-Centered Assessment of Value. As the market moves to a value-based design, and as business models converge, the patient perspective must be refocused and included. And the population health management market reflects a consumer engagement renaissance this year. Many PHM vendors are beginning to invest in and incorporate true patient and consumer engagement strategies that will tackle the environment of fragmented consumer-initiated interactions, consumer and wearable technologies, and consumer data within the platform.

As Health Affairs suggests, all stakeholders benefit from payer-provider-consumer collaboration and convergence. And, the US market may benefit from consumer engagement efforts in European markets. At an international conference on population health in the Netherlands last week, there were notable discussions detailing initiatives to include patient- supplied data, perspectives and expectations.

In the US market, It is time to bring the consumer back to the middle of the conversation. This time, the model is more than a consumer-centric data model – it is a consumer-centric collaborative model.

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