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Title: Consumers: Their Wish, ITs Your Command


1
Consumers Their Wish, ITs Your Command
  • Holly G. Atkinson, MD
  • Chair, iVillage Health Initiatives
  • Editor, HealthNews
  • Massachusetts Medical Society
  • Assistant Professor of Public Health
  • Weill Cornell Medical College

2
Bottom line
  • The consumer is the customer.

3
1 ITs about spending the money.
  • Consumers have to pay more.
  • Consumers are willing to pay more.

4
Premiums are Rising Again
Three year increase 1996-2002 33.3
Annual Change in Average Health Benefit Cost
13 - 20
Source The MedTrend Group/William M. Mercer, 2002
5
What Drove the Rise in Costs?
What made up the 13.7 increase in premiums
between 2001- 2002?
Source The MedTrend Group/PriceWaterhouseCoopers
Study, April 2002
6
Employers Responses
  • Shifted from HMOs to PPOs
  • Shifted health premium cost increases to
    employees
  • Reduced benefits
  • Increased out-of-pocket costs copays,
    deductibles and co-insurance
  • Launched Consumer-Directed Health Plans (CDHP)
  • In some cases, dropped health coverage entirely

7
Number of Uninsured Rising
2009 Estimate 48M 61M if recession
Estimated
Percentage
Millions of Individuals
Source The MedTrend Group/US Department of
Commerce, Economics and Statistics
Administration, Bureau of the Census, 1998
National Coalition on Healthcare, 2002
8
Billions and Billions Paid
  • Alternative Medicine - 27B in 1997 with 10
    growth since
  • Supplements - 19 B up 5x in 10 years
  • Diagnostic procedures
  • Total body scans
  • Online DTC laboratory tests
  • Genomic screening
  • Quality-of-life therapies
  • Cosmetic surgeries 6.9 M procedures
  • Laser vision correction 1.8 M procedures

9
1 Implications
  • Consumers are spending more of their own money
    either because they are forced to or choose to.
    They are willing to experiment and pay for it if
    they perceive a value.
  • Nobody spends somebody elses money as
    carefully as they spend their own. -Milton
    Friedman
  • Bottom line Consumers will become far more
    discerning in choices. Those who offer them
    cost-effective/compelling choices will win.

10
2 ITs aboutmaking the decisions.
  • Consumers are becoming medical
  • entrepreneurs.
  • Consumers have an eight-percent
  • solution.

11
Entrepreneur
  • Someone who runs a business at their own
    financial risk.
  • -Websters Dictionary

12
Critical Issues in America?
Source The MedTrend Group/ Health Confidence
Survey 2002
13
Key Trends Among Medical Entrepreneurs
  • Making decisions based on benefits received, cost
    of care and convenience, rather than access to
    preferred physician
  • Making decisions on which hospitals to go to
    based on key characteristics, rather than rely on
    physicians recommendation
  • Searching for information to support decisions
  • Responding to direct marketing

Source Solucient, National Trends in Health Care
Consumerism, 2002
14
Most Important Factors in Selecting a Health Plan
Source Solucient, National Trends in Health Care
Consumerism, 2002
15
Physicians Role in Hospital Selection
Source Solucient, National Trends in Health Care
Consumerism, 2002
16
Most Important Factors in Selecting a Hospital
Source Solucient, National Trends in Health Care
Consumerism, 2002
17
Types of Information Researched by Consumers
Source Solucient, National Trends in Health Care
Consumerism, 2002
18
Major Sources of Health Information
Source Solucient, National Trends in Health Care
Consumerism The Influential Health Care
Consumer, August 2003
19
Responsive to Targeted Marketing
20
The Eight-Percent Solution
  • About eight percent of the populationapproximate
    ly 17 million individualsmake decisions for
    about 17 of the population and may influence up
    to 33 of entire population.

21
Influential Health Care Consumers
Source Solucient, National Trends in Health Care
Consumerism The Influential Health Care
Consumer, 8/2003
22
Influential Health Care Consumers
  • Spend a lot of time gathering information
  • Primary decision makers in household and use
    broader set of criteria than average health care
    consumer
  • Above average prevalence of disease in family and
    themselves
  • Highly responsive to targeted marketing efforts
    of hospitals and MDs.

Source Solucient, National Trends in Health Care
Consumerism, 2002
23
Propensities of the Influencers
Source Solucient, National Trends in Health Care
Consumerism The Influential Health Care
Consumer, 8/2003
24
Major Sources of Health Information
Who Use as Source of Information
Source Solucient, National Trends in Health Care
Consumerism The Influential Health Care
Consumer, 8/2003
25
Most Important Factors in Selecting a Hospital
Saying Factor Was Very Important
Source Solucient, National Trends in Health Care
Consumerism The Influential Health Care
Consumer, 8/2003
26
Who Are The Influential Consumers?
  • Age distribution is similar to general
    population
  • Income influencers more prevalent at the two
    ends of the income scale, low or very high
    income, but almost 60 have moderate incomes
  • Gender 60 are female
  • Life stage mothers 18-34 and single women 35-54
    with or without kids, any income level.
  • Group is likely to grow as population ages,
    utilizing more services and becoming more
    discerning.

27
Strategic Importance of Women
All Ages
Age 65
Age 85
Male49
Male30
Male42
Female51
Female58
Female70
Source US Census Bureau, Resident Population
Estimates of the United States by Age and Sex,
2000
28
2 Implications
  • Consumers are enlightened and independent, and
    are willing to make their own decisions.
  • One of consumers greatest demand is for
    information not just about diseases, but the
    full range of information that one needs to make
    a wise healthcare decision. Dr. Holly Atkinson
  • Bottom Line Consumers are fast becoming the
    most important decision makers in healthcare.
    Those who cater to themproviding them with
    critical information and forging a relationship
    with themwill win in the marketplace.

29
3 ITs aboutdelivering the goods.
  • Consumers expect miracles.
  • Consumers demand equal treatment.

30
Todays Consumers Are Better Educated and Have
More Money
estimated
Source The MedTrend Group/Institute for the
Future, 1998 U.S. Bureau of the Census, 1996.
31
Baby Boomers Driving Demand
1990
Source The MedTrend Group/U.S. Census Bureau,
HCAB 2002
32
Expecting a Miracle
  • In the US, the baby-boom generation has
    transformed every institution with which it has
    come into contact. As this generation ages and
    begins to have chronic disease, we can expect
    healthcare to be next They have made
    consumerism a way of life The aging of the baby
    boomers and the Internet make up a powerful
    combination that should accelerate the rate of
    change in the healthcare system.
  • -T. Lee, NEJM, 344, 26 2001

33
The Outcomes Problem Gender
  • Women CVD
  • 1 killer more women than men have died each
    year since 1984, yet women receive
  • 33 of angioplasties, stents and bypass surgeries
  • 28 of inplantable defibrillators
  • 36 of open-heart surgeries
  • Less beta-blockers, ACE inhibitors or even
    aspirin post MI
  • Women still only 25 of subjects in research

Source National Center on Health Statistics,
NHLBI and AHA, 2002
34
The Outcomes Problem Race
  • PHR Panel found over 400 peer-reviewed articles
  • documenting racial disparities such as
  • Blacks 13 less likely to have coronary
    angioplasty and 33 less likely to have bypass
    surgery than whites.
  • Among preschool children hospitalized for asthma,
    only 7 percent of black and 2 percent of Hispanic
    children, compared with 21 percent of white
    children, are prescribed routine drugs to prevent
    future asthma-related hospitalizations.
  • Blacks are nearly twice as likely as whites to
    have above-knee amputations for PAD.
  • Blacks 27 less likely than whites to receive a
    major procedure for Rx of colorectal cancer.

Source Physicians for Human Rights Report The
Right to Equal Treatment, 2003
35
Lack of Awareness
  • Physicians do not generally perceive bias in
    the health care system. A Kaiser Foundation
    National Survey of Physicians conducted in March
    2002 found that 55 of doctors asserted that the
    health care system rarely treats people
    unfairly based on racial or ethnic background an
    additional 10 said never. Similar denials were
    found of unfair treatment based on gender, or on
    fluency in English."
  • -PHR Report The Right to Equal Treatment, 2003
    _at_ www.phrusa.org

36
3 Implications
  • Consumers expect consistent, high-quality
    outcomes from their providers.
  • Of all the forms of injustice, discrimination
    in health care is the most cruel. -Rev. Martin
    Luther King Jr.
  • Bottom line Consumers want quality care.
    Providers must offer both the perception and
    reality of delivering great healthcare at
    affordable prices. They must also track their
    outcomes and publish their statistics.

37
4 ITs aboutproviding the service.
  • Consumers are connected, and want
  • high tech.
  • Consumers are people, and want
  • high touch, too.

38
The Arc of Change
  • We always overestimate the change that will
    occur in the next 2 years and underestimate the
    change that will occur in the next 10 years.
    Dont let yourself be lulled into inaction.
  • -Bill Gates, Business _at_ the Speed of Thoughts,
    1999.

39
Technology has changed everything!
40
E-Health Consumers Dissatisfied
  • Increased expectations of service based on other
    industries healthcare hasnt delivered.
  • Using web mostly as modern Encyclopedia
    Britannica, but prefer much more.
  • Frustrated by the variation in quality and
    availability of information on the Web.
  • Almost 3/4 say theyd change to a physician/
    practice that had website and email capabilities.
  • Industry has failed to provide consumer-centric,
    personalized, interactive functions.

41
Consumers Want High Tech
  • Publish disease information provider outcome
    report cards drug outcomes, prices, and
    alternatives lab tests results and
    interpretation consumer-generated satisfaction
    ratings
  • Interact email with doctors health plans,
    reminder messaging, risk assessment tools
  • Transact scheduling, decision support tools,
    prescription renewal, e-commerce, account
    management
  • Integrate computerized patient record, disease
    management, account management, in real time 24/7

42
Consumers Want High Touch Too
  • The new generation of patient also wants
    access. They do not want to wait two months for
    an appointment in fact they do not want to wait
    at allPatients who have questions they would
    like answered and requests for prescription
    renewals, referrals and appointments do not see
    why these issues cannot be raised on a weekend.
    Sometimes, patients would like to talk to a human
    being, not a computer masquerading as a
    receptionist, and they do not want to wait 30
    minutes for a harried nurse, nurse practitioner,
    or doctor to return their call. -T.
    Lee, NEJM, 344, 26 2001

43
Consumers Are People, Not Cases
  • I will remember that there is art to medicine
    as well as science, and that warmth, sympathy,
    and understanding may outweigh the surgeon's
    knife or the chemist's drug.I will not be
    ashamed to say "I know not," this awesome
    responsibility must be faced with great
    humbleness and awareness of my own frailty. Above
    all, I must not play at God.I will remember
    that I do not treat a fever chart, a cancerous
    growth, but a sick human being, whose illness may
    affect the person's family and economic
    stability. My responsibility includes these
    related problems, if I am to care adequately for
    the sick.
  • -Hippocratic Oath

44
4 Implications
  • Consumers expect a high level of service, which
    other American industries are providing.
  • Patients today are increasingly unwilling to
    live with the perception that their needs are
    going unmet. -Dr. Thomas Lee
  • Bottom line Consumers expect both good customer
    service by providers (courtesy and respect) and
    highly functional web-based applications
    (reliable, fast, easy and secure) that give
    access to their local providers.

45
Its aboutengaging in best practices.
  • Consumers want from the healthcare industry what
    they get from the best of other American
    industriesworld class products and services.

46
Learning from American Industry
  • Market forces that made other American
    industries become more focused and
    consumer-friendly are reshaping healthcare
    delivery. -Regina Herzlinger
  • Forces
  • Businesses are becoming more focused
  • Consumers are demanding greater service
  • Technology is changing everything

47
Convenience Clinics
  • Reasonably priced, integrated care offered in a
    convenient and efficient manner
  • From Medical Monoliths to Focused Factories
    one-stop shopping, 24/7, that save the consumer
    time, money, and sometimes even their lives

48
Conclusion
  • The consumer is the customer.
  • Your challenge is to consistently provide a level
    of service to the customer not yet seen in
    healthcare.
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