Amid rising costs, personalized healthcare experiences are a must

June 3, 2019

Patients have a growing number of options for care, so providing a personalized end-to-end experience is no longer optional.

When the cost of a good or service rises, someone typically wins. But, this is not necessarily the case in healthcare. From bankrupting patients with surprise bills to physician practice cash-flow headaches to potential disruptions for traditional insurers, almost all stakeholders are struggling.

Healthcare costs are inflated to unreasonable levels with little hope on the horizon. According to a new report from CMS, this trend is expected to continue through 2027. Since 2011, patient cost-sharing has risen by 66 percent and deductibles have increased by 230 percent. This means that as costs rise, so does the percentage of that amount that patients are expected to pay. 

In contrast, while costs continue to rise, the end-to-end healthcare experience for patients has not significantly improved. This is somewhat ironic, considering healthcare is often far less personalized than what you get in less life-critical industries like retail. We talk about the “consumerization of health care” repeatedly, but that promise has left many wanting more.

Why should Nordstrom, Nike and Best Buy have a better ability to leverage data and cater to consumers’ preferences than a medical practice or health system? The retail approach should be leveraged across healthcare, offering personalized experiences that give patients the “superior experiences” they expect and deserve, without necessarily increasing costs further. With patients fed up with rising costs, everyone in the healthcare ecosystem - especially physicians - should take the concept seriously. 

Such experiences start with personalization throughout the entire patient journey - from checking in for an appointment to the clinical encounter to payment for a bill (especially considering that patient satisfaction ratings fall by more than 30 percent from post-discharge through the billing process). And this personalization starts with data and technology. 

Here are three areas where better data use and technology can improve and personalize the patient experience:

 

Patient check in 

Checking in for appointments is painful, largely because it’s one of the most archaic processes in the modern world. Beyond a few of the most technologically advanced providers, it still consists of filling out paper form after paper form every single time you go to a provider.

EHRs were supposed to both create a more seamless experience for healthcare consumers and deliver more holistic patient histories to providers, but figuring out how to make this work better is a problem that even Apple has worked hard to figure out. While they seem to be making progress, as exampled by a recently signed program with the VA to give veterans access to health records on iPhones, there is still more work to be done. 

Imagine if we could finally make the promise of portable EHRs, stacked with a comprehensive view of patients’ health data, a reality. Then layer on top the personalization technology power used in both brick-and-mortar and online retail. Personalization engines, powered by machine learning, have raised the table stakes in e-commerce. Some analysts actually predict it will be a multi-trillion-dollar industry.

If healthcare can use similar technology to connect patients’ personal and clinical data together (while adhering to strict privacy standards) and remove paper headaches, we can eliminate a lot of the patient and provider administrative burden at check in. Patients would spend less time struggling to fill out forms and remember every single health condition or procedure they’ve ever had in their life. 

There would also be fewer administrative issues (and possibly costs) for staff recording data and filing away paper forms. Providers might also spend less time trying to piece all of that information together to properly diagnose and treat patients. All that “less” gives everyone “more,” ultimately improving the experience for patients. 

 

Patient-specific health plan information

When providers see patients and diagnose their conditions, they typically have a sense of what treatment options they want to prescribe. However, many times some of those treatments - whether procedures or prescriptions - are not covered under patients' plan. Or, there are lower-cost alternatives available. 

Patients don’t often think to ask about the cost share of a treatment or even if it’s covered under their benefits. It’s usually not until after patients leave - or worse, receives a bill - that they find out. In this day and age, this is unacceptable.

In order to truly provide patients with a superior healthcare experience, we need to arm clinicians with the information needed to better inform care decisions, not only on based on treatment but also on cost, specific to each patient. Given that providers have access to every patient’s health plan information, it seems very possible and quite viable for providers to improve the patient experience by providing benefit-level information enabled through individualized health plan data right in the treatment room. 

Provider office staff usually gather plan information upon first visit, so it’s  possible for health plans to partner with the provider and health IT communities to build better technologies that make providers stronger arbiters of cost transparency.

There is an early example of this in action in the form of CVS Caremark’s Real-Time Benefits technology. Using the “pipes” from Surescripts and CVS’ pharmacy benefit manager plan information, providers have access to plan-specific drug benefits information and lower-cost alternatives right in the treatment room. That way, providers not only can be reminded of prescription options that might be lower in cost for their patients, but patients won’t be surprised when they arrive at the pharmacy. Imagine if patients could know the full expected cost of all healthcare services and treatments before they walk out of the doctor’s office. 

 

Personalized healthcare payments 

Consumer Reports found that nearly three in 10 insured Americans had an unpaid medical debt sent to a collection agency, which in turn impacted their credit. Of those, 24 percent didn’t realize the bill was owed and 13 percent said they’d never received the bill in the first place.

Healthcare organizations are not skilled in informing patients about their bills and often do not provide smart payment options. Many times, patients are “ping-ponged” back and forth between providers and their health plans as costs get adjusted or deductibles are applied, leaving them largely unclear on their true responsibility. Health plans, especially, have a 360-degree view of their members’ recent healthcare services, which can provide tremendous insight for a provider’s billing procedures.

Currently, organizations like Kaiser Permanente, which has the advantage of being both the payer and provider, is doing some of this with its cost estimate tool and through personalized payment options, but there is a greater opportunity for this to occur across healthcare. If, by sharing data between providers and payers, a medical practice knows that a patient recently had a lot of services resulting from an episode of care - and thus is on the hook for thousands in cost shares - that might present an opportunity for practices to offer more personalized payment terms, such as payment plans, discounts or introductions to financial assistance programs. 

With costs where they are today, patients deserve better experiences and more value. We shouldn’t accept the fact that it is more seamless and personal to shop online than it is to get care, but it will take a larger embrace of data-sharing and digital technologies to make this a reality.

 Florian Otto is co-founder and CEO of Cedar, a patient payment and engagement platform.