Physician’s Guide to the New Consumer Market

July 31, 2014

With costs front and center for patients, in simple and stark terms: If you can’t deliver what the consumer perceives as quality, you will lose.

New studies are showing that overall healthcare spending is down; with the paradox being that individual healthcare spending is dramatically increasing.

Skyrocketing deductibles, copays, and co-insurance have dramatically shifted financial responsibility to consumers sparking a very personal realization of the real cost of healthcare. Healthcare costs are becoming more tangible to the public and so has their perspective of value and quality.

This is a critical and profound economic shift that will affect medical practices. Be aware and be prepared!

Patients paying an increasing share of the cost will expect better service, superior outcomes, and value, on their terms - not yours. It matters little what the medical value might be. What matters is what the customer expects and appreciates. Physician practices must move from providing professional services in a manner determined best for the provider into the competitive world of consumer-centric retail services. Patient-centric care will be here, if not because physicians embrace it, then because economics will dictate it.

You see it manifesting in plan designs, cost sharing, increased demands for price transparency, patient's rights, patient engagement, shared decision making and demands for improved access, quality, results, and better communications.

Your world is changing, and all of that education, training, and experience you have amassed as physicians cannot hold back for forces of change. In simple and stark terms: If you can’t deliver what the consumer perceives as quality, you will lose.

Quality might still be measured in technical terms, and these measurements will be refined with improved data exchange, but the most important metric for your practice will clearly be "patient satisfaction." This is not about sacrificing good medicine just to play to the desires of the patient, but it is about investing in patient education, patient engagement, patient empowerment, and shared decision making. The era of the paternalistic physician practice is ending. What will not change is those organizations that produce superior quality, value, and improved outcomes at a lower cost, and a corresponding brand identity, will be increasingly valued by patients, insurers, and employers. If you want to be in position to dictate your future, you will need your patients as supporters and allies. That means transforming your practice and aligning with other similar minded practices, to produce a critical loyal patient following that will demand your services, compelling insurers to conform to your model, not theirs.

Healthcare has become a commodity. It happened first in the hospital arena.

Just 30 years ago, there were about 7,000 short-term acute care hospitals, virtually all of them independent. Twenty years later, and in a period of strong growth in healthcare, almost half of them are gone. Today, only a handful of tiny rural hospitals are independent.

The physician component of this restructuring is here (narrow networks). When the captains are picking their teams, all that counts is what you can do on the field to help the team to win.

The winning teams will be patient centric. Managing those who are chronically ill is critical. So will appealing to those patients who you rarely see. It is those patient premiums that will help to pay for the high utilizing members. If they walk away because they don’t perceive your value, so does the income from their premiums in a value-based system. In a prepaid, gain-share, or budgeted system, it is critical to have a well contented mass of patients who don’t require intensive services, but provide the resources to treat the chronically ill.

The winning teams will stress with every recruitment effort, with every message, with every presentation, and with every conversation, that they are all about building a truly patient-centric model, where patients value their relationship with their personal network physician. That means that patent satisfaction comprised of relationship, retention, and results are the most important quality goals. The networks will be handpicked, will have an enabling IT platform and risk-based health plan contracts.

The consumer demand for these services will guarantee long-term value and the financial success that will follow.

Willi Sutton said, "Follow the money." Well, here it is, and, the last place that you want to be is on the sidelines wondering why you weren’t picked.