Consumers' Influence on Health IT in 2015
Health consumers and health care providers live in parallel universes when it comes to health IT, a smart CMIO friend of mine recently told me. 2015 will be a year when consumers, patients and caregivers pressure providers to converge toward greater convenience, access, transparency and quality using health IT. This health IT forecast for 2015 focuses on the forces that could advance and slow that convergence.
Consumer-directed care gets real as people get shopping. The phrase "consumer-directed health" came into use when employers' health insurance consultants began to design plans where employees bore more financial skin-in-the-game, in the form of higher copayments for services and prescription drugs. That was over a decade ago, and consumers didn't direct their care much as the copayments didn't feel like real money to them. In 2015, most workers who get health insurance at the workplace, as well as people buying health insurance on the exchanges, will face some level of high deductible, which has begun to hit covered people hard enough to feel like real money. This is forging consumer-like behavior in the form of shopping for services first and foremost on the basis of cost, which the first year of health insurance exchange shopping behavior demonstrated. An analysis by Healthsparq also found that certain types of medical services can motivate shopping, with expectant mothers being some of the most frequent health care shoppers according to Healthsparq's data. It added, "With labor and delivery varying between $9,485 and $25,254 in Oregon alone, shopping can make a huge difference."
Word-of-mouth for doctor-shopping goes online. Consumers have begun to use online physician reviews to find doctors. Software Advice's 2014 survey found that 25% of people used online reviews, growing by 68% since 2013. Yelp was the most popular online review site and was tied with HealthGrades for being the most-trusted online source for such reviews. In 2015, consumers will more frequently access transparency tools when shopping for health care, and they will be frustrated with the lack of consistency and completeness of information available.
DIY has come to health care. Beyond shopping for insurance and providers, consumers are seeking the same quality retail experiences in health care they appreciate in other aspects of their lives. Financial services, travel and restaurants' self-service options have set a challenging bar for the health care industry. Industry conferences lure attendees with the question, "Where are the Amazons and Ubers in health?" An obvious self-service on-ramp for health care providers is online scheduling, which Accenture found two in three patients expected to do by the end of 2019. Self-service on the part of consumers could save $3.2 billion for U.S. health care providers by saving staff time for appointment-booking, as well as filling in open spots and last-minute cancellations in practice schedules.
Consumer wearables: Getting them to stick. In these weeks leading up to the 2014 holiday shopping season, every Big Box, consumer electronics and pharmacy chain store print ad has featured at least one brand-name digital health tracker, usually in wristband form. PricewaterhouseCoopers' consumer survey on wearables found that one-half of U.S. consumers planned to buy one of these devices in 2015. 2015 may be the year of irrational exuberance for wearables, a forecast which the 2014 Gartner Hype Cycle supports. While forecasts for digital health tracking devices are bullish, most do not factor in consumers' willingness to pay for such devices. PwC found that two-thirds of consumers would be willing to use self-tracking devices for health when given them at no cost by employers. As employers couple high-deductible health plans with wellness initiatives, companies will play a growing role as "sponsor" for health tracking devices. Seventy percent of consumers say they would wear employer-provided wearables streaming anonymous information to a database in exchange for a discount on health insurance premiums. This scenario of a "quantified workplace" is described by Gigaom Research, which looks to a new generation of employee wellness programs that support a culture of health, which includes employee health tracking "nudged" with behavioral economic incentives and real-time tools supporting behavior change.
Crossing the apps chasm from health to medical. While the health apps consumers use are overwhelmingly focused on food/nutrition and exercise, physicians are beginning to value the role of apps in clinical care. IMS Health launched its App Script store one year ago to enable doctors to develop, crowdsource and group-curate favorite tools. In 2015, more physicians will recommend or "prescribe" apps for patient self-care. In Canada, PwC's team has envisioned an Apps Pharmacy as an integral component enabling the virtualization of health care. In describing PwC's work with clinicians in Canada and the U.S., Will Falk explained: "Let's get a clinical group together as we've done for prescription drugs, a [pharmacy and therapeutics] committee. Think of this as a P&T committee for health apps assessing what apps we have and which ones might be good for our clinicians to use in practice." The challenge for this group would be to assess and curate what's on the "apps formulary," identifying those apps where evidence has proven them to be effective and safe. A similar idea is being implemented in the United Kingdom where the National Health Service is evolving an apps library to assist British doctors and patients in accessing the best health apps. Another type of curation is emerging with self-tracking devices: Think Birchbox-comes-to-self-care. Babyscripts recently launched a product that bundles a Wi-Fi scale and a blood pressure cuff, attractively boxed up with baby booties for pregnant women to track weight and blood pressure. The company, 1EQ, is working with groups of obstetricians who purchase the boxes on behalf of their low-risk pregnant patients who can choose to opt into the program and download the Babyscripts app that organizes their personal health data.
Telehealth will proliferate in 2015. Convenience is driving health consumers to new care delivery settings, as people are using mobile platforms and videochat in their daily life. At the same time, the economics of health care reimbursement are aligning with consumers' interests in convenience, making telehealth more viable than ever before. Halloween ushered in the new CMS reimbursement level for doctors who "see" patients virtually. In 2015, Medicare physician payments will cover remote patient visits with the CPT code 99490 at a rate of $42.60 per encounter. A code is the key for getting paid in health care. Wellness visits, psychotherapy and prolonged visits are included in the new Medicare payment provision. Medicare's coverage of remote patient care will inspire commercial insurance companies to expand telehealth coverage. A handful of providers already use telemedicine to extend physician services to patients. Kaiser Permanente's Northern California region estimates that it conducted 10.5 million patient visits virtually in 2013, representing about 50% of all patient visits for the plan. To bring telehealth direct-to-consumer, Walgreen has partnered with MDLIVE to bundle their physician visit capability into the Walgreen mobile app, starting in California and Michigan.
The importance of social and consumer-generated data. A 2014 Institute of Medicine report recommended that electronic health records accept consumer-generated data. This recommendation is based on the growing recognition of the role of the social determinants of health. IOM identified 17 "domains" for such data, including race/ethnicity, tobacco use, alcohol use, residential address, educational attainment, financial resource strain, stress, depression, physical activity, social isolation, intimate partner violence and neighborhood median-household income. One example of the practical use of these data for health care outcomes and cost savings was demonstrated by Cincinnati Children's Hospital Medical Center, which analyzed data for children with asthma who were admitted to the hospital. Research revealed that children living with poor air quality were 84% more likely to be readmitted to the hospital. Capturing data where people "live, work, play and learn" would enable providers to better manage population health and take on the financial risk that value-based health plans and accountable care organizations demand.
The dark side of consumer health data. In an article titled, "They Know You Buy Viagra, and They Want to Sell You More," Bloomberg reporters discuss a Big Data analytics process called "matchbacks," where third parties mash up consumer-generated data with health care data (such as retail receipts with pharmacy claims) to identify consumers for pushing relevant advertising. This is an area where HIPAA may not apply, and consumers are largely in the dark about the practice. I dove deep into this growing phenomenon in a paper, titled, "Here's Looking At You: How Personal Health Information Is Getting Tracked and Used," that was published by the California HealthCare Foundation. CHCF publishes iHealthBeat. The Federal Communications Commission has begun to focus on this area, which could involve HHS as it relates to HIPAA and health information privacy and the Federal Trade Commission as the issue relates to advertising and commerce.
Consumers and health privacy: Ambiguity. Data breaches in health care are expected to grow in frequency in 2015, according to the Experian 2015 Data Breach Industry Forecast. Experian attributed the increase in risk to the proliferation of EHRs and consumers' growing use of health wearables. "Most health care organizations are not prepared for the level of sophistication and persistence we have seen from attackers in the retail segment," according to Ken Westin, security analyst with Tripwire. Furthermore, expanded use of mobile apps and BYOD devices add to risk for health breaches, based on analysis by Arxan Technologies. But consumers see the value of EHR systems with respect to privacy. The National Partnership for Women & Families survey concluded that, "The more patients experience the benefits of EHRs, the more they trust providers to protect their privacy; and the more they trust that their privacy is protected, the more they use and benefit from EHRs."
Consumers still highly trust physicians. As consumers continue to highly trust physicians, patients expect their doctors to be good data stewards for their protected health information. One of the National Partnership's strategies for patient engagement is to foster trust with patients by showing how their health information is stored, exchanged, used and protected. That process may be more challenging than the Partnership anticipates: A special poll of more than 1,800 physicians conducted for this Perspective by Sermo found that physicians' biggest technology challenge for 2015 will be EHRs, cited by 59% of the responding doctors.
As consumers bear more financial and clinical decision-making responsibility, their influence will be seen and felt throughout the health care ecosystem. Given peoples' ubiquitous use of digital technologies in their daily lives, consumers will push providers and payers to be as user-friendly as Amazon, OpenTable and Uber. Those health providers and health insurance plans that provide retail-style convenience will be valued by the growing ranks of health care consumers. And health IT underpins the Uber-ization of health care.
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