Consumerized Healthcare: More Aspirational than Operational

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The healthcare industry is undergoing a massive change as federal regulations and consumer expectations align, transforming an industry that has an infamously poor customer care record.

Discussions about the evolution of healthcare in the era of the empowered consumer were front and center at the 12th Annual World Health Care Congress in Washington D.C. this week. The healthcare industry is undergoing a massive change as federal regulations and consumer expectations align, transforming an industry that has an infamously poor customer care record.Approximately 26 million more people will be insured by 2017 under the Affordable Care Act (ACA), estimates the Congressional Budget Office. With millions of new consumers expected to shop for health insurance, payers and providers are scrambling to adapt to a consumer-oriented and value-based market.

In the face of an evolving healthcare industry, organizations should focus on the opportunities to provide better patient experiences, noted keynote speaker and Forbes Media Chairman and Editor-in-Chief Steve Forbes. "Why is demand for healthcare considered a crisis when rising demand for other things is considered an opportunity?" he asked.

Indeed, there are numerous opportunities for healthcare organizations to provide better experiences and meet customer expectations, commented Don Peppers, founding partner of Peppers & Rogers Group. During a panel discussion, Peppers noted that consumers expect healthcare organizations to provide the level of convenience and choice that retailers already offer. "Customer expectations are being set by Amazon, JetBlue, and Apple even in healthcare," Peppers said.

And like other industries, he added, healthcare organizations must overcome a number of obstacles that include company culture, data integration issues, and accountability, among other challenges. David Chou, chief information officer at the University of Mississippi Medical Center, agreed that "culture plays a huge role in [technology] adoption."

In discussing the challenges of meeting federal requirements to use electronic health records in a meaningful manner, Chou noted that most organizations "are not there yet" and one of the problems is that the healthcare industry is "risk-averse."

"Change management is hard," said William Copeland, Jr., U.S. life sciences and health care leader at Deloitte LLP in a panel discussion about the transformation of health plans over the next five years. "Most people in healthcare are used to the mentality that [when it comes to payers and providers] someone wins and someone loses," he said. "Payers and providers don't share data and no one has a complete picture [of the patient]."

Michael Lachenmayer echoed Copeland's point that it's imperative for health insurance companies and providers to be transparent and share data, but there are numerous barriers. In addition to data integration challenges, "it's not easy to publish your rates," Lachenmayer commented. "The risk is that's a source of competitive advantage. The other thing is there are rates we have out there that if one health system knew how much we paid another health system, we'd have a major problem."

While there was no shortage of discussions about the need for healthcare improvements during the conference, industry experts had few concrete answers on how to implement the solutions. There's also a fear that little will change, admitted Danette Coleman, senior vice president and general manager of individual and family business at Medica.

"I'm afraid we won't transform," Coleman told attendees. "We talk a really good game, but then you get to the same contract negotiations between the payer and provider and it doesn't feel transformative. It feels like we're both just looking at our bottom lines."

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