For years, entrepreneurs have tried to apply the same consumer Internet strategies that worked for Amazon, Google, and Uber in retail, entertainment, and transportation to revolutionize health care. Shouldn’t we be at a tipping point by now? Unfortunately, we’re not.
One reason for this is that entre
preneurial innovations have been so narrowly focused on self-directed activities which are largely disconnected from traditional health care. When patients are ill, they receive clinical care as part of their relationship with credentialed providers, who also prescribe their pharmaceuticals. But in these relationships patients typically lack control of the search, selection, and purchase of the services and supplies.
To win consumer adoption of innovative, Internet-based healthcare applications will depend on the use of four proven consumer Internet strategies:
- Transparency of Information
- Permission-based Personalization
- Continual Business Model Reinvention
1. Transparency of Information
Across industries, Internet search has transformed global commerce by empowering consumers to make decisions with far more information than ever before. This access to more information has enabled transparency, but transparency of information still lags in health care. More transparency of healthcare information is regarded by experts and consumers alike as central to reforming health care and empowering patients. Unfortunately, there are three big obstacles to transparency of information in health care:
- No “real-time adjudication” — In other words: Price. Unlike in most other consumer facing industries, determining the cost and price associated with a healthcare service is extremely hard. Healthcare product and pricing data is fragmented and scattered across payer systems, which prevents consumers from getting accurate cost and price information on the care they receive.
- Data Exchange Restrictions — Sharing patient data across healthcare entities is difficult due to regulations, internal provider organization processes, and vendor practices. One obvious blocker is HIPAA, which is meant to promote the exchange of patient information, yet has become a giant excuse for anything but.
- Non-Standard Patient Data and Quality Metrics — Patient data is scattered within and across organizations in many versions of different systems. The app store model has fragmented consumer-supplied data even more, scattering it among disconnected individual healthcare applications like MyFitnessPal. Likewise, quality metric definitions vary, and policy experts and front-line providers often disagree on how to apply them.
2. Permission-based Personalization
Permission-based personalization takes the proven techniques of direct marketing to a new level by encouraging the consumer to swap personal information in exchange for online transactions that are more interactive, accurate, and complete. Unfortunately, health care is way behind here. The sad irony is that the industry one assumes is most personal is the industry that most consumers report treats them “as a number.” As consumers, we should be able to get care recommendations specific to our personal situation rather than generic printouts from a rack in the waiting room — or simply set up a list of caregivers and family who have permission to see our medical records.
This is where payers and health systems who build rich permission-based relationships could have a significant advantage as insurance product choices proliferate and benefits are more finely targeted to population sets. Patient and member portals are beginning to provide enough valuable personal detail to drive adoption. However, the failure to combine administrative data validated by one’s insurance company, with clinical information validated by one’s doctor, continues to hold personalization in health care back, almost as much as the lack of trust in the data included in any reliable dataset. For most Americans, there is no HIE and trust in the healthcare establishment is low.
A key insight of the original Internet entrepreneurs was that having connected computing everywhere would render obsolete the idea that scarcity creates value. The last 20 years have proven that if you can aggregate the human community online, revenue will follow.
The power of the consumer to choose applications and websites that provide them with value is well established in health care, but is largely disconnected from payers, hospitals, and regulators. For example, Under Armour, since its acquisition of MyFitnessPal, claims 140 million unique visitors. Unfortunately, few patient-facing applications are linked closely to payers or providers. For the healthcare system to work in the new world, deeper integration of these consumer technologies — and the data that underlies them — must be made available and open across the healthcare ecosystem — including consumers themselves.
Fortunately, telehealth is a positive sign that we are moving in the right direction. Having found its original foothold outside the mainstream as an urgent care alternative, telehealth uses the network to provide consumers with quick access to a doc via search on their smartphone and then delivers service over the same channel. Once a disconnected option, telehealth is exploding into the mainstream as a viable alternative interaction model for physicians with their own patients, based on close integration with the eligibility, referrals, authorizations, and payment systems of the payer.
4. Continual Reinvention
In the 90s, business thinkers predicted the Internet would drive wave after wave of fundamental business restructuring by giving consumers so many information streams and purchase options that traditional institutions would lose much of their power to “channel” them through traditional structures. As more consumers adopt a network, the network becomes more powerful and offers more opportunities, leading to a constant cycle of disruption, learning, and innovation.
In health care, we have plenty of examples of disruptive business models, from CVS’s Minute Clinics and Zoom+, who are changing how some patients receive routine care, to insurance start-ups like Oscar Health. Each of these disruptive innovations has one thing in common: each depends on the use of the network in today’s always-connected world. Each either connects the consumer to the payer to ensure the consumer’s costs are covered OR connects the consumer directly to a credentialed clinical provider outside of the payer relationship, focusing on the growing share of healthcare cost paid directly by the consumer.
Inclusive Networks Needed
Everyone in health care is trying to discover, design, and build a business model that will satisfy the healthcare consumer’s most important priorities, while meeting the goals of the Triple Aim. Discovering and implementing these new models will not be a slam-dunk for the healthcare establishment. Payers and providers will need to build competence through API-based platforms in order to engage the energies of entrepreneurs and providers. They must build networks that include, not exclude, the new forms of clinical organization and consumer empowerment, including the ability to personalize relationships based on world-class informatics at scale, the building of trust over long time periods, the intensive use of collaborative computing techniques, and the development of compelling consumer connections. Only then will the classic consumer Internet strategies enable the power of consumerism to drive needed change in health care.
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