Shopping cartImagine walking into a storefront where you can shop for an arthroscopy procedure, mammogram, or appointment with a primary care doctor based on price, availability, quality, and other consumers’ opinions?

Welcome to the “health care automat,” the online healthcare marketplace. This is a separate concept from the new Health Insurance Marketplace, or Exchange.

This emerging way to shop for and access health care services is explored in my latest paper for the California HealthCare Foundation (CHCF), Help Yourself: The Rise of Online Healthcare Marketplaces.

What’s driving this new wrinkle in retail health care are:

  • U.S. health citizens morphing into consumers, whether managing out-of-pocket spending for services not covered by health plans; growing high-deductible health plans where people are spending more of “my” money up-front before their plan kicks in; and, uninsured people looking for various health services “à la carte”
  • Growing demand for transparency of health care prices, quality, and locations by payers (employers, especially, trying to manage medical trend cost growth, and patients)
  • Peoples’ interest in healthcareDIY – shopping for, researching, accessing care for themselves the way we shop for other goods and services at-retail
  • Expanding platforms for online health, from report cards to on-ramps for finding a primary care provider and scheduling appointments online for convenience.

There are a few dozen of these marketplaces online as of mid-2013. They vary by:

  • Business model, and how they generate revenue
  • Geographic focus, from national to hyper-local
  • Types of services offered, and comprehensiveness of those services
  • Features and customer-support options, and
  • Pricing mechanism, whether price-setting, price-taking, percent discount, or via negotiation.

Examples covered in the report include the very successful ZocDoc, akin to an OpenTable for doctors’ appointments, now available in major metropolitan markets; ClearHealthCosts, led by a journalist who is evangelizing price transparency for health services in and beyond New York City; PokitDoc, a portal of health provider “storefronts” where consumers can search for a service by geography, price and other features;  DocASAP, aggregating physician appointments through health plan channels; OKCopay, designed like a for health services; Leslie’s List, a Chicago-based Yellow Pages-style portal built by a doctor responding to her patients’ needs; and, HealthSouk, focused on providing people access to dental services in California especially salient for the safety-net population in the state.

As with all new technologies and tools in health care, there’s an adoption curve that’s a function on drivers like those listed above, and barriers that can slow take-up of the innovation. Some of the challenges that online health marketplaces face include,

  • Consumers’ not realizing they “need” health price information – a market in search of demand – as Leslie’s List’s founder, Dr. Leslie Ramirez, has found
  • The Affordable Care Act (health reform), which could both foster and retard use of these marketplaces
  • The challenge of eHealth literacy, wherein some people lack the skills to navigate the internet for health care services beyond searching via Google
  • Providers’ roles on the supply side of providing information on their practices, hours, services, and features
  • Lack of standardization in health care ratings and reviews – from Yelp! and patient-generated reviews, to other sources such as U.S. News & World Report, Consumer Reports, and Medicare.Gov for long-term care.

Health Populi’s Hot Points: Online healthcare marketplaces have attracted an initial cadre of health consumer – I repeat, “consumer” – who are keen to benefit from price and quality transparency in health care. These people can fall into the 3 categories of uninsured, under-insured., or fully insured — but perhaps not for cosmetic or other more discretionary services. Thus, online healthcare marketplaces have the potential to serve a range of health consumers with various needs, from primary care to Botox injection over the lunch hour, for dental services accessible to migrant workers in northern California to getting kids’ education physicals at a discount price from an accessible retail clinic.

These can all be very good things episodically, insofar as they are services people may need and want. However, the larger question is begged: what of continuity of care? How might information generated through this single encounter flow to an electronic health record where the patient might have a regular medical home? If the patient/consumer does not have a PCP or usual medical home, how might continuity-of-care be managed, if at all?

The prospects for the health care automat – that is, online healthcare marketplaces – are positive for the immediate to medium-term. With health reform being implemented in and beyond 2013-14, more people will buy into health insurance. These millions of health plan enrollees will become health care consumers, many seeking information for managing their deductibles in bronze and silver plans. Others of us who have been insured for years will also look for services not covered by our plans, at a desired price, expectation of quality, and convenient location.

As in all-things-retail, caveat emptor – buyer, or patient, beware – must be the watchword until standards for quality and issues around continuity-of-care congeal.

For more details about online healthcare marketplaces, download the paper freely at Help Yourself.