Among people who have health insurance, managing the costs of their medical care doesn’t rank as a top frustration. Instead, attending to health and wellbeing, staying true to an exercise regime, maintaining good nutrition, and managing stress top U.S. consumers’ frustrations — above managing the costs of care not covered by insurance.

And maintaining good mental health and staying on-track with health goals come close to managing uncovered costs, Oliver Wyman’s 2018 consumer survey learned. These and other important health consumer insights are revealed in the firm’s latest report, Waiting for Consumers – The Oliver Wyman 2018 Consumer Survey of US Healthcare.

The Oliver Wyman team explored the concept of the new front door in health care several years ago, and since then has been tracking consumers’ use of these alternate entry points. Whether retail clinics, telehealth, or asynchronous physician visits via mobile health apps — consumers’ adoption of these sites, away from traditional brick-and-mortar doctors’ offices and ambulatory care clinics, has hovered around 10%, Oliver Wyman gauges in this report. That 1-in-10 consumer use statistic hasn’t budged for over a year since the company looked at the question in May 2017.

But this time around, polling health-insured consumers in July 2018, Oliver Wyman perceives a change in consumers’ “willingness to try new kinds of health services.” Specifically:

  • 42% of consumers would consider receiving advice and recommendations on well-being via telehealth
  • 39% of consumers would consider receiving treatment for minor medical events in a retail clinic
  • 26% of patients would consider treatment for managing a chronic health condition via telehealth, and,
  • 26% would consider advice on well-being interactive with artificial/augmented intelligence (AI).

There are differences cross-generation between consumers’ awareness of these alternate sites of care: older people are less aware of the options, and at the same time, more younger consumers are comfortable receiving care without being face-to-face with the doctor, the survey found.

This survey was conducted among 2,509 U.S. health-insured adults in July 2018.

Health Populi’s Hot Points:  One of the most overlooked social determinants of health is access to healthcare, the second graphic shows us via Kaiser Family Foundation’s detailed listing of SDOH elements. The far right column, the Health Care System, identifies components of heatlh coverage (that is, insurance), provider availability, cultural competency to promote health literacy, and quality of care.

The consumer respondents in the Oliver Wyman survey were all covered consumers, with health insurance from government sources such as Medicaid and Medicare, or those privately-insured through employers, unions, and associations.

This is a big reason why these covered consumers’ frustrations with the health system, revealed in the survey, were more focused on health and well-being than on managing the costs of care not paid for by insurance.

Being covered by insurance nudges patients to the “front doors,” in Oliver Wyman terms, that are reimbursed by a health plan: visits to doctors’ offices with a $20 co-pay, a trip to the emergency department for a $100 co-pay, and the like. These are natural patient work-flows that are well-understood and time-tested.

The new front doors are, well, “new” front doors. Once a patient enters that healthcare new front door of, say a retail clinic, one-third of these people told Oliver Wyman that it was a better experience. One-half said it was “about the same.”

Only 16% of patients’ experience at a retail clinic said it was “worse” than a doctor’s office visit.

So as in all new consumer experiences, it takes a nudge and a trial, and then a positive outcome, to make behavior change.

For telehealth, that nudge will come from consumers receiving health insurance at the workplace where most large employers have begun to cover virtual care in various ways: contracting with telehealth companies like American Well, Doctor on Demand, and Teladoc, or through contracting with integrated health system providers who are private labeling virtual healthcare services in local markets.

Retail clinics, too, will see more consumers through behavioral economic nudges — health plan designs that provide financial incentives to members that choose to visit a retail clinic for a minor (not acute) medical event. More sophisticated and artful health plan designs are moving in this direction, to help bend the cost curve for both health plan sponsor (e.g., employer, union) and the consumer herself who faces a lower co-payment for a visit to a retail or urgent care clinic versus the emergency department at the nearby hospital.

[As a sidebar on employer-sponsored health benefits, note that this week, Morgan Stanley hired Dr. David Stark as chief medical officer and head of HR data and analytics. It’s a new role at Morgan Stanley, which the bank’s CHRO said is meant to address employee wellness and rising healthcare costs. Do not confuse this with the Amazon-JPMorgan-Berkshire-Hathaway healthcare alliance. JPMorgan is a very minority shareholder in Morgan Stanley these days.]

So we return to how I chose to title this post: “can healthcare providers supply this demand?” for well-designed consumer-enchanting care through new front doors, closer to where people live work, play and pray. The answer is “yes,” it can be done — through alliances in communities with retail brick-and-mortar “doors,” like pharmacies, grocery stores, shopping malls, health clubs and gyms, farmers’ markets, faith institutions, and schools. The social determinants of health drawing offers lots of ideation opportunities.

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