AHIP Coverage (July/August 2008)
Filling the Health Care IT Gap:
Survey Identifies Opportunities for Health Plans to Leverage Technology to Address Diverse Needs of an Evolving Consumer Market
By John T. Bigalke, Paul H. Keckley, and Mike Canning
As Americans increasingly assume more personal responsibility for their health and health care and gain greater awareness of treatment alternatives and quality differences among providers, they want to take greater control of their medical care decisions. Many Americans no longer view themselves as traditional patients, but as consumers. As such, they want to make informed decisions when they “shop” for health care, just as they do when selecting other products and services.
According to the Deloitte Center for Health Solutions 2008 Survey of Health Care Consumers (www.deloitte.com/us/healthcareconsumersurvey), a nationally representative, online survey of more than 3,000 Americans, consumers are seeking enhanced access to online information, tools, and services in their quest to become more educated, quality- and cost- conscious purchasers of health care services. They want to use online services to access their medical records and tests, manage claims, schedule appointments, and gather information about the cost and quality of care.
While consumer demand for these innovations is strong, there are still large gaps between the types of health care technology and services consumers expect and what is currently offered by our health care system. As the Deloitte Center for Health Solutions has noted in studies about innovations including the medical home, connected care, medical tourism, and retail clinics, information technology (IT) is a critical component of realizing the potential of consumerism, both for delivering information and facilitating communication and for transforming the way health care decisions are made and care is delivered.
Closing the Gaps
Health plans are in a unique position to help close these gaps, enhance the overall patient experience, and improve the quality of care. How they will do this depends on their ability to leverage IT as a key enabler to customize products and services in ways that acknowledge and appeal to distinct consumer behaviors and attitudes. The health care consumer market is not homogeneous—Deloitte’s survey identified six segments, each distinguished by a unique set of behaviors and attitudes. A key differentiator among the segments is their use of and interest in using innovative approaches to seek information, receive care, and obtain financing. The presence of such distinct segments means that a one-size-fits-all approach to product and service delivery no longer works, clearly pointing to the need for customized communication.
Many health plans already are leveraging IT to address the needs of a diverse consumer market, while others are formulating strategies and researching specific technology applications. Approaches to consider include the following:
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Become the trusted source for health care cost information.
Health plans are seen as a reputable source of information about the cost of health care services. In fact, nearly three in four consumers are interested in accessing cost or quality information from their health plans. To capitalize on this position and become consumers’ trusted source for this information, health plans should create/ enhance capabilities and services that increase interactions with consumers and engender trust.-
Consumers prefer to get information regarding costs from health plan Web sites, rather than from providers directly. Twenty-two percent of survey respondents state that they have used their health plan’s Web site to get information about the cost of provider services, compared with six percent for hospital Web sites and five percent for physician Web sites.
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Play a lead role in defining transparency.
Consumers are becoming increasingly active in pursuing information about treatment options and quality of care, in addition to costs. Health plan strategies should focus on pay-for-performance data presentation and its transparency for consumers.-
Consumers perceive significant quality differences among doctors, hospitals, and health plans and are looking for sources of information to seek the best health care. Easy online access to quality information may become a key differentiator between health plans.
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Health plans also should focus on the distribution of quality information to members. Twenty-six percent of health care consumers have checked a health plan Web site for quality information. Gen X, baby boomers, Hispanics, and the commercially insured were more likely to have done so.
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Traditional provider directory information should be improved with quality information to assist consumers as they select providers. Twentyfour percent of surveyed consumers lean strongly toward choosing a new doctor based on quality, while 13 percent lean toward choosing a new doctor based on cost.
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Continue to develop tools and services that support online connectivity.
Health plans can improve customer satisfaction through the use of online advisory and information services, and many are doing so. In fact, some plans are actively encouraging member use of personal health records (PHRs) and paying for e-visits to doctors. Health plans should continue investing in tools to enable consumers to manage their care through online access to medical records, test results, and provider communication.-
There is a correlation between customer satisfaction and the use of advisory services for information regarding wellness programs, quality, and coverage options. Health plans have provided these services in numerous ways and should continue to leverage their information and relationships with consumers to provide advice and creative health care management tools.
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Health plans should encourage the use of electronic medical records (EMRs) and PHRs. Three out of four consumers want their physicians to provide online access to an integrated medical record that combines information from tests, doctor visits, and hospital stays; one in four would pay more for this service. One in four consumers maintains some kind of personal health record; 46 percent would be willing to use a software program or Web site to create one. Recognizing consumers’ interest, health plans are starting to make PHRs available.
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Health plans need to encourage providers to engage in “non-traditional” communication with members. Three out of five consumers surveyed want physicians to provide online services to get test results, schedule appointments, exchange e-mail, and access medical records. Again, health plans are responding.
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Seizing the Opportunity
Transitioning to a consumer-centric health care delivery model requires new capabilities to respond to the changing market. To remain competitive, it will be critical for health plans to adopt new technologies and offer enhanced services to meet consumers’ expectations or they may risk losing future business. Among the top priorities is incorporating online tools and services into benefit plans. Numerous online resources already exist, including tools that could enable consumers to understand their treatment options and estimate the approximate cost of care after receiving a new diagnosis.
Health plans also should promote transparency as a core feature of benefit plans and build the infrastructure to make it happen. Doctors, hospitals, health plans, and new market players all have an opportunity to become consumers’ trusted source of clinical, quality, and cost information, as well as online services and tools. If health plans are able to provide the information consumers need in a timely, easy-to-use, and personalized format, they will likely become that trusted source.
Health care industry stakeholders are making some progress in developing the online products, information, services, and other tools that consumers need. But a large gap remains between what is available and what consumers say they would use. The opportunity to fill this gap with new, innovative products and services is up for grabs. Health plans that tailor their products and services to meet the diverse needs of the new health care market will gain a tremendous advantage as the system continues its transformation toward a consumer-centric model.
John T. Bigalke is vice chairman and U.S. industry leader, Health Sciences & Government Practice, Deloitte LLP; Paul H. Keckley is executive director, Deloitte Center for Health Solutions; and Mike Canning is principal, Deloitte Consulting LLP.
