Will Consumers Derail Your Value-Based Care Success?

Your health care organization may be on the tightrope of still coping with COVID-related illness and delivering essential patient care, amidst staffing and supply shortages. But in 2022, life is not poised to give health care a breather. Likewise, there is no slow-down to the expansion of Value-Based Care and payment models or development of further stages in 2022.

This year, providers in traditional Medicare will rack up stiffer penalties if costs are higher than CMS algorithms calculate. More ACO providers will progress along the path to Risk, and more will participate in alternative payment models (APMs). This will be the case especially for Direct Contracting and Primary Care First for primary care groups and the Kidney Care Choices (KCC) or similar models for specialists. Mandatory payment models, CMS has strongly suggested, are coming.

As you move forward with value-based strategies, however, you may not expect that a very significant group could derail the success of your efforts: consumers. Consumers are, in large part, directing how the pandemic continues to unfold. Their choices to vaccinate and take other actions to protect themselves and others—including you—are not much different than how they act when you are treating them as patients. But recognizing their enormous leverage as they move in and out of your system is key to your ultimate success in Value-Based Care.

This article will explore three key areas where consumers have momentum to directly affect your ability to succeed under Value-Based Care. Our next post will itemize strategies you can use to fortify your organization with consumer-directed strategies.

Why Consider Consumers Versus Patients? The Latter Have Trust Issues

To get a fresh start with strategies, think of those you serve as consumers rather than patients. Why? Because the concept of consumers envelops the elements of choice and preferences. “Consumers” make personal decisions based on information. Choice influences their health and their attitudes about health care as an industry, as a place to seek care, and you.

“Patients” implies responsibility on your part, and a historical, built-in hierarchy based on the premise that you decide or act on their behalf. But faith in your actions that reflect such responsibility—and the validity of your decisions— is not universally accepted by consumers. The fact is, they often don’t believe you. Don’t take it personally; it’s not just you. Maybe your older patients are more tolerant, but Gen X, millennials, and Gen Z cardholders are making up their own minds about all systems of authority.

Therein lies the root of trust issues that are rocking the foundations of the health care system. Trust issues are fueling volumes of research into how this factors into making health care work effectively—or not.

Another distinguishing feature of consumers is that they are always making choices, whether or not they are directly involved in treatment with you. What do you call your patients who see you once a year, at best, and the rest of time are making their own health care decisions? Those are consumers, doing what consumers do: making decisions that affect their lives and health all of the time, not just when they are under your treatment.

Value-Based Care is critically dependent on “patient engagement.” They must desire to improve their conditions while responsibly using health care resources. If you are not even aware of what is going on when they are not in front of you, it’s very hard to reach them. Your strategies must be broader to be effective and earn trust.

Health Illiteracy, Long Neglected, Has Come Back to Bite Us All

Science is complex, and constantly shifting as we know more. But as the pandemic made clear, people don’t like evolving or unclear messages. The CDC is coming under fire partly for continually changing its messages about the trajectory of COVID-19 and protective measures, failing to deal with ideas that vary from its chosen course, and, most recently, appearing to submit to political rather than scientific data in its advice to consumers.

We all know that health illiteracy is being weaponized as misinformation that affects the course of the pandemic, and the stakes are getting even higher. Burnout and staff shortages continue to get worse, and financial margins will deteriorate further for health systems.

The U.S. educational system has always failed to adequately educate children about health, health risks, and basic human biological development and genetics. In adults, there is little understanding about the incidence and results of metabolic diseases that develop over years and kill us or damage quality of life. The knowledge gap is too big for an underfunded public health system to even begin to fix it.

Thus, many experts believe providers need to play the role of educating consumers as part of their engagement in health care encounters, and to use their community presence to do more to educate. We will evaluate strategies like these in our upcoming article.

How Are You Engaging with Consumers’ Health Information?

Alongside the “official” health care delivery system is a growing system of consumer-directed health information and guidance. The two are almost always completely independent from each other and don’t share information. That is a problem for you because it feeds the divide between your patients’ treatment plans and their status outside your data.

Adoption of consumer health care technology is growing fast, with 85 percent now owning smart phones and a majority of surveyed consumers owning smart watches or fitness trackers that they use to monitor activity. Health-minded consumers also splurged during the pandemic, buying fitness equipment and gadgets to conduct business and socialize while at home.

According to McKinsey research, 40 percent of the general population consider wellness a top priority in their lives. The number of consumers who reported using mobile health apps increased from 50 to 75 percent during the pandemic. As gyms have reopened, futurists are predicting a more hybrid model of both gym and personal training with the help of connecting technology.

Technology advancement in wearables and related devices is advancing rapidly. Smart scales can now do body scans and project not just BMI, but estimated bone density. Smart watches can report on not just heart rate and steps, but identify falls, possible atrial fibrillation, and aerobic fitness. Some can measure blood pressure accurately. Coming soon will be more devices that measure blood glucose. Even ear buds are now being equipped with heart rate monitors.

Exercise equipment is connected via apps to general health applications like Apple Health, which may also, with patient consent, be connected to providers’ EHRs, so that patients can access both their EHR results and personal data from one device.

What’s key to the consumer health care technology increase, however, is that there is an industry that is now supporting these trends with medical and scientific advice. While available health research online still restricts consumers from accessing studies not funded by NIH, which are held behind specialty journal paywalls, there is now an explosion of websites, podcasts, and knowledge-sharing from entrepreneurial physicians and fitness experts, including metabolic disease experts, nutritionists and fitness coaches, physical therapists, and other health experts.

Besides fitness apps, consumers are storing their health information with websites focused on pain and symptoms, specific conditions, and general health sites. Consumers are not, however, usually able to store any of this information with you. As a result, you could significantly underestimate their capabilities, misdirect your guidance, and lose the advantage of their enthusiasm or willingness to participate in health.

Implications for the Divide of Health Care and Their Consumers for Value-Based Care

Health care that is missing consumer engagement because of mistrust, misinformation or lack of good consumer-based data will hurt the health care system. As private data platforms that cater to consumer interest proliferate, health-wise consumers will seek guidance there to self-manage health, using health systems exclusively for sick care. Higher average costs due to adverse patient selection, diminishment of primary care, and financial vulnerability will damage systems that cannot create strategies to help consumers cross the literacy, cultural, and data boundaries to understand and direct their services.

Too often, Value-Based Care has focused exclusively on payment model features to influence providers. The current priority on health equity may be a key exception to this and will hopefully prove to facilitate more holistic Value-Based Care initiatives. If all our efforts focus on inducing providers to make cost-effective clinical decisions or to use influence to change consumer behavior, the results of Value-Based Care will be disappointing. We need both providers and consumers to share the responsibility of effective health care. Now let’s create realistic strategies to get there.

Founded in 2002, Roji Health Intelligence guides health care systems, providers and patients on the path to better health through Solutions that help providers improve their value and succeed in Risk.

Image: Bruno Nascimento