Center Voices
Consumer Demands Are Changing Care Delivery
By Jayne Oliva
Consumers’ march toward personal control over their health care is fueling changes on the front lines of medicine and ushering in a new era of responsibilities and relationships not unlike the advent of managed care in the 1980s.
Increasing numbers of payers are offering a variety of consumer-driven health care products that place purchasing decisions and dollars squarely in patients’ laps. More consumers are managing provider selection—purchasing health care services directly and shopping around for the best deal. Whether you’re a proponent or critic of this consumer groundswell, big changes are afoot.
Light the Lanterns
Physician board members, by virtue of both their governance role and clinical experience, should be able to understand the challenges their colleagues on the front lines of care face and can help their fellow board members better understand how to address these challenges. As board members, they can and must persuade their lay colleagues to allocate the resources necessary to build a competitive edge in a marketplace that is all about meeting consumer needs.
Out-of-pocket health care is a multi-billion dollar trend and many people are willing to go outside their insurance plans to pay for care. It is imperative that the board strategize now to ensure that their organization is positioned to manage the growing numbers of patients who will pay out of pocket and demand more in the way of care and services than they have in the past.
Physician leaders and board members must convince their hospital’s board and executive leadership to move decisively and quickly to embrace new opportunities for patient access, service and convenience. Survival is at stake, along with the privilege of leading the charge.
Knowledge is Power
What strategy can physician board members and clinical leaders take to help their organizations build a competitive edge? They will need to stress the message, forcefully and consistently, that not only are patients the center of care but they are directing it as well.
Patients are demanding that clinicians order certain diagnostic tests and want proof that physicians are following best practices. Spending out of their own accounts and empowered with information—often provided by health care advisors hired by payers—consumers have higher expectations today that the service their health care provider recommends or performs is the most advanced and appropriate care.
Proof of quality care has never been more readily available for patients, payers, and state and federal regulators to compare and contrast. The board should continue to focus the health care organization on superb outcomes and budget accordingly in order to keep pace with state-of-the-art technology, changing protocols, and the ability to hire the most talented staff available. The board should ensure that the care provided in their organization incorporates evidence-based medicine and new treatment algorithms that reflect the latest medical and research breakthroughs.
Tighten the Ship
There is no room for costly inefficiencies in today’s competitive, consumer-driven market. The board should urge management to re-examine how care and services are delivered. Tightening operations may require a reconfiguration of provider and staff responsibilities. Consumers want same-day access, minimal waiting time and convenient locations and hours. That means hospitals must coordinate as many services as possible—before, during and after the patient’s visit—to ensure that all interactions between patient and provider are seamless and reimbursable.
Lobby for Information Technology
Patients, as savvy shoppers, use the Internet to gather information, analyze pricing data, compare and contrast hospitals and guide decision-making. The Web is rapidly becoming indispensable for patients and physicians alike. Boards should urge their hospitals to invest in information technology to stay ahead of software and hardware trends.
Who says care has to take place in the physician’s office or in the hospital? Just as banking has moved into supermarkets and malls, so, too, have some routine forms of care and patient services. Further, caregivers and administrators should become comfortable accommodating “virtual” visits with patients, who want to talk with their doctors online and are paying for e-mail consultations. Doctors can use e-mail dialogue with patients to assess next steps, such as asking the patient to come in for a visit or to schedule tests. Some insurance carriers are, in fact, already reimbursing for e-mail consultations. Telemedicine units provide home-based care and monitoring. The board can help its organization think outside its walls—and fund the care there.
Additionally, boards should urge their health care organizations to stress the importance and economy of preventive care and further consider specialized centers of care, such as cancer centers or women’s health centers.
Patients with chronic conditions are more compliant with disease management programs because they understand that stemming disease progression is more cost-effective than paying for acute interventions.
Specialized care centers (e.g., those targeting heart disease or cancer), can provide quality, customer-friendly, cost-effective care that meets both patient and physician needs.
The consumer drive toward control presents a new world for caregivers and medical administrators, and a steep challenge for physician trustees who must help hospital leaders and the board to both understand and develop strategies to address this trend. They must enlighten the board and help introduce useful, cost-effective solutions to the front lines of care.
For organizations to distinguish themselves in a consumer-conscious marketplace, they will need to help their colleagues demonstrate excellent quality, easy access, white glove service and around-the-clock convenience.
Jayne Oliva is a principal with The Croes•Oliva Group, a Burlington, Mass.-based consulting firm. She can be contacted by calling (781) 272-5055 or by e-mail at joliva@cogrp.com.
This article 1st appeared in the December 2099 issue of Trustee Magazine.
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