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Consumerism in Healthcare

Consumerism in Healthcare

With new technology and easier access to information, consumer choice is increasingly continuing to drive change in every industry, and healthcare is no exception. Consumers value the same qualities in healthcare as they do with any other industry, including good customer service, delivering on expectations, making life easier, and offering great value. In order to harness the consumers, it is important that the healthcare industry ensures “satisfaction and loyalty”1, which often includes “transparency and choice in their healthcare experience.”2 With new levels of transparency and rising out-of-pocket healthcare costs, consumers increasingly expect the same experiences with healthcare providers. This includes, but is not limited to “walk-in visits, online scheduling, virtual visits, and direct messaging with providers.”3 Now more than ever, patients have a deeper involvement and awareness of their options. The various factors that can weigh in on a patient’s decision include quality, location, accessibility, other patient reviews and testimonials, reputation, costs and billing, doctor recommendation, word of mouth, online research, resources available, and insurance. As healthcare spending continues to rise– it was 18% of the 2016 U.S GDP (~$3.3 trillion dollars)4–it is important that healthcare companies understand their consumers.

The culture of healthcare has changed as consumerism has risen. This in part has to do with a demographic change. Baby boomers are now being outnumbered by the “tech-savvy generation” known as millennials, who were raised in a technology-powered environment where transparency, convenience, and quick delivery are expected.5 These millennials are often the ones responsible for making decisions about their parents and family care. There has also been a transition in our healthcare industry from fee-for-service to value-based care.6 Value-based care initiatives focus on the quality of the care being provided to patients and communities by eliminating quantity-based incentives and motivations. With the shift in care focusing on value, there has also been a shift in our health insurance. Consumers now have higher deductible plans, meaning patients are spending more out-of-pocket for an increasingly expensive industry, creating a higher investment in personal health and causing more patients to want to shop around. Technology applications and more information on the internet have allowed for wider accessibility of information and data.

This has created a demand and necessity within the various healthcare sectors to understand the current consumer. Consumers are accustomed to making non-healthcare decisions based on factors like, costs, specialization, and convenience. Now they are applying this decision-making process to their health. In order to encourage a consumer to choose their product or service, providers will need to prioritize patient satisfaction, concerns, and value of care. Having a positive patient experience has become an integral part in a successful, sustained healthcare business.

Post-Acute Care

Within healthcare, consumerism has become more prevalent in the post-acute care industry. This is driven by the general overall consumerism trend, but also changes in reimbursement models and government policies, such as accountable care organizations (ACOs), bundled payments, and the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). Patients want to become more involved in their post-acute care decisions, but they need the information and tools to navigate the industry and make good decisions.

Currently, the way most patients are discharge from the hospital to post-acute care is inefficient and outdated. Hospital discharge planners, typically case managers or social workers, hand patients a standard paper list of post-acute care options for the patient to choose from. This list has limited to no quality information or details about each post-acute care provider and therefore patients often rely on unreliable word-of-mouth recommendations to make this important post-hospital care decisions. This ineffective process leads to a lack of patient involvement and poor decision-making regarding their post-hospital destination. The rushed timeline and lack of information leads to patients receiving no or low-quality post-acute care. This can be problematic when around 22.3% (~8 million) of all hospital stays ended with discharges to post-acute care services.7 A bad post-acute experience for a patient can lead to poor health outcomes, increased healthcare spending, and higher rates of hospitalization readmission.

With so much money being invested in the health of a person and their transition into post-acute care, it is important that they are receiving the best care. Outside of just post-acute care, around “one fifth of the 11,855,702 Medicare beneficiaries who had been discharged from a hospital were rehospitalized within 30 days, and 34.0% were rehospitalized within 90 days”, adding up to about $17.4 billion in 2004.8 For patients who receive post-acute care, around 33% of Medicare beneficiaries discharged “experienced adverse or temporary harm events.”9 In 2011, half of the residents who experienced harm returned to a hospital for treatment, which cost Medicare $2.8 billion.10 In our current health system, Medicare is the primary payer for ~73.4% (5.8 million people) of the approximately 8 million discharges to post-acute care facilities.11 Therefore, not only does hospital readmission lead to possible medical errors and trauma to the patient, but is a huge monetary burden.

With all these high costs, there is a shift in the healthcare industry to put more emphasis in discharging patients to high-quality post-acute care. This requires hospitals to find a facility that is the best fit for the patient’s medical needs and is accepted by their insurance provider to promote a fast and easy recovery. Post-acute care is vital to a patient’s recovery; failure to understand and address patient needs could lead to unnecessary costs, wasted time, and frustration from all parties involved. Recent laws and policies have reflected this patient-first philosophy. Value-based care, as discussed earlier, puts quality of care and patient wellness as the priority. Rehospitalization penalties also focus on the care being provided, pinpointing long-term recovery and post-hospital solutions to reduce readmissions. Data collection required under the IMPACT Act holds facilities accountable to provide quality services. These, as well as other policies, have incentivized the healthcare industry, particularly physicians and hospitals, to invest more time and effort in the patient’s long-term recovery and overall health rather than just their acute care treatment during the hospital stay.

Consumerism in post-acute care–the push for patients to go to post-acute care facilities and receive high-quality care–can be exemplified in the “Proposed Fiscal Year 2020 Payment andPolicy Changes for Medicare Inpatient Rehabilitation Facilities (CMS-1710-P)” by the Centers for Medicare & Medicaid Services, which pushes for more quality reporting, data monitoring, and standardization to promote effective communication, coordination and quality of care, and patient safety.12 “In 2014, a total of 59.2 billion Medicare dollars were spent on PAC services. The highest amount was spent on skilled nursing facilities (SNFs)($29.1 billion), followed by home healthcare agencies (HHAs) ($17.9 billion), inpatient rehabilitation facilities (IRFs) ($7.1 billion), and long-term acute care hospitals (LTACs) ($5.1 billion).”13 With this shift to prioritize post-acute care, it is important for patients and families to be more involved in the post-hospital care transition. This has been problematic in the past because patients and families often lack the resources to properly evaluate the post-acute care providers and make informed decisions. Some patients and healthcare providers may not understand the variability in post-acute care, the importance of choosing a high-quality provider, or what is involved in the transition and duration of a stay at a post-acute care facility.14 It is important that there are more comprehensive resources available for patients and their families or caregivers.

Repisodic – A Patient-Facing Solution

Repisodic has developed a technology platform that helps all stakeholders get the most out of the post-acute care transition process. We work with hospitals and post-acute care providers to provide a patient-facing solution that guides patients through the care transition process. Our hospital platform, Repisodic Choice, has created a simple interface to make information like insurance, location, and medical services of a post-acute care facility readily available so hospital discharge planners can easily identify the best option for each individual patient. This matching process revolutionizes the manual, time-consuming task of case managers reaching out to post-acute care providers to determine which facilities are appropriate for an individual patient. Now, case managers have more time to conduct in-depth and personalized discussions with patients about the importance of post-acute care and how to select a provider that best meets their needs. Increased involvement, knowledge, and engagement in the decision-making process leads to better decisions, improved patient satisfaction, and overall better health outcomes.

[1] “Debunking Common Myths About Healthcare Consumerism”

[2] “Healthcare Trends for 2018”

[3] “2017 State of Consumerism in Healthcare: Slow Progress in Fast Times”

[4,6] “Making “Cents” for the Patient: Improving Health Care through Consumerism”

[5] “Millennial Expectations Are Fundamentally Changing The Healthcare Landscape”

[7,9,11] “An All-Payer View of Hospital Discharge to Postacute Care, 2013”

[8] “Rehospitalizations Among Patients in the Medicare Fee-for-Service Program”

[10] “Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries”

[12] “Proposed Fiscal Year 2020 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities (CMS-1710-P)”

[13,14] “Changing Payment Models: Shifting Focus on Post Acute Care”