The Biggest Change Coming in Healthcare…“Have it Your Way”

Lately, a considerable amount of our time is being spent helping our clients imagine the future that their companies face and then developing a plan to maximize their opportunities in that future. The healthcare industry is facing so many major changes that it’s challenging to stay on top of the business environment. One coming change, however, stands above all others and is a product of the combination of healthcare reform, the rising cost of healthcare, state and federal budget crises, the fruits of the Internet and the distrust of formerly highly regarded institutions.

By far the biggest change coming to our industry is the emergence of the empowered individual consumer as the healthcare decision maker.

Why?

New ways to choose health insurance - As the early provisions of the Patient Protection and Affordability Act (PPACA) roll out, individuals seeking healthcare plans will be given state-by-state information on available plans (www.healthcare.gov) that will soon include rates, network specifics, quality scores and possibly even consumer ratings of each plan. As the exchanges become reality, individuals and employees from small employers (in 2014) and large employers (optional in 2017) will begin selecting their health plan on an individual basis by utilizing a wealth of on-line information about each plan. In addition, as the work of the various clinical effectiveness committees progresses, consumers will be able to access information specific to the treatment options available for their conditions.

Employer changing attitudes about health insurance - The rising cost of healthcare is pushing many employers to reduce their contribution to their employees’ health insurance or causing them to eliminate the benefit completely. This will be exacerbated as overall healthcare costs continue to rise -- and further exacerbated when the exchanges become functional and many employers simply provide their employees with fixed credits to purchase the health insurance coverage that best meets their individual needs.

New managed care populations - The states’ budget crises will force states to move the largest portion of their Medicaid budget, long-term care, into managed care programs. Not only will this result in savings but it will provide heath plan choices for members who previously had no choice. In addition to the long-term care populations, Medicaid eligibility expansions will add new groups of individuals who will be selecting their health plans for the first time.

New communication and purchasing tools - The Internet has brought a host of new opportunities for individuals to network and exchange information about products and services. Facebook alone is regularly used by over 120 million Americans with people over the age of 26 accounting for 60% of daily users. Twitter is adding 300,000 new users and processing over 600 million information searches every day. Increasingly Americans are relying on their social networks for information. The largest segment of today’s uninsured market (25-34 year olds) is the most Internet-savvy and they will be selecting their health plan based on different criteria than purchasers in the past.

Loss of trust in institutions - The investment banking debacle, Toyota’s “accelerator” problems and more recently the British Petroleum disaster have contributed to a significant decline in Americans’ trust in institutions, including the government, media and the healthcare industry. As a result there has been a significant rise in grassroots activities that attempt to move institutional power to the individual. This is evidenced in the growth in activity on websites such as PatientsLikeMe, Yelp and Angie’s List.

How will this change healthcare? In a nutshell, what is happening is that a tremendous amount of actionable healthcare information is becoming available to individuals who are increasingly willing and motivated to take action on it. The power of this change will impact every aspect of healthcare as it evolves and grows. Smart organizations will recognize and redevelop with this change. The smartest organizations will be part of the change and say to this new market force, “Have it your way”.