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Billions at stake in tech-driven healthcare economy, PWC survey says

By Joseph Conn
Posted: April 10, 2014 - 1:30 pm ET

Paying only lip service to consumer demands for more convenience and lower costs in healthcare will cost providers billions in lost revenue, a study by the Health Research Institute at PricewaterhouseCoopers concludes.

“This is a call to action,” said Vaughn Kauffman, a principal with the institute's advisory team. “The consumer has more choices than they ever had before” when it comes to healthcare delivery.

The report, “Healthcare's new entrants: Who will be the industry's” samples 13 healthcare services, procedures or treatments that consumers would be “very likely” or “somewhat likely” to obtain some way other than through their traditional providers, if they cost less than the traditional choice. Responses come from a survey of 1,000 U.S. adults.

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In aggregate, 64% of those surveyed indicated they were open to trying new, non-traditional ways of seeking medical attention or treatment, if the price is right, and another 18% indicated they would be willing to look elsewhere, regardless of price.

Venues and modes of new encounters included in the survey ranged from basic, already available alternatives, such as a consumer having his vital signs checked by a device attached to a mobile phone, to the more capital intensive and futuristic, such as obtaining an MRI at a clinic in a retail store or pharmacy.

Rates of consumer willingness ranged from a high of 59% of survey respondents indicating they would be likely to use an at-home test purchased at a store for strep throat, to a low of 26% who would be likely to want to have dialysis performed at a medical clinic in a retail store.

That the numbers weren't higher is a testament to the importance of “the physician-patient relationship,” particularly for older survey respondents, said Trine Tsouderos, director of the institute.

But that preference for traditional provider relationships is eroding, Tsouderos said. Only 38% or those over 55 indicated they were very or somewhat likely to choose new healthcare options, while 45% of those 18 to 34 leaned toward the alternatives and 50% of those 35 to 54 did.

The PWC researchers took the data a step further, matching these services or procedures to appropriate billing codes and then matching them again against a data base of Medicare and private-payer payments for 2011 to estimate national expenditures for each that could shift if consumer wants and needs aren't satisfied.

In total, for these 13 services alone, $64 billion in provider revenues a year are potentially in play. “More will follow,” the report authors said.

Americans are already spending $267 billion a year (2012 data) on what the PWC report calls “health-related goods and services,” such as personal fitness monitors and organic foods.

Particularly in the tech world, “New entrants such as Nike and Jawbone sell wearable devices to monitor basic fitness markers, offering useful, sharable information while gathering valuable consumer health data,” according to the report. “Yet few in the healthcare industry have used this tsunami of data to deliver more personalized care and experiences.”

Broader adoption of these consumer-facing technologies is being constrained by the current healthcare payment system, particularly fee-for-service.

Some healthcare organizations have their toes in the water with home monitoring programs for patients with chronic illnesses in preparation for payment reforms, including accountable care organizations, patient-centered medical homes, and value-based purchases and are learning how to triage the data coming from these home-based or portable devices.

In contrast, though, organizations that already have global budgets, such as the Veterans Health Administration, have long since gone all in with consumer-facing programs such as mobile apps and, particularly, its decade-old home health monitoring program that served 144,000 veterans with chronic illnesses in fiscal 2013.

But even absent payment reform, a combination of factors is shifting market power toward consumers, Kauffman said.

They include the rise of high-deductible health plans, the widespread use of smartphone, tablets and other wireless devices, and a number of new startups and established Fortune 50 companies pouring into the healthcare arena; all are vanguards of what the authors call “The New Health Economy.”

What consumers want is someone to guide them in their healthcare decisionmaking, someone “advocating for consumers,” roles existing plans and providers can play, Kauffman said.

Follow Joseph Conn on Twitter: @MHJConn

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