Wanted: Patients who are obedient, self-sufficient and healthy. In other words, those who always follow doctor's orders, don't make unnecessary appointments and don't use many healthcare services.
That's today's ideal healthcare consumer, and it's who you want in your health plan or patient base. The ability to listen to them and meet their changing needs will determine the winners and losers in the marketplace.
Anyone who says consumers don't matter anymore is asking for trouble. With or without reform, consumers will demand and receive a greater choice in how they obtain healthcare.
With that in mind, how should health plans appeal to the "ideal consumer"?
Changing expectations. Today's consumers are a new breed. They're changing their expectations, actions and attitudes as managed care begins to affect them. They're more likely to accept alternative delivery systems, such as HMOs, and are even willing to trade choice of physicians and hospitals for lower costs and benefits such as easier claims processing.
This reflects a dramatic shift in the conventional consumer mind-set. Choosing your own doctor used to be considered an inalienable and non-negotiable right. Consumers wanted choice and were willing to pay more for it. To them, choice ensured quality. They resisted any effort to limit choice and selected fee-for-service plans over HMOs.
Fast forward to today's exploding growth in HMO enrollment. Does the reduction in provider choice mean HMO enrollees are less satisfied than their counterparts in fee-for-service and PPO plans? And are they choosing HMOs over other types of plans?
The answers are yes and no. No, they're not unhappy, and yes, they're choosing HMOs over other plans, according to a survey of 5,000 households on consumer attitudes toward health plans that was conducted by the Sachs Group.
In fact, when given a choice, HMO consumers are nearly twice as satisfied as consumers in other kinds of plans: 60% of staff-model HMO enrollees are satisfied overall, compared with 55% of those in independent-practice-
association model HMOs, 36% in PPOs and 34% in fee-for-service plans. And there's more evidence of their overall satisfaction: 79% of respondents in staff-model HMOs would recommend their health plans to a friend, while only 57% of respondents in fee-for-
service plans would do the same.
The plans of choice. Most of those who joined the HMOs had a choice in the decision. The study reveals that staff-model HMO enrollees had other health plan options 86% of the time. On the other hand, only 37% of respondents in fee-for-service plans had other options. In other words, when given a choice, consumers are choosing HMOs.
Clearly what's driving consumer choice and satisfaction isn't access to an unlimited choice of providers. It's price. The research shows that low deductibles are the primary reason consumers select HMOs. And satisfaction is being driven by a variety of factors, not all relating to quality.
For example, when asked how they felt about the range of services offered by their health plans, 57% of respondents in staff-model HMOs said they were satisfied. In contrast, 32% of those in PPOs were satisfied with their range of services. The satisfaction figure is 30% for fee-for-service plans (See chart).
So HMO consumers are happy with their access to services-happier than consumers in other plans with unlimited options. How can this be? One theory is that HMOs are doing a better job with the little things such as quick and courteous handling of billing problems.
Other areas where HMO customers are more satisfied than their counterparts in other plans include waiting time for appointments, waiting time in physicians' offices, ability to obtain referrals and location of offices.
When examining waiting time in physicians' offices, staff-model HMO enrollees are most satisfied. Some 34% are happy with the waiting time, twice as high as those in fee-for-service plans. The differences could be the result of well-managed expectations. Patients in staff-model HMOs may have the expectation that because they're in an HMO, the level of service won't be as great as in fee-for-service or PPO arrangements. That's the "traditional" mind-set. They may expect to wait longer, so when they do, they don't become disgruntled.
It's critical for providers and health plans to realize that if they expect to survive, they cannot ignore the needs and demands of consumers.
A new perspective is required. Health plans transfixed on wooing employers now must focus on having consumers pick their plan from those offered by employers or regional alliances. Providers, now focusing on the formation of health plans, also have to pay attention to consumers to make sure they're in the right network.
Those who don't position themselves for a consumer-driven marketplace won't be differentiated from the competition. And that spells failure.
Which brings us back to today's changing consumers. They're key to your organization's future bottom line, so pay attention to what they're saying.