Healthcare Trends: What Customers Want – and Don’t Want – From Insurers vs. Providers

There are three significant and interrelated trends we are seeing from our research with health insurers and their members, providers and patients, and payer-provider systems. Taken together, these trends point to specific directions for health plans and healthcare provider organizations to take in order to better engage and satisfy their customers.

Improving Health: 3 Trends in What People Want

  1. More people want personalized health advice on what’s right for them.
  2. They expect doctors to provide them advice on their physical health and medications. But for lifestyle issues like stress management, weight loss, sleep–they seek solutions elsewhere.
  3. For lifestyle changes, they are open to advice from insurers–as long as it’s tied to how to use their health plan to stay healthy.

One key driver of the differences in what people want from their health plan vs. from their providers is mindset. Generally, people take on a “patient” mindset when they are sick and actively needing care from providers. They take on a “consumer” mindset when making lifestyle choices for chronic conditions and when dealing with their insurance company. These different mindsets lead them to want, expect, and accept different things from insurers than from providers. Understanding these two mindsets is critical for insurers and providers to develop the right programs and services people want and will use.

What People Want From Providers: The Patient Mindset

When a person has an acute illness or injury, they are in patient mode. What do patients want, and from whom? Patients want advice from their provider on their condition, symptoms, medication, treatment, and prognosis. Patients believe providers have the training and expertise to help them and should have their best interest in mind. After all, that’s what doctors, nurses, and other providers are meant to do.

Patients do not want advice from their insurance company about what care is appropriate for acute illness or injury. Right or wrong, patients often see insurers as obstacles to optimal care, not enablers. In the heat of the moment, they may lose sight of the fact that their health plan provides them with significant benefits and instead they focus on what they don’t get.

For many health conditions, patients sort of have to trust. As my friend and lifetime health educator, the late Dr. Shimon Camiel, said: “Sure, if I have high blood pressure, I want to be empowered and involved. But if I have an ax in my head, I just want the ER doc to take it out and save my life!”

So in the traditional patient/provider acute care relationship, the “contract” is this: patients trust, providers fix.

What People Want From Payers: The Consumer Mindset

When a person is dealing with coverage or benefits, they are in consumer mode. They expect to go to their insurance company – not their provider – about coverage decisions, or determining what providers they can see, or where to get their prescription filled. Similarly, they are open to getting advice about how to improve their lifestyle or better manage a chronic condition from their insurance company, as long as the advice is tied to using their benefits better. Consumers are not particularly wanting or expecting health improvement advice from their insurance company if it is not tied to benefits. To consumers, it makes sense and is reasonable that their insurance company will help them do things that both improve health for the individual and save money for the payer. That’s the heart of the win-win.

Consumers do not expect advice from their providers about benefits utilization or coverage. And many don’t turn to providers for help with health habits and lifestyle management unless it is tied to particular conditions like high blood pressure, obesity, or diabetes. Note that when dealing with long-term chronic conditions, people tend to be more in a consumer mindset than a patient mindset– even when interacting with their providers. I’ll cover this complexity in a separate post.

Like sick patients do, consumers sort of have to trust in the system. What is and is not paid for is governed by what their health plan covers, or what they are willing to pay for out of pocket. So the “contract” between consumers and insurers is this: Consumers make good choices, insurers pay for them.

Acting on the Trends for Better Business

Leverage these three trends as a starting point when you think about what your organization can and should offer to your customers. Then do the research to make sure you’re solving meaningful problems that people want your organization to solve.

The result is happier and more engaged patients and consumers and a far better user experience. That translates into brand loyalty and ultimately improved health and reduced costs.

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