Category Archives: partnership

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.

Patient Engagement: What Is It Really?

patient_engagementWhen a patient worries about their health condition, is that engagement? What about when a patient tracks their condition with wearables? Is a provider required for patient engagement to happen? Or is it only engagement when a patient is taking action to improve their condition?

A few years ago, health IT strategist Leonard Kish called patient engagement the “blockbuster drug of the century.” At HIMSS last week, there were numerous presentations on patient engagement and countless vendors offering patient engagement solutions. Yet, there is still no clear agreement as to what exactly patient engagement is, what it does, and how to measure it.

Let’s try to fix that. This first post in the series will focus on what patient engagement is.

We’ll start by defining what a patient is. (Interestingly, the word “patient” originally meant ‘one who suffers’ according to Wikipedia). The most common definition of a patient is simply someone receiving medical care. Note there is a connotation of passiveness in the notion of receiving care. The other relevant point is that receiving care requires interaction with someone who is providing the care. That means patient engagement requires a provider, not just a patient alone. So to be a patient, all someone needs to do is accept care from a provider.

What is engagement? I see engagement in degrees, from caring to understanding to acting. A patient is minimally engaged by virtue of caring about her health. She is more engaged when you actively work to understand her health. And she is deeply engaged when she is taking action – doing things – with the intent of improving her health.

One more component to add: Most patient engagement definitions include: a) participation, use of resources, and interaction with a provider, b) a goal of positive health behaviors, and c) an end result of health management or health improvement.

Put in all together and we have this definition of patient engagement:

Active participation of a person in their health and healthcare, which includes using resources, working with their provider, and taking action to understand, manage and improve their health condition.

How does this definition work for you? Any suggestions for improvement?

Now that we have a good working definition, we can move on to what patient engagement does, and how to measure it. Stay tuned!

Med Device Companies and DMEs: Is Hate Required?

“We hate our customers! We do, we hate them,” a longtime client confided in me. This client is a smart, honest, and increasingly frustrated senior product manager at a large med device company. The company sells through a “middle man” – in this case durable medical equipment suppliers (DMEs).

The dynamics between this med device manufacturer and the distributors of its life-saving products are beyond bad. Driven by unexpressed fear and resentment, the relationship is filled with dislike, disdain, and disrespect. Who wants to do business in that kind of environment??

What’s the alternative? It’s simple, so simple it may sound naive.

TELL THE TRUTH.

Both sides need to tell the truth about their fears and frustrations. DMEs need to acknowledge the business reality they face. Many are going to become irrelevant as robust, med device-friendly, Amazon-like distribution systems are established that have built-in many of the services DMEs now provide. Can DMEs pivot and stay relevant and viable? A few, yes, if they change fast.

Med device manufacturers need to express their frustration and that they feel manipulated. They also need to recognize that many DMEs are fighting for their lives and will do anything to survive.

DMEs need to stop the high-pressure tactics that desperation breeds. Manufacturers need to show the DMEs compassion – even if they end the business relationship.

With open minds and hearts, both sides can come together and brainstorm new kinds of partnerships and alliances that can help both sides achieve their aims. Or at least reduce unnecessary suffering.

My humble recommendation? End the enmity. It hurts patients, and it’s no good for business. Embrace the alternative. It’s time.