Social Determinants, Consumerism Become Focus for Healthcare

Providers and payers are tackling the social determinants of health in order to prepare for an industry increasingly driven by consumerism.

By Jennifer Bresnick

March 19, 2019 - 2019 is shaping up to be a turbulent year for the healthcare industry as internal and external forces combine to put pressure on the status quo, according to a new survey from Change Healthcare and the HealthCare Executive Group. 

Providers and payers are facing numerous new challenges to their existing business models, including changing attitudes towards consumerism, the advent of artificial intelligence, and the growing financial and clinical importance of addressing the social determinants of health.

In the 9^th Annual Industry Pulse survey, providers and payers reported focusing more intently on collecting and leveraging population health management data – in part to prepare themselves for a slew of new consumer-friendly entrants into the healthcare field.

The threat of Amazon, Walmart, Google, Apple, and other non-traditional players is looming large for the executive-level survey respondents.

One-third of the participants believe that these companies will bring serious disruption to existing business models, largely by introducing new consumer experiences and innovating more effectively than healthcare organizations have managed to do themselves.

Close to ten percent are specifically concerned about the formation of large vertical companies, no doubt prompted by the recent series of megamergers between entities such as CVS Health and Aetna.

“Healthcare is navigating disruptions on multiple fronts, and as a consequence, payers and providers are finding themselves stretched thin as they try to address a perfect storm of change,” said David Gallegos, SVP, Consulting Services, Change Healthcare.

“As if insurance market changes, value-based care, consumerization, and regulatory uncertainty weren’t enough, this year the industry is facing a new breed of market entrants and innovators whose impact remains unknown but could be substantial. Even the largest healthcare organizations don’t have the people and processes to move on all these fronts alone, yet they can’t ignore these changes.”

Vertical companies have the advantage of accessing huge volumes of data from across the care continuum, supporting the creation of longitudinal portraits of patients as they access services from disparate entities.

Comprehensive patient monitoring – and the subsequent ability to manage that patient proactively – has always been a goal for health IT adoption in the clinical space, and healthcare stakeholders may not be entirely pleased that non-traditional companies are getting there first.

While providers and payers are making steady progress towards developing actionable big data analytics capabilities, few respondents believe that their organizations are ready to challenge data-native companies like Amazon.

When asked how effective analytics have been for supporting systemic improvements, the response was tepid at best.

Only 28 percent believe that data analytics have been very or extremely effective for improving population health, and the same number feel strongly that providers are more productive when they have data at their fingertips.

They are even less likely to believe that the health system overall is more efficient as a result of analytics or that big data tools are currently working to reduce costs.  Respondents had the strongest negative reaction to the idea that data is a cost-cutting tool: sixteen percent said analytics were not effective at all for this purpose.

However, not everyone with a poor opinion of data analytics tools is currently using them.  Only half of respondents actually have clinical data integration capabilities within their organizations, a separate question found.

Just 20 percent accept patient-generated health data – a growing source of insights now that consumer have embraced wearables and home devices en masse – and a mere 19 percent are using artificial intelligence or machine learning in any form.

Half of respondents do have future plans to embrace AI, and 40 percent are looking to improve their data integration toolkit within the next few years, which may significantly boost their ability to extract actionable insights from their big data assets.

And the addition of social determinants data will probably help.  Providers and payers are beginning to recognize that solving non-clinical problems such as transportation access and food insecurity can have major downstream impacts on clinical spending and outcomes.

Organizations are most deeply concerned about care coordination, with 64 percent planning to address this issue within the next year, and they are turning to non-clinical data and community partners to help them do it.

Eighteen percent of respondents are actively working with community organizations to integrate socioeconomic data into their patient profiles, while 15 percent are offering a social assessment alongside their clinical assessments of patients.

Only 13 percent are turning to more structured, large-scale data sources, such as census data or geographical data, to supplement their insights, but appropriate data sources are still hard to find for many communities.

Participants stated that their other challenges include a lack of effective metrics (49 percent), data sharing limitations (43 percent), securing staff talent (41 percent), and identifying the right health IT solutions for their needs (33 percent).

Interestingly, healthcare entities may be attacking these issues to prepare themselves for changes in patient attitudes, not changes in reimbursement structures.

Organizations still believe that value-based care with two-sided risk modeling is far off in the future: the majority of respondents said that it will take more than three years for value-based care to become a major factor in the industry.

“Year after year, shared-risk, value-based healthcare has appeared to be just around the corner,” said the survey. “However, healthcare seems to be perpetually stuck at being three to five years away from adopting shared-risk value-based contracts.”

Patient expectations, however, are changing much more quickly, and providers recognize that they are in a move-it-or-lose-it situation. 

“Most healthcare stakeholders consider patient engagement tools and services to be strategic necessities,” said the survey. “In this era of consumer-driven healthcare, if providers or payers fail to make partners of their patients or members, they run the risk of losing them.”

Organizations are starting to ramp up their patient engagement and patient experience capabilities to prepare for the changing world.

Just over ten percent are actively identifying the communication preferences of their patients or members, while a similar number are trying to make more of a splash on social media.

About seven percent have started to offer personalized content, but only 3 percent use instant messaging or chatbots to communicate with their audiences.

“The industry will have to do better on this—and on delivering a more engaging consumer experience, which should include many of the features that this question asked about,” the survey observed.

Providers and payers may need to take a more coordinated approach to addressing these myriad issues – and that starts by defining the business challenge that these initiatives are designed to overcome.

If the industry is not, in fact, very strongly motivated by the distant prospect of value-based care, then they should be architecting their programming around more immediate challenges.

For some organizations, this may indeed be the pending large-scale disruption from Amazon or Walmart; for others, it may simply be retaining patients or members in a highly competitive local environment, or seeing some measurable improvement in a specific area of quality.

No matter what the challenge, organizations will need to be able to clearly articulate both the goal and the tasks leading up to it so that they can optimize their business strategies.

Leveraging big data analytics to support enhanced population health management programs will be a vital step for both payers and providers looking to improve their consumer experiences, prepare for artificial intelligence, and brace against the potential impact of new entrants in the field.

https://healthitanalytics.com/news/social-determinants-consumerism-become-focus-for-healthcare?eid=CXTEL000000460294&elqCampaignId=9006&elqTrackId=1f8bc2fedc00486e81bc0429d4880b66&elq=e9e9bfa72a964ece9efbbead737a7f22&elqaid=9476&elqat=1&elqCampaignId=9006