Consumer-Driven Trends in the Patient Experience
Though begrudgingly nudged along in the early years by regulatory mandates and value-based purchasing models, the patient experience has since dramatically changed healthcare delivery. It is now a business imperative.
The voice of the customer has taken center stage.
Before throwing hands in the air, exclaiming healthcare is not about amenities, consider this – there’s indisputable research that links patient experience and engagement to patient safety and positive clinical outcomes. Embracing key practices and market trends can be a golden opportunity for prosperity!
We now know that the future of the patient experience is inextricably tied to:
- Rising healthcare consumerism
- The internet and doctor-shopping based on online reviews
- Physician reputation management
- The demand for healthcare organization transparency
Let’s review the market trends and while doing so, consider your own practice’s readiness to adopt or react.
The internet has been a significant disruption in healthcare and the patient experience. Online reviews are increasingly driving decision-making in the healthcare sector. Patients can easily discover a wealth of publicly posted information about healthcare providers. ZocDoc, Google, Healthgrades, WebMD, Physician Compare, Yelp, and Angie’s List (to name a few) all publish information on quality, safety, and patients’ ratings of healthcare providers.
Patients (consumers) are approaching healthcare the same way they approach other goods or services – they choose providers with the highest patient experience ratings or hospitals with the highest safety measure performance (such as the lowest infection rates). Healthcare consumers are also more engaged. Though “word of mouth” and recommendations from friends and family continue to be influential, patients increasingly base their choice of providers, practices and hospitals on information from the internet. Prior to their visit, patients frequently have researched their medical condition, treatment alternatives and preferred medications.
Since 2003, pharmaceutical industry spending on direct to consumer (DTC) promotion on the television, print (magazines, newspapers), radio, internet, and other forms of mass media (billboards and direct mailings) has increased from $59 million to $1 billion. DTC advertising for prescription drug products is both beneficial and detrimental to the consumer. Nonetheless, the impact on the patient experience could complicate clinical decision-making for providers who find themselves in situations where patients request (or demand) medications or treatments not indicated for their condition.
Healthcare organizations are increasingly fielding patient requests for “satisfaction-related” measures such as a comfortable waiting room, amenity-laden birthing suites, free Wi-Fi, coffee, or even individual work areas with charging stations. The business case supports providing some degree of these amenities, as a satisfied patient is more likely to rate the provider higher and recommend the hospital or practice.
As consumers have become more accustomed to healthcare as a commodity, the demand for convenience, including better access and communication has increased. Here are several convenience-related market trends:
Patient Web Portals
The use of web portals where patients can message providers, enter and update personal health information, request appointments, check lab results, and request prescription refills has become the norm. Though studies have demonstrated that older adults are less likely to adopt portals even though they utilize the greatest proportion of health care resources, this is expected to change as portals become more patient-centric. Overall adoption has increased year over year since 2012.
The future of patient portals will likely include more mobile-friendly applications, the dominant platform preference for consumers. Other projected advancements include:
- Organization and synthesis of multiple sources of health information, including disparate electronic health records and wearable devices data such as fitness trackers
- Improved communication between providers and patients such as reminding patients about their treatment protocols
- Virtual visits with a provider
There has also been a shift from the traditional model of private practice to new points of service. In-store clinics, such as those in CVS or Walgreens, debuted in 2000 and have increased in numbers by 445% between 2006 and 2014. These clinics primarily treat minor infections, injuries, and provide routine care such as vaccinations.
Some medical professional associations have been vocal critics of retail healthcare, citing concerns over quality and the disruption of continuity of care between patients and their primary care physicians. However, a 2016 Rand research brief found:
- Only about one-third of retail clinic users said that they had a primary care physician
- Retail clinics offer care comparable to the quality of physician offices and urgent care centers
- Retail models have been found to be serving a population who do not otherwise have a relationship with a primary care physician and may otherwise seek care in an emergency department
- Up to 20% of emergency department visits for a non-emergency condition could safely take place at a retail clinic or urgent care center with an annual savings of $4.4 billion
Beginning in the 1990’s, telemedicine emerged as yet another consumer-driven method of healthcare delivery. 90% of healthcare executives endorse having or developing a telemedicine program. Telemedicine especially benefits the 20% of Americans who live in a rural area and have less access to care.
“Virtual visits” are convenient for patients, but also offer an efficient means for physicians to provide routine care for minor issues and manage chronic health conditions. Insurance companies are increasingly covering virtual visits. As organizations struggle to meet access demands and perform well on patient experience measures, it is likely that telemedicine utilization will increase.
“Virtual visits” are convenient for patients, but also offer an efficient means for physicians to provide routine care for minor issues and manage chronic health conditions.
At the passing of the Patient Protection and Affordable Care Act in 2010 (ACA) and the individual mandate to purchase health insurance, many patients selected high deductible health plans. With increased out-of-pocket expenses, consumers are focused on getting more value for their money. Thus, health plans and healthcare organizations are increasingly transparent regarding cost and quality.
Accustomed to “shopping” for good and services, patients want the most cost-effective care possible.
Patient Reported Outcome Measures
Since 2009, The National Health Services in England has been measuring patient reported outcome measures (PROMs). PROMs are subjective reports on post-surgery health improvement from the patient’s perspective.
CMS’ Quality Payment Program (QPP) has implemented “Meaningful Measures”, moving towards outcomes-based measures and reducing the focus on process measures. Patient Reported Outcome (PRO) Measures include functional outcomes reporting ranging from orthopedic-related surgeries (hip, knee replacements) to cataract surgery.
As mentioned earlier, patients are increasingly using social media to post physician reviews online. Though negative online reviews seem to shape patient attitudes, one study demonstrated no correlation between online physician ratings and several clinical outcomes, such as coronary bypass mortality rates among cardiovascular surgeons.
To combat the potential lasting impact of negative online reviews, providers are increasingly using patient experience survey vendors to take control and proactively manage their reputation. Displaying “star ratings” can help market the practice and raise their level of transparency. The patient experience is a key driver of a practice’s reputation, profitability, patient volume, and ultimately its success.
With the rise of the internet came a myriad of information sources. Patients are increasingly educating themselves on their health-related conditions, treatment options, and alternatives. The internet also provides a vast source of information on quality and safety outcomes – data from regulatory agencies as well as social media sites. This has catapulted healthcare into a consumerism model where patients are able to compare and “shop” for healthcare as they would any other commodity.
CMS and other regulatory agencies will continue to include the patient experience as a measure of quality and safety for the foreseeable future. Though the regulatory environment changes frequently, the focus on measuring the patient’s perception of their care will persist. Recently, the additions of Patient Reported Outcomes Measures have been integrated into value-based reimbursement models.
There is a strong association between the patient experience, patient engagement, and clinical outcomes. This places the onus on healthcare organizations to develop innovative systems that use this information to empower patients and meet the objectives of IHI’s Triple Aim: Improving the patient experience of care (including quality and satisfaction); Improving the health of populations; and Reducing the per capita cost of health care.
Addressing the patient experience is mission-critical for healthcare organizations. Engaged patients lead to improved safety, effectiveness, efficiency, and value. In an increasingly competitive environment and disrupted markets, organizations who embrace the market trends associated with patient experience are best positioned to win BIG.