Creating the Healthcare Consumer – Who should pay?

By | September 5, 2017

There is a lot of discussion concerning better access for patients such as retail clinics and virtual care. The hypothesis is that having such access will lower the cost of care and improve service at the same time. As these models are very consumer friendly, we are beginning to see the impact of the more consumer driven approach.

As it turns out, there is now data showing that in fact those that use such services have overall higher costs than those that do not. This seems counter intuitive, but it does make sense. If the new models are designed from a consumerism perspective, one should expect to see higher utilization. What is effectively happening is people are using these services in addition to what they used to do instead of substituting the service for a more costly one.  In the case of retail clinics, people are using them instead of just waiting and see what happens or calling their physician. Virtual care is used more as an opinion source and most people still seek or are told to obtain further care at other locations, basically paying twice.

However, there are models where both these consumer driven modalities can lower the cost of care, when the models are used as a substitution for a higher cost service. Using retail clinics as an extension of an office practice and using virtual visits to solve geographic issues are two such examples.

Is all this bad? Absolutely not. We should continue to innovate in ways that is more consumer centric but we need to make sure our payment models track with the desired outcomes. If the model is designed to be truly consumer driven thus increasing wanted but unneeded services, then the consumer should pay. If the model is designed to be used as a lower cost substitution model, or provide access to a specific need that was previously difficult to obtain then our present payment structure make sense.

As we begin to couple our new designs and innovations, we are creating true consumers and we need to make sure we design our payment models to match this new concept of buying what I want versus payment for what I need.