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Advancing health through alternative sites of care

Nontraditional sites can enable more convenient, accessible, and equitable care. See how to leverage these settings to meet consumer demands.

Alternative care sites are an opportunity to meet the demand of increasingly empowered health care consumers, provide a better customer experience, and advance health equity. Alternative sites of care (defined as care outside the traditional doctor’s office) aren’t new, but they’re rising in prominence as the retail and digital worlds converge and the public sector recognizes the need to advance health equity and improve the consumer experience. At the same time, consumers are changing the way they want to access care and pushing the traditional health care visit and experience to be more in line with other encounters they have in daily life.

In the United States today, unequal access to care is a major factor contributing to health disparities.1 Historically vulnerable and underserved populations have difficulty accessing care, given work demands, health literacy, transportation, health insurance coverage, and system trust deficits. Universal improvements are needed as patient satisfaction and trust in health care providers—both of which are linked to health outcomes—are uneven among those who have access, too.2 The question is, how can the US health system position alternative care sites to reverse some of these trends?

To understand how alternative sites of care can be leveraged to provide accessible, convenient, and equitable care and help fill gaps in care delivery, the Deloitte Center for Health Solutions surveyed a nationally representative group of 4,545 consumers in February and March 2022. To supplement the data collected in the Deloitte 2022 Survey of US Health Care Consumers and to zero in on how to create a more inclusive and equitable experience, we examined data from online focus groups with 445 consumers who identify as Black, Hispanic, Asian, or Native American (see the sidebar “Inside the Deloitte consumer surveys,” for more information).

To build consumer loyalty and trust, health care organizations need to provide a care experience that reduces friction and addresses the factors that contribute to inequitable care and poor access. With the rise of nontraditional sites such as retail clinics, the home, and virtual settings, health care organizations now have more options than a traditional doctor’s office to achieve these goals.

Inside the Deloitte consumer surveys

  • 2022 Survey of US Health Care Consumers: Since 2008, the Deloitte Center for Health Solutions (DCHS) has surveyed a nationally representative sample of US adults (18 and older) about their experiences and attitudes related to their health, health insurance, and health care in general. The national sample is representative of the US census with respect to age, gender, race/ethnicity, income, geography, and insurance source. As part of this effort, from February 24 through March 14, 2022, DCHS conducted an online survey of 4,545 US adults.
  • Health Care Consumer Response to COVID-19 Survey: DCHS conducted three anonymous, online research focus groups with a convenience sample of 525 individuals who identify as Black, Asian, Hispanic, or Native American in the United States in the spring of 2021. Participants were recruited through an established vendor using vetted panels. The sessions were one hour long and were conducted in English. We asked participants a mix of open-ended and multiple-choice questions exploring trust and how it impacts their decisions around how they access care, what trust means to them, and what organizations can do to improve trust.

Alternative care sites could improve access for underserved populations

Alternative care sites can help make care more equitable and accessible by providing more patient touch points and expanding the location options for well visits, mental health care services, and so much more. Our survey findings show that retail clinics, virtual health, and community health centers could bridge care delivery gaps for populations that have been historically underserved.

The survey revealed a large gap between consumers’ current utilization of these alternative sites and potential future utilization. For example, just 10% of consumers have used a retail clinic over the past year, but many more say they would be “likely to” or “maybe would” use retail clinics for preventive care (55%) or mental health care (47%). Black, Asian, and Hispanic respondents said they’re more likely than white respondents to use retail clinics, and urban respondents are more likely than rural respondents (figure 1). In addition, rural respondents appear less willing to use retail clinics, perhaps because awareness is lower or the retail locations in their areas do not yet offer the services. With these findings in mind, retail clinics have an opportunity to deliver care for these populations.

 

We also explored how consumers’ use of virtual health is shifting from just urgent or acute care to also include preventive and mental health care. Since 2018, the number of consumers using virtual health has increased across all age groups (figure 2). Our study data not only revealed that the biggest uptake was among millennials, but that use among seniors had increased too—albeit at a slower pace. The 2020 survey was conducted pre–COVID-19 in late February to early March, so it’s worth noting that this may have affected our data on how consumers were using virtual in 2020.

We see an opportunity for even more consumers to use virtual health, which in turn, would help address gaps in care. Consider:

  • Nearly three in four consumers with Medicaid (74%) or HIX plans (73%) would use virtual health (apps or virtual visits) for mental health visits.
  • More urban consumers (65%) would use virtual visits for well visits than suburban (53%) and rural (51%) consumers.
  • Nearly two-thirds of consumers—across all races/ethnicities—would use virtual visits for preventive care.

The shift to hospital-at-home and virtual-hospital models

In addition to virtual preventive, acute, and mental health care, more hospitals are shifting to the “hospital-at-home” model for care delivery. The idea of accessing health care at home is increasingly popular with consumers of all ages. In a recent study about aging, 77% of respondents 50 and older said they want to remain in their homes for the long term.3 Consider the impact: In 2019, there were 54 million people aged 65 years old and older in the United States, and that population is projected to reach about 81 million by 2040 and about 95 million by 2060.4

The hospital-at-home approach will be increasingly important as we see the US population shifting to an older population who will likely need more health care than younger populations. In studies, the approach has shown improvements in care quality and health, and now some evidence is showing improvements in patient satisfaction and experience, too. Several health systems have invested in strategies to deliver more types of care at home. Here is an example:

Brigham Health’s Home Hospital: Through the home hospital program, patients receive hospital-level care in the comfort of their own homes. Evaluation research found that patients in the program experienced fewer clinical interventions, more physical activity, and comparable patient satisfaction scores as those being cared for in the hospital. The program has also helped lower costs and hospital readmissions. In addition, the home hospital patients reported having less anxiety and more control and had an easier time visiting with family and friends and getting physical activity. Patients in the hospital recorded an average of 160 steps during their stay, compared with 1,800 steps for patients at home and spent 18% of the day laying down, compared to 55% in the control group.5

Alternative care sites help build trust by connecting consumers to diverse care teams

From our research on rebuilding trust in health care, we know that trust deficits are still a major barrier for people seeking care.6 Consumer and community trust in health care providers and organizations is critical for optimal health, as trust influences patients’ willingness to get medical care, preventive screenings, and mental health care.7 Trust between a patient and a health care provider also is linked to improved patient experience, health outcomes, and the patient’s perception of the care they receive.8 However, it is also well documented that not all communities in the United States have the same level of trust with their health care providers. A critical area of focus for health equity—the fair and just opportunity for every individual to achieve their full potential in all aspects of health and well-being—is therefore rebuilding trust with racially and ethnically diverse communities.

We found in our 2021 focus groups that:

  • Two out of three participants who identify as Black and half of Asian and Hispanic participants would prefer to see a health care provider who is similar to them, either in race/ethnic background or lived experience.
  • For Asian (59%) and Hispanic (53%) participants, having a provider who is empathetic and culturally competent is a top priority when choosing a provider.
  • About half of the participants are willing to trade access to convenient, in-person care for a virtual visit with a provider who looks like them and is culturally competent. About half of those who identify as Hispanic (54%) and Black (49%) are willing to use virtual visits, as are 41% of Asian participants.

Alternative care sites—if staffed with diverse and empathic care teams—could be opportunities for health care organizations to connect with their consumers and rebuild trust. One step to rebuilding trust is employing clinicians and care teams who look like, have shared experiences, and demonstrate empathy toward the communities they serve. Consumers most often look for providers that empathize, understand, connect, and care for their well-being. Yet many report that they aren’t connecting with their health care provider or aren’t seeking care at all because they can’t connect, have experienced racism, and/or have been subjected to unconscious and implicit bias.

Alternative sites of care could improve access to mental health services

Mental health is a core component of health and wellness, yet it is not available or easily accessible for many who need treatment. Demand for mental treatment continues to rise, particularly since the onset of the COVID-19 pandemic. In a recent study of psychologists, respondents reported increased demand compared to prior to the pandemic, and the increase continued to grow from 2020 to 2021.9 In addition, many with mental illness are not accessing treatment. Consider, nearly 50 million adults in the United States experienced some form of mental illness in 2022, yet more than half of them received no treatment for their conditions.10

For consumers seeking mental health services, some of the biggest barriers are accessing care and being connected to effective therapists. Access to mental health providers is uneven across the United States, with 37% of the country living in a mental health provider shortage area, which are areas with one or fewer mental health professionals per 30,000 residents.11 Two-thirds of those shortages occur in rural or partially rural areas.

The Deloitte 2022 Survey of US Health Care Consumers found that alternative care sites could serve as a bridge that connects consumers—particularly young and racially and ethnically diverse populations—with the appropriate mental health care. We found that young consumers are more willing than their older counterparts to consider using alternative care sites for the mental health needs. In fact, half of Gen Z (50%) and Gen X (47%) and 61% of millennials would consider going to retail clinics, more than 60% of these generations would consider going to community health centers, and about 70% would consider virtual visits (figure 3). In contrast, just about half of baby boomers would choose virtual therapy services and 30% would use retail clinics.

According to our survey data, virtual mental health care is nearly as popular as in-person visits. Virtual visits could be a way for increasing access to mental health care, particularly for individuals in communities where stigma is high. Virtual health could provide access to a clinician who has a shared background or lived experience that an individual may not be able to see during an in-person visit.

It is also well documented that navigating the mental health system is challenging and is another major reason why individuals don’t access care, even when they are interested in getting treatment. Finding a mental health clinician that is affordable or takes health insurance can require a level of patience and persistence that can be difficult, especially when an individual is in distress or crisis.12 Retail clinics, community health centers, or virtual health apps that can feel like a safe and accessible way for individuals to access care, could fill a much-needed gap for consumers who want mental health treatment.

Alternative care sites could meet consumers’ demands for convenience and transparency

Consumers’ desire for convenience is well-known, but important—and we need to solve for it because consumers are increasingly expecting a health care experience that feels like experiences in retail, banking, and other industries. Our research suggests that consumers would be more likely to use alternative sites for their health care needs if they can figure out how to deliver a better experience.

In fact, convenience is driving consumers to virtual health visits (it’s the No. 1 reason why consumers use virtual health) but bad interpersonal connections are turning people away from virtual health offerings (figure 4).

The top two reasons why consumers who have had a virtual visit choose not to return are:

  • Bad experience with the technology.
  • Poor connection with the physician and/or health care provider.

Another component of a positive patient experience is transparency. In our 2018, 2020, and 2022 consumer surveys, consumers said “having clear explanations of costs” was the best indicator of a good patient experience in health care. Retail clinics and therapy apps tend to provide fixed and transparent pricing, and most accept insurance/Medicare, which is not necessarily true among more traditional providers.

Implications for health care organizations

  • Create more access points and include opportunities to address drivers of health. Organizations have an opportunity to address the issues that exacerbate disparities. Retail clinics and community health centers can enable better access to traditional care as well as access to food, educational resources, connections to other social services agencies, and information.
  • Develop diverse care teams. Consumers are most likely to be comfortable receiving care from teams that are “like them.” One avenue is to cocreate teams with the community versus assuming what consumers wants in a health care team.
  • Ensure care continuity. For individuals with chronic conditions or older adults requiring more complicated care, retail clinics can focus on seamless interaction with other health systems or the primary care setting.

- Provide an easy mechanism to send the patient’s visit details with the patient’s entire care team.

- Create a reminder for patients to bring their complete medication lists.

  • Invest in virtual health technology. Investing in virtual health technology and facilities can benefit both consumers and organizations. Improving telehealth capabilities and designing a process whereby consumers can access their own physicians instead of third-party services could help health care organizations streamline and maximize the benefits of virtual health.
  • Train clinicians on virtual health. Consumers still aren’t completely satisfied with their virtual interactions with physicians and other clinicians. Training these personnel in building virtual interpersonal relationships can be a major step toward improving the virtual visit experience. And while physicians explore ways in which to improve their virtual interactions, organizations should support them in the sustained use of virtual health, instead of returning to traditional in-person visits to ease the friction.

Ensuring alternative care sites meet consumers’ needs

By focusing on expanding access, building connections, and having empathy, health care organizations can not only improve health outcomes but bring us closer to achieving health equity. By understanding what consumers’ needs are today and incorporating the wide range of perspectives in their communities, organizations can shape better strategies—and connect consumers with a better health care experience.

 

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Endnotes
  1. Carole A. Robinson, “Trust, health care relationships, and chronic illness: A theoretical coalescence,” Global Qualitative Nursing Research 3 (2016); Johanna Birkhäuer et al., “Trust in the health care professional and health outcome: A meta-analysis,” PLoS ONE 12, no. 2 (2017).

     View in Article
  2. Penn Medicine News, “Study finds patients prefer doctors who share their same race/ethnicity," accessed September 1, 2022.

     View in Article
  3. Michelle R. Davis, “Despite pandemic, percentage of older adults who want to age in place stays steady,” AARP, November 18, 2021.View in Article
  4. ACL, “Projected future growth of older population,” accessed September 15, 2022.

     View in Article
  5. AHA, Brigham and Women’s Hospital—Boston, accessed September 15, 2022.

     View in Article
  6. Leslie Read, Leslie Korenda, and Heather Nelson, Trust in the health care system, Deloitte Insights, August 5, 2021.View in Article
  7. Robinson, “Trust, health care relationships, and chronic illness;” Birkhäuer et al., “Trust in the health care professional and health outcome.”View in Article
  8. Penn Medicine News, “Study finds patients prefer doctors who share their same race/ethnicity," accessed September 1, 2022.

     View in Article
  9. APA, Worsening mental health crisis pressures psychologist workforce: 2021 COVID-19 practitioner survey, October 19, 2021.View in Article
  10. Mental Health America, “The state of mental health in America,” accessed September 3, 2022.View in Article
  11. HRSA.gov, “Shortage areas,” accessed September 3, 2022.View in Article
  12. Alison Muckle Egizi et al., A human-centered vision for improving the mental health care ecosystem, Deloitte Insights, July 14, 2022.

     View in Article

 

Acknowledgments

The authors would like to thank the project team, comprising Apoorva Singh and Jessica Overman who contributed significantly to the research and analysis of the consumer survey. They would like to extend additional thanks to Apoorva Singh who helped with the writing and editing of this paper as well.

Secondly, the authors would like to extend their thanks to Wendy Gerhardt who provided invaluable guidance and support throughout the project.

The authors would also like to thank Nicole Kelm and Laura DeSimio for their insights and feedback. They would also like to thank Rebecca Knutsen for her contribution toward the writing and editing of this paper, and Zion Bereket for multiple contributions over the project process.

The study would not have been possible without the research participants who graciously agreed to participate in the survey and were generous with their time and insights.

Cover image by: Natalie Pfaff.

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