Improving engagement at three key touchpoints in a consumer's health care journey could help health care stakeholders improve patient outcomes and reduce the cost of care.
CONSUMER engagement with health care continues to grow, from searching for care and accessing new channels of care to tracking and sharing health data. Consumer engagement could be the key to improving patient outcomes and reducing health care costs; patients who are informed about their condition and involved in their treatment decisions tend to have better health outcomes and typically incur lower costs.1 Many health systems, clinicians and health plans—as well as biopharmaceutical and medical device companies—are developing tools and strategies that can help consumers become more engaged in their health. But what do health care consumers really want?
The Deloitte Center for Health Solutions conducted a nationally representative survey of US adults from February to March 2018 to identify trends in health care consumer engagement. We identified three touchpoints during a consumer’s health care journey when active interaction with the health care system peaks: searching for care, accessing new channels of care (for example, at-home testing, diagnosis and digital tools) and sharing personal health information.
Our findings show that:
Understanding consumer attitudes and preferences across the patient journey can be central to supporting healthy behaviours, achieving better health outcomes and improving the patient experience. As life sciences and health care organisations continue to evolve their strategies, they should consider:
Since 2008, the Deloitte Center for Health Solutions (DCHS) has polled a nationally representative sample of US adults (18 and older) about their experiences and attitudes related to their health, health insurance and health care. 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, in February and March 2018, DCHS conducted an online survey of 4,530 US adults, from which this article draws insights.
In this paper, we offer a framework to organise our 2018 survey findings about consumer attitudes and behaviours across three different stages of consumer engagement. While not inclusive of the entire patient journey, the stages that we examined for this study include:
Consumers want in-network and convenient health care providers. One key step in the patient journey is finding the right health care provider. Half of the surveyed consumers said making sure a physician or hospital was a part of their health plan’s network was one of the most important factors when choosing a doctor (see figure 1). For 43 per cent, a convenient location was important. Reputation (39 per cent) and bedside manner (34 per cent) were the third and fourth and not far behind were convenient hours and out-of-pocket costs (32 and 31 per cent, respectively). Few consumers said technology for online scheduling and accessing labs and test results were important.
These findings suggest that health care consumers are less focussed on “bells and whistles” and more on convenience, cost and bedside manner, possibly because they continue to face challenges accessing and obtaining affordable and reliable care.
More consumers are looking at quality ratings and pricing tools than in previous years, but use is still low. More consumers are looking up pricing and quality information in 2018 versus 2015 and while use is still relatively low, the trend is upwards. The percentage of consumers looking up cost information has nearly doubled in the last three years from 14 to 27 per cent (see table 1).
Previous research, including Deloitte’s, has shown that there is a gap between what consumers say they are likely to use and what they actually do.2 In 2018, 53 per cent said they were likely to use a tool to look up quality ratings for specific physicians or hospitals, but only 23 per cent did so in the past year and though 50 per cent said they were likely to use a tool to look up pricing in the future, only 27 per cent did so in the past year. However, this gap is decreasing, down to 20 per cent in 2018 from 30 per cent in 2015. This persistent, though decreasing, gap may indicate an opportunity to improve current pricing and quality tools and make them more user-friendly.
About a third of consumers are interested in using apps for identifying symptoms and for health coaching. The number of digital tools and apps available for health care and health coaching is increasing significantly,3 and many developers are offering more evolved and sophisticated tools. These tools have the potential to improve health outcomes through faster diagnosis, 24/7 access to health coaching and the ability to recognise mood and lifestyle changes that could affect adherence to a treatment plan.
About a third of respondents are interested in using apps for these purposes (see figure 2):
Consumers who consider themselves to be in excellent/good health are more likely to use such tools than are less-healthy consumers.We found that consumers who consider themselves to be in “excellent” or “very good” health are more interested in using health apps or digital tools than are less-healthy consumers. On the other hand, respondents who consider themselves to be in “poor health” are also more interested in such tools than those who consider themselves to be in moderate (good or fair) health. Health care providers may need to find ways in which to engage consumers who consider themselves to be in “fair” or “good” health. Considering that 43 per cent of consumers considers themselves in fair or good health, this is a sizable segment that has the potential for increasing engagement. Organisations may attract these consumers by offering to help them identify tools that target prevention of potential health issues and possibly combining these tools with diagnostic or predictive (for instance, genomic profiling) solutions in the market today. In addition, health systems or health plans may consider building a role for a person who can proactively approach consumers and educate them on the use of digital tools and platforms.
At-home self-diagnostic and genetic tests are becoming more popular among consumers. Many consumers are comfortable using at-home tests for their current health concerns and identifying potential future health issues. For instance:
At-home tests, mobile devices and related technologies are helping to enable new ways to diagnose, monitor and manage patients and their treatment. Many companies are developing these tests and apps along a continuum of wellness and prevention, ranging from acute diagnosis and chronic-disease management to identifying future risks of illness. Some examples of recent innovations are shown in table 2.
As these tests become more widespread, consumers will likely need actionable information, including medical advice from a physician or a genetic counsellor. As consumer interest rises, we expect the development of at-home tests for many other diseases. The use of these tests also has the potential to help with provider efficiency and making sure the patient is getting the right level of care when needed.
The use of technology to monitor health and measure fitness levels has increased since 2013. Sixty per cent of surveyed consumers say they are willing to share personal health data (generated from wearable devices) with their doctor to improve their health. The use of tools for measuring fitness and health improvement goals jumped from 17 per cent in 2013 to 42 per cent in 2018, according to our survey results. (Figure 3.)
Of the consumers who have used a wearable fitness device in the past year, 73 per cent said they used it consistently, 25 per cent used it sporadically and only 2 per cent completely abandoned the device. It appears that persistence is increasing with wearable fitness devices. Prior studies have shown that fitness devices were discarded much sooner.10 This increased persistence could be due to consumers getting more comfortable with the idea of health quantification, the devices increasing in utility and price points going down.
The data generated from wearables can help improve population health, advance clinical research and enhance the performance of the device. How do consumers feel about sharing this data? Our survey results indicate that consumers are most willing to share this information with their personal doctor to improve their care (figure 4).
The survey results also show that:
This sharing of data can help both providers and consumers be more proactive in their health management. Health systems and clinicians should think about how to organise this incoming data, if they decide to work with patients’ tracked data.
Consumers are most willing to share their medical record data with their health plan or a hospital affiliated with a university. Every time a patient interacts with a hospital/health system, another piece of health care data is created and stored in an electronic health record (EHR). We found that many consumers are willing to share EHR data (provided their personal identifiable information is protected) with their health plan or with a hospital affiliated with a university (46 per cent each). Fewer are willing to share this information with medical device manufacturers (35 per cent), state/public health agencies (34 per cent), or pharmaceutical companies (31 per cent).
Organisations will likely need to build trust to encourage consumers to share their data. One way may be to let consumers own their health data. Today data often resides in multiple medical records across different providers. This makes valuable nuggets and a complete picture of one’s health unavailable to doctors, researchers and the consumers themselves, sometimes making it difficult for people to get the targeted care they need at the most critical times.
Some organisations are working to help consumers own their data:
These organisations are working to give consumers one-stop access to their medical information, in addition to control over data-sharing. But this can require interoperability between the various organisations that currently “own” or shop the data, so this movement has the potential to create pressure for centralised records and interoperability in the industry.
Consumers are turning to health/patient advocates and other trusted sources for information, especially about costs. Despite a growing number of tools that can help engage consumers at each stage of the patient journey, many consumers still find it difficult to navigate the health care system.13 Health or patient advocates—that some consumers can avail through employers, private agencies, health systems and health plans—can help individuals with everything from finding specialists for hard-to-diagnose diseases to negotiating medical charges with hospitals and doctors to resolving claims-processing issues with insurance companies.
Our survey indicates that what consumers want most from an advocate is help with cost issues (see figure 5). About half of consumers say they would like to use an advocate’s aid for appealing a health insurance claim or for lowering prescription costs. Health advocates could help consumers navigate prescription assistance programmes or use their benefits to help ensure they are getting the lowest cost on their prescription medications. Just 35 per cent of respondents said they were interested in getting health coaching services for lifestyle behaviour changes from an advocate.
While a variety of organisations provide health advocacy services, more consumers would trust an independent health advocacy/navigator service (44 per cent) or a hospital to provide the service than a health plan (36 per cent) or their employer (24 per cent).
Employers or health plans looking to offer these services should consider ways to build consumer trust—such as ensuring privacy and confidentiality and clear communication about these services and how they are used. They could also consider partnering with reputable third-party organisations.
Hospitals and medical societies top the list of trusted sources for information on effective/safe treatments. Consistent with our previous studies, we found that consumers trust information from hospitals and medical societies more than any other source.14 While consumers’ trust in health plans and pharmaceutical companies is still fairly low, they are twice as willing to trust information from these groups than they were in 2010. (Figure 6.) To continue to foster consumer trust, organisations should focus on developing resources and tools that are centred around consumer needs, including privacy and clarity on how patient data will be used and shared. Organisations that are low on trust but are developing tools to provide information on treatments may consider a partnership with a more trusted source to attract consumer interest.
Engaging the consumer can hold profound potential benefits for health care. New digital tools can play an important role in the future of care—monitoring a person’s health, helping individuals get access to more convenient care, giving caregivers peace of mind and helping older adults stay in more comfortable settings. These tools also have the potential to increase consumer satisfaction, improve medication adherence and help consumers track and monitor their health (including signs and symptoms that may alert them to the need for care).
To increase consumer engagement, organisations should provide easy-to-use platforms, high-quality care through these newer channels, and security and privacy of health and personal information.
Some observations and implications from survey results include: