Last November, I was struggling to breathe. I was suffering from an asthma flare-up as I recovered from the flu. When I called my pulmonologist to make an immediate appointment, I was gasping well before they shocked me with the news: They could not see me until February. I called my concierge doctor for help. Within hours, that same pulmonology office would conduct a virtual appointment.
This is health-care privilege, and I’m not proud of it.
My story underscores some of the harsh realities people face when seeking care: dangerously long wait times, no upfront pricing, and privileged access to providers. We don’t tolerate this treatment from any other industry, yet when it comes to our health care, we’ve allowed it—for decades. Isn’t it time that health care meets the same high expectations we have for other industries?
Health-care stakeholders are seeking quality health outcomes, improved patient satisfaction, and lower costs.
People’s wallets are saying it’s time. Right now, there is a powerful shift toward consumerism happening in health care. Will it be powerful enough for us to jump from tolerant patients to informed shoppers? I believe it will.
In 2023, consumerism will drive the biggest shift in senior care.
Aging Americans are getting more educated about how they consume health care. They realize that their overall health and well-being is not the sum total of their doctor’s visits. Rather, it is the consistent quality of life they live between those visits that really impacts their health. As such, they’re seeking more value from their health-care choices.
They want benefits that address them as a whole person, not just a patient in need of medical attention. They’re prioritizing benefits such as free grocery and prescription delivery, free transportation, in-home pet care, and companionship. They are demanding more value, and they are increasingly choosing Medicare Advantage (MA), the private insurance alternative to traditional Medicare, to get it.
According to the Commonwealth Fund’s 2022 Biennial Health Insurance Survey, respondents cited additional benefits as the top reason for choosing MA. In the last decade, MA has skyrocketed in popularity. Next year, market penetration is projected to reach 52 percent, overtaking original Medicare for the first time, according to KFF.
With an estimated 10,000 Americans aging into Medicare by turning 65 every day, there is an incredible opportunity for Medicare Advantage.
Consumerism will also drive vertical consolidation.
In 2022, major retailers like Amazon and Walmart leveraged their brand recognition and geographic reach to scoop up some of the $4.1 trillion US health-care market. Amazon acquired One Medical for $3.9 billion; Walmart launched a 10-year partnership with UnitedHealth to deliver preventative, primary care services to its Medicare beneficiaries; and CVS Health acquired Signify Health’s network of clinicians who focus on in-home assessments.
Consolidation is ramping up in part because health-care stakeholders are seeking the Shangri-La of value-based care—quality health outcomes, improved patient satisfaction, and lower costs.
Yet, the promise of value-based care remains elusive because the definition is too limiting. Today’s definition is framed against cost reduction and pushes the risk onto physicians through reimbursement models that don’t really work. Under today’s definition, value-based care handcuffs physicians’ decision-making to financial guardrails instead of clinical opinion. It essentially creates two insurance companies in the supply chain. That’s not sustainable or attractive to providers.
A more sustainable approach is one that creates a virtuous cycle, reducing costs by improving delivery. Fortunately, technology already exists to help us do that by leveraging better data: data that quickly identify the most at-risk members, predicts their care needs, and facilitates the actions needed to keep them out of the hospital. The cost savings generated from preventive actions are then reinvested into the supplemental benefits consumers are actually looking for. It’s a win-win.
We have the opportunity to redefine value-based care around the value realized by the end consumer—patients. When we align incentives between insurers and providers to create that value, we’ll raise the bar on health care for good.
Having loyal customers who value your brand and trust health-care products that meet them where they are is the ultimate definition of value-based care. It’s what we’re striving for at Alignment Health.