Patient Skepticism Slows Healthcare Consumerism

The healthcare industry has only partially adopted a consumer-focused approach to selling its services and "there is a competitive need for providers to get transparency right, in terms of what information to present and through which channels," says one industry analyst.

Driven in part by high deductibles, Americans are increasingly looking at their healthcare choices in the same way they shop for other commodities, comparing prices and quality to get the most for their money.

Hospitals, health systems, and insurers are responding with more transparency and price estimation tools to help the consumer. So why aren't more consumers using those resources?

Part of the answer lies in how the healthcare community has only partially adopted the consumer approach to selling its services, says Jean-Pierre Stephan, head of customer relationship management at Accenture, the multinational consulting company with a strong presence in healthcare. If healthcare organizations are going to use a more traditional business approach by providing prices and quality information, they have to fully embrace it and solicit participation, Stephan says.

"There has to be a trigger for the consumer to change behavior," Stephan explains. "Just having information out there, thinking patients will come to the information because you're transparent and it's there, is not how other industries have solved consumer behavior problems. That is why we're seeing low adoption rates with these solutions."

Related: How Real is Healthcare Consumerism?

That view is supported by an analysis of a large national health insurance plan database by researchers from Harvard T.H. Chan School of Public Health, which shows that only 3.5% of those who had access to Aetna's pricing tool, called the "Member Payment Estimator," used it in between 2011 and 2012.

Though participation probably has increased in the ensuing years, the figure still would be quite low today, says lead author Anna Sinaiko, PhD, research scientist in the Department of Health Policy and Management.

Sinaiko points out, however, that a price estimating tool will be useful only to a subset of the overall population that has access to it. Only patients who are planning for a healthcare service that has pricing information available will use the tool. That subset is much higher than 3.5% of all Aetna customers, so the figure still indicates low participation, she says. The Aetna tool covers more than 600 procedure bundles.

The researchers found that colonoscopies, mammograms, and childbirth services are the most searched-for medical services in cost estimators. Other top searched-for services in the study included MRIs, vasectomies, physician office visits, and other non-emergency services, according to a recent study in Health Affairs.

Profile of a Price Shopper

Most of the healthcare price information people sought was for "shoppable" services, the type that patients can plan for ahead of time, such as preventive screenings or outpatient procedures such as knee replacements, tonsillectomies, or hernia repair.

Most who used the price transparency tool were in the 19 to 34 age range, healthier than the general population, and had higher annual deductible spending than those Aetna members who did not use the estimator. Women used the tool more than men.

"Engaging patients in the use of this information is an ongoing process" Sinaiko says. "More effort is needed to engage patients, particularly those with high deductibles who could make the most use of the information."

Sinaiko notes that her previous research on consumerism in healthcare indicates a strong desire among patients to have cost and quality information available to them, with a survey showing that half of people who had recently received care wanted access to that data.

But only 3% said they actually had shopped for a good price before their care. The explanation must be that there is a disconnect between the patient who wants information and the healthcare entity providing it, Sinaiko says. "Developing strategies to deliver salient price information to our patients is really the next step in the process."

Online Shoppers' Perception of Bias
Use of healthcare consumer shopping resources varies significantly among different demographic groups, Stephan and Sinaiko say. The highest usage comes from younger consumers with a high digital profile, those who regularly use social media and online resources.

These "digital consumers" typically are younger consumers of the Millennial generation, which means they are healthier and have some of the highest deductibles. They have expectations and attitudes that may seem counterintuitive to the healthcare leaders designing shopping resources, Stephan says.

Related: Patient Skepticism Slows Healthcare Consumerism

For instance, consumers most comfortable shopping online and using digital resources are the most skeptical. In general, consumers are less trusting of cost and quality information provided by insurers, thinking they're being steered towards what's best for the company rather than the patient, Stephan says.

"There is this sense that the information being published is biased," Stephan says. "Among all healthcare consumers, the trend is moving toward less thinking that the information is biased. But among digital consumers, those who are using these resources the most, the trend is inverse. They are moving more toward thinking it is biased."

In addition, digital consumers expect as much personal interaction with clinicians as older, more traditional consumers. Their comfort in using online resources does not mean they see them as an alternative to in-person or telephone communication, Stephan says.

Consumers also expect to see patient reviews of the services they received, just as they rely on posted reviews on other websites for products, restaurants, and hotels, he notes.

Transparency and serving consumers' concerns could affect consumer loyalty and the bottom line, Stephan suggests. Healthcare consumers already are known to switch providers more than in other industries, and switching is expected to become easier in the future, he says.

"There is a competitive need for providers to get transparency right, in terms of what information to present and through which channels," Stephan says. "Consumers who get the information they want, in the way they want it, are less likely to take their business elsewhere just for a small cost savings. When people feel that they can easily get information they can trust, that has a value to them."