Changes in the health care system driven by self-service and DIY health

Apps reflect the public's pressing health concerns

Health care is migrating from the bricks-and-mortar doctor’s office or care clinic to the person him or herself at home and on-the-go–where people live, work, play, and pray. As people take on more do-it-yourself (DIY) approaches to everyday life–investing money on financial services websites, booking airline tickets and hotel rooms online, and securing dinner reservations via OpenTable–many also ask why they can’t have more convenient access to health care, like emailing doctors and looking into lab test results in digital personal health records.

The public clamor for digital outreach by health providers

85% of U.S. health consumers say that email, text messages, and voicemail are at least as helpful as in-person or phone conversations with health providers, according to the Healthy World study, Technology Beyond the Exam Room by TeleVox. Furthermore, one in three consumers admits to being more honest when talking about medical needs via automated voice response systems, emails, or texts than face-to-face with a health provider.

And three in ten consumers believe that receiving digital health care communications from providers—such as texts, voicemail, or email—would build trust with their providers. Half of people also say they’d feel more valued as a patient via digital health communications. When people look to engage in health with an organization, the most important enabling factors are trust and authenticity.

All consumers, from Gen X and Gen Y to Baby Boomers, welcome the era of personalized medicine via digital communications, looking for these messages to be personally tailored. That 1 in 2 consumers (49%) say they’re open to receiving medical care between visits via email testifies to consumers’ demand for telehealth services.

Figure 1 reveals the popularity of email among patients for their interactions with the medical establishment, and other media show up strong as well.

Relative popularity of various channels for doctor/patient communication

Figure 1. Relative popularity of various channels for doctor/patient communication

The Internet and mobile apps support self-health

Most consumers spend time throughout the year seeking health information online–about an hour a week on average. Time with a doctor? An hour a year. That 52:1 ratio of hours spent on health, outside versus inside the doctor’s office, raises the question: what can the health care field do in the interstices of time to enhance peoples’ health and experience with the health care system?

The answer is in the cloud and mobile technology platforms, combined with the already-well-used Internet. People have been maturing in their use of the Internet for health, with about 1 in 3 people moving beyond Web 1.0 into Health 2.0’s era of blogs, wikis, and social networks of peer-to-peer support, the Wisdom of Patients kicking in. A Harris poll found that at least one-third of people who participate in online activities are keen to use smartphones or tablets to “do” health online: to ask doctors questions, make appointments, and receive medical test results, for example.

Clinical Management Apps: Creating Partnerships Between Providers and Patients, from The Commonwealth Fund, posits that apps can help to transform health care delivery across all populations–even hard-to-reach lower-income people who often fall through both the health care safety net and the digital divide. The authors of the report look into the 40-60,000 health and wellness apps in the market, and believe that these may be beneficial for low-income and minority patients disproportionately affected by chronic disease. Because these people often face barriers to accessing health care, self-managed apps – when adopted and used – can address this challenge. The researchers point to data from the Pew Internet & American Life Project showing that African-Americans and Hispanics are more likely than white people to own a smartphone and that among cell phone owners, minorities are also more likely to use their phones for accessing health information.

Food = Health

People are also embracing food as a health input. More consumers are project-managing their chronic conditions outside of the doctor’s office, and good food choices can play a huge role in wellness for noncommunicable diseases — notably heart disease, diabetes, and other life-style amenable conditions like Crohn’s Disease and diverticulitis.

The most downloaded category of mobile health apps are those dealing with food and nutrition. Among the most downloaded food apps are:

The growth of food items on store shelves at retail pharmacy chains is an important factor to note in this morphing marketplace of food = health. “Today we’re a supermarket company,” Ad Age quoted Steve Burd, CEO of Safeway, the food chain. “I think in ten years’ time, we’ll be thought of more of a wellness company selling food.” So watch for grocery stores and pharmacies stocking fresh food to expand their existing apps to support consumers in their personal health missions.

Online health marketplaces

Imagine walking into a storefront where you can shop for an arthroscopy procedure, mammogram, or appointment with a primary care doctor based on price, availability, quality, and other consumers’ opinions. Welcome to the “health care automat,” the online healthcare marketplace (a separate concept from the new Health Insurance Marketplaces, or exchanges that the Affordable Care Act has put so much in the news).
What’s driving this new wrinkle in retail health care are uninsured and under-insured people, along with those managing high-deductible health plans, seeking health care services “à la carte;” growing demand for transparency of health care prices, quality, and locations by payers; and expanding platforms for online health, from report cards to on-ramps for finding a primary care provider and scheduling appointments online for convenience.

Several marketplaces have gained traction among consumers in specific metropolitan areas. ZocDoc, akin to an OpenTable for doctors’ appointments, is now available in major metropolitan markets. ClearHealthCosts, led by a journalist, is evangelizing price transparency for health services in and beyond New York City. PokitDoc is a portal of health provider “storefronts” where consumers can search for a service by geography, price, and other features. DocASAP aggregates physician appointments through health plan channels. For more on this emerging way to shop for and access health care services, see the California HealthCare Foundation (CHCF) paper, Help Yourself: The Rise of Online Healthcare Marketplaces.

The person as part of the health team: limitations and expectations

The next phase in the evolution of DIY health is shopping for, and managing, care in the clinical setting. People have begun to develop these new muscles as they’ve taken on the mantle of “health consumer.” For example, as managed care tightened the reins of cost management in the 1980s, some people received denials for care and therapies; people learned how to appeal a health insurance claim denial to gain access to services. Facing high deductibles, people will be playing this game with their own money, placing them squarely in the role of clinical health shopper.

At some point in nearly everyone’s life, we will need a doctor or hospital bed. “Human-machine interactions may change so dramatically that people can no longer be neatly divided into categories such as patient, clinician, and support staff,” according to a report from The Commonwealth Fund on the impact of eHealth on the demand for physician services.

While the consumer/patient will be playing an increasing self-service role in her health care, “Patient-centered provider teams will need to take advantage of data that are generated before, during, and after a visit (whether face-to-face or remote) and that come from numerous nontraditional, community-based sources,” the report concludes. This will require data generated through peoples’ Observations of Daily Living (via activity trackers, food diaries, and blood pressure devices) to integrate and inter-operate with physicians’ electronic health records. This Holy Grail of the personal-mash-up-with-clinical data has yet to be realized.

Furthermore, there are two main limiting factors to peoples’ universal embrace of DIY health: activation and money/financial incentives. There is growing recognition in health plan benefit design circles that behavioral economics can play a role in “nudging” people to make positive health behaviors and engage people, in a sustained way over time, to engage in health. However, without these artful health plan designs, only a minority of people will choose to take on deep DIY health engagement.

Although health IT is a necessary ingredient for self-service health care, it’s not sufficient: internal (consumers’ personal values and motivations) and external (institutional, health policy, environmental, financial) forces must also converge to motivate people to assume greater mindfulness and expend energy on their health. Not all people will want to take on the mantle of health consumer, even given enchanting and artfully-designed apps, tools and devices.

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