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27 October, 2017| Author : Hemangi Hanote, Varun Agarwal, Tanay Agarwal| Healthcare
Business Analyst
The Future of Healthcare in the
Consumerism World
CitiusTech Thought
Leadership

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Objective
 The main aim of this document is to provide an overview of healthcare consumerism, its growth
drivers and challenges / barriers providers and payers face while adopting it
 The document provides insights on how providers and payers can tackle the rising wave of
consumerism in healthcare industry
 The document also provides some real-life examples on market trends which emphasize the need
to brace consumerism in healthcare
 At the end of this document readers shall be able to:
• Recognize the current market trends on consumerism prevailing in the healthcare sector
• Identify areas where they can gain competitive advantage by acting early
• Understand the process of adopting consumerism in healthcare

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Agenda
 Introduction to Healthcare Consumerism
 Key Drivers of Consumerism
 Key Challenges
 Consumer Access Points
 Current Market Trends
 Opportunities to Leverage
 Technology Enablers
 5 Step Approach to Consumerism
 References

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Introduction to Healthcare Consumerism
What is Healthcare Consumerism?
Consumers are taking an increasingly active role in healthcare decision making. Healthcare
Consumerism is defined as the actions individuals take to become better informed and more directly
and proactively involved in decisions and behaviors that affect their health, insurance coverage, and
health care. These actions may include:
 Researching for information about health concerns and compare treatment options
 Taking deliberate steps to monitor and improve their health
 Cooperating with physicians to make treatment decisions
 Sharing information with doctors
 Taking cost and quality aspects into consideration in their decision making
 Adhering to recommended treatment plans
Key Stakeholders
Providers PayersConsumers/Patients

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Key Drivers for Consumerism
Regulatory reforms
(ex. ACA)
Market for private HIX solutions deployed by U.S. employers will
grow at a CAGR of 41.9% between 2016 and 2020 – Frost & Sullivan
Growth in
co-pays - Individuals
as biggest payers
>35% of total healthcare payments were out of pocket in 2015 and
the trend is only increasing – HIMSS
Shift to
value-based care
models
Healthcare transformation task force is working on a plan to shift 75%
of members’ contracts to VBPs by 2020
Focus on wellness
and prevention
91% of consumers want to be more proactive in managing their
health – A Xerox survey
More expectations -
Access to digital tools
/ info
By 2022, 20% population with chronic health conditions will rely on
virtual health assistants

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Key ChallengesConsumerExpectations
More for less
Quality vs. Price
On demand access
Information and care
Continuous engagement
Communication and loyalty
Self help / timely resolution
Automation and integrated
customer service
Customized care
Tailored solutions
Key Technology Considerations
User Experience
Data security and privacy
Integration and Interoperability
Scalability / Cloud
HIPAA / PHI compliance
Enterprise Mobility
CRM / Web enablement
Internet of Things
Enterprise BI and Analytics
Providing a simple and effective consumer experience is hard! It needs organization to connect
various disparate data sources and work across many different technologies.

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Consumer Access Points
47%
15%
27% 27%
34%
37% 38%
50%
19%
48%
35%
23%
Retail Clinics Urgent Care
Centers
Freestanding
Imaging Sites
Virtual Visits
Not Available Limited Access Significant Usage
Patient Engagement initiatives
Source: Kaufman Hall 2017 Healthcare Consumerism Survey
Enhancing access with a variety of entry points is a must for legacy healthcare providers
to enrich consumer experience.
Availability of Innovative MethodsTraditional Methods for Consumer Access
4%
11%
13%
18%
23%
6%
34%
30%
26%
42%
69%
43%
48%
41%
27%
Online Patient Portal
Message between
Patient and Providers
Extended hours of
dignostic services
Extended hours of
primary care
Virtual Visits
Its Available
We are working on it
Not available and not working
It’s available

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Current Market Trends (1/3)
Retail Clinics
A retail clinic is a category of walk-in clinic located in retail stores, supermarkets and pharmacies
that treat uncomplicated minor illnesses and provide preventative health care services
 Memorial Hermann has partnered with RediClinic to provide 22+ retail clinics in Houston
area
 RediClinic operates quick-care clinics in grocery stores, to offer convenient, low-cost
access to consumers who need minor care
Enhancing access to quick care at convenient location at right time through retail clinics,
providers are taking the right step in transitioning to customer-centric model .
 Renton-based provider has teamed up with Walgreens to offer 25 walk-in clinics
 The clinics will bridge the gap between hospital-based urgent care and coordinated
primary care
 Retail health clinic offers transparent pricing, no pre-appointment and extended hours
 Arizona's largest healthcare provider
 Partner with Safeway grocery stores to open retail-based clinics at 3 different locations
 All 3 locations will have a nurse practitioner on site and will be open 365 days per year
 The objective is to provide patients with the same level of care as in an emergency
department but with less waiting time and cost
Banner
Health
Providence
Health
Memorial
Hermann
Source: Banner Health | Providence Health | Memorial Hermann

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Current Market Trends (2/3)
Patient Engagement Initiatives
A concept that combines a patient's knowledge, skills, ability and willingness to manage his own health
and care with interventions designed to increase activation and promote positive patient behavior
 The project provides a way for providers to share patient-centric information directly
with the patients
 Instigates communication and engagement between patient and provider by making
physician notes available via a secure online portal
 Patients feel more empowered in their healthcare, and have reported that having
access to their notes would influence their decision to choose the provider
 Physician-led integrated health system based out of Pennsylvania
 Its ProvenCare model offers money-back guarantees for care experiences that don’t
meet patients’ expectations. The patients decide how much they get back—no questions
asked. In six months just 74 patients asked for their money back, totaling about $80,000
 It has launched an innovative CRM program in collaboration with GH’s Fresh Food
Pharmacy which brings medical, dietary and social care to families struggling with food
insecurity and diabetes. 50% of nearby Shamokin city residents are diabetic and 30%
don’t know where their next meal is coming from. When diabetic patients order insulin
from a Geisinger pharmacy, they also get a week’s worth of tasty, diabetic-safe food
delivered.
OpenNotes
Geisinger
Source: Open Notes | Geisinger

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Current Market Trends (3/3)
Healthcare consumerism and digital patient engagement are becoming the new norm to meet
the challenge of the patient-consumer’s service expectation, convenience and value.
 Leading insurance company, serving approximately 46.7 million people
 Teamed up with the Financial Planning Association for a public education campaign
dedicated to helping patients navigate the financial aspects of their health benefits
 "Find a Doctor & Estimate Costs" tool provides members with cost and quality data
 The tool provides searching doctor by location, cost estimates for procedures, the
amount members would have to pay and read and write doctor reviews
 Members can also check quality data of doctors and compare doctors side-by-side
 Pardee is a non-for profit hospital managed by UNC healthcare
 They have customized search on their portal wherein patient can select the doctor by
selecting up to 14 personality characteristics
 Algorithms also list doctors based on compatibility, distance and location
 The largest integrated health system in New York state
 Developed a mobile app that offer instant feedback options for patients
 Any “unsatisfied” result trigger, alerts to appropriate physician / staff who then attend to
patient need within 15 minutes
 Satisfied patients prompted to identify staff people for recognition as well
Aetna
BlueCross
BlueShield
Pardee
Health Care
Northwell
Health
Source: Aetna| BCBS | Pardee Health Care | Northwell Health

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Opportunities to Leverage
 360-degree customer view
 Consumer analytics
 Segmentation analytics
 Real-Time patient
Feedback system
 Staff operated feedback
system
 Enterprise application
framework to support
apps across care
continuum
 Build Advance Virtual
Care
 Multichannel Navigation
Platform
 Application integration
and interoperability using
EAI platforms
 Data integration support
for care coordination and
patient engagement use
cases
 Uncover points of
frictions between
patient and provider
 Discover digitalization /
transformation
opportunities
 Integrated search, price
estimation and
scheduling
 Externally embedded provider
search
 Automated price estimates
 Hospital locator and way finding
inside hospital
 Online scheduling
 Integrate portals and apps
 Consumer-driven personalized
healthcare plans
 Bargain-base pricing
 Simplified billing & payments
eHealth Platform /
Mobile Support
Data Intelligence
and Analytics
Device / Data
Source
Interoperability
Consumer
Journey Mapping
/ UX
Consumerism
Purchasing Ease
Reconfigure
Access Channels

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Technology Enablers
 E-visits
 Personal analytics
 Patient Portals
 Digital care coordination
 Omnichannel experience
 Digital care records
 Virtual health
 Telehealth
 Remote patient monitoring
system
 Patient Wearables
 Real-time health systems
 Sensors and host boards
 IoT enabled medical
devices (including OS,
firmware, drivers)
 EHRs / EMRs
 CRM
 ERP
 EDW
 Cognitive HIS / RIS
Consumer Ecosystem
Devices IT Systems
Consumerism Platform
Intelligence
 Population Health
Management
 Precision Medicines
 Genomics
 Real-time Analytics
Key Enablers
User Experience
Artificial Intelligence & Machine
Learning
Integration and Interoperability
Scalability / Cloud
Enterprise Mobility
CRM / Web enablement
Internet of Things
Enterprise BI and Analytics

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5 Step Approach to Consumerism
Establish vision
and governance
Discovery and
current state
assessments
Strategic blue
print and gap
assessment
Reprioritization
Execution blue
print and kickoff
 Clearly
articulated
strategy around
consumerism
with key
outcome
expectations
 An empowered
team structure
to drive
integrated
consumer
centric initiatives
 Current state
assessment
through interviews
and focus group
discussions,
discovery
workshops, asset
inventory
exercises,
document reviews
and observation
and analysis
 Current state
customer journey
maps
 Draw a
strategic
blueprint that
is aligned to
the vision
with a
detailed gap
analysis
 Rethink the
initiatives
based on
current state
assessment
 Reprioritize the
initiatives after
detailed
considerations on
multiple dimensions
- investment vs.
returns; impact vs.
complexity; tactical
vs. strategic etc.
 Consider impacts
like change
management,
process re-
engineering and
enterprise
architectural
adjustments
 Finalize the phases
and sprints for
prioritized initiatives
 Come up with clearly
articulated key
success factors for
each of the
initiatives
 Define fail fast and
fail safe
expectations;
leverage tools and
methodologies like
design thinking,
rapid prototyping
and journey
mapping

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Summary
 Consumerism will reshape the healthcare industry in the coming years
 The age of consumerism will be even more profound in 2018-2020 as more choices and
information will be available to the consumers for decision making due to advancement of
technology
 Use of alternative care options for example retail clinics will grow substantially in the few years
 The key to survive for healthcare organizations is loyalty
 Healthcare organizations who will be able to understand, guide and engage consumers will have
a significant opportunity to make difference and earn the loyalty
 Healthcare organization should also think about the role of new healthcare technologies in
understanding consumerism to gain competitive advantages

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References
 The Reality of Consumerism on healthcare
https://www.td.org/Publications/Blogs/Healthcare-Blog/2016/07/The-Reality-of-Consumerism-on-Healthcare
 2017 state of consumerism in healthcare
https://www.kaufmanhall.com/sites/default/files/2017-State-of-Consumerism-in-Healthcare.pdf
 HFMA report on Health Care 2020 - Part 2: Consumerism
http://www.hfma.org/Content.aspx?id=49983
 Banner Health opens 3 clinics at Arizona grocery stores
http://www.beckershospitalreview.com/facilities-management/banner-health-opens-3-clinics-at-arizona-
grocery-stores.html
 Providence to own healthcare clinics
http://www.modernhealthcare.com/article/20150820/NEWS/150819875
 Memorial Hermann Medical Group RediClinics
http://mhmg.memorialhermann.org/doctors-specialties/rediclinic/
 A $10 Million Victory for Patients
https://gopvi.org/blog/a-10-million-victory-for-patients
 Pardee Hospital & Northwell Health
http://www.himssconference.org/sites/himssconference/files/pdf/INV5.pdf
 Blue Cross Blue Shield
https://www.fiorente.tv/heath-care-consumerism/
 Geisinger Health System
http://www.pressganey.com/docs/default-source/industry-edge/issue-3/breaking-new-ground-in-the-era-of-
health-care-consumerism.pdf?sfvrsn=2
 Aetna
http://investor.aetna.com/phoenix.zhtml?c=110617&p=irol-newsArticle_Print&ID=909224

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Author:
Hemangi Hanote
Varun Agarwal
Tanay Agarwal
Healthcare Business Analyst
thoughtleaders@citiustech.com