Consumer Driven Healthcare.
Though I’m glad that we are finally starting to put the consumer in the middle of the healthcare equation, I still cringe when I hear those words. Let’s be clear – consumers have not been driving this evolution – they have been given the “gift” of financial responsibility. 15.5 million Americans are on an HSA/high deductible plan – steadily growing 15 percent over the last several years (according to AHIP 2013 census). For a family of four, out-of-pocket health spending can be up to $15,000 – the second highest household expense beyond housing.
Many would agree that it’s beneficial over the long term to move to a system where individuals can behave like true consumers – comparing prices, looking for value, evaluating alternatives and getting recommendations from “people like them.” The challenge, however, is that in order to take responsibility, consumers need “response-ability.”
I have spent significant time looking at solutions that either enable or support the rise of the consumer – where individuals are not only more empowered, but also have the tools, resources and incentives to take charge of their health. While I have seen many interesting companies across a range of market segments, a few key areas stand out.
Selecting and understanding benefits
The days of the HR manager as benefit consultant are waning. Companies such as Connected Health are creating decision support tools based on behavioral economic theories to help consumers navigate the insurance decision making process and maximize their benefit dollars. Such tools allow consumers to make more informed choices based on their preferences, values, health status and available options.
Understanding treatment options
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
How many of us have been in a situation where we had to make critical health decisions with limited time or knowledge? WiserCare is trying to make it easier for consumers to figure out what treatment options are available to them, help them match their options with their preferences and values, and provide a platform to discuss the options with their provider. Another interesting company, WiserTogether, gives consumers treatment options based on outcomes data, personal preference, crowd preference, cost and benefits coverage. Instead of focusing on where you should go to get knee surgery, the product educates you on other options besides surgery.
Managing controllable health factors
As a healthcare investor, one could spend all day, every day looking at the myriad of new condition management solutions that leverage mobile and social technologies. Through the increasing use of technology to passively collect data, these solutions typically make it easier and more fun for consumers to optimize their health as well as get critical information to their clinician. While many players in the market today will end up being interesting tools or features – not companies – a few such as Omada (pre-diabetes), and Propeller Health (asthma and COPD) have the potential to become leading proprietary platforms.
While I remain excited about the new incarnation of health and wellness players, I believe the most interesting play in this space is with integration platforms that provide a more holistic solution for both consumers as well as population health managers. Welltok integrates many of the point solutions in the market (condition management programs, wellness programs, applications, tracking devices, content and communities) into one experience and uses premium reductions, co-pay discounts, gift and cards to incent healthy behavior.
Finding healthcare value
Price transparency is one of the most high profile areas in HCIT right now. Who can argue that the consumer has a right to know how much their care costs and where they can get the best value? Companies such as Castlight and Change Healthcare bring together cost, quality and benefits information to allow consumers to make more informed choices about their treatment decisions. While I believe work still needs to be done to get the right information to the right consumer at the right time, I am excited that these companies are forcing open the black box of healthcare cost and pricing information.
Getting a second opinion
I remember being shocked the first time I saw the data showing that one-third of medical diagnoses are wrong and more than 60 percent of treatment plans need to be revised. Companies such as Grand Rounds and Best Doctors provide a starting place for getting a second opinion by helping match individuals with the right clinician based on their symptoms or condition. Better, a recently launched mobile app service developed in conjunction with the Mayo Clinic, acts as a personal health assistant for consumers. The application and service can help with second opinion consults as well as other health related topics such as health planning and insurance reimbursement.
Finding people like you
Social networks and media channels like Facebook and Twitter have changed how we interact with the world around us. But if you have a serious medical condition, most individuals are not likely to share their personal health stories. Enter PatientsLikeMe and MyHealthTeams – two examples of communities where individuals can find others like them, compare symptoms, get advice on treatment options and give back to the community by sharing their health information. Curious is taking things a step further by challenging the traditional medical research model. By opening up access to personal health data, the company is allowing consumers to start asking health related questions and testing hypotheses with the help of others who want to be part of the solution.
All of these innovative companies are setting out to empower consumers and give them the ability to participate in their health. Now it is up to the consumer to respond and take action.
