Industry Trends: Right Care, Right Time, Right Setting

Industry Trends: Right Care, Right Time, Right Setting

It is an ongoing challenge that every employer addresses at one point or another—how do I get my employee population to engage in the health care system for the right care, at the right time, in the right setting? Preventive screenings, biometric and metabolic screenings, wellness visits, emergency or urgent care, etc.?

There are many reasons why employees and their families may not be taking the important steps to care for themselves—time, fear, knowledge, inconvenience are just some of the few. But access to health care is changing. We are in a new communication age in which change has happened so fast that the technology we use every day was unimaginable to most just 20 years ago. 80% of Americans own a smartphone and digital technology has become part of the innovation to engage members in their care.  Social networks and text messaging are just two ways that technology can support care and facilitate communication in an ongoing and continuous platform. These health care solutions are patient-facing and directed toward patient education, self-management, and on-demand diagnostics and service; therefore, medical care should become more of a continuous experience that patients can access when and where they need it.

Adding on-demand services such as the ability to obtain medical information specific to the individual, real-time diagnostics, and communication with health experts has huge potential in that it creates a unique opportunity to design digital disease management solutions for patients that address as many of their health care needs as possible. One of the unique aspects of digital technologies is that they allow for the integration of information from across a patient’s entire care network. For example, a particular mobile application was designed for drug adherence for hypertension that also provides dietary information, activity tracking, a supportive social network, and texting ability to facilitate communication between patients, patient-designated caregivers, and physicians.  All at the fingertips of the member without the dependence of a patient to visit a brick-and-mortar health care facility, in essence providing a greater advantage for patients for whom those visits may be physically or financially challenging.

Consumers have more ways to obtain care than ever—including, for example, grocery store retail clinics and video chats with clinicians via smartphone. Access to traditional care settings also is increasing, with the number of urgent care establishments nationwide estimated to grow 32 percent (2015 to 2019, HRI Report). This is great for convenience, but this “care anywhere and everywhere” trend can also drive higher utilization. Anytime you make it easier to access the healthcare system, you increase utilization. To meet the demand for convenience, plans need to offer different types of health care touch points to their members. Some programs, such as wellness programs, aren’t direct medical care but are “low touch” and can lead to follow-up on medical care which can identify health concerns and prompt further care.

The increased availability of care may be driving higher utilization, but the question is whether that utilization is occurring in alternative, lower-cost settings that are replacing a higher-cost visit in the next couple of years. While the short-term result of increased access may be increased utilization, payers (insurance carriers) and employers hope that access will reduce costs in the long term by detecting and treating health concerns early and shifting care from higher-cost settings to those that cost less. Achieving appropriate utilization will require employers, payers and providers to strike a balance between access and convenience to avoid delaying care or creating unnecessary demand.