Changing patient expectations
With the advent of the internet, providers have found that patients, their families and caregivers are increasingly well informed about their treatment options and care pathways. At the same time, consumers’ experience with other service industries means that the services offered by many health providers is increasingly out of line with the client-focused and data-driven approaches being utilized in other parts of the economy. Indeed, patients are increasingly expecting to interact with their service providers through a variety of channels (such as the web and mobile devices) and will expect the same type of approach from healthcare.
Amplified patient voice
Along with changing expectations, patients have also started to proactively take control of their health management. Social media and the internet have not only provided valuable access to opinions and information regarding personal health issues, but have also amplified patient voices and allowed individuals to advocate for greater influence on their treatment and the quality of service they receive. In turn, this has shifted the balance away from the traditional ‘doctor knows best’ relationship and towards one where patients take a more active role in their treatment plans.
Growing value of shared decision-making
Evidence shows that, for a range of conditions, patients often make better (and more cost-effective) decisions about their care when they are fully informed about their treatment options. In many cases, patients tend to choose more conservative and often lower-cost options than those chosen by their physician. The incentives to get involved in decisions are even greater in circumstances where patients have a direct financial stake in the costs of a procedure.
According to Professor Al Mulley of the The Dartmouth Institute for Health Policy & Clinical Practice in the US, there is a widespread failure by clinicians to properly understand the preferences of their patients and how the proposed interventions will affect their lives. He calls this ‘preference misdiagnosis’ and argues that there is a major problem of wasted resources and harm to patients as a result.
There is also growing concern that there is an increasing amount of ‘overdiagnosis’ in which patients are over investigated and screened. As a result, some patients are being treated for conditions for which the benefits of the intervention are – at best – marginal and in some cases harmful. The bottom line is that an informed patient that is aware of the risks may be less likely to agree to these procedures.
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The need to improve planning for end-of-life care
Advance planning and ongoing communication with end-of-life patients and their caregivers will improve decision-making and ensure the appropriateness of care for patients near end of life. And, since the clinical goal for medical support should be on preserving and enhancing quality of life, there is growing consensus that efforts need to be made to reduce the proportion of patients dying in hospital and the amount of expensive, futile and often harmful care given at the end-of life. Shifting to more appropriate and less clinically intrusive care settings should be a priority.
Making chronic disease care more effective
Healthcare systems are increasingly recognizing that many patients with chronic diseases are already engaged in high levels of supported self-care. Experience from other industries that have adopted ‘self-service models’ shows that self-serve approaches are popular with customers, even though they effectively mean that the consumer is undertaking a greater share of the work load. In many cases, consumers enjoy the benefits gained in convenience and control, as well as the potential for lower prices. And, as patients and payers start to experience mounting costs in insurance premiums, deductibles and co-payments, these approaches become much more attractive.
The fact that patients already manage much of their own care means that they are often experts in the management of their own condition, and are more likely to follow treatment plans and be motivated in achieving their personal health outcome goals. In fact, in the case of rare diseases, many patients have shown that they have more information than their primary care physician. They also often know more about how their bodies react to particular treatment options. Interestingly, many providers have been rather slow to capitalize on new innovations such as the use of social media to connect patients who share conditions, which enables them to exchange ideas, tips for self-care, and other information.
Opportunities to reduce the costs of care through changes in behavior
As payers become more aware of the opportunities to improve quality and reduce costs by getting patients more involved in their treatment decisions, many are also exploring opportunities to promote more healthy lifestyles, and the use of preventative care. And while the economic arguments for this approach are somewhat less clear than the ethical ones, all signs suggest that the economic evidence is growing. Regardless, the shift in behavior represents both a major challenge and an opportunity to payers, providers and patients and will require some significant rethinking of traditional approaches.