Direct to Consumer Chronic Care Management
Direct to Consumer Chronic Care Management

Trust is not absolute, even though we think it is.

In reality, trust changes over time, varying by person and context.

Smart phones and tablets were around since the 1990’s. But until Steve Jobs, consumers never considered them to be necessary. Now they are considered necessary to the point where we cannot live without them. And we have come to trust our smart phones more than we trust the people in our lives.

Trust changes with the changes we see in our everyday lives. And as we adjust our lives to be more technology dependent, we grow to trust technology more. The same applies to healthcare.

As the COVID-19 pandemic and the infusion of technology change healthcare, the perceptions of trust will change as well – sometimes for the better. For years physicians were leery of artificial intelligence, to the point that many resisted the implementation of electronic medical records.

Now physicians rely on artificial intelligence to analyze patient data and to make clinical decisions. An adjustment that came about only after physicians began to trust data. Now artificial data platforms may revolutionize how we aggregate and store medical records – an overdue change in patient care.

Although physicians are not the primary driver of change in healthcare. That would be patients, the largest stakeholder in healthcare. And the changing trends of trust among patients will determine the changes we see in healthcare. The most notable of which is the growing distrust in traditional healthcare systems.

But this tells only one part of the story. Patient’s distrust in traditional healthcare comes with a growing trust in decentralized forms of healthcare, including what many call direct to consumer healthcare services. These include clinical services offered over the internet or at the convenience of home.

For many years healthcare providers believed that healthcare requires the traditional context of a patient-physician encounter in a medical office building, or that acute clinical care requires the infrastructure of a hospital. The pandemic revealed the limitations of these beliefs.

Now patients are increasingly accepting customized forms of clinical services delivered in unique ways directly to them, bypassing the infrastructure and cultural beliefs of traditional healthcare. The success of these novel methods of clinical services have surprised many industry experts.

Venture-backed companies like Ro, Curology, and GoodRx and have captured significant market shares by providing clinical services that require patients to pay directly out of pocket. Something many considered impossible just a few years ago.

As patients change their behavior, they grow familiar with the changes, and the familiarity breeds trust. The success of these companies has less to do with the services or products offered, and everything to do with the convenience of delivery.

Patients value convenience to the point that they will pay for it directly, and they trust startup companies enough to pay them for their clinical services.

Many experts in the venture capital industry try to explain the rise in direct to consumer models by pointing to industry trends pushing patient behavior in this direction. They then cite the cost of acquiring patients through traditional healthcare insurance mediators, or the changing job economy in which fewer people retain employer coverage.

But trends in healthcare do not come from industry pushes. They come from changes in patient behavior, pulling healthcare with them. The startups that succeed in the direct to consumer space might have enjoyed early success because of the convenience they provide to patients. But they will enjoy sustained success from the trust they build with patients over time.

And as patients adjust to direct to consumer care, they will grow to trust it more. And healthcare will pull further into the tide of patient convenience. Already we see United Healthcare and Humana unveil virtual-only healthcare plans. These healthcare plans are a blend of direct to consumer clinical services covered through insurance, and reflect the growing desire for healthcare convenience.

It would seem that direct to consumer models are not only here to stay, but growing, acclimating to the complex blend of insurance based coverage and direct to pay coverage. In each case, we see a unique blend of coverage for different clinical services, but in every case we see blends that are based upon trends in patient trust.

Eventually, the more fundamental aspects of patient care will change accordingly. Primary care will no longer be beholden to traditional patient visits intermixed with the occasional telemedicine visit. Instead, we will see a complex blend of customized care in which patients dictate the care they want and the modes of delivery for it.

Some patients will want to manage their hypertension through traditional patient encounters, and others will want to trend their blood pressure online, sharing data with their physician through virtual engagements.

The possibilities are limited only by the available technological capabilities. But the models that prevail will be dictated by the trust engendered among patients.

So those who seek to predict or to invest in future healthcare trends should focus less on the financial metrics influencing the healthcare industry, and more on the qualitative metrics – specifically, does it foster trust in patients?

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