Oliver Wyman and Altarum Institute, with support from the Robert Wood Johnson Foundation (RWJF), are engaged in a major, multi-disciplinary study of the consumer health-information space. The research is specifically examining the barriers vulnerable consumers may encounter in accessing and using health information, and also how the marketplace views and prioritizes the health information needs of those consumers. Here, Andrea M. Ducas, MPH, program officer with RWJF working to build a Culture of Health, shares early insights from the research:
I have a confession to make: I’m a millennial. I’ll leave it to business forecasters to posit what that means for my life in the workplace and how I consume culture (there’s a reason I had to frame that as a confessional!), but here’s how my age manifests itself when I make healthcare decisions: When I’m feeling unwell, I look up my symptoms online. If I decide I need a doctor, I check out Zocdoc, read through reviews—I also check Yelp and sources of official quality ratings. I book my appointment online. I walk in with my paperwork fairly complete. I expect clear and understandable instructions, along with access to a patient portal. I expect to be charged a reasonable price, and know how to shop around for one if necessary. If I can’t see a doctor soon enough, I look up a retail or urgent care clinic nearby, or use a telehealth app like Doctor on Demand.
I am the healthcare consumer of the future; but I am also something else: highly privileged. I have a good job and generous commercial insurance. I’m a young white female with a master’s degree, and without serious health needs or a sick person in my life that I’m caring for. I represent a small sliver of Americans who interact with the healthcare system … and yet, so much healthcare innovation appears to be designed for people just like me.
As a program officer at the Robert Wood Johnson Foundation, I work with my colleagues and grantees each day to push for an affordable, high-quality, and high-value healthcare system that contributes to a culture of health in America. Not just for people like me, but for all Americans. What does that mean? As a start, a high-value healthcare system is one that is designed around the people it serves—and that requires that the system be accessible. Accessible not only in the traditional sense (e.g. can people get in the door and get care?), but in the holistic sense as well (can they get the kind of care they want and need?). Ensuring access requires that the system understands and responds to what a multitude of people want and need; and also requires that people—who are often their own best advocates—have the means to seek out or benefit from care that conforms to those needs.
With that in mind, the Foundation embarked on a study with Oliver Wyman and Altarum Institute that started with two questions:
- What is it that people—especially vulnerable populations like low-income Americans, caregivers, the uninsured, and non-English speakers—want when it comes to information that allows them to make the best healthcare decisions for them?
- How does that stack up against what the health information marketplace actually provides?
What we’re learning about low-income consumers
Over the past couple of months, we’ve begun to release early insights from that work. We are learning, for example, that low-income Americans often just want to know whether they are covered by insurance, and if they are, what they have access to. Then, when it comes to information about which doctor to see, unlike those at middle-incomes, lower-income Americans look predominantly for indicators or signals of respect. And they find patient reviews as an invaluable source of that information. But they have a lot of trouble finding them—usually they are stumbled upon via an unspecified Google search.
This is similar to what we’ve learned about how people seek out healthcare price information. Most Americans, including low-income Americans, have tried to find price information, but don’t know where to look for it. As a group, caregivers are hungry for information and support, but are frustrated by what’s available. We also see that mistrust of the system is an issue that runs deep among some vulnerable consumers, and better and more transparent information could start to address the divide.
What we’re learning about the marketplace
Oliver Wyman took some of those early insights to marketplace stakeholders, and we are now beginning to learn from the “supply side.” The preliminary responses are mixed. While players nearly uniformly view providing health information as important, and some are doing innovative and interesting work, it is not a strategic imperative in and of itself. And as Graegar Smith points out, in the cases where health information is provided (how to find a provider, for example), it often comes from multiple sources (both payers and providers, for example) and can be confusing and sometimes contradictory.
Additionally, stakeholders largely lack a targeted or well-articulated approach to the health information offerings they do provide, and also have a limited sense of how to measure impact. That makes it hard, if not impossible, to improve and engage in better or more inclusive outreach, or to provide more effective forms of health information.
Finally, most organizations aren’t talking to vulnerable patients to assess their wants and needs. This sometimes is due to a first-order assumption that there’s not a viable business model there or an important gap to fill.
What we hope
Our hope is that our continued research will begin making the case to the marketplace that, in fact, there is a viable business model and an important gap to fill. We’re already surfacing that vulnerable consumers want health information and are seeking it out, but they are doing so with much greater difficulty than an “accessible” system requires. Often they are also seeking out information that isn’t readily available to find or must be intuited through softer signals. And if a consumer is non-English speaking, there’s not much out there to find at all. This is a far cry from my own experience, both as a largely informed consumer, but also as the target demographic so many new tech innovators are trying to reach.
There are already clear steps the marketplace can take to bridge this gap, as my colleagues are beginning to point out. We are eager to dive even deeper this summer, and to help explore supportive, more inclusive paths forward with marketplace stakeholders—paths that focus on the many different healthcare consumers of the present.