Enormous opportunity exists to meet consumers’ expectations of convenience in the health care system, enhance patient experiences in seeking and receiving care and, critically, to empower them to choose high-value care.

“Value” for the consumer and the system arises when patients take preventive medicines, adhere to a care plan and choose lower-cost, higher-quality doctors and facilities. Consumer “activation” in this setting means empowering the patient to self-manage, and that is more likely when they have had a more positive experience.

Through consumer-focused tactics, the US system can democratize price and quality information, incentivize high value selection and bring experiences with the health care ecosystem in line with modern consumer expectations. In addition, data show deploying patient-centered care can improve the short- and long-term value of care, reduce catastrophic outcomes and minimize the impact of health disparities. Tactically, this can take the form of activation (the ability of patients to manage their own health), coordination and navigation services, and shared decision-making.⁹ While both consumer-focused tactics and patient-centered care support efficient decision-making by leveraging existing patient value drivers, the system at scale has been unable to deliver these interventions or measurably enhance consumer experience.

The challenges to activating consumers are:

• Unintended consequences of cost sharing: The rise of high-deductible health plans and the use of value-based insurance designs have demonstrated limited improvement in health care delivery value.¹⁰ High-deductible health plans have been shown to cause consumers to reduce their use of health care indiscriminately, leading to lowered preventive care and medication adherence, potentially exposing patients to risk of catastrophic exacerbation of a disease. Similarly, cost sharing designed to induce a focus on prevention has had mixed results with the current primary care delivery system designed to generate downstream service volume.¹¹
  
  
• Complexity of care decisions: Despite the significant increase in the availability of accurate clinical quality and transparent price data, only a small subset of patients uses this information actively today. Patients, particularly those with chronic conditions or severe diseases, face complex decisions about their care that they may not be equipped to make, even when armed with the right information to support high value selection. First, only 30%-40% of health care dollars are spent on planned services.¹² Second, patients may struggle to make decisions because of low health literacy, their diagnosis or accompanying health-related social needs. Finally, physicians, a trusted guide in the care journey, may not have the time or training to engage patients in shared decision-making or provide strong guidance on downstream care cost and quality.
  
  
• Implementation costs: Providing quality and cost information, effective care coordination and supporting patient activation requires capital and human resource investment by health care entities. Data collection and reporting consume significant organizational resources, while care coordination requires staffing and health care technology investment to provide more seamless patient experience. Activation approaches rely heavily on clinician assisted coaching and require significant time to help patients acquire the necessary skills to self-manage. Staffing shortages and volume-based reimbursement models create opportunity costs if care delivery organizations prioritize patient activation.

Solutions to help activate consumers:

• Payment incentives: Paying for value will enable clinicians to invest time in building trusted relationships and coaching patients to achieve activation and self-management. Quality-based payment can help leading care delivery organizations differentiate themselves and attract well-informed patients. By valuing improvements in health outcomes and reductions in low-value care expenditures, health organizations will create incentives to transform care delivery from transactional provider visits to long-term, trusted relationships. Structured across engagement channels, these incentives can help mitigate disparities in access/resources across populations.
  
  
• Personalized engagement and tools: Health care organizations can incorporate behavioral analysis of social profiles and willingness to change to focus efforts on patients who are likely to increase activation and health ownership. This will help ensure efficient allocation of resources to those most likely to benefit and subsequently drive high value care decisions. Similarly, health care organizations should focus on increasing their array of resources and tools (e.g., informational resources, community affiliations, remote patient monitoring, digital therapeutics and tools with a strong personalized feedback loop) to match patients’ unique barriers and to help keep healthy behaviors and health status top of mind.
   

• New care models: Organizations can offer more convenient virtual and at-home care to improve patients' experiences and remove barriers to access. Initial returns on hospital-at-home programs show improvements in total cost of care and patient satisfaction, while patient surveys suggest a majority of patients would prefer to schedule virtual care follow up and use at-home urgent care for low-acuity needs.¹³ Health care systems can drive activation by expanding convenient care options that meet patients where they are while improving navigation and data sharing across settings.

Example: An urgent care chain focused on a specific patient population sought to improve growth and efficiency following its COVID-19 pandemic expansion and the launch of a new segment. Working with the EY-Parthenon team to develop a transformation roadmap, the business identified $40m in opportunities to both enhance revenue and lift margins. The chain invested in marketing technology to better reach its unique patient population and communicate its value proposition for them specifically. Health care technology investment also helped the business improve labor management.