Since the 1970s, American healthcare has been a market like almost no other. It’s not just that healthcare is afflicted by bloat, waste, and inefficiency. It’s that the whole system behaves irrationally, as if it were exempt from the basic laws of economics. The magic of competition, in particular, has failed in healthcare, leading to sagging value and runaway costs.
The new healthcare world we are entering is not about limiting access or offering price-discounted care. It is about putting together the pieces in a way that lets healthcare professionals actually accomplish their most important goal: keeping people well and giving them more years of productive, good life.
What will it take to realize this evolution? What if the health system really could enable and encourage good decision making not just about doctors and treatments but about healthy living – about diet and exercise and lifestyle and compliance with treatment plans? What if healthcare organized itself not just around healing the sick but around guiding people to live better lives?
Idea 10 of Oliver Wyman’s Ten Ideas shows how encouraging consumers to make healthier choices will yield big savings and better outcomes.
Better Engagement + Incentives = Healthcare Savings
If the industry could figure out how to organize healthcare around guiding people to live better lives, backed by the enormous market power of employers and the government, the impact would be measured not just in dollars but in years of better living across the population. If accomplished, we estimate the United States could save nearly $500 billion in healthcare costs. That’s more than 15 percent of the $3 trillion health market, as illustrated by the interactive graphic below:
1What would it take to make healthcare more rational?
A good place to start would be to help consumers make better choices about the things that drive the majority of costs – doctors, hospitals, and treatments. They already have the power to choose, but not much in the way of information or incentives. Yes, there are rankings of doctors and hospitals, but they leave out as much as they consider. Prices are all but invisible. And because consumers have been financially insulated by employer-sponsored health insurance, they have no real reason to make a value-based choice.
2What is the biggest challenge facing healthcare providers?
Learning the art of influencing individual behavior. Education is the foundation, though it is usually insufficient. Incentives are useful, but they have limits. The most successful new models rely on social interaction, close relationships with patients, high touch, quantified-self-help tools, and even fun to keep patients engaged. As more healthcare companies apply these new approaches, they will alter our understanding of what an effective, well-functioning healthcare marketplace looks like and of what it means to have a relationship with customers.
3Is it really possible to guide people to healthier lives?
We know it can be done, at least on a small scale. Iora Health, an innovative provider of primary care, reduced hospitalizations for its patients by 40 percent compared to a control group, emergency room use by roughly 50 percent, and use of specialists by 80 percent by using “smart” care teams, health coaches, “clubs” for certain chronic conditions, and biometric feeds to alter how patients interact with their medical conditions and risk factors.