Chaos, Confusion and Caring - a U.S. Health Consumer Forecast for 2018

As 2018 approaches, consumers will gather healthy New Year’s Resolutions together. Entering the New Year, most Americans are also dealing with concerns about healthcare costs, cybersecurity, and caring – for physical health, mental stress, and the nation.

Healthcare costs continue to be top-of-mind for consumer pocketbook issues. Entrenched frugality is the new consumer ethos. While the economy might be statistically improving, American consumers’ haven’t regained confidence.

In 2018, frugality will impact how people look at healthcare costs. 88% of US consumers are likely to consider cost when selecting a healthcare provider, a Conduent survey found. Physicians know this: 81% of providers say patients have talked with them about health care costs.

Consumers confront chaos in U.S. healthcare reform: the over-arching GOP health reform efforts were scuttled by a slim margin of “nay votes,” but the proposed GOP-sponsored tax bill repealing the individual mandate would create further confusion in health insurance markets. “Repeal and replace is now co-opt and confuse,” Dr. Ann Hwang, a primary care physician, wrote in Modern Healthcare this week.

Millions of people in the U.S. won’t have health insurance in 2018, and so will face a truly retail experience with health care providers and suppliers in their communities. Cost is the barrier to coverage. Having health insurance makes a difference in whether people get medical care they need, and impacts how healthy people are: consider how people self-ration and postpone care due to cost, ranging from avoiding preventive screenings and not filling prescriptions to not seeking care when feeling very unwell. Having ready access to a primary care provider saves costs downstream in wealthy countries with strong primary care backbones. Health insurance is indeed a social determinant of health.

“All health sectors have started to try their hand at social interventions,” PwC’s 2018 top industry issues report notes.

One healthcare industry that will get increased consumer and legislative scrutiny in 2018 will be prescription drugs. Across Democrats, Independents and Republicans all, most consumers would like the U.S. Federal government to take more action on lowering the cost of medicines. The Conduent poll also found that 60% of U.S. consumers believe making Rx drugs more affordable should be the nation’s top healthcare priority. Americans are quite aware of their role as payors of the highest prices of prescription drugs in the world. Scott Gottlieb, the current FDA Commissioner, has talked about this policy priority for 2018.

Because consumers have a retail relationship with prescription drugs through pharmacies, the issue gets peoples’ attention due to greater price transparency – at least in the form of co-pay, coinsurance, or first-dollar payment under a high-deductible health plan. Pharmacies understand their role as accessible retail health on-ramps for medications and counsel, and growing role as health care providers. In 2017, CVS launched a drive-up service for consumers to collect their prescriptions at the curbside. Then the company announced intentions to deliver Rx to patients’ homes. Finally, CVS announced its intention to acquire Aetna, the health insurance company.

This vertical integration will be just the start of new business models developing to bring healthcare more conveniently and, potentially, cost-effectively to the consumer in 2018. Perhaps Walmart will buy Humana, Ana Gupta of Leerink Partners recently discussed on CNBC’s Squawk Box.

Expect more retail-facing health delivery programs in the New Year, such as the relationship recently struck between Walgreens and New York Presbyterian’s On-Demand suite of consumer digital health services. Walgreens has been an important influencers in promoting consumers’ use of wearable technology to track health, through the company’s Balance Rewards loyalty program. The company started the Center for Health and Wellbeing Research to expand research into consumer health and self-care. This is but one more sign of the evolving retail health landscape that’s positioned to meet consumer demand for greater access to cost-effective, empowering care channels in the community.

Promoting the use of wearable tech has been part of Walgreens’ consumer health strategy for several years. There’s a growing “retail of physical wellness” Field Agent’s research talks about. 96% of U.S. adults expect to exercise, work out, or play a sport in 2018. People will endeavor to do more physical activity in the New Year, along with nutrition and diet, weight management, and better managing stress and anxiety levels. 57% of Americans own at least one wearable technology to enhance fitness and sports participation, Field Agent found, from activity trackers to apps.

Consumers’ interest in virtual and telehealth will grow in 2018: Accenture’s Voting for Virtual Health poll found that 3 in 4 consumers are interested in using digital technologies to track health status like blood pressure, to follow up appointments after seeing a doctor, to follow-up hospital stays, and to receive reminders for healthy living.
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Don’t think it’s only Millennials who demand virtual health services. PwC’s consumer survey found an older age cohort 65 and over willing to use digital devices at home and engage in telehealth visits, too. What underpins older consumers’ willingness-to-try digital health tools is their increased adoption of smartphones: two-thirds of people aged 55-75 had smartphones in 2017, up from 53% in 2015, Deloitte’s Mobile Consumer survey learned.

The FDA’s newly-issued guidance defining what constitutes a medical device clarifies what software and digital health tools constitutes a “medical device.” These reg’s should enable more products to come to market in 2018 for consumers’ use at home and on-the-go for self-care. Consumers’ purchases of digital assistants, like Amazon ECHO and Google Home, will also expand peoples’ digital health adoption through voice-first technology in 2018. With CES 2018 happening in January 2018, I’ll be curating innovations for consumers’ healthcare, so do stay tuned to Health Populi for new-news on the topic of consumer-facing wearable and digital health.

Notwithstanding the FDA’s greater clarity on the supply side development of digital health tools, consumers remained very concerned about the security of their personal health information. The Equifax breach of 2017 made the majority of Americans quite aware of the value of personal data. Most doctors’ information systems have been breached, research from the American Medical Association and Accenture reported. “Physicians, overwhelmingly, are finding themselves the target of cyberattacks that disrupt their practices and put patient safety at risk,” the report observed. “More support from the government, technology and medical sectors would help physicians with a proactive cybersecurity defense to better ensure the availability, confidentially and integrity of health care data,” AMA and Accenture recommend.

But people have a trust paradox when it comes to their digital connections, based on a new poll from Cisco. The paradox is that consumers’ perceived value of the Internet of Things may be high, but trust is low. Despite this chasm, peoples’ connectivity is integrated into daily lives, so much so that many people are unwilling to disconnect. While security breaches erode consumer trust, we may be at a “point of no return,” in Cisco’s words, when it comes to people unwilling to disconnect due to their values for convenience, efficiency, and cost-savings generated through connected cars, smart homes, and wearable technologies.

It may give health consumers some solace to know that hospital leadership looks to increase funding for cybersecurity in 2018, based on UPMC’s Center for Connected Medicine joint survey with The Academy.

And so stay connected people will, some voicing, “Alexa, remind me to eat cleaner today.” Two-thirds of Americans are determined to eat healthier in the New Year, Field Agent’s research found. More people vow to eat less fried food, fast food, and sugar. And, more consumers look to eat more fruit, vegetables and salads, per the CDC’s recommendations based on the Center’s recent report finding that too few Americans consume enough fresh produce in daily diets. Food prescriptions, whether self-imposed or recommended by physicians or health coaches, will be more common in 2018. Emerging food trends will include neuro-nutrition for “mood food” and brain health. Examples of this are Honeybrains, a café with a menu developed by a neurologist, and the subscription meal vendor Euphebe (an abbreviation for their mantra, “You’ll Feel Better”).

Why growing attention to self-care among U.S. healthcare consumers? It’s to feel better and manage healthcare costs, for sure, but there’s another factor: other people. 53% of Americans are engaging in better self-care to be better for others, Field Agent’s poll found.

I conclude this tea-leaf reading on consumers and healthcare for 2018 with another form of connectivity: social. Loneliness takes a toll on our health: “We can’t discount the risks of being socially isolated even if people don’t feel lonely,” Julianne Holt-Lunstad of Brigham Young University said. Despite growing digital connectivity, socially isolated individuals are “a growing epidemic,” according to Dr. Dhruv Khullar at Weill Cornell Medicine NYC.

The APA Stress in America Survey – The State of Our Nation poll found that 59% of Americans say we’re at the lowest point in our nation’s history that people can remember. The biggest sources of stress among Americans are worry about the future of the country, health care, money, work, political climate, and violence and crime.

Let 2018 be a year of greater social connectivity, in real-life, in real-time.

Wishing you a healthy, loving holiday season and New Year of community and personal peace.

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