Global healthcare systems confound consumers and clinicians alike and cost more each year. Overall, we spend nearly US$10 trillion globally on healthcare with a wide disparity of access and outcomes. Chronic health conditions are increasing in incidence and prevalence in developed and emerging markets, further taxing clinicians, payers and hospitals. To serve growing populations of consumers demanding quality care that demonstrates clear clinical and economic value, access to and the provision of primary care needs to expand, enabled by technology and supported by non-physicians with a focus on prevention.
“We need to flip the system on its head,” said Nancy Gagliano, MD, senior vice president at CVS Health and chief medical officer of CVS/minuteclinic. Rather than playing its historic role as gatekeeper to a scattered array of specialties, primary care will become the nexus, providing simplicity, value and better health outcomes. That will mean taking risks and challenging old assumptions.
The global assumptions of looming physician and nurse shortages are based on outdated care delivery models. In the New Health Economy, with the emphasis on giving purchasers greater value for their healthcare dollar, do-it-yourself consumers and integrated care teams armed with a black bag of virtual tools are poised to reinvent primary care and close the gap. Traditional healthcare players will need to partner with New Entrants to adapt to a vastly changing healthcare market and achieve global objectives of lower costs, better outcomes and access points that meet consumer demands.
With over US$3 trillion spent annually on healthcare, the U.S. market is at the forefront of the transformation of primary care. But, market incumbents remain susceptible to new entrants who identify and commercialize more flexible, lower cost, preventive care solutions in emerging markets.
To understand how the New Health Economy will force changes in the provision of primary care, PwC’s Health Research Institute recently interviewed 25 executives from industry, trade associations and academia and surveyed 1,500 clinicians and 1,000 consumers in the U.S. on the future of primary care. The key findings from our research include:
Purchasers are banking on primary care to save money. The US government is pumping billions of dollars into primary care improvement and innovation. Employers, who remain significant payors for healthcare in the US are igniting change by adding lower cost, more convenient primary care options: 48% of employers will make telehealth services available to employees in 2015.
Consumers are selecting primary care that fits their lifestyles. As busy individuals take on greater responsibility for their health bill, many by-pass the family doctor. Yet about eight in 10 consumer survey respondents said they would be open to non-traditional ways of receiving basic medical attention. PwC surveys in Australia, Germany and Sweden validate the global nature of this shift in consumer expectations and willingness to embrace new care delivery models.
New entrants are disrupting the health industry with innovative primary care models. Newcomers offer convenience and value to consumers and purchasers through five modern options: convenient care, house calls, at-your-service care, digital health, and nurse-led care.
Some traditionalists are adapting to stay relevant: about one-third of physicians told HRI they have changed their business model to adapt to changing models of care. Some have started providing entirely new services to compete with new entrants on virtual care and one-stop-shopping conveniences such as co-locating care team offices with lab, imaging, physical therapy and other complementary services.
Seven core consumer markets are emerging. Companies must cater distinctly to seven major consumer markets identified by HRI by delivering “a la carte” care to: the frail elderly, consumers with complex chronic disease, consumers with chronic disease, consumers with mental illness, healthy families, healthy adult enthusiasts and healthy adult skeptics.
As the health sector undergoes rapid transformation, healthcare providers must reimagine primary care to stay ahead in the New Health Economy. PwC recommends four strategies for competing:
Know what you’re good at and whom to serve: traditional healthcare organizations need to inventory strengths and identify consumer targets. Consumers want multi-dimensional health interactions with a broad team of experts. Since there is money to be made in all consumer markets, look beyond health status and consider location, income, age and individuals’ health and wellness priorities when deciding how to staff up and build clientele.
Explore new roles: nurses, pharmacists, behavioral health specialists and other non-physicians have big roles to play in progressive primary care models such as patient-centered medical homes, accountable care organizations and at-your-service care practices. Primary care teams that explore new roles are expected to surpass others.
Partner where it makes the most sense: in the U.S. one-third of physician practices are partnering, or planning to partner, with industry newcomers such as retailers, telecommunications companies and data companies that use tried-and-true approaches to expand their market footprint. New entrants are also teaming up. Globally we have seen partnerships between mobile carriers, technology vendors and local providers all in an effort to improve the quality of care while maintaining a cost and pricing structure that works in emerging markets.
Pull it all together: the future of care will be based on a triage system that rearranges the traditional patient office visit to the most-appropriate, least-expensive clinicians and sites of care. Successful companies will offer a combination of services through a primary care ecosystem that embraces the health needs of the whole person, rather than isolating one acute problem for attention.