As consumers’ views of health and the components of health care change, the health care system will have to adapt. (Image: Shutterstock)

In addition to the standard health insurance offerings, many employers today are adding wellness programs and incentives for their employees, recognizing the potential of the latter to reduce the costs of the former. This shift, as well as the shift toward consumer-driven health plans, is driving an expansion in the definition of health, one that includes more than just what goes on in the clinical setting.

In a recent webinar, Welltok chairman and CEO Jeff Margolis and Sam Glick, a partner with Oliver Wyman took a look at how this changing perception is impacting the health care industry. Through the webinar, the pair aimed to get listeners to think more about how the various entities in the health care system need to redefine their approach to customer service.

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Margolis started by outlining the two aspects of health care today: the clinical world and the consumer world. “You can’t achieve optimal health without thinking about those actions that are best performed by clinicians, and what things can only be performed by consumers.”

For too long, he said, “health” has just been about what goes on in the doctor’s office—or when a person has a medical issue. But those visits represent a small fraction of the components of a person’s overall health. “For far too long, the only information we had on individual was claims data,” Glick said. “It covers a very small percentage of the amount of time people spend living and breathing—it covers a billable encounter with a health care provider. Most of my days are not spent sitting in front of a health care provider.”

“As we skew younger, we see people who think more holistically about their experience. Health means a lot more to them than what it does to us,” Glick added. Things like getting enough sleep or exercise, managing stress and eating right are among their top health concerns.

In fact, 70 percent of health drivers exist outside the clinical care setting—a combination of environmental factors and lifestyle factors. “When you ask consumers what their biggest concerns are about health, they care about cost and cost predictability,” Glick said. “They also talk about losing weight, managing stress, going to assisted living to visit mom, making decisions about their kids. These are things that we don’t talk about in the traditional system.”

As consumers’ views of health and the components of health care change, the health care system will have to adapt. Margolis and Glick explored four factors driving the shifting perception of health and the challenges and opportunities each presents to the health care system.

1. Changing consumer expectations.

“We’ve been talking about health care becoming a consumer business for some time, and there’s a lot of debate about what that really means,” Glick said.

He doesn’t mean “consumer” in the sense that when people are responsible for spending their own money on health services they make better choices (though that does come into play). Instead, he’s referring to the actual health care business model and its ability to use and capture and use data.

The current hospital model is reliant on after-the-fact data, such as test results and electronic health records—a very reactive approach compared to the proactive and holistic data gathering companies like Google and Amazon are doing. Glick said. “Compare that to any consumer company, and they’re looking at your income status, the things you by, your emails (behavior) and all of these things that make the whole person. It’s not just about using that data to do better in the exam room, it’s about using that data to fundamentally redefine health.”

The rise of consumer-driven health care has facilitated consumers’ willingness to share that information, Glick said. “We’re now in a place where our consumers spending their own money want us to talk to them about health and are willing to share data to get there.”

In fact, Margolis later noted, the whole idea of data privacy in health care needs to be redefined around the consumer. “You’re going to see more and more data control shift to consumers. It’s not owned by the health care agencies at all. We have to stop thinking of health care data privacy as a barrier but think about how we’re going to use it while protecting privacy.”

2. Advancements in consumer analytics, machine learning and AI

The health care industry has a wealth of data on patients and health plan members—data that can be very useful in helping sick patients, but not so much the healthy ones. The more important data, Margolis argued, comes from that consumer dataset.

“Conventional data—medical records, risk assessment, etc.—gives you a very small picture,” he said. That picture doesn’t include the factors of their everyday life; Welltok tracks some 800 variables in its algorithms. “It’s thinking about a year in the life of a consumer, understanding what their risks and needs are, how those are constrained by economics or realities of their situation.”

Using that more holistic picture, combined with other advances in artificial intelligence and machine learning, allows providers to be more predictive and proactive. Rather than waiting for a patient to come in with a problem, a provider can use AI to anticipate his or her health care needs and develop a plan to address them.

3. Explosion of consumer point solutions

Almost a decade ago, the federal government introduced legislation to drive adoption of electronic health records among medical providers with the intent to make patient information easier to access and more portable. While the medical world continues to struggle to create user-friendly technology, the consumer world has been excelling.

“There’s all of these devices, online business-to-consumer apps that are available, digital and non-digital solutions that are meant to help people with daily living, disease and condition management and so forth,” Margolis said. “What we have to do is get a system in place that can organize these point solutions.”

This again comes back to creating a more holistic view of health, not just one focused on the sick-care system, Margolis explained. “The benefit plan of the future, or the provision for total health care and well-being, has to be a combination of resources for sick-care plus this array of point solutions that address the non-clinical things that help and support us.”

4. Changing health care economics and profit models

The health care economic model has never been particularly consumer-focused. Providers performed a service and then submitted a bill to the insurance company. Neither the doctor nor the patient gave much concern (or really knew) what those costs were or if they were appropriate for the services provided. “Profit model innovation in health care has gone from paying for care on a transactional basis to paying for outcomes,” Glick said. “But neither one of them is really a whole-consumer view of the world.”

Again, the prevalence of cost-sharing has caused a shift in the behavior of the consumer. Even if they’re not shopping for health care as they would other high-ticket items, they’re thinking of it as one. “It’s really starting to think about tradeoffs with everything else they buy,” Glick said—a choice of health care or new tires for the car.

This change in consumer thinking requires a coordinating change of the various entities of the health care system. “Whether we’re a health plan, IT, service provider or insurer, it starts with a simple question: ‘Am I starting every meeting with what I’ve got today to sell? (Sick-care), what are the skills I have? The assets I have?’ If I start with that, and say what’s the best I can do for people, I will never get there,” Glick explained.

In contrast, what the innovative and successful consumer-focused companies take a very different tact, Glick said. “They start with, what does somebody want, what are their hassles, their pressures, their motivations? Then they figure out how to line up their systems and processes behind that.”

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