From the April 2016 issue of HealthCare Business News magazine

For providers of health care products and services, engaging consumers throughout the health management process is the first step to monetize the emerging health care economy. One large health care provider and payer jointly reduced costs by using a common care management software platform to track a specific patient population suffering from chronic conditions.

It started with the grouping of people with similar chronic illnesses — heart failure, diabetes and so on — and specifying types of medical interventions and patient self-care that a certain illness called for. Then, the progress in making sure these steps were followed through extensive care management notes enabled by the software. The upshot: the organization identified what health care interventions — wellness programs, member education, thorough attention by a care team in a doctor’s office — tended to work for which condition, and for which consumer profile. The true success in reducing costs was in engaging patients, mapping their daily routines and honing interventions before patients experienced serious complications, while identifying and discouraging costly procedures.


The new incentives governing approaches to care are not so much around cutting expenditures, but rather counseling the consumer to achieve his or her best outcome, and to get there on a path that is both proven and what they prefer. Health care payers and providers must look at wellness, and its financial implications, through the eyes of the consumer. Consumer-centric shifts are making an impact on the major components of health care:

Payers: The long-time dependence on taking medical information from insurance claims is being replaced by continuous feeds of health status data required for timely management of chronic conditions and other ills. Consumer-oriented digital innovations are playing an important role.

Medical devices: They can no longer stand alone, performing their functions and keeping valuable clinical data to themselves. They have to seamlessly connect with the mainstream of data flowing to electronic health records.

Retail health: This creature of consumerism, offering simple health screenings and creating personal health records, is emerging as a competitor to traditional health care.

About the author: Bipin Thomas is a renowned global thought-leader on consumer-centric health care transformation. Thomas is a board member of HCBN and chairman of ICURO, a digital business outcomes management organization.

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