Next phase of health reform in the U.S. to focus on individualized care: PwC

PricewaterhouseCoopersApr 6 2010

The next phase of health reform in the United States will reflect a concerted effort to keep people well, out of the hospital and more actively engaged in managing their own health, according to PricewaterhouseCoopers LLP (PwC).  Embedded in the U.S. Health Reform package are lesser known provisions that increase emphasis on prevention, positive health outcomes, better coordination of care and comparative effectiveness research that includes personalized medicine, paving the way for a new era of individualized care in a more patient-focused health system.

Pilot programs for the creation of accountable care organizations and collaborative care networks, new reimbursement models and increased funding for community and primary care services are keys to improving outcomes and reducing health costs.  These seeds, planted in the new law, mark a turning point for healthcare delivery in the U.S. and support the conclusions of a year-long study by PricewaterhouseCoopers' Health Research as detailed in a report published today entitled HealthCast: The customization of diagnosis, care and cure.

PricewaterhouseCoopers' research identified an emerging phenomenon, not only in the U.S. but in every major health system around the world:  In response to the global recession and pressure to reduce rising healthcare costs associated with chronic diseases, government and health leaders see the potential for individuals to take greater ownership of their health and the need for fundamental structural changes in the health system to help them do so.

PwC expects that over the next five years, the trend will lead to significant health industry business model changes, more regulatory reforms focused on efficiency and effectiveness, greater investments in prevention and a growing role for information technology to enable information-sharing and provide interactive, customized care in a virtual world.

Nearly 600 government and health leaders in 20 countries, including 50 health leaders in the U.S. were surveyed by PricewaterhouseCoopers' Health Research Institute.  Findings include:

• The consensus was that individuals have the greatest influence on their own health status, but that physicians have the greatest external influence on changing patient behavior.
• Ninety-seven percent agreed that patients should have some responsibility for managing their chronic conditions such as obesity, asthma, diabetes and heart disease.  Of those, 76 percent of U.S. health leaders and 57 percent of global leaders think patients should have a "great deal" of responsibility in this.
• Eighty-two percent of U.S. health leaders and nearly three-quarters of global health leaders (74 percent) believe that unhealthy behavior will become increasingly unacceptable in their country.
• Lack of willpower was cited as the biggest barrier keeping individuals from managing their own health.

"Through incentives baked into our health system, many health organizations have been too siloed in their thinking. They've focused on their silo rather than the whole continuum of care and patient engagement.   If patients are not engaged, it is impossible to adequately manage care, consumption and spending." said Kelly A. Barnes, US Health Industries Leader, PricewaterhouseCoopers.   "The overarching challenge for our health system will be to shift the internal focus from the siloed bureaucratic healthcare infrastructure that exists today to one that puts patients at the center of care and engages them to take charge of their health over their entire lifetime."

Mass Customization of Care Driven by Digitization and Personalized Medicine

PricewaterhouseCoopers' analysis found that healthcare is playing catch-up to adopt innovations and trends in consumerism from other service industries such as automotive, retail and entertainment.  It concludes that healthcare needs to become more adept at customizing health solutions to consumer-centric attributes and segmenting consumers beyond  health status or disease group, looking at economic status, personal preferences and cultural barriers to change.  

According to the report, mass customization will be enabled by technology and the convergence of multiple devices such as smart phones, EMR databases, home health monitoring, telehealth, as well as wireless communication, social media and other Internet innovations.  But it is personalized medicine and greater understanding of the human genome that PricewaterhouseCoopers says is at the heart of customized diagnosis, care and cure.  

"We have a better understanding that chronic diseases are influenced by a combination of genetic factors, individual behavior and the environment, which are not within the control of today's medical delivery system," said David Levy, MD, global health leader at PricewaterhouseCoopers.  "The practice of medicine will undergo transformational change when scientists, clinicians and individuals are armed with knowledge about genetic variations and when patients and doctors can use this information together to guide lifelong behavior and treatment decisions."

Ninety percent of U.S. health leaders and 84 percent of global health leaders surveyed by PricewaterhouseCoopers believe that the merging of information technology and healthcare is a key factor for change.  Fifty-eight percent of U.S. health leaders and 45 percent of global health leaders said they expect personalized medicine to be an important and growing development that will change healthcare delivery.  

Strategies for Changing Behavior

When PwC surveyed health leaders about the most effective strategy to engage individuals in their own health, the top answers revolved around education and communication; the top three were health education, greater awareness and increased patient responsibility. The fourth was better communication, but the ordering of these strategies shows that health leaders recognize there's a lot of education and relationship building needed to support individuals.

Also recognized is the need to change incentives in a way that strengthens partnerships between physicians, their patients and employers, and which link their success to mutual goals around health and wellness.  

• To create incentives for physicians to encourage behavioral changes in their patients, 94 percent of U.S.  health leaders and 84 percent of global health leaders surveyed agreed that compensation to hospitals, physicians and other providers should be based on quality health outcomes.
• 86 percent of U.S. health leaders and 60 percent of global health leaders surveyed said there need to be more incentives for patients to be compliant with their medications.
• Health leaders also increasingly understand that behavioral change depends on partnerships with private industry. When PwC surveyed global health leaders about outside influences that were having a positive or negative effect on population health, the most negative response was to grocery stores and supermarkets. As obesity rates grow across the globe, look for more public-private partnerships aimed at influencing consumer behavior in what they eat.

A Toolkit for Customizing the Consumer Experience

In its report, PwC outlines five areas where health systems can customize care and better engage individuals in managing their health.

1. Coordinated care teams: Consumers want coordinated care. Integrated care networks that share information, care and accountability for patient outcomes are likely to become models for the future.
2. Fluent navigators: Individuals lack the knowledge and skills they need to navigate the health system and understand their choices. In a patient-centered health system, there will be a growing need for consumer advocates beyond friends and family. PricewaterhouseCoopers sees the role of healthcare-fluent navigators being played by pharmacists, community workers and possibly the emergence of a new professional field much as financial planners emerged with the rise of consumer-directed investing.
3. Patient-experience benchmarks: In a patient-centered health system, more attention will be paid to understanding and meeting consumer expectations. Many health systems already are tracking and publicly reporting on patient-centric metrics of care, such as cleanliness, wait times and physician satisfaction, allowing patients to make more informed decisions.
4. Care-anywhere networks: The definition of access is being redefined by telehealth, wireless mobile devices, remote monitoring and new care delivery models that move care from hospitals, nursing homes and physicians' offices and into patients' homes, which increasingly are wired with networked devices.
5. Medical proving grounds. Through collaboration and investment, some regions and other countries are positioning themselves to be medical proving grounds, or centers of excellence in medical innovation and care as a way to attract patients, researchers and providers looking for the shortest path to access and innovation.