Consumer-Enabling Technologies: A Decision-Making Renaissance is Remaking U.S. HealthCare
by Robert James Horne, Daniel Maley, and Sam Feudo
Key Takeaways
A renewed shift toward consumerism is occurring in medical care markets dominated by customers using health insurance as payment.
A.I. technologies, acting as personal medical assistants for patients, are breaking down language barriers between doctor and patient which in turn are fostering new economic opportunities for stakeholders and investors alike.
This shift back to consumer decision-making as an economic force in healthcare markets will be gradual and keep pace with innovation, but over time we expect it will become near absolute.
Investors and stakeholders should consider consumer-enabling digital technologies with A.I. platforms as gateways to these markets.
We highlight A.I. healthcare company Decoded Health to help tell our story.
“Office Visits” Come to Us in Consumer-Centric Healthcare - Copyright FHL 2024
Introduction
There are markets opening in healthcare where the goods and services covered by health insurance are increasingly consumer facing. This new age of consumerism is largely a green field of opportunity because it shifts more of the economic power behind personal decision-making and away from the medical profession.
This shift toward consumerism will be gradual and keep pace with innovation, but over time we expect it will become near absolute. Investors and stakeholders in healthcare markets would be wise to consider the progression of this issue as indicators of future market dynamics.
Artificial Intelligence is changing U.S. healthcare. It is disrupting traditional medical service delivery models, acting as administrators for health insurance companies, and personalizing care experiences for people. More importantly: people now have more opportunities to act as true consumers in a sector long marred by distorted incentives and incomplete information across patients, payers, and providers.
Key Terms
We use the following terms in this article:
Consumer – A person who purchases goods and services for personal use.
Patient – A person who purchases goods and services as directed by a medical professional.
Consumer-centric describes emerging healthcare markets where people drive more decision-making through enabling technologies including Artificial Intelligence.
People Are Not Consumers in Healthcare Markets
Consumerism doesn’t exist in health care markets like it does for other U.S. markets. This is because the ability and means to purchase medical goods have traditionally been controlled by others.
The reasons are simple enough. The business of medicine and health insurance is overly complicated, and the average consumer doesn’t have a sufficient grasp of the science or medical goods and services to shop much beyond comparing prices.
The consequence of this dynamic is a market designed to rely upon various stakeholders as decision-makers for individual consumers. Medical service providers control which goods and services can be purchased, which reduces some of consumerisms’ purchasing power. Health insurance companies reduce it even further by paying on behalf of the consumer and negotiating prices in advance.
The results are:
Markets where insurance companies and medical service providers act as consumers normally would.
Those seeking treatment do not act as consumers but patients under the care of a doctor.
Low out-of-pocket costs mean that many people are price insensitive when purchasing goods and services.
These results, while understandable, make it hard for people to inform their own care through decision-making, or take advantage of the economic forces that shopping normally produces for people such as lower costs.
The Age of Consumer-Centricity: New Consumer Appetites & Tech-Enabling Business Models
Consumerism has largely been missing as an economic force in healthcare markets where insurance is the main form of payment. The COVID-19 pandemic, changes in employment prospects, and newfound preferences for consuming medical goods and services are behind a shift back to consumerism that we see today.
While patients are happy with their doctors, they want greater control over their health outcomes. They want more opportunities to decide the goods and services they purchase and are beginning to see the value in comparison shopping like in other sectors. People now seem comfortable using digital tools and medical workforce alternatives in pursuit of this goal.
In November 2022, CVS Health released the results of a patient survey that support this contention:
“Patients value deeper and more meaningful relationships with their primary care physicians (PCPs) and other providers and are finding that new virtual care options are filling in gaps and making it easier to achieve successful relationships with their PCPs. People want their PCPs to know and understand their lifestyle choices, personal health goals, family medical histories, and more and are open to their health information being shared virtually across care settings to ensure seamless continuity of care. Coordination and communication are the two watchwords for a new generation of health care.”
These are important dynamic shifts and tell-tale signs of consumerism re-emerging in healthcare.
Some in healthcare have developed new business models and processes to meet these emerging consumer demands. Evolving retail medical service delivery models by Amazon and CVS Health are at the beginning stages of disrupting the traditional provider-centric business models.
Some in healthcare have developed new business models and processes to meet these evolving consumer demands. For example, retail service delivery models by Amazon and CVS Health are at the beginning stages of disrupting the traditional medical service delivery business models.
A key technology in these models, and behind the rise of consumerism in medical care, is Artificial Intelligence (A.I.).
Artificial Intelligence: The Means of ‘Coding’ Consumer-Centricity in Healthcare
As noted previously, healthcare statutes and regulations governing medical care markets were developed in part to take decision-making responsibilities away from consumers. Our concern: people lost the economic advantages that result from consumerism in the process.
More frequent interactions with sources of medical advice and insight, in addition to visits with their doctor, are what people want. (A.I.) now makes this possible. It can serve as a medical assistant for people seeking decision-making opportunities in medical care encounters. It can help decode medical terminology and help facilitate conversations between patients having trouble understanding medical language and doctors facing operational barriers and increased burnout. A means to overcome historic language barriers separating doctors and patients for the very first time.
Consider Decoded Health, an A.I. healthcare company, as a use-case. The company:
“scales clinical patient engagement through automated conversations. Unlike a ‘chat-bot’ our system enables patients to express their concerns and ask questions in fully natural language conversational dialogue.”
This conversational approach to translating issues of medical care between patient and doctor solves one of the biggest issues in healthcare today. Decoded Health’s ‘conversational’ system helps, among other things, determine a patient’s reason for seeking medical advice, aligns patient input with medication history, performs patient-specific screenings, asks clinically informed and highly differentiating medical questions, and follows up with patients to track health status.
More importantly, Decoded Health provides patients with opportunities to directly inform their medical care. An assistant able to translate the thoughts and decisions of patients into medically relevant information doctors can use represents a sea-change in healthcare and opportunity to solve many age-old issues for health systems and lawmakers alike. Furthermore, it represents a foundation upon which patients can tap into the economic forces of consumerism inside and outside of encounters with medical professionals.
You can find out more about Decoded Health on their website.
Test-Drive A.I. Conversational Interface Technology
If you would like to become more familiar with how A.I. can overcome language barriers, meet MedLM. Forest Hill Labs latest A.I. digital assistant is able to reduce complex medical terms and meanings into plain language.
Designed and made available for free to the public by Daniel Maley, MedLM is designed to help bridge the gap between technical medical knowledge and everyday understanding. This makes it an ideal tool for people looking to test A.I. capabilities.
If you would like to test-drive this technology, please click on our MedLM here: https://chat.openai.com/g/g-3C0DxemKC-medlm.
NOTE: MedLM is for entertainment purposes only. If you have a medical concern, do not use MedLM. Contact your doctor instead.
Conclusion
Health market disruption is underway. The benefits of disruption, however, are too often told through the lens of medicine or business of insurance. Rarer are opportunities to talk about the benefits of reform of individual Americans.
Patient Perspectives is a new article series designed to tell stories of disruption through consumer and patient perspectives.
If you have a patient perspective story you want to tell, please share your ideas through our submission portal at the bottom of our website homepage: www.foresthilllabs.net.