In This Report

Consumerism in the healthcare industry has been steadily building for more than a decade with the consumer increasingly placed at the center of the care delivery and decision-making process. Viewed through the lens of many healthcare product and pharmaceutical companies as well as select services providers (e.g., Weight Watchers) that have been addressing the health needs of consumers through business-to-consumer (B2C) and direct-to-consumer (DTC) models for considerably longer, consumerism is already here. For payers and providers however – and for the technology and service companies they rely on – consumerism is new, and the change is having a significant impact on the industry.

This change originated largely through the introduction of consumerdirected health (CDH) plans as a vehicle for employers to shift a greater portion of total healthcare costs to employees and engage them in the management of their own healthcare. Initial employee uptake was slow, but increasing healthcare costs have persisted and continue to influence employer and health plan strategies to help consumers make better decisions about how to navigate the healthcare system and manage their own care and conditions. Despite continued growth in adoption of CDH plans and the accompanying significant shift in financial liability to consumers, the impact to date on getting consumers to manage their health has only been modest. Today, CDH is one important part of the consumer equation, but evolving market forces, including the blurring of lines between payers and providers (e.g., payers vertically integrating with providers; and providers taking on risk and becoming more like payers), are further complicating the landscape by redefining who the consumer engages with as he or she navigates the healthcare system.

The shifting of the healthcare cost burden to consumers has impacted not only who pays for care but also how treatment options and care experiences are evaluated. This new role is changing how consumers are being marketed and communicated to. As a result, new tools designed for consumers to better manage their own health and care options have emerged. Today, the market is focused on improved transparency, quality, and customer experience through tools and services more akin to the financial services and retail sectors than healthcare.

Marketplace demand for more dynamic consumer focus is also being accelerated by health reform. For payers, the expansion of insurance coverage coinciding with the implementation of insurance exchanges is creating new distribution channels where direct linkages with consumers can be established. Providers are facing new consumer realities as well, as reform has initiated and accelerated the development of accountable care organizations (ACOs) and valuebased reimbursement models, which require providers to think about consumers in new ways as patients, members, and consumers whose experience, satisfaction, and outcomes needs must be addressed. These macro forces are creating demand for a more “retail” environment across an industry that has previously resisted these levels of consumer transparency and control. If successful, this transformation would eliminate the historical barrier between the healthcare system and the consumer, paving a path for a more retail-oriented healthcare market as B2C and business-tobusiness-to-consumer (B2B2C) models penetrate the system. While the impact of consumerism may be top of mind for many organizations, it’s still early and true consumer platform solutions are unique. Healthcare organizations know that a failure to promote transparency and increase consumer engagement going forward will challenge their business models. As a result, constituents across the system are focused on developing and maintaining points of intersection with consumers in order to maintain engagement and influence decision making.

Numerous research pieces have focused on the opportunity to activate the healthcare consumer through B2C and DTC business models; this report predominately focuses on the B2B2C models that are pervasive in healthcare.