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Opinion

You Say Consumer, I Say Patient — Who Is at the Center of It All?

Consumer-driven or patient-centric health care? Across the life cycle of a health care intervention from clinical discovery to pricing and coverage to utilization, some argue the terms are interchangeable. They aren’t.

A focus on consumerism in health care aims to lower costs and improve quality by empowering individuals to “shop around” for medical services and items. The concept is that when consumers have their own money on the line, they’ll make more fiscally responsible decisions, drive down unnecessary care and reduce their — and their health insurer’s — overall costs.

There is some proof that consumerism in health care has beneficial effects. More than 77 percent of patients have used online reviews as an initial step to find a new doctor. And the Choosing Wisely campaign rightly touts successfully educating and changing patients’ and physicians’ behavior about low-value care. The bottom line is that evidence shows that patient activation leads to better outcomes with less costs.

But a consumer-based approach to optimizing care and utilization is reactionary; it’s mainly after-the-fact and wrongly assumes that the options available already take into account consumer needs and perspectives. Patient-centered health care, on the other hand, seeks to identify and ensure clinical care that is designed to meet patients’ preferences and goals as well as their clinical outcomes.

The choice of this frame is a critical difference between consumer-driven and patient-centric health care: empowering patients as decision makers and also ensuring that the genesis of health care interventions — from novel therapeutic compound to a covered therapeutic intervention — is informed by patient experience.

If patients are only engaged on the back end as a user (a consumer), then there is little incentive to understand unmet needs or preferences that drive outcomes, and the result will be homogenous care options that don’t meet the needs of a diverse population.  

In contrast, engaging patients early in defining need, informing research and weighting risk and value of interventions improve the likelihood that resulting treatments and the policies that govern access to them will account for population differences and patient perspectives, thereby making choices more relevant to the true end user.

The good news is that progress is being made gathering patient data and input earlier. Patient-centered research, such as pragmatic clinical trials, which evaluate the effectiveness of interventions in real-life routine conditions among non-average patients, is gaining momentum. The Food and Drug Administration has issued guidance for collecting representative information on patient experience to inform the development and evaluation of drugs and medical devices. And pharmaceutical companies are beginning to employ artificial intelligence to analyze data from multiple sources, including real-world data, to accelerate clinical trials.

Accounting for heterogeneity, real-world data and the patient experience in drug discovery is an important step, but to truly implement value-based care, all stakeholders — from manufacturers to payers to employers — must work together to accelerate shared progress in how the value of health care is assessed. And to unlock an inclusive definition of value, patients must be at the center and be active partners with manufacturers, payers and their employer to define the factors that matter within a given disease community. Such complexity is an acknowledged barrier, but it is a vital commitment to ensure that value-based care actually translates to value for the patient and not just value for the payer/provider/hospital/manufacturer.

Research entities are exploring next-generation models that assess value beyond the current cost per quality-adjusted life year. We’re seeing more front-end involvement by patients to bring perspectives to value definitions.

Several frameworks and platforms, such as those our organization builds, are increasingly able to account for factors that matter to patients and have the structure for patients to view value based on their own unique perspectives. That’s important progress, but we need to do more.

It is right to call patients the ultimate consumer in health care. Patients are increasingly making informed decisions in their health care, and there is unprecedented focus on patients as equal players in defining research, creating care plans and managing information.

But the benefit of patient consumerism will remain limited until health care options truly meet diverse patients’ needs and aren’t solely evaluated on parameters like cost. If patients are expected to select and bear increasing financial responsibility for their health care, their choices must be optimized to deliver the highest value based on factors central to their experience and needs.

 

Jennifer Bright is executive director of the Innovation and Value Initiative.

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