A majority of people in the United States (70%) said they want health systems to be more actively involved with their health management activities, according to the 2022 State of the Healthcare Consumer Report from Kaufman Hall.

People are interested in receiving support for healthy eating (41%), paying for exercise equipment or programs (40%), or providing telehealth visits to discuss symptoms (39%). Overall, 34% of those surveyed manage their diet and nutrition (34%), wear fitness trackers (31%), engage in physical health activities (29%), receive mental health services (22%), practice self-care activities (18%), use at-home diagnostics (12%), and use alternative therapies (12%).

The health management activities that consumers engage in are not always integrated into a medical visit. While 59% of consumers who use mental health services do so under a physician’s supervision, only 43% of consumers who use a wearable device do so under a doctor’s supervision.

“As people adopt behaviors that make them more mindful of their health and well-being, they are increasingly interested in integrating those activities with their health care experience,” said Dan Clarin, a managing director at Kaufman Hall and the report’s lead author, in a statement. “Unfortunately, the health management activities consumers engage in are often disconnected from their clinical care. By listening to their consumers and integrating their insights, health systems have an opportunity to better meet evolving consumer needs.”

The report notes that the narrowing of access to health care services complicates things. Nearly 4 of every 10 people who receive health insurance through their employer have access to 1 plan (38%), or 2 plans (33%). Fewer insurance choices mean fewer affordable options for consumers and clinicians to design the type of health care experience patients may want, with services covered by the plan.

Those in commercial insurance plans reported participating in 8 health management activities on average, while people with Medicaid reported engaging in 6 health management activities.

“Today’s insured consumers often have fewer options for health plans, which can translate into less choice for the services they are looking for,” Clarin said. “At the same time, persistent health care disparities are posing major public health challenges. Health systems must be able to both elevate the voice of the consumer throughout their organizations and play a leading role of lifting the health of the communities they serve.”

Report authors say the health care industry will be increasingly challenged to identify and meet evolving consumer demands for personalized health management, and that incorporating the voice of the consumer will not be easy or quick. Adopting consumer-centric principles to care delivery, and building respectful, sustainable relationships with the patients they serve, will be imperative for health systems moving forward.

Kaufman Hall surveyed approximately 3500 health care consumers for the report.

Clarin D. 2022 State of the healthcare consumer report: who will help consumers put the pieces together? Kaufman Hall. September 27, 2022. Accessed October 21, 2022. 

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Physician involvement can determine how much patients benefit from services provided.

Patients want health systems to be more involved in their health

A study by investigators at the University of Michigan looked at the association between financial and physical health and found that, compared with people who have no medical debt,those with medical debt forgo care at higher rates and have higher rates of poor physical health, psychiatric disorders, and all-cause mortality.

Researchers found a link between chronic disease diagnoses and adverse credit report outcomes across all examined outcomes. The more chronic conditions the patients had, the more likely they were to have medical debt in collections, nonmedical debt in collections, any delinquent debt, a low credit score, and a recent bankruptcy. Not surprisingly, they also had significantly greater amounts of debt.

According to the report, medical debt varies significantly across conditions. Among individuals with medical debt in collections, severe mental illness was associated with the largest increase in debt burden, followed by substance use disorders, stroke, congestive heart failure, dementia, and liver disease. A cancer diagnosis conferred the smallest increase in rates of medical debt in collections and had less associated medical debt in collections than other chronic conditions.

Researchers also found a negative association between age and adverse credit outcomes, with younger people experiencing negative outcomes more often than older people. Women were also slightly more likely than men to have an adverse credit outcome.

The study notes that not all causality can be shown. “Some portion of this association is likely explained by poor financial health leading to the development of additional chronic conditions, while another portion may be due to chronic disease causing additional financial burden and worsened credit outcomes,” the study reads in part. “We find that both medical and nonmedical debt in collections rise with increased chronic disease burden, although medical debt in collections rises faster, suggesting that both direct costs (the out-of-pocket expense of medical care) and indirect costs (effects of illness on an individual’s ability to earn income) may have important associations with adverse financial outcomes.”

Researchers note that if further research shows that financial distress leads to additional chronic disease, policymakers should consider new social safety net policies to reduce poverty rates and incorporate improvements in physical health—and concomitantly lower health care spending—as a benefit of antipoverty programs. “If chronic disease diagnoses are directly leading to adverse financial outcomes, then improving commercial insurance benefit design would be warranted to provide additional protection from out-of-pocket medical expenses, particularly for conditions identified as being costly for patients,” the study reads in part.

Becker NV, Scott JW, Moniz MH, Carlton EF, Ayanian JZ. Association of chronic disease with patient financial outcomes among commercially insured adults. 

. Published online August 22, 2022. doi:10.1001/jamainternmed.2022.3687

The more chronic conditions patients have, the more likely they are to be in debt.

Medical Debt Is Tied to Multiple Chronic Conditions 

Pennsylvania State University College of Medicine investigators have found that the 15 most prevalent types of cancer in the US cost approximately $156.2 billion in 2018, with medication representing the biggest expense for breast, lung, lymphoma, and colorectal cancers.

The investigators examined a database that included statistics on cancer care for the 402,115 privately insured patients with cancer below the age of 65 in the US. The aim of the study was to gather data to help understand how money is being spent on cancer care, which has traditionally been difficult to track, mainly because the US has different ways to cover health care costs, such as private insurance for people younger than 65 years of age and Medicare for people 65 and over.

“Cancer is a leading cause of death, actually overtaking heart disease as the leading cause of death in the US over the past few years,” said Nicholas Zaorsky, MD, MS, researcher and assistant professor from the departments of radiation oncology and public health sciences at Penn State Cancer Institute, in a statement. “But it’s still unknown what we pay for in cancer care. As a team, we wanted to look at what private insurances are paying for each kind of cancer and for each type of service.”

The investigators assessed a database that included 38.4 million types of Current Procedure Terminology codes for the 15 cancers, including breast, prostate, colorectal, lung, lymphoma, melanoma, uterus, head and neck, bladder, kidney, thyroid, stomach, liver, pancreas, and esophagus cancers. The cohort study used 2018 data, the most recent complete numbers available, from the IBM Watson Health MarketScan.

The sample included 27.1 million privately insured individuals, including patients with the most prevalent cancers.

Breast cancer incurred the most services, about 10.9 million services and procedures, followed by colorectal cancer, which had approximately 3.9 million services listed in the database. Breast cancer was also the most expensive type of cancer, costing a total of $3.4 billion, followed by lung cancer and colorectal cancer, which were both estimated to incur around $1.1 billion in costs.

Drug costs represent the most expensive category for treating patients with cancer. Approximately $4 billion was spent on cancer related drugs, which is twice the $2 billion spent on surgeries. Other direct costs included diagnostic tests, hospital fees, and physician fees.

Pathology and laboratory tests accounted for the highest number of services performed in the study, although the drug therapies cost more than these services.

Investigators noted that these figures highlight discrepancies between the spending associated with different types of cancer but does not offer an explanation to justify these variations.

For example, pancreatic cancer is one of the deadliest cancers, yet the total cost of care devoted to pancreatic cancer is relatively low compared with indolent prostate cancer.

Future research should seek to determine which services are of the most and least value to patients, factors/parameters, etc, that may or may not be directly correlated with higher costs. Furthermore, identifying areas of high out-of-pocket costs will also be an important part of reshaping policy to ease patient burden and improve quality of life for patients with cancer. 

Zaorsky NG, Khunsriraksakul C, Acri SL, et al. Medical service use and charges for cancer care in 2018 for privately insured patients younger than 65 years in the US. JAMA Netw Open. 2021;4(10):e2127784. doi:10.1001/jamanetworkopen.2021.27784

Medication is the biggest expense for breast, lung, lymphoma, and colorectal cancers.

Cancer Care Costs US Billions— Mostly in Drug Expenses

The coronavirus disease 2019 (COVID-19) pandemic took what was mostly niche telehealth technology and brought it to a much larger patient population. But as the novelty has worn off and people have regained confidence in going to in-person appointments, both the government and private payers have begun making moves that will impact the technology’s long-term viability.

®, spoke with Thomas Conroy, CEO of MedSign, about how telehealth is viewed and what its future might look like.

: With the massive expansion of telehealth during the pandemic, how well has it worked out for clinicians and patients?

: In the beginning, telehealth was positioned for rural areas and now it’s across the nation. I think it’s a learning process. Because of COVID-19 and the inability to get the physician’s office, telehealth has opened up the door, but we have got to do a lot more than that. We need to make some technology changes to enable those who are, let’s say, technology averse, to access telehealth, in the comfort of their home, and I’m talking about seniors.

So I think overall, for [clinicians], you’ll find that the younger [clinicians] are totally open-minded and want to embrace telehealth and maybe the older doctors are the type that would like to see the patient in the home. And they’re going to learn over time that this is an incredible tool that they’ll have in their war chest to help to keep people healthy and well in the home.

Medical Economics®: In the past, Medicare primarily focused telehealth benefits on rural areas where care could often be hard to access. Is that the right approach?

 CMS took what they were doing in the rural areas and applied it to a nationwide program. It was a great way to start, and they understood some of the shortfalls there. What we need to do though…is make sure that the information that’s provided and the connectivity that is provided is for all Americans, and not just the young people today. They all understand just having happiness in your hand in the form of a cell phone is the way to go, because that’s what they live by. We’re going to see more and more of that as we progress in the telehealth arena. But we have to embrace those people and get others to adopt the system, and I think CMS has done that in the beginning here very well.

®: Many patients who used telehealth have since returned to in-office visits, and doctors who reported a lot of telehealth usage in early 2020 now say it’s declined. What does that say about the long-term future for telehealth?

 I think this is a generation issue. The old generation wants to be able to go into the doctor’s office, look them in the whites of their eyes, and get the people to care for them personally. The young people [are] used to the use of technology that exists today, and it’s just only going to grow. We’re not really seeing a real reduction, but an increase in in-home and in-office care. What we are seeing is that the seniors would like to actually talk and see the doctors themselves. Well, that will change over time as telehealth becomes commonplace.

And what you really have to consider is, there’s another area of seniors that is really important: those who have chronic diseases. They don’t want to go to the hospitals, they don’t want to see their doctors, they want to sit and stay in the comfort of their home, but you have to provide technology that enables them to do that.

There’s technology out there, like the one that I’m working on, that enables the seniors to talk to the physician or their nurse, or even their loved one, through the comfort of their home using a home television set. And I think that if we can apply that common technology that is in 120 million homes, we get to sell a winner here. 

When we talk about the seniors, you have to provide them what they know best, and that’s access to a product that they use every day in their home, and it’s a television set. So that will be the embracement part. The adoption part that telehealth needs is that you have to bring in those people who are pretty much using most of the Medicare and Medicaid dollars. It’s the seniors over 75 years of age especially. And here’s the other thing: That population is growing. Think about it: Because of all the health care that they’re receiving, they are living longer. We have to make sure that we can embrace those folks, and the way you do it is providing technology so that they can adopt it with ease.

The pandemic brought telehealth into the mainstream, but will it stay there after the COVID-19 pandemic is over, especially as the population ages?

Todd Shryock

Articles

Patients want health systems to be more involved in their health

Medical Debt Is Tied to Multiple Chronic Conditions

Cancer Care Costs US Billions— Mostly in Drug Expenses

Telehealth: Hope or Hype?