For Legacy Healthcare Providers, The Retail Threat Keeps Getting Bigger – Industry Analysis by Loyale Healthcare

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COVID-19 has accelerated and expanded the plans of nationwide retail organizations intent on wooing healthcare consumers with greater convenience, better access, lower prices and a more customer-centered experience. Health systems and hospitals planning to resume growing after the pandemic will have to adjust to counter the competitive threat posed by this increasingly potent new competition.

U.S. Healthcare consumers will have a lot more choice in the months following the COVID-19 crisis.

By augmenting the industry’s well-earned reputation for exceptional clinical care with systems that meet healthcare consumers on their terms, experience has taught us that patient loyalty can – and should be – a healthcare provider’s most valuable asset. - Kevin Fleming, CEO, Loyale Healthcare

Late last week, retail giant Walgreens announced that it plans to open forty on-site primary care clinics by the third quarter of 2021. Operated by Village MD, which recently received an investment commitment from Walgreens for up to $1 billion to open primary care clinics, the openings are part of Walgreens’ long-term plan to open as many as seven hundred primary care clinics in more than thirty U.S. cities over the next five years. At about the same time, Village MD announced that it had been accepted by the Centers for Medicare and Medicaid Services’ (CMS) new Direct Contracting program.

The program is just one of three CMS primary care initiatives VillageMD participates in. It was developed to support CMS’ goal of, “building an American healthcare system that focuses on primary care, pays for value, and places the patient at the center,” according to U.S. Dept. of Health & Human Services secretary Alex Azar, who concluded saying, “These new models represent the biggest step ever taken toward that vision.” For CMS, it’s apparent that the growing retail channel represents an important new partner in the realization of their “patient-centered” goal.

Meanwhile, according to a Healthcare Dive insight, “competitor CVS Health now has more than 200 of its health-focused stores open in 22 states and is on track to launch 1,500 by the end of next year.” And Walmart continues with its plans for a nationwide expansion of its health superstores. Lori Flees, SVP and COO of Walmart U.S. Health & Wellness touted the company’s early success, blogging in September that, “Walmart is having a real impact on increasing access to care in our communities.”

While sharing the company’s intention to open more locations, Flees elaborated on the refinements it has made to its healthcare model and their outcomes to date. They include:

  • Patients and clinicians approve of the Walmart Health model, with strong patient satisfaction
  • There’s a clear need for convenient, quality, affordable healthcare – as evidenced by increasing visits (50% of which are return patients), and 96% of patients saying they “felt cared for.”
  • The pricing and convenience of Walmart Health is making a difference – reporting that customers were telling them they had “no idea healthcare could be so affordable.”

There are other distinguishing characteristics and outcomes. Most of them are comparable to the healthcare initiatives at Walgreens and CVS. In essence, these retailers are exploiting what Flees describes as “the vulnerabilities of our healthcare system,” to win market and wallet share from a healthcare consumer that has never been more willing or interested in exploring nonconventional models of care delivery.

Retail’s enthusiasm for primary care was revived then surged because of the pandemic. As recently as late last year, Walgreens had actually announced its intention to close 160 of its walk-in clinics, largely because at the time, "the majority of consumers (67%) said they preferred to receive healthcare services from their own doctor or hospital.” But Walgreens later changed their plans, because of – you guessed it – the COVID-19 pandemic.

International healthcare consultant and strategist, Rita Numerof, analyzes the pandemic’s impact on the U.S. healthcare industry in a recent Forbes article titled, Retail Healthcare’s COVID-Fueled Rise Could be Legacy Providers’ Fall. In it, she cites the results of a PBS NewsHour – Marist poll published in September that found that more than a third of Americans - thirty five percent – feel their healthcare system is below average worldwide (up from 25% since February). As reported by the Healthcare Financial Management Association (HFMA), another national survey of healthcare consumers conducted by The Harris Poll for Change Healthcare found that:

  • 81% believe COVID-19 will fundamentally change healthcare delivery
  • 81% believe the pandemic will speed digital adoption
  • 89% say COVID-19 made telehealth “an indispensable part of the healthcare system”
  • 65% plan to use telehealth more after the pandemic
  • 78% said COVID-19 showed the extent to which more telehealth options are needed

According to Numeroff, “Consumers’ eyes and minds have been opened, and as a result, it’s become imperative for hospital leaders to immediately let go of the notion that someday soon, all will return to normal. This isn’t just a temporary blip. This is becoming the moment we will all remember as the one that changed American healthcare; the moment that destroyed the legacy providers that couldn’t (or wouldn’t) compete with outside-sector disruptors.”

The shift in consumer sentiment isn’t new, but COVID has accelerated and expanded it. We wrote on the topic in the summer of 2019 in an article titled We the Patients: Consumerism, Convenience & Technology. In it, we noted research and analysis detailing a generational shift in consumer preference (45% of millennials have no primary care provider), and the growing problem of care accessibility, convenience and affordability (67% of millennials said they would consider a virtual visit for same day service and 62% said healthcare costs are a major stress).

At that stage in the evolution of healthcare consumer sentiment, we pointed out that health systems, hospitals and other legacy providers already possessed many of the building blocks needed to respond to emerging client expectations and new competitive threats. These included their EMR systems (EPIC, Cerner, etc.), Patient revenue cycle management from point solution providers like TransUnion and Experian, and large-scope revenue cycle services from companies like Parallon and Optum.

Looking ahead, the challenge for legacy providers when COVID is finally behind us is “blending all of these disparate systems into a single, seamless whole. One that adapts to every setting in the healthcare ecosystem and is flexible enough to incorporate new and emerging solutions while maintaining strong user engagement.” This is especially important as the demand from healthcare consumers grows and their expectations for accessibility, affordability, convenience and quality intensify.

One solution in the area of patient revenue cycle is Loyale’s own Patient Financial Manager™ (PFM), the industry’s most widely deployed patient financial engagement platform. PFM interoperates with, and seamlessly blends, all patient financial interactions across an enterprise. Its unique capabilities support price transparency; intimate, personalized communications; payment planning with multiple payment scenarios (to bring care within reach financially); and a consumer-friendly patient portal, or Digital Front Door, to encourage patient self-service by simplifying the patient experience.

In an article titled COVID-19: Healthcare Consumerism’s Tipping Point, published this September, we shared the results of a PwC Healthcare Research Institute survey of 2,533 Americans in early April, before the COVID-19 surges we experienced over the summer and the one we’re in the midst of now. At that early date, about 16.5 million Americans had already started using telehealth. 88% of them said they would use it again.

The article also shared some sound advice for legacy healthcare providers gleaned from a Medical Economics article, 5 Things COVID-19 is teaching us about the patient experience. To that advice, we added our own insights (informed by millions of patient financial encounters) to help legacy healthcare providers compete in the patient-centered marketplace that will prevail after the pandemic. To summarize:

1.    Keep it Simple – Solutions must be easy to implement and use to engage patients. With respect to patient’ financial experiences, interactions should more closely mimic the seamless experiences users have in their financial transactions with popular providers in other sectors like retail, technology and hospitality.
2.    Make it Familiar – Virtual workflows should match the familiar steps of an in-office visit. Patients, many of whom are facing extraordinary financial distress because of job, business and revenue losses brought about by the pandemic and related lock-downs will be looking for affordable payment plan options as they do with other larger expenses.
3.    Be Convenient – Integrating digital check-in technology with the the telehealth platform. Financially, the patient’s financial obligation should be seamlessly integrated into the registration process, so they are exposed to their estimated obligation and options for payment early, when the decision to pursue care is made. When appropriate, the opportunity to prepay may benefit both patients and providers.
4.    Keep it Short - "As restrictions lift, providers and practices likely will offer both traditional and virtual appointments. Digital check-in tools, with their ability to capture upstream data, can eliminate the frustration of waiting rooms with their long wait times, tight appointment windows and petri-dish environments.” Financially, patient payment plans can be developed and linked to the care episode, providing one-click access to manage treatment, billing and payments.
5.    Put Patients First - "Keep patients engaged and connected by bringing together services in a way that’s seamless, fast and accessible.” In the financial dimension of care, the presentation of one bill that combines every billable entity into a single presentation will make it easy for patients to understand, manage and pay, relieving anxiety and improving not only the probability of payment, but the likelihood that care will be accessed.

At Loyale, we have complete confidence that health systems and hospitals can and will adapt to changing consumer expectations and the growing competitive threat that retail providers represent. It won’t be easy, but America’s healthcare professionals have demonstrated an astonishing capacity for innovation and resiliency over the last nine or ten months. By augmenting the industry’s well-earned reputation for exceptional clinical care with systems that meet healthcare consumers on their terms, our experience has taught us that patient-provider loyalty can – and should be – a healthcare provider’s most valuable asset.

Kevin Fleming is the CEO of Loyale Healthcare

About Loyale

Loyale Patient Financial Manager™ is a comprehensive patient financial engagement technology platform leveraging a suite of configurable solution components including predictive analytics, intelligent workflows, multiple patient financing vehicles, communications, payments, digital front doors and other key capabilities.

Loyale Healthcare is committed to a mission of turning patient responsibility into lasting loyalty for its healthcare provider customers. Based in Lafayette, California, Loyale and its leadership team bring 27 years of expertise delivering leading financial engagement solutions for complex business environments. Loyale currently serves approximately 12,000 healthcare providers across 48 states. Loyale is proud to have an enterprise-level strategic partnership with Parallon which includes the deployment of Loyale’s industry leading technology at all HCA hospitals and Physician Groups.

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