Empowering patients in a consumer-driven healthcare system

• In an era of consumer-driven healthcare, patients must become health citizens who are provided with adequate tools and resources to make informed choices
• Healthcare engagement benefits from an omni-channel approach, where patients can seamlessly navigate between online and in-person care, much like a retail experience
• In this context, true healthcare equity is increasingly complex and requires addressing financial, digital, and structural disparities

The healthcare landscape today is undergoing a fundamental transformation towards a more consumer-driven healthcare system. Patients now demand clear cost and quality information, accessible preventive care, and seamless service experiences that reflect the consumer-driven standards of other industries. 

For healthcare executives, the shift towards consumer-driven healthcare represents a powerful opportunity to enhance patient satisfaction, improve outcomes, and lower long-term costs.

In this interview, health economist Jane Sarasohn-Kahn shares strategies to help leaders drive innovation that meets rising patient expectations, from cost transparency to integrated digital and in-person care. Her insights offer a practical guide to creating a patient-centered system that thrives in a consumer-driven world.

HT: In your experience, what are the biggest barriers to achieving healthcare equity and how is it related to consumer-driven healthcare?

Sarasohn-Kahn: When we talk about healthcare equity, I envision the layers of an onion: think access to care, financial equity (especially around healthcare costs), and finally digital equity or “techquity.” Let’s break those down.

For access to care, we start with what we call the social determinants of health (SDOH). These are the factors that shape our health from before we’re even born. Managing risks of SDOH means things like access to clean air and water, food security, and income stability. In the U.S., job security is often tied to whether you have health insurance, which is an on-ramp to care access.

There’s also transportation, whether you can get to your job, school, or a doctor’s appointment easily, and perhaps the most important factor is education. Research shows education is the foundation for everything else: a good job, better living conditions, and ultimately, better health.

Financial equity in healthcare is another big barrier. Many people still have to ration their care due to cost, especially if they’re uninsured. But even having health insurance, with a high deductible plan, there is also the risk of self-rationing due to the costs of meeting that deductible. This leads to delayed diagnoses, which, ironically, end up being more expensive to treat downstream.

Then there’s digital equity, which has become more critical than ever. If you can’t access the internet, you can’t use telehealth, look up medical information, work remotely or attend school from home. The COVID-19 pandemic showed us how important this is, and we’ve started using the term “techquity” to describe the need for fair access to technology in healthcare. When it comes to some of the major developments in the emerging consumer-driven healthcare system, digital equity becomes a clear priority.

Ultimately, we need to address all these layers—disparities, biases, and gaps—if we’re going to achieve true healthcare equity and health justice. Consumer-driven healthcare positions patients as payers, which means that financial equity is foundational to operating in this new landscape. It’s a big challenge, but it’s essential to create a more inclusive system and enable more productive economies of healthy, flourishing citizens.

HT: Patients are postponing diagnostic tests due to cost. What steps should hospitals and policymakers take to ensure that people can afford essential diagnostic tests and treatments without delaying care?

Sarasohn-Kahn: This trend actually started before the pandemic. Patients have been carrying more of the financial burden, what we call having more “skin in the game.” I’ve written about this as patients self-rationing care because of costs. Then, during the pandemic, we saw medical distancing, which was essentially like social distancing from doctors and diagnostic tests. IQVIA estimated a drop of nearly one billion (with a “b”) diagnosis visits in the U.S. in 2020 – the difference between visits expected in a non-COVID scenario and the number of visits actually seen. Some patients and health systems are still playing catch-up.

The financial barriers we’re talking about make self-rationing even worse, especially for preventive care and early diagnosis. If people delay these tests, they risk more severe illnesses, which will drive up healthcare costs in the long run.

In the U.S., the Affordable Care Act helped ensure preventive care coverage for both men and women. It included important tests like prostate and breast cancer screenings. But many of these screenings were delayed during the pandemic, and now we’re seeing a rise in diagnoses of these diseases and other cancers because of that medical distancing.

So, how do we address costs? First, we need public and private payers to recognize that prevention saves money in the long run, and public policymakers should embed prevention into policies due to a positive impact on people’s productivity and ultimately, the taxes they pay at the workplace. Early diagnosis is a good return on investment (ROI). But beyond cost, we also need to make it easier for people to access preventive care.

Healthcare needs to be more accessible where people are—in their communities, near where they work, live, shop, or go to school. This reduces their personal costs, like transportation or time away from work or family, and possible lost wages from taking time off for medical appointments. We especially have to think about busy parents and adult children with aging parents who may delay their own care because they’re focused on caregiving. If we can make testing convenient—whether that’s through community health centers, retail locations, big box stores, and schools—it becomes more affordable and accessible. Ultimately, making it easy and low-cost to get preventive care will reduce both financial and health burdens for patients.

HT: You advocate for patients as informed consumers, not just payers. How can the healthcare system foster a culture where patients are empowered to understand the cost and quality of the treatments they are receiving?

Sarasohn-Kahn: Understanding cost and quality is part of a bigger health literacy issue. Before patients can evaluate cost and quality, they need to be informed about their condition—the diagnosis, how it developed, and what to expect going forward. This is the foundation of health literacy.

Once a patient has that understanding, the next layer is financial literacy—knowing how much they will pay out-of-pocket and how to assess the value of the care they receive. This is what I refer to as “health citizenship.” Healthcare should not only be a right, but patients, as health citizens, have the responsibility to be informed. If you have access to healthcare, you also have a duty to make mindful decisions about your care. This can extend even further such as voting with healthcare in mind and supporting policies that prioritize health which might include a candidate’s position on the environment, clean air and water, and safe and accessible food supply.

To make this a reality, we need transparency and tools that genuinely engage patients. These tools have to be well-designed and tailored to the individual. A patient needs to know, “How much will I spend with my specific  health plan?” and “Where can I find the best quality care for my condition based on where I live or work?” Ideally, patients should have access to report cards on procedures or providers, allowing them to make informed choices based on both quality and cost. But it doesn’t stop there—the information also needs to be actionable. Imagine being able to click and make an appointment with a provider who meets your cost and quality expectations, creating a seamless, omnichannel experience.

Unfortunately, we’re not quite there yet. While there is legislation in the U.S., for example, requiring hospitals to provide some of this information, the progress has been slow. Consumers aren’t fully taking advantage of these tools, and the system isn’t yet equipped to offer perfect and personalized information at the click of a button.

Part of the challenge is aligning the interests of all stakeholders—hospitals, providers, health plans, and insurance companies. Cost information is often seen as proprietary, held within negotiations between health systems and insurers, but the patient is really at the center of it all. I believe that when these interests finally align, we’ll see significant progress. But for now, we’re still in the early stages of that alignment.

HT: How are healthcare organizations responding to the increased engagement of patients in their health, and how has this influenced their strategies or products?

Sarasohn-Kahn: This is a space I’m really focused on right now—thinking about the patient not just as a patient, but as a payer, a consumer, and even a customer in a retail sense. Now, a consumer-driven healthcare isn’t entirely retail, but this shift in perspective is helpful. When we used to talk about “retail health,” we’d think about pharmacies. But now, we need to expand that thinking. Patients today are acting more like consumers—they’re paying for healthcare, comparing services, and expecting the same ease and convenience they experience in other industries like banking, travel, and food delivery.

It’s fascinating to see how healthcare is starting to catch on to this. Organizations are hiring experts from other industries—particularly service design professionals from consumer-obsessed companies like Disney (via the Disney Institute, which works with healthcare providers around the world) and marketers with backgrounds from companies like Procter & Gamble. They’re bringing in this retail mindset to improve how healthcare organizations interact with their patients in omnichannel platforms.

When you think about how hospitals initially rolled out patient portals, it wasn’t exactly a seamless, enchanting, retail-like experience. Patients could access their records, but it lacked the delight or ease they were used to with other online services, like booking a flight or checking their bank accounts with less friction in the process.

We’re starting to see some progress, though. Major lab companies now offer apps where patients can access lab results right after their tests, sometimes within the same day. This is one of the most popular features of patient portals, like Epic’s MyChart. Patients love being able to see their lab results immediately, instead of waiting days for a call or follow-up.

Similarly, chain pharmacies have stepped up their game. Their apps notify patients when their prescription is ready for pick-up, saving them an unnecessary trip. And, of course, these apps often come with loyalty programs—just like in retail—encouraging patients to shop while picking up their meds, which helps boost pharmacy chain revenue at the front of the store.

The common theme here is empathy for the patient. Healthcare organizations are realizing that to truly engage patients, they need to design experiences that not only meet their needs but delight them. Part of that is ensuring privacy is respected, especially in an omnichannel world where patients move between online services, brick-and-mortar clinics, and digital health platforms and apps.

Ultimately, I think the future of healthcare engagement lies in this omnichannel approach, consumer-driven healthcare where patients can seamlessly navigate between online and in-person care, much like we see in retail.