This is the Healthcare Delivery Providers, part of the Healthcare Marketplace Specialization. This is module 5.1.4, Community and Consumers. Learning outcomes for this lecture will be to review how customers or consumers of healthcare impact the delivery of healthcare. So, where do the customers or consumers of healthcare impact and touch the delivery system? Obviously, the customer is all throughout the delivery value chain. This term is becoming more and more common in the US, the healthcare value chain. So again, learning form the industry that this is a chain that creates value in sequence. And the consumer that we used to call the patient is the thing that moves through the healthcare value chain. And also, the thing that is different about this particular value chain compared to manufacturing, for example, is that the consumer transforms the value chain itself by interacting with it. A very large debate that is happening is the discussion of whether what's moving through the value chain should be called a patient or is it a consumer again learning from industry? First thing that customers or consumers do, of course, is they pay for healthcare. So, they either pay through their employment, so they pay a part of the premium. They pay insurance premiums. They also have increasing responsibilities with some sticks and carrots techniques and tactics. For example, a type of insurance plan now is called the high deductible insurance plan. So, it has a higher deductible, but it also covers less of the services. So, if you need to go in to the emergency department or the hospital, because of the high deductible, a lot of the cost would be shifted directly to the customer which makes them more savvy, more cost conscious. And also, a much more engaged and health literate consumer. Another important piece in the consumer realm is the discussion and debate over choice. So, here the balance between individual health versus population health comes in. So, for example, we've discussed a case like this before, a couple of the patients in a population might be wanting a lot of extra tests or procedures. And they could drive up the healthcare costs for the entire population. Now, can they choose that? Should they not be allowed to choose that? Where's the autonomy and the choice versus the good for the greater population health? So again, that's the debate that is actually happening right now. Another thing that is being debated is the protocol driven or what's called the cook book medicine. So, these are the protocols that the providers follow. And again, when faced with a patient that says, I want that expensive test, how do you deal with that? And how do you balance the protocol and the evidence base versus what a patient wants, which may or may not be needed? Now again, remember at this point Harlan Reeves and his choices that he was making, and also his family dynamics with his daughter, son and wife. The other thing that is emerging in the US is what's called the health insurance exchange. So, this is a open marketplace where consumers can go and choose the insurance plan and the level of insurance that they want. So again, it's a free market. There's a lot of choice and there's a lot of pull and push levers being pulled. Obviously, as you can imagine, with the newer generation and also the changing of the technology and what's exposed to the various consumer, the expectations of the customers are changing. More and more the delivery providers, even physicians, are being considered commodities that are exchangeable. Also, virtual care is almost being demanded by some of the generations and also the ability to meet the customer where they are at, so at home or at work. And again, it may or may not work for the delivery system, but that's what the customer wants and demands that they get. Another debate that is happening right now is around privacy. So again, to take care of a patient, an individual in a population, the healthcare system and the payer and sometimes the government needs information about their history, about their case. So again, how much information is too much information? That is being discussed and debated now. Also, the balancing opposite effect is that sometimes, due to privacy concerns, very critical information, maybe about the mental or behavioral health diagnosis, may not be available to the provider that is taking care of the patient. And that can directly hinder the provision of good care. So again, it's a push and a pull and a balance of these two arenas. And as we have discussed before, consumer experience or patient experience is a lever and a metric that is being measured. So, here's a patient that wants an expensive test. It is not evidence-based and for the condition that she has. It's not a test that should be given, but she wants it. So, let's say the physician is able to say, my protocol says you should not have it. Well, is she going to leave the clinic and rate the physician very poorly? So again, we are thinking about what are the right questions to gauge consumer experience with healthcare without giving into choices which do not match the evidence-based medical care that we have. So in summary, customers and consumers are one of the most important ingredient in the healthcare value chain. And obviously, they influence the delivery system in many direct and indirect ways. Sometimes directly and individually, and other times through their organizations, their civic engagement and community based organizations and their free will, a free voice, and the power of being out there and raising some issues. So all of these things have to be taken into consideration as the delivery system transforms.