Redesigning healthcare for the consumer: Survey insights from PwC's Health Research Institute
Changes in consumer behavior, many of which were accelerated by the COVID-19 pandemic, are fueling a redesign of the health ecosystem. PwC's Health Research Institute (HRI) mined its proprietary survey data to uncover insights about how and why specific groups of consumers used health services during the pandemic - from mental health and telehealth to in-home care and other non-traditional care sites - and their willingness to use them again in the future. Even attitudes about how clinical research is conducted are changing. A health industry that closely monitors these consumer signals and designs accordingly will likely emerge more consumer-centric as the pandemic wanes.
Consumers have grown bullish about receiving more of their healthcare at home.
The “house call” of the past is taking on new life as consumers get more familiar with receiving their care outside of the traditional doctor’s office during the pandemic. Just 4% of consumers responding to an HRI survey in 2020 indicated that they had had a doctor, nurse or other clinician visit their home to provide care, but consumer interest is growing. More than three-quarters of consumers said they are willing to get in-home care for anything ranging from a well visit to chronic disease management. At-home care may also help ease certain patients back into the health system after having deferred care during the pandemic. Thirteen percent of consumers said that being able to receive care in their homes, including virtual and in-home options, would make them feel most comfortable about rescheduling care they had put off.
Implications
- Health care providers and health plans should evaluate their in-home care strategies and identify opportunities to increase their use of these channels to reach more consumers, or deliver care in a more cost-effective way.
- Employers may also consider more in-home options outside of virtual visits post-pandemic to reduce absenteeism and increase productivity while workers telecommute.
Providers and consumers may be misaligned on how telehealth should be used.
With many introduced to virtual health visits for the first time during the pandemic, consumers are becoming increasingly willing to receive virtual care for a variety of services. Almost two-thirds (62%) of consumers would be willing to use virtual care in the future, according to an HRI survey.
However, HRI analysis found that provider executives and consumers are largely misaligned on the services they think should be offered virtually. For example, 37% of consumers said they would be willing to use virtual visits for ongoing treatment of a condition, such as a chronic disease, while only 17% of provider leaders said that virtual visits are effective for ongoing health management. This may mean a missed opportunity to serve consumers with complex chronic or chronic disease, especially those whose conditions may have worsened due to deferred care during the pandemic.
While most providers told HRI they are using virtual visits for follow-up appointments, 34% of consumers said that they would like to use them for an initial visit to assess a new health issue.
Consumers and provider executives are aligned, however, on mental telehealth, a promising sign considering that 32% of consumers told HRI that they have experienced anxiety or depression as a result of the pandemic.
Implications
- Provider executives are most likely to offer virtual visits for mental health, family medicine, OB/GYN and pediatrics, according to the HRI survey.
- Health plans and health systems must determine which types of virtual visits make the most sense and for whom. They should consider consumer preferences and willingness among specific groups by age, race, insurance type and health status. Patient education will be important for managing expectations.
New care settings get a lift from COVID-19. Will they become the new norm post-pandemic?
The share of Americans using health settings outside of the traditional doctor’s office increased during the pandemic. According to a consumer survey conducted by HRI in September 2020, the share of consumers reporting they had used virtual visits doubled by September compared with before the pandemic. The share reporting they had used a retail clinic increased by 40% and the share reporting they have gone to an urgent care center grew by nearly one-fifth (18%) over that time period (see figure). Most (at least 75%) said they would use these sites again.
Who are these new users? The profile varied depending on the site. For example, men were much more likely than women to choose retail clinics and urgent care centers, as were younger groups. Consumers age 65 and older and those with complex chronic disease accounted for the largest share of virtual visit users; 92% of those 65 and older reported using them for the first time.
Implications
- The healthcare system must prevent these new care channels from becoming another set of disconnected options for consumers, and care coordinators could become essential. Half (51%) of consumers surveyed by HRI said they wanted a care coordinator or navigator to help orchestrate virtual and in-person care; 68% of provider executives said they plan to use more of them in 2021.
- Employers and payers are nudging people toward lower-cost sites of care. Payers are designing plans to encourage members to choose free-standing facilities and in-home care, rather than more expensive sites. How those benefits are designed and how employees perceive the costs will shape the effectiveness of site of care strategies.
Want to get vaccines in arms? Consider race and age for “last-mile” distribution.
As the funnel of prioritized individuals widens for a COVID-19 vaccine, consumer preferences could become a major factor to help ensure vaccine uptake and minimize concerns over vaccine hesitancy or pandemic fatigue.
Nearly two-thirds (62%) of consumers surveyed said that they would get a COVID-19 vaccine within the first year it was available. Of them, while half (51%) said they preferred receiving it at their doctor’s office, a sizable share (38%) said that they would prefer to receive it in a non-traditional health setting, such as a retail clinic or urgent care center.
Preferences for the site of vaccination differed based on age and race. White consumers were twice as likely to prefer vaccination at a doctor’s office than Black and Latinx consumers (52% versus 27% and 28%, respectively). Non-white consumers preferred vaccination at non-traditional settings over a doctor’s office. Preferences also varied across age groups.
Implications
- The industry needs an end-to-end view in a supply-constrained world that includes the “last mile” to the consumer
- Healthcare organizations may consider a variety of sites to ensure access and equity across a diverse set of populations as they make decisions about vaccine distribution.
- Investment in advanced analytics and consumer segmentation could allow manufacturers to better deliver on the promise of the right treatment to the right patient at the right time and in the lowest-cost appropriate setting.
18-24 year olds have been most affected by the mental health impacts of COVID-19. Here’s where they are turning for help.
Already a crisis before the pandemic hit, the deteriorating state of mental health in America was fueled by the pandemic. Nearly one-third (32%) of consumers said they have experienced anxiety or depression as a result of COVID-19 in an HRI survey in September 2020. Americans between the ages of 18 to 24 were hit hardest at 48%. More than half (54%) of this age group said they sought out care for COVID-19-induced anxiety and depression.
About two-thirds (62%) of 18- to 24-year-olds responding to a separate HRI survey said that they sought mental health services in the last five years, higher than any other age group. One-quarter of them accessed these services for the first time during the pandemic.
How did 18- to 24- year-olds access the mental health system? Most frequently through their primary care doctor, but they were also more likely than any other group to choose mental telehealth as their first point of access. Notably, consumers between the ages of 18 and 24 were three times as likely to use emerging virtual mental health tools, like emotional support apps and online support groups, than the average consumer with mental health needs.
Implications
- Virtual mental health management might offer an opportunity to better serve a nation already struggling with a mental health crisis before the pandemic hit. HRI found that consumers with mental health conditions are twice as willing to use mental telehealth than all consumers (46% vs. 23%). Provider executives surveyed by HRI in the fall identified mental health and psychiatry as the top focus for telehealth investment.
- Mental health utilization is expected to be an inflator of medical cost trend in 2021, but it may lead to savings in overall health costs in the long term. Employers should consider offering new mental telehealth services or promoting those they already provide. Of employed consumers surveyed, only 8% of consumers said that their employers offered new mental health benefits during the pandemic.
The pandemic fire-tested new strategies for clinical trials. Will moving trials out of the hospital help boost enrollment?
Decentralizing clinical trials—the exercise of moving them out of the hospital setting—may help boost enrollment, according to HRI research. The ability to conduct elements of clinical trials virtually or closer to home was attractive to most consumers. When asked which factors would make them more likely to participate, the ability to participate from home using telehealth was most influential in increasing the likelihood of participating. Sixty-two percent of consumers said the ability to do so would make them more likely to participate, followed by local travel to the clinical trial site (46%).
Running studies in unconventional locations closer to where patients live may serve to boost enrollment. HRI's survey found that as options for participating in clinical trials move closer to the home, consumers are more willing to say they'd participate. This was true across races; almost half (47%) of Black, 56% of Latinx and 66% of white consumers responding to HRI’s survey said they would be willing to participate in a trial from home.
Pharmaceutical and life sciences executives also believe that conducting elements of clinical trials virtually may improve the diversity of enrollment, according to a September 2020 survey by HRI. Eighty-seven percent of executives believe this could improve racial diversity, and 74% believe this could improve gender diversity.
Implications
- Travel has been a known deterrent to clinical trial participation. Exploring options to decrease commute is one key to boosting clinical trial participation, HRI found.
- During the pandemic, for example, the FDA worked with pharmaceutical companies to diversify clinical trial participation to include individuals most likely to be impacted by COVID’s adverse effects. Under the Biden Administration, the FDA is expected to continue to advocate for clinical trial diversity.
About the research
This HRI survey insight is based on three online consumer surveys and one health executive phone survey conducted by HRI in 2020. The online consumer surveys represented a cross section of the population in terms of race, age, gender, income and geography. The April survey included a sample of 10,003 US adults, the May survey included a sample of 2,501 US adults and the September survey included a sample of 2,511 US adults. The US health executive survey, conducted in August and September, was based on a sample of 153 provider executives, 124 pharmaceutical and life sciences executives and 128 health plan executives. The surveys collected data on consumer and executive perspectives about the healthcare landscape before and during the COVID-19 pandemic, and their views about its post-pandemic future.
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