Americans’ frustration with the current healthcare system has reached a tipping point. From cost to efficiency to transparency, individuals continue to experience barriers to getting the care they need, too often forgoing crucial treatments, key preventative consultations and essential medications. Behind the scenes, the healthcare framework is predominantly controlled by system intermediaries that thrive on keeping reference prices as high as possible to maximize their resultant compensation, altogether creating a hyper-expensive environment for patients.
As we head into 2023, our capacity to change this stark reality has never been more robust or requested. While there has no doubt been a plethora of technical innovation within the biopharma and medical field in recent decades, we have yet to apply this same vigor to improving the end-to-end patient experience and pricing transparency.
As the founder of digital pharmacy DiRx, we are among the new generation of companies working to help uninsured and underinsured individuals access affordable care outside the current price-gouged, PBM-dominated system. Still, there is more work to be done when it comes to getting all patients the most cost-effective and streamlined care experience. Online technologies hold the key to unlocking this new status quo and making health equity a reality for everyone.
Bridging the tech skills gap
Telehealth services boomed over the last few years and are here to stay, with reports estimating that telehealth utilization has stabilized at levels 38x higher than before the pandemic. Despite this dramatic increase in uptake, the tech skills gap remains a roadblock for communities that typically require the most care, thus rendering services like telehealth futile. Known as the “digital divide,” this gap also directly impacts all companies building online technologies to reform the patient experience. If left unaddressed, this barrier will ultimately prevent telehealth services from becoming the leading care route in the years to come.
For startups, properly addressing these barriers means allocating sizable funding to outreach and education efforts in senior living/care facilities, specific patient groups and local community centers, and building this activity into immediate business priorities in early 2023. Considering the significant costs of digital marketing programs may be unviable for startups, a stronger focus on grassroots outreach programs through a variety of aligned groups will help boost uptake prospects. In addition to outreach programs directed to those hindered by the digital divide, robust education of younger patients will also yield word-of-mouth communication and knowledge-sharing among older family members, friends and community members. In fact, studies estimate that 22-26 million American adults currently provide caregiving services for older family members and friends.
Startups and disruptors, in particular, have a unique opportunity to build grassroots outreach and education into their ethos from the very beginning to ensure vulnerable communities are receiving adequate care and properly accessing all the latest resources available.
Cash-based collaboration is key
Alongside the digital divide, consumers are also increasingly burdened by inflation, and therefore more frustrated with the broken insurance system forcing them to pay sky-high premiums for even pricier deductibles and co-pays – all while still receiving inadequate coverage. To help patients significantly lower overall annual costs, many online-first healthcare providers, ranging from virtual primary care clinics to imaging and diagnostic services to pharmacy services, are now operating completely outside this insurance system and turning to cash-based care. Simultaneously, there has also been an emergence of concierge services that help patients navigate this transition and evaluate relevant options in this emerging ecosystem.
Since the care continuum is multi-faceted, each cash-based online tool or patient service will only be so effective on its own. Startups in the health-tech space need to consistently explore partnerships and service integrations with other players offering complementary services, so patients can have an accessible and affordable end-to-end experience. This complete service line could include cash-based primary care providers, online specialists, digital pharmacies and more. In this modern ecosystem, patients will be able to address all their health concerns quickly, virtually and affordably, only scheduling in-person visits when necessary.
Because these business models circumvent predatory industry markups, the combined annual cost of integrated cash-based PCP telehealth services, prescription orders and specialist consultations end up significantly lower for patients than if they continue to pay monthly payments and high out-of-pocket costs. It’s a win-win for everyone.
Online-first channels will reach marginalized communities
As health-tech companies come together to bridge the tech skills gap and offer seamless online care channels, more marginalized communities will have affordable access to the crucial services they need. From supporting individuals in rural communities and pharmacy deserts that may not have adequate healthcare facilities nearby to cutting down costs for underinsured families with significant coverage gaps, a virtual-first healthcare experience can address a variety of patient needs across the country.
The sheer number of Americans in need of this paradigm shift is dire. For instance, an estimated 41 percent of people currently face healthcare debt, with an alarming 12 percent of Americans facing $10,000 or more, and those struggling include individuals already paying expensive employer or individual plans. Additionally, 43 percent of working-age adults were inadequately insured in 2022, and 46 percent report skipping or delaying care because of the cost. It’s clear the current system isn’t adequately serving anyone, even those supposedly covered by high monthly insurance premiums.
With the influx of new technology and payment structures coming to market, no consumers should have to decide between medical care and essential resources like food and housing, especially when existing online business models can already deliver care remotely, quickly and at a consistent, affordable rate.
As such, it’s vital that in the new year, disruptors in the health-tech space make it a core business priority to work together, sustainably reform the patient experience and invest in building a complete online-first ecosystem that responds to Americans’ long-standing healthcare needs.