Jane Sarasohn-Kahn

The Patient is the Payer is the Consumer is the Citizen

Jane Sarasohn-Kahn is a health economist and advisor supporting organizations at the intersection of health, technology and people. Jane founded THINK-Health and the Health Populi blog after working for ten years with healthcare consultancies in the U.S. and Europe. Her clients are all stakeholders in health: technology, bio/life sciences, providers, plans, retail, financial services, food and consumer goods. Jane is a frequent speaker and also contributes to the Huffington Post.

The advent of $4 generic drugs and growing tiers between prescription drug co-payments was my lightbulb moment, about twelve years ago, which got me thinking about the patient-as-consumer.

Back in 2006, Walmart disrupted the pharmaceutical world by introducing patients to generic drugs at a low price: $4 for a monthly supply.

Today, we take low-cost generics for granted, but they were a sentinel event that began the morphing of the American patient into a health care consumer. With Walmart's first move into the $4 generics world, patients began to shop around for generic deals on Rx drugs, and soon, other pharmacies adopted the $4 Rx plan as a kind of loss-leader to get consumers to shop in their stores, whether freestanding retail pharmacies or groceries with on-site pharmacists.

Since then, that consumer has taken on more financial and clinical responsibility through more people enrolling in high-deductible health plans, and through shopping on health insurance marketplaces, public and private alike.

At the same time, those patient-consumers have morphed into homo informaticus, that multi-platform, multi-channel human that is information-seeking on many channels. It's mainstream to "page Dr. Google" with symptoms and to research unpronounceable names of new medicines their side effects and prices as well as their benefits.

That's the demand side: where patients-as-consumers have gotten more serious about getting smart and engaged with their healthcare: especially about cost, and eventually about access to personal medical records.

How people use their mobile phones and platforms for their daily lives managing money, booking travel, finding restaurant tables, sharing rides, and ordering shoes and books and laundry detergent and pet food that's the mainstream consumer, and she wants her life-flow for healthcare to be as streamlined and user-enchanting as the digital tools she uses with other industries she patronizes.

So we now must deal with the patient-as-payer.

Central to her ability to be that patient/consumer/payer is data liquidity, and data well-designed: with privacy, security, understandability, and accessibility baked in.

An old saw goes, "he who pays the piper calls the tune." Today, our personal workflows in healthcare don't feel at all like an Amazon Primed experience, where we are the payer and Amazon, increasingly, the e-commerce piper.

The tune, we expect, is an elegantly designed smartphone app, financial services portal, or travel scheduler. Or, at a minimum, no surprise medical bills, the correct personal data in our EHR, and on-line bill payment, among a long list of demands we new healthcare consumer-payers deserve and, increasingly, demand.

In the U.S., health citizens should know that the nation ranks far down the quality roster of health system excellence. Americans spend more and get less.

Greater personal and patient health engagement can help drive better outcomes and bend our personal and public healthcare cost curves. Our access to "our" data helps us manage what we can measure, the same way we say we must do in business.

Our current business model in American health care is deeply embedded in one-fifth of our nation's macroeconomy: healthcare costs comprise $1 in every $5 of the U.S. economy. Without the patient-payer being the best, most engaged patient she can be, we don't have a prayer bending our cost curve or dare I say enchanting American patients. A key pillar of this vision-goal is liquid data under the control of patients, the new and ultimate healthcare payer.