2014 Year in Review: Consumer Engagement

For better or for worse, 2014 was a big year for consumer engagement.

• Big on promises from industry on wearables, smartphone platforms, and connected health, to the tune of over half a billion dollars of VC investments in consumer-related healthcare companies.
• Big on growth for consumer-centered technologies (video visits) and disruptive models of care such as the 2,000 retail clinics that now exist across the country.
• Big on expectations from Washington for the greying patient portal model, which along with much of the rest of Stage 2, is turning out to be an ill-advised, ill-received and possibly ill-conceived plan for fostering better engagement.

This combination of big investments, big disruption, and big disappointments has been a perfect storm for some industry newcomers. Ginger.Io, Wellframe, Omada, Twine, and a few other startups have had a year filled with successes, launching pilots that in some cases have grown into steady customers. A handful of big corporations turned heads this year as they pivoted or expanded product offerings directly into healthcare with big PR fanfare, from CVS to Samsung to Apple. New models for care delivery (Iora) and insurance (Oscar) are grabbing the tablecloth and giving it a hefty shake, emboldened by disruptive trends such as price transparency, employers’ shifting costs onto individuals, and the growing numbers enrolling via HIX.

Yet, as readers of this blog know well, we are extremely wary of associating hype with progress. Despite the hints of improvement we read about online, there are more questions than answers about how these new technologies will actually work. And despite the growth of retail care, I was reminded firsthand that simply adding new pieces doesn’t fix market fragmentation or ensure a seamless experience.

Despite the emergence of consumer-driven models, the clinical side of patient engagement remains idiosyncratic and inconsistent for the vast majority of patients. When it comes to accessing care, navigating specialty care across a network, settling a bill, etc., the ability of payers and providers to remove bureaucracy, use data effectively, and offer patient-centered experiences is missing. The death of Aetna’s CarePass reflects the twofold reality that big payers lack both the internal leadership and the consumer buy-in to introduce new methods of engagement. Will 2015 be the year we finally see consumers embrace a go-to “app store” model for healthcare – and if so, where will that model come from?

Over the course of 2014 it has become increasingly clear that incumbent HIT vendors are simply not going to lead when it comes to improving between visit care, enabling a complete, longitudinal record (which includes preferences, information, and other inputs from the patient) and incorporating new tools into doctors’ workflow. To be fair, some of these features are showing up in the market (though in practice they remain limited to only the most advanced delivery systems, like Advocate or Sharp). And some of the ambulatory vendors, like PracticeFusion, athenahealth, and eClinicalWorks took promising steps forward this year.

Yet for those big HIT vendors, the problem of interoperability still looms large, as we discovered that EHRs are still rendering corrupt or unreadable CDA files, hamstringing efforts to produce longitudinal records. Enabling provider-to-patient messaging outside of the confines of a system is simply not on the to-do list for EHR vendors. This gap spawned a handful of ‘build your record’ startups this year, such as Picnic Health, CareSync and Prime. On the provider side, delivery systems big and small, from the Memorial Hermanns to the Reliant Medical Groups, seem to be resisting the inclusion of PGHD into a longitudinal record. Perhaps it’s just about the culture of medicine, not the technology.

Many are hoping that the delivery systems’ lack of interest in what goes on between visits will improve with CMS’ decision to begin reimbursements for care management, another big headline this year. Numerous care management startups with strong engagement components have sprung up like mushrooms this year: Conversa, Healthloop, RoundingWell, Patient.Io, Seratis, Better, and more. Of course, one of the big headlines here at Chilmark was our decision to add this important emerging IT market to our domains of coverage.

2015: Much More to Come

2015 will be another big year for engagement, shaped by two stark contrasting market forces: The undeniable shift into a consumer-centric future, tempered by the sobering present-day reality of an overburdened delivery system served by legacy models, that have put engagement dead-last on their long list of priorities. So despite our market-hardened realist outlook, we certainly have a lot we are looking forward to moving into 2015, from ramping up the adoption of advanced engagement tools, to clever models that combine engagement and marketing, to the emergence of more disruptive startups to serve the health needs of consumers.