Rae Woods (00:12):
From Advisory Board, we are bringing you a radio advisory. Your weekly download on how to untangle healthcare's most pressing challenges. My name is Rachel Woods. You can call me Rae. There's a trend that's been making the rounds lately, and it's this idea that 2026 is the new 2016. I'm not going to unpack what that means in the context of social media, but it could be worth exploring in the context of healthcare. At least if we think about where we've made progress in the last decade and where our collective efforts have fallen flat. For me, 10 years ago, my own healthcare research focused on the emerging consumer revolution. At the time, our take was simple, but it was novel. It was the idea that patients would start behaving like active consumers when they had choice in their care, transparency in what it will cost, and enough financial skin in the game to push them to shop. And if you could win that choice and earn consumer loyalty, you could win in a consumer market.

(01:09):
But here's the thing, that didn't quite happen. With all respect to past Rae, achieving those aims has been a lot harder in practice than in theory. I think it's fair to say that healthcare business hasn't been meaningfully transformed by consumerism in the last decade. And that's worth noting because we arguably need a consumer-centered shift now more than ever. Affordability continues to be an existential challenge. Patient trust is eroding everywhere, and purchasers and policymakers are still exploring ways to incentivize a consumerist ethos into the healthcare market. If 2026 is the new 2016, then we're still on the brink of a consumer revolution. But what would it take to actually move toward meaningful progress? Well, to help us learn from the last 10 years of effort and understand what pushing consumerism forward would look like next, I've invited a round table of Advisory Board experts, Shay Pratt, Devon Airey, and Natalie Trebes. Shay, Devin, Natalie, welcome to our Consumerism Roundtable.

Natalie Trebes (02:11):
Hey there.

Devin Airey (02:12):
Good afternoon.

Shay Pratt (02:13):
Thanks for having me.

Rae Woods (02:15):
I think we can all agree that we are not sitting here in 2026 living in a healthcare consumer utopia, right?

Natalie Trebes (02:21):
No utopias anywhere, I think.

Devin Airey (02:23):
Definitely not.

Rae Woods (02:25):
But that doesn't mean we haven't been trying to move closer to a consumer-centric model in the last 10 years. Let's name some of the good things. What are some of the wins that you would call out from providers, from plans, even from the government?

Shay Pratt (02:38):
Well, one, the entire system got a lot more ambulatory and pretty quickly there's been a ton of investment there. We can certainly use more of that investment, but we have made a lot of progress there. There's a lot more access points, a lot more types of care you can get. It's diversified. A lot of markets have that diversity of sites of care.

Natalie Trebes (02:58):
I think there's a lot more attention paid to communication around access and ongoing follow-up afterwards. And so just like we've seen other industries, of course, always ahead of healthcare there is just a lot of effort to communicate with patients about what they should expect and what information is needed. It's not perfect, but a lot of strides been made there.

Devin Airey (03:19):
On the technology side, we have made some strides connecting on the systems that allow us to trade data, information, communications between health systems, ambulatory, but also all the other players that have added themselves into the system in the last 10 years or more.

Rae Woods (03:33):
Scheduling, Care management.

Devin Airey (03:35):
Right. All the above.

Rae Woods (03:36):
You bring us into what have the health plans perhaps done in their decade of effort. We ran to provider first. 10 years ago, we were talking all about high deductible health plans and that being the instrument that would push consumers to shop because suddenly they had thousands of dollars at stake for their healthcare costs.

Natalie Trebes (03:56):
Yeah. For a health plan, I think the index is much more on that steerage point, right? Trying to help consumers behave in a way that leads to lower overall cost experience for the consumer out of pocket, but also for all enrollees in the insurance product for lower premiums in theory. And so the attention is around the choices that they're making as far as where they go versus in the provider setting, I think there's a lot more attention on the experience of what it's actually like once you show up or choosing that provider.

Devin Airey (04:25):
What's been interesting though is as the health systems get more into the experience and as the health plans continue to do more navigation, they're running into each other. So while there's been a lot of progress individually, and I would add the pharmacy aspect to this, I would add all these other players that have come in to take in different parts of the healthcare journey. I think it has confused in some places more than it's helped, but that doesn't mean it's not progress.

Rae Woods (04:48):
Yeah. The progress we've made has been incremental if it has pushed us forward and it has resulted in some fragmentation, more cooks in the kitchen, more options that maybe have also held us back.

Natalie Trebes (05:01):
Correct.

Rae Woods (05:02):
We named a couple of key features for the recipe for consumerism that I named in the outset to this episode. First is choice. Shay, you named all of the different ambulatory options. We now have virtual care that provides a second choice pretty much in every market, even if there are not other physical choices to receive care from. And then not only you started running at what health plans have done in terms of financial skin in the game, we've expanded upon the very blunt instrument of high deductibles into more steerage. The other element here though is transparency. You need to actually know the difference between the choices that you make. Have we made progress here?

Natalie Trebes (05:42):
Well, I think that's also a good example of we make a step forward and then a step back where it fits and starts. And so I think we've expanded obviously through government auction price transparency data that's available, but now we're in this weird middle territory where the price you see is still not necessarily lining up with where you actually land. And so 20 years ago, you didn't know the price at all. Now you know a price, but you still have to go through that adjudication and figuring out what codes are actually billed and settled when it's all done.

Devin Airey (06:14):
Yeah. We're in this era of visibility, right? So it started, or at least it picked up quite a bit several years ago with price transparency. And now we have more information, but it's not necessarily the right information for all consumers because the majority of people do have insurance and that comes with a negotiated rate. So it's not necessarily what they're going to see on the website of a hospital or a health system. So that does push us forward, but so far it actually hasn't been that useful to consumers. It's been more useful to vendors and providers and others, folks who are grabbing that information and using it to do the navigation work we've been talking about.

Shay Pratt (06:47):
I don't think there's enough information to make an educated choice as a consumer in healthcare. There's just not enough specific information and I don't know if there ever will be. I guess as consumers, we're not equipped to know the finer points of healthcare to actually make an informed decision. I'm just not going to be on the same plane as like an orthopedic surgeon or an ER doctor or whatever, which is not going to happen.

Rae Woods (07:11):
I want to ask you a simple question that I'm pretty sure I know the answer to. A decade of work, experiments, attempts, did we make consumerism happen in healthcare?

Devin Airey (07:22):
No.

Shay Pratt (07:24):
No. I don't think so.

Rae Woods (07:26):
Natalie, you are waiting with beta breath.

Natalie Trebes (07:29):
Maybe not in the way we wanted to, but I think for better or for worse, patients are willing to make trade-offs based off of experiences and financial difficulties.

Rae Woods (07:40):
Oh, so consumerism happened even if it didn't happen.

Natalie Trebes (07:43):
On our terms. Yeah.

Rae Woods (07:44):
Even if it didn't happen on our terms. I just want to acknowledge for our listeners here that the term consumerism is a loaded word with a lot of different opinions, especially over whether or not consumerism could or should exist in healthcare. Shay, I know you have thoughts here.

Shay Pratt (08:04):
Yeah. I just think it's going to be really hard to make a truly consumer oriented healthcare marketplace. We just don't have the information. The pricing is opaque. All the things you really need to know to make a decision just aren't there and I don't expect that to change. I do respect all the progress that we've made to try to inch closer to a consumer friendly healthcare market. And there's a lot to be proud of as an industry, but there's still such a big gap.

Devin Airey (08:31):
I also think it relates to the call to action now in healthcare, which is affordability, which I define as value for cost or value for price. And there's always been a discussion about the amount of money that we spend in healthcare and are we truly getting value out of that? A lot of that conversation was happening through the industry in these rooms at conferences, executive board meetings, et cetera. Now it's happening in the public.

Rae Woods (08:56):
Yes. Which goes back to Natalie's point of, did consumerism happen on our terms or did it just happen?

Devin Airey (09:00):
Right. Exactly. I think the hard part for all of us being kind of research minded people is that calling us consumers does not quite fit. Yeah.

Natalie Trebes (09:07):
Yeah. I'm always going to push against the reductive binary. We can even ask the question of, are we trying to get to 100% consumeristic market? Probably not. But it's what are the principles of consumerism that will help us in this ambition of overall improving access, improving quality and reducing costs?

Devin Airey (09:26):
Great point. Because additionally, we tend to liken healthcare to every other industry. Is that even appropriate?

Rae Woods (09:33):
Which we caveated back in the day. Shay, you and I were at the helm of some of this research 10 years ago, not to age us a little bit here, but at the time we used the word shopping. We used the word loyalty to say that you could win a consumer and keep them ideally across a lifetime. I'm definitely not sure that that is possible and it's certainly not what actually happened. Natalie, you admitted that you like to resist the urge to think in black and white. I set up three elements that are needed for consumerism to happen. I think you actually want to add some others to it.

Natalie Trebes (10:10):
Yeah. So you talked about for there to be consumerism and the way we traditionally think about it, we need to have choices. I need options that I can pick between. I need to know what the prices are so that I'm making an informed choice and hopefully also quality information too.

Rae Woods (10:24):
Or access. How quickly can I get an appointment?

Natalie Trebes (10:27):
And then I need to have skin in the game that's going to drive me to optimize across that choice. So that's our classical definition of consumerism. And I would add, you need to actually want to make a choice and to defer that choice as a consumer. And while there's a lot of AI based tools out there that want to help inform me, a lot of consumers don't want to hand over that kind of expertise and have to make that decision themselves. It feels like a lot of pressure. And then in my view, most importantly is, do I even know I'm making a choice at a given point in time? And I think that's actually our biggest struggle in healthcare is most patients don't know the moment that they are making a healthcare shopping decision is not obvious until basically the bill comes. And that's based off of the conversations that you're having with the doctor in the office that's based off of the choices you make in advance, that's based off of your enrollment and your insurance.

Rae Woods (11:24):
Or the choices that the physician makes. Where do we send you for your labs, et cetera. And you just use the word shopping, which was the word that Shay and I used 10 years ago when we were talking about consumerism for the first time in healthcare business. We talked about winning the share of wallet, which is how other products think about success. That's how grocery stores think about their success, for example. Shay, is that still the right goal if we think about the next decade of consumerism?

Shay Pratt (11:50):
What I emphasize to organizations when they try to think about consumer choice is that you have a couple of different jobs, you have to get chosen by a consumer for a service. Then you have to retain them across that episode of care, but then I think it really stops there and the next time they need another service, you have to win them all over again. I think it's realistic to want patient loyalty through a care episode, but after that, it's anyone's game.

Devin Airey (12:19):
Right. It comes back to the thing that I always get on my soapbox about when I'm talking about this in presentations and meetings, that we've looked at hundreds, thousands of consumer surveys over the last 10 years or more. And two things always stand out to me. One is that people want to be navigated. They actually want someone to give them some advice of where to go, especially for their healthcare. And then two, they also want the illusion of choice. It's my center of excellence models work. That's why the copay plans are coming out now are of interest to people. We have this idea of choice, but also a choice you've been like led to water or whatever. Yeah.

Natalie Trebes (12:54):
I want curated

Devin Airey (12:55):
Curated choices.

Rae Woods (12:56):
And Devin, you just used the word they, right? They actually want to be navigated. This is where the common question that we get from our listeners, from Advisory Board members is, but is that true for all consumers? Is that true for the older population versus the millennials versus the Gen Z versus some archetype I've come up with, the savvy shopper or whatever it might be? Who's they?

Devin Airey (13:18):
It's everyone. There are some differences between the generations and sure, the youngest generation is a little bit more computer savvy now and looking for more information online or with things like ChatGPT. We know that ... What is it? Like 30% of consumers or people under 30 years old are using ChatGPT for their healthcare at least once a month. We also know that people of all generations are twice as likely to listen to health tactics from social media than health tactics they got from their physicians. So there's just a lot of dynamics at play there, but classically, the younger generations use their healthcare more transactionally and the older generations who are just more into the healthcare journey ... They've used more healthcare, they're more activated because they need to be and so they become maybe not more loyal, but also just more active.

Rae Woods (14:07):
They just need care more often.

Devin Airey (14:08):
They need more care. Exactly.

Shay Pratt (14:10):
Agree that in general, people want to be navigated, but I also think that they want to be navigated as long as they can keep their preferences intact at the same time. And that's, I think what's challenging for physicians and health systems and health plans and trying to anticipate what that person cares about.

Rae Woods (14:27):
And when the needs are very, very different. I often talk about on every consumer archetype, I, and probably all of us would be defined as somebody that's very digital first because we are in our normal lives, but my phone couldn't have delivered my children. My phone isn't going to help me if I need stitches because I cut my hand while making dinner. Health needs are just different and then what you access for care are just different. That's my little mini soapbox, Devin.

Shay Pratt (14:53):
So for example, I personally had to do a quick follow-up appointment with my PCP and we could do it by Zoom and I was like, "Oh, this is great. Very easy." Five minute call, we resolved what we needed, but then four weeks later I got the bill for it and I had to pay out of pocket because of my health plan and I'm never doing that again. So now my preferences have changed. My doctor has no idea until I tell her and it's just a surprise.

Rae Woods (15:20):
Wait. That's so interesting because your preference from an accessibility standpoint is absolutely the virtual visit. Let's do a five-minute phone call, but that pales in comparison to your preference for your bill.

Shay Pratt (15:31):
Yeah. It was more expensive than an attorney and an attorney's hourly rate or whatever. But I think in the next conversation, I will probably explain that to my doctor and maybe then she'll-

Rae Woods (15:44):
Or ask in advance, how much is this going to cost?

Devin Airey (15:46):
And will you be surprised if they don't know the answer?

Shay Pratt (15:48):
For an industry where the bill comes later, I think physicians aren't really equipped to even have the conversation.

Devin Airey (15:54):
No. Exactly.

Rae Woods (15:55):
And that is unchanged, I think. I think they know that they are getting more questions, but they are not more equipped to answer those questions is the biggest difference.

Devin Airey (16:03):
The other thing I think is interesting about that is that the trade-off of convenience for price is happening all over the place. We are seeing health systems, everyone setting up concierge practices, immediate care on top of urgent care and the ED and-

Rae Woods (16:16):
Where some are willing to pay more for the convenience.

Devin Airey (16:18):
People are willing to pay more and health systems across the country are like, "Should we get into this game?"

Rae Woods (16:23):
Yes.

Devin Airey (16:24):
Because they're willing to pay more for access. I feel the exact same way. If I have to pay more for a virtual visit? I might as well go in and have probably a better conversation with my clinician, but people are doing that all over the place and that's the trade-off. Everybody wants to know what people are willing to pay for.

Rae Woods (17:32):
So it seems to me that after a decade of effort, I'm not sure we have much to show for it. In fact, I think reflecting on the conversation we just had, some parts of consumerism may be worse than they were in 2016. So my question, my genuine research focused question is, why should leaders keep pursuing consumerism or should they? Is this still the worthwhile goal we should have?

Natalie Trebes (18:00):
Well, at a high level, healthcare is too expensive and every purchaser across the nation would like to figure out how to reduce those costs. And so that generally breaks down into, am I getting a patient to go to somewhere that is more cost-effective or am I getting a patient to engage in their healthcare in some way that will lead to better outcomes, reduced complications, and lower total cost of care? Both of those have an element of trying to influence how a patient engages with the healthcare system. It's, I don't believe exclusively about the choices that they have to make, but we have to engage the consumeristic patient in their activities across healthcare.

Rae Woods (18:47):
So it sounds like your answer is not, should we? Could we? It's we must.

Devin Airey (18:53):
I agree because at the core healthcare, whether you're a hospital or a health plan or a virtual urgent care vendor, whatever, this is a business and we have to engage our buyers. And if I equate this probably ineffectively to like another shopping experience or consumer good, we have to engage the people who are coming through the doors in a way that is useful to them and to us. Whether it's loyalty or share of wallet or some other metric, new patients, et cetera, everyone has their growth opportunity here. There has to be a way for us to say, "We are meeting the people where they are."

Rae Woods (19:26):
Because the people are saying the experience is bad.

Devin Airey (19:27):
Correct.

Rae Woods (19:28):
The cost is bad. The access is bad.

Devin Airey (19:30):
Yes. Time and time again, people are delaying care because they feel like they're not being heard. They are not coming through their doors because it's potentially too expensive. They're not even sure what the expense will be and they don't feel like they're going to get a good result. They don't feel like they're going to actually enjoy the experience that they're going to receive. And so we have to fix that in some way. I think the hardest part is just the inertia we have in healthcare and it's hard for us to change.

Rae Woods (19:55):
It's interesting because Natalie, you ran at why it makes sense for business leaders. In particular, I think purchasers to try to make consumerism happen as a way to reduce spend. Devin, you ran out why it's important for the people, the consumers themselves, because of what they are really experiencing on the ground when they try to engage with healthcare. Shay, as one of the key architects to the beginning of this at Advisory Board, is consumerism still a worthwhile goal?

Shay Pratt (20:22):
Yes. It always has been, always will be. If you're a health system or a physician group and you're trying to figure out ... If you try to boil it down, like simplify, what are the three ways in which a patient comes to me? It's either the patient chose to do it themselves, a physician told them to do it, or a health plan, or employer told them to do it. And so that triumvirate is always important. Percentages of, and their influence may shift over time, but I've always thought that consumer choice is much more important than we've ever been able to measure when it comes to how a patient ends up in your door.

Rae Woods (20:53):
I'm going to ask this from the perspective of the provider. If consumer is a still a worthy goal, to what end? What am I trying to achieve if I'm the chief strategy officer of a health system?

Shay Pratt (21:05):
The hard part is understanding what consumers care about right now. I looked back at our work 10 years ago. We did a bunch of surveys at the time, right? We had a survey about what do consumers value when they make a decision about outpatient surgery or orthopedics or whatever. The number one thing at the time was subspecialization. This physician I'm picking has the expertise to give me the care I need. Number two is out of pocket expenses. I would argue that one of those two is the same now. One is very different, which is I think people assume subspecialization and what they really want is access.

Rae Woods (21:41):
Yep.

Shay Pratt (21:41):
The hard part about tracking all this is, do I really understand what people are making a decision on or is my thinking outdated?

Rae Woods (21:49):
I agree with this so much because even the definition of access I think has shifted. It used to mean access to an appointment and I think now it much more often means access to a treatment.

Devin Airey (21:58):
Or access to information. Because when we talk about appointments not being the right metric for access, it's how are you being perceived as accessible? Is that through the app that you want to be actively chatting with someone from the physician office? Is it, "I have this pain in my shoulder and I'm not sure who to see." We've been seeing call centers, we flipped to access centers. We've seen folks that just want to appear more accessible to their community.

Natalie Trebes (22:28):
And it's access to not just a treatment per se, but just mitigating fear or admit like assuaging the concern that I might need to do something, might not. I don't know. I think there's so much more uncertainty about what you should be doing as we have more and more treatment options available, more and more alternative sources. Part of the access is access to your point and then expertise and guidance.

Devin Airey (22:52):
Which is why in that vacuum, people not feeling that they can trust the system or they're going to get the right information or they'll be heard in that interaction, they're going to other sources.

Rae Woods (23:03):
I want to admit that as we're having this conversation, we're kind of naming what the healthcare industry should do while also following it with all the mistakes that have been made. And that's because the last decade of effort has been, I'm going to call it messy at best. We all kind of collectively realize the consumer experience is bad, affordability is bad, access is bad, quality is unclear at best or uncertain at best. And a lot of different players have inserted themselves into our business to try to make this better. I'm increasingly thinking that rather than actually making anything better, it's just left us with a much more messy experience, with more fragmentation.

Shay Pratt (23:45):
It does feel messy, but I also am encouraged by a lot of the experimentation that's happened.

Devin Airey (23:50):
Yeah. Same.

Shay Pratt (23:50):
There's been a lot of things organizations have tried to make it better for specific segments of patients. If you have a new cancer diagnosis, there are second opinion clinics and they will be very happy to see you very soon. You can get a diagnostic mammogram the same day as an abnormal screening mammogram. There are a lot of different innovations that have happened to make people's lives easier. I think we just have a lot more of that to do. More nuance in access is what's required and kind of feels like consumer expectations are growing and changing faster than providers can react.

Rae Woods (24:26):
I want to dig deeper into this idea of enabling access. The consumerism principles that we preach 10 years ago would have said that access was all about access points. We said we needed a retail model, we needed expanded hours, we needed to focus on convenience, and we tried to build, buy or partner our way through creating more entry points. More access points didn't actually get us more accessible care. So what does it take?

Devin Airey (24:52):
One of our colleagues likes to talk about how access is actually not a strategy issue. It's a execution issue. We know what we need to do. We need to have more availability, but also have more accessible and be perceived as accessible, et cetera. And I think there's an opportunity there to create a system that we all know would be better for us, but a lot of that is just the hard work of change management.

Rae Woods (25:18):
And change management with the doctors.

Devin Airey (25:21):
Mainly yes, but across the care team in general.Even all of the workforce changes or team-based care, certainly in the clinics, because that's where we see access being the biggest issue, is figuring out what does it look like to truly have aligned in more strategic scheduling

(25:38):
Where

(25:39):
As we've also been talking about for the last 10 years, you have this kind of autonomy being the currency of physicians and the operational autonomy, their schedules mainly, being kind of like their last thing they're holding onto. But if we actually, and we've seen this time and time again, if you can get to a place where the schedules are more consistent and the templates work, et cetera, you actually do create more access.

Shay Pratt (26:01):
I hear from organizations a lot that if only we could fix physician productivity, we'd have all the access in the world. I don't believe that at all.

Rae Woods (26:08):
I don't either.

Shay Pratt (26:09):
I think that it really extends far beyond the actual blocks on the calendar and it involves finding ways to scale access in certain ways that don't require physician schedule innovations. And it is very hard to change schedules, but there are a lot of other things you could try and do. I was reading back through some of our older case studies on access and they came across a urgent care center that specialized in orthopedics and they staff three APPs between 4:00 and 8:00 PM, no doctors. And that's when all the care comes in the door because everybody hurts themselves after work or something. I don't know.

Rae Woods (26:44):
Or that's when they have time to go to the doctor

(26:44):
Back to the point about accessibility.

Devin Airey (26:44):
For they hurt themselves during the day.

Shay Pratt (26:51):
But I thought that was a just really creative way of accommodating demand while not making all about the physician's availability. And I think that the more we can explore those ideas, I think the better off we can be and accommodate a lot of different types of preferences into our system without making it so complex for us internally at the same time.

Natalie Trebes (27:11):
That's kind of where you started the conversation earlier, Shay, with how are we actually defining the impact of some of these activities and efforts. And so there is not always going to be necessarily a clear direct ROI because some of the spillover of that is to ease the pressure on access during other hours of the day. And so basically our calculations for ROI and impact is going to have to evolve and get a lot more expansive.

Rae Woods (27:39):
Which is one of the reasons why I push on what's the goal. And I think a easier goal that we could name that's at least clearer to our audience is accessibility. If I keep focusing on the provider for a moment, that the provider who's able to win access is the one who's going to win the consumer. Do we agree with that?

Shay Pratt (28:02):
I do. I agree very strongly with that. I just get the sense that in the markets today, it's really hard to distinguish yourself. I think consumers assume a certain level of specialization and quality and all that.

Rae Woods (28:14):
Oh yeah.

Shay Pratt (28:15):
What they really need is the ability to get their issues solved. As Natalie said, either like mitigate something that I may or may not need care for or if I do need care, open the front door quickly and do it in a way that accommodates my needs.

Devin Airey (28:30):
I think there's another additional layer to this now, which is the broader experience, but the financial experience. So it's access, making sure that you are accessible in ways they want to engage in the system. But also, do they know what they're going to have to pay? And that's a big piece that we are still missing and need to figure out what is the overarching experience, including that financial experience?

Natalie Trebes (28:55):
And when we talk about winning a consumer, I think that language is actually problematic for the conversation because that implies that it's a one and done and you've won that consumer wholly. And what you've won is them interacting with you for one service. And it's not just that they might go somewhere else for another service. They might be interacting with a bunch of other different sources of care at that very same timeframe simultaneously because we are in a world where there's so many different forces and players involved in influencing what consumers think about healthcare, what options they have, who they turn to, who they trust, et cetera.

Devin Airey (29:34):
They may be dating multiple providers.

Natalie Trebes (29:36):
Exactly.

(29:37):
At the same time.

Devin Airey (29:37):
At the same time.

Natalie Trebes (29:38):
We're not exclusive.

Devin Airey (29:38):
We are not exclusive.

Rae Woods (29:41):
Well that's real though. We used to talk about how most consumers split their care across like three, four, five different healthcare organizations in part because to the point that you made, Shay, your needs vary. Who I receive, who my kid's pediatrician is different than where I go for orthopedic care is different than where I go for my obstetric care, et cetera. We talked about the idea that the provider that can solve access is the one that will win, but I'm cognizant that in 2026 with today's margin pressure, it's not about winning any consumer, it's about winning the high margin commercial volumes. It's about winning a very certain kind of consumer, which feels operationally and even tonally different than what you would do to enable access across the board, which is more of the physician, the change management, the care team, et cetera. Is this more targeted approach to consumerism the right path forward in 2026?

Devin Airey (30:34):
I think that all players are overwhelmed with the idea of trying to orient their consumer strategy to four or five, six different groups of people. And it seems more homogenous to just go after all commercial, which really is a huge group of people. We say the exact same thing about seniors. Don't just go after the 65 and over. You have to go through 65 and then the 75 and over and break those people down too. And so I think there's opportunity, but because the commercial volumes are valued financially at a higher rate than the others, I do think folks are orienting to the commercial population more than any others. I also am strongly advising them to think about the senior population as we march towards 2032 when the majority of seniors are actually over 75 and not just over 65.

Shay Pratt (31:23):
I also think that if you just focus on commercially insured individuals, there's just not enough of them to go around. And you're also going to be missing a lot of important strategic goals with individuals in other segments. I think that organizations need to prioritize access for Medicaid, Medicare, Medicare Advantage, just as much as commercially insured, but for different end goals.

Natalie Trebes (31:47):
You're trying to prevent bad things from happening as much as you're trying to attract high margin volumes.

Shay Pratt (31:53):
Yeah, you're trying to deescalate costs for certain groups. And so you need to attract them to your organization so you can learn how to do that and achieve those outcomes.

Devin Airey (32:05):
We also have to remember that the commercial population is not growing.

Rae Woods (32:07):
Mm-hmm. Throughout this conversation, it is very, very clear to me and hopefully to our listeners that there has been a lot of activity in the name of consumerism. You can think for yourself, whether that's good or bad, whether that's brought us forward or inserted more fragmentation and messiness into the system. The real question I want to ask and leave our listeners with is, if we want to make meaningful progress for the next decade of consumerism, how can healthcare leaders tangibly assess and improve their consumer strategy moving forward?

Devin Airey (32:37):
I think they have to be willing to break things. We are at a high change fatigue time in all industries in the world, but certainly in healthcare too. And it leads us to want the things that are familiar and to work kind of on the edges of the care journey that we've had forever because it's something that we know how to manage. And I think we're to the point now, we have to be able to kind of break down the details and the kind of classic model.

Natalie Trebes (33:04):
And for incumbents, I think that goes hand in hand with recognizing that they are in an ecosystem that is much broader than them, that they are no longer fully in control of. And so taking a very hard look at what they really want to own and what they want to partner with others on, and that relates to all of the things we're seeing with interoperability and the push to make data more accessible. That is being forced on the incumbents. They don't necessarily want to do that, but they're going to have to figure out how to play ball in a way that is productive for the consumer experience, not just following the law for the sake of compliance, but actually making it a part of strategic partnership to compliment their gaps.

Devin Airey (33:47):
Great point.

Shay Pratt (33:48):
Whenever consumerism pops back up in the healthcare discussion, I usually think it's because something feels different in the market. There's a sense that consumer preferences have changed and we're not quite sure exactly how, but we have that feeling. I think that now is kind of that moment. Since I do work with data a lot, I'm going to suggest an analytic approach and ask the question, do we truly understand our consumer populations in the way we should? And are we detecting any changes? For example, the number of individuals self-referring for specialty procedures, is that going up or down? What is your marketing cost per new patient? There's all kinds of metrics that you can look at and try to understand what exactly is changing and how do I need to adapt as a system? So I think there's more to learn, deeper insights to be had about the community we serve.

Rae Woods (34:41):
Well, Shay, Natalie, Devin, thanks so much for coming on Radio Advisory.

Natalie Trebes (34:45):
Thanks for the conversation.

Devin Airey (34:47):
Happy to be here.

Shay Pratt (34:48):
Thank you very much.

Rae Woods (34:55):
You might be leaving this episode still questioning whether or not we're on the brink of a "consumer revolution". I'm not sure that's the right question to ask because what I'm sure we can all agree on is that there is still meaningful work to be done, to improve accessibility, to improve affordability, to make healthcare a more reliable and consistent, positive experience, one that we want to engage in ourselves as consumers and one that supports our business model. It's a lot of work, but remember, as always, we're here to help.

(35:57):
New episodes drop every Tuesday. If you like radio advisory, please share it with your networks. Subscribe wherever you get your podcasts and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by me, Rae Woods, as well as Abby Burns, Chloe Bakst, and Atticus Raasch. The episode was edited by Katy Anderson with technical support provided by Dan Tayag, Chris Phelps, and Joe Shrum. Additional support was provided by Leanne Elston and Erin Collins. We'll see you next week.