Meet tomorrow’s primary care consumers

Meet tomorrow’s primary care consumers
In the New Health Economy, consumers spending more of their own money are choosing how and where to receive primary care. Instead of one-dimensional, in-person visits with a
primary care physician, consumers will have multi-dimensional interactions with a broader team of caregivers among an array of convenient care sites.
In the future, health status should be the main driver of where consumers go for primary care services. The sites consumers choose will be different for scheduled—or planned —care
versus unscheduled, urgent care. Health systems must guide them for both cost and health reasons. HRI identifies seven consumer markets for primary care in Primary care in the New
Health Economy: Time for a makeover (www.pwc.com/us/futureofprimarycare). Explore the stories of seven consumers representing these markets below.
Super Utilizer Steve
Steve is a very unhealthy adult who has a hard time
managing multiple health issues: congestive heart
failure, chronic obstructive pulmonary disorder and
Type II diabetes. As his health continues to deteriorate,
Steve has been missing more and more work. He held
five different jobs last year and fell behind on his car
payments. He is a frequent flyer at the local emergency
room because he believes the ER is the best place to
have all his health issues treated quickly and in a single
location. He feels he is the only one looking out for his
health, which is overwhelming to him. Steve racked up
over $1,200 last year in out-of-pocket healthcare costs,
which he now struggles to pay. With $540 going
towards prescriptions, it is difficult for Steve to adhere
to taking the medications he’s been prescribed. Steve
needs intense care management and coordination and
is an ideal candidate for 24/7 remote monitoring,
clinician house calls, a patient centered medical home,
and nurse-managed clinics.
Soccer Mom Sally
Bold Blood Pressure Ben
Mother of four soccer stars and organic coffee
entrepreneur, Sally carefully watches her own health
and manages the health of her family. Other than
suffering from the occasional ear infection or
sprained ankle, Sally’s children are healthy. On
average, her family makes two or three visits to
clinicians each year and spends $160 on medical
care out-of-pocket. The family's prescription drug
utilization is low – on average, just one prescription
at $10 each year. Increasingly, Sally also helps her
ailing father make decisions about a growing
number of health issues, including Type II diabetes.
Sally and her family will likely gravitate toward digital
options and convenient care clinics and value the
preventive, wellness and integrative services
at-your-service care practices offer.
Sad Sara
A business executive and father dealing with a high
stress career, Ben also values a fast-paced social life
with his friends in the city. When it comes to his health,
he is looking for the most convenient way to manage
his chronic hypertension; sometimes this means
skipping doctor’s appointments because of work or
social conflicts. Ben is interested in finding a care team
that can monitor his blood pressure outside of the
doctor’s office so he has more control over his health
treatments. Today, he visits a clinician at least six times
per year. It’s costly (over $700 last year out-of-pocket),
and it interferes with his busy lifestyle. Ben is also on
prescription medications just for his blood pressure,
which means he spends $200 on drugs to manage his
health. Ben may benefit from population-based care
teams, specialized nurse clinics and retail clinics that
offer disease management.
Frail Fiona
A professional photographer with work cited in
several fashion magazines, Sara is in good physical
health but has a history of anxiety and depression.
Occasionally, Sara becomes deeply depressed and
her friends and family feel helpless. When this
happens Sara feels isolated but seeks out care to
help her connect with the simple pleasures of daily
life. She sees a psychiatrist regularly, about five
times per year, but dislikes the social stigma she
feels is associated with going to a mental health
clinic. She also dislikes having seven refilled
prescriptions as a part of her mental health
treatment. Because of her frequent healthcare visits,
she spent $500 last year on her care out-of-pocket,
including $140 on medications. Sarah may find a
match in medical homes with integrated behavioral
health services and may use on-demand telehealth
for unscheduled care.
An octogenarian, Fiona is a retired health food store
owner in the Midwest. Fiona lives alone with
advanced osteoporosis, which puts her at risk for
falling. She has a number of other health issues that
are becoming harder and harder to manage,
especially now that she has been diagnosed with
early stage dementia. Last year she visited a clinician
more than 16 times, including by ambulance to the
ER and hospital. Fiona spent $2,000 out-of-pocket
last year on healthcare, including $500 on over 30
prescription fills. Fiona needs intense care
management and coordination and is an ideal
candidate for 24/7 remote monitoring, clinician
house calls, and either patient centered medical
homes or geriatrician/internist practices with
team-based care.
DIY Daphne
An artist, Daphne balances her personal life with her
professional one. She manages a private art studio,
and leads a yoga class each Sunday with a group of
art professionals. Daphne doesn’t have health
insurance or a regular doctor but uses apps on her
phone to track her sleep and regularly wears a
pedometer. Daphne went to see a clinician just once
last year, when she had a very bad case of the flu and
couldn’t treat herself at home. She tries to avoid
spending on prescription medications as well, and
typically picks up one prescription per year. Her frugal
use of the healthcare system means that she spends
only about $220 annually out-of-pocket on healthcare
including $20 on prescriptions. Daphne is likely to
gravitate toward digital health options such as DIY
diagnostics and DTC telehealth companies as well as
retail clinics and clinician house calls that keep her out
of traditional care settings.
Health Hadley
A healthy single adult and avid runner, Hadley
manages a local fitness store. When it comes to
health, Hadley is interested in preventive care (regular
physicals and screenings) and is always seeking
ways to track and improve his health. Recently, he
has also been thinking about finding a wellness
coach. Hadley spends about $280 out-of-pocket on
medical care each year, including $35 on one or two
prescription drugs. Hadley will likely gravitate toward
digital options and convenient care clinics and value
the preventive, wellness and integrative services
at-your-service care practices offer.
Primary care in the New Health Economy: Time for a makeover | Health Research Institute
Tomorrow's primary care consumers: Where will they go for care?
Health status is expected be the
main driver of where consumers
go for primary care services. The
sites they choose will be different
for scheduled—or planned—care
versus unscheduled, urgent care.
Retail
health
At-your-service
care
DIY
diagnostics
House calls
Nurse-led
clinics
PCMH
Remote
monitoring
Emergency
department
Physician
practice with
team-based
care
DTC
telehealth
companies
For more insights about how age,
geography, income and care
preferences impact where these
consumers will go for primary care
in the future, visit HRI’s online
interactive model at
www.pwc.com/us/futureofprimarycare
Unscheduled
care
Scheduled
care
DIY
Daphne
Bold
BP
Ben
Frail
Fiona
Super
utilizer
Steve
Sad
Sara
Healthy
Hadley
Soccer
Mom
Sally
Primary care in the New Health Economy: Time for a makeover | Health Research Institute