Healthcare's Changing Environment

Healthcare's Changing Environment

The Changing Healthcare Marketplace

A complement of factors are rapidly driving the healthcare marketplace toward a model of consumerism. Rising costs are compelling employers and payers to shift more of the coverage burden to employees and members. The power of the Internet, social media, and advertising has allowed the public to become more informed about care options and demand more choice. Moreover, a potentially seismic consumer shift is about to unfold because of Healthcare Reform legislation.

The Patient Protection and Affordable Care Act (ACA)— the legislation behind Healthcare Reform— passed into federal law in March 2010, and was upheld by the U.S. Supreme Court the summer of 2012. An objective of Healthcare Reform is to expand access to healthcare coverage for all U.S. citizens, driven by 45 million uninsured Americans. Now that it is 2014, individual consumers are required to have health insurance, either covered by their employer or purchased directly from health insurance companies on state or federal “Exchanges” that are intended to help individuals and small businesses shop for and compare coverage.

This is creating an environment of both confusion and opportunity for consumers and healthcare providers. While there currently is not widespread understanding among consumers (and, arguably, providers) of the specifics behind the ACA or its impact on them, accelerating changes in the market will require an evolution of this knowledge and an adaptation of health & wellness behaviors.

For example, health insurance is an industry historically focused on Business-to-Business (B2B) relationships and marketing to employers, groups and other large healthcare intermediaries. However, health insurance companies competing on the Exchanges will shift much of their efforts directly toward consumers, a marketing approach that may be well outside the core capabilities for many of these companies.

Many healthcare stakeholders are adjusting in this environment:

  • Hospitals, Integrated Delivery Systems, and ACOs (Accountable Care Organizations) will need to deliver patient-desired experiences in order to realize maximum reimbursement, and to motivate positive health behaviors to prevent hospital readmissions and avoid related penalties.
  • Pharmaceutical manufacturers will need to differentiate in a me-too marketplace and deliver new value propositions to consumers and Payers with efficient selection and use of products… or be prepared to deliver maximum rebates.
  • Employers will need to consider and position their employee coverage strategies carefully (to Exchange or not to Exchange, that is the question!) to mitigate negative response or to attract and retain top talent.
  • Retailers can benefit by driving self-directed care, linking front end Treatment, Prevention, and Wellness solutions with pharmacy services.

Thus, healthcare organizations must become more consumer-centric in a bid to succeed in this new environment – changing their mindset from patients to consumers.


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Segmentation and the
Health Care Consumer