The battle for getting the consumer and patient dollars is just beginning. The largest technology companies have forayed into healthcare and are creating partnerships to expand and change healthcare delivery. The common goals are to deliver better patient outcomes, higher user satisfaction, and lower costs. Consumerism, protecting and promoting the interests of the consumer, is the popular theme for 2019. Here are the top 4 things that will add power and impact the consumer this year.

1. Consumer Held EHR Data. The Apple Health Records data viewer that is able to access different hospital, health system and clinic EHRs will grow exponentially. It will become the most common way for patients to aggregate and view their electronic health records at supporting institutions using Apple iOS devices (iPhone, iPad). This gives consumers the convenience and flexibility to easily share their EHRs with other providers, literally power in the patient’s hands. It definitely enhances the consumer experience and is health information exchange at the most basic level. The consumer EHR sidesteps the lack of interoperability between provider EHRs. The feature is the first visible sign to patients that it is possible to securely access, obtain and share their health data with providers who are not in the same organization. Patients can use the app to view health information including allergies, medical conditions, immunizations, lab results, medications, procedures, and vitals from various healthcare organizations. Patients also receive notifications when their health record is updated by any participating health system with new information. The EHR data is downloaded directly to the device (no Apple servers are traversed) and updates are automatically downloaded to the device. This eliminates the need for the patient to know credentials and login to each provider portal. Users can search for and connect with any participating system in the country. Look for more institutions to enable access. Currently, there are 169 participants and more are continually added to the list.

2. Primary Care on Every Corner. Individuals and families will seek care that minimizes time and maximizes convenience. Waiting the national average of two weeks for an appointment with a primary care doctor isn’t going to make the cut for visits that don’t need a physician’s expertise. Immunizations, colds, urinary tract infections and other non-urgent maladies can be treated by nurses or physician assistants. The primary care units will mostly be located in existing pharmacy or drug stores and treat the most common ailments. The merged CVS and Aetna entity has thousands of locations and expects to expand their Minute Clinics when they roll out a menu of new services including post-hospital follow-up visits, lab tests, eye exams, hearing tests and a chronic disease management program. A new partnership with Walgreens and Microsoft will build digital health tools to deliver telehealth, improve medication adherence and reduce emergency room visits. Their focus is on preventive care and chronic disease patients. Employers are highlighting retail clinics whose copays are less expensive than urgent care clinics to incentivize employees to utilize lower cost options.

Patients with high deductibles will find these services attractive at prices that are lower than hospital ancillary services. The big question is how well can these services be smoothly integrated into a patient’s overall care..

3. Telehealth Use Expands. Big changes in Medicare reimbursement means more providers will use telehealth with more patients. As of January1,2019, Medicare will reimburse for virtual check-ins, remote pre-recorded information and interprofessional internet consultations. Medicare will also reimburse RHCs and FQHCs for communication based technology and remote evaluation services not already captured in the RHC AIR or FQHC PPS payment, waiving the face-to-face requirement. Prolonged preventive services and physiological monitoring are now reimbursable with new codes. The Bipartisan Budget Act of 2018 allows treatment of end stage renal disease from home and dialysis facilities and acute stroke can be diagnosed and treated from any eligible originating site without the geographic site requirement.

Remote monitoring for patients with chronic diseases can reduce the cost of care with earlier intervention and avoid the emergency room. Center for Connected Health Policy reports 20 states offer Medicaid reimbursement for remote patient monitoring. Surveys show that patients across all ages are very interested in using telehealth to save a trip to the hospital or doctor’s office. Many employer plans already include telehealth services and encouraging employees to use it by lowering or waiving the copay.

4. ECG Watches. Electrocardiogram (ECG) capability has until now have been the purview of doctor’s offices and hospitals that require expensive equipment. That was upended by the advent of ECGs on wearable medical devices. Apple’s 4th generation watch has a feature that notifies wearers to capture ECG data when an abnormal heartbeat is detected. Verily’s Study Watch received FDA approval as a prescription only medical device that is intended for use by healthcare professionals, adults with a known or suspected heart condition, and health conscious individuals. These mobile devices are unobtrusive and capture data that can contribute to population health in addition to improving clinical care.