By Anthony Cirillo

Now that there is scary.

Most people have been assuming that with healthcare reform, everyone will opt to have insurance and therefore seek care routinely.

But little is being said of the option to opt out of insurance or the types of coverage that will be available. Consider that people with high deductible plans, even though insured, are now and will continue to opt to delay or skip care. Healthcare reform has not brought us pricing reform and from all indications health premiums are still rising and will keep rising. And the employer landscape would suggest that high deductible plans are becoming the norm not the exception.

[More:]

Findings in a recent study suggest providers do have something to fear: people who no longer seek out medical services.

One in five Americans did not seek medical care for a recent illness or injury, according to a Deloitte Center for Health Solutions report. And four out of 10 cited cost as the primary factor. Seventy nine percent of respondents sought medical attention in 2010, down from the 85 percent who did so in 2009.

Fifteen percent of consumers reported visiting a retail clinic and 34 percent said they would do so if it cost half as much or less than the cost of a doctor's appointment. More consumers are seeking alternative or natural remedies before seeing a physician. Consumers are also receptive to medical tourism, but only 7 percent sought healthcare services outside their local community in the last 12 months.

The report notes that providers are cautiously optimistic that once deductibles are met and insurance kicks in, the volume of activity for medical services may return.

That last sentence is telling. It suggests that hospitals and physicians are sitting by, assuming that "this too shall pass."

But what if it does not?

There are of course financial implications in the here and now as volumes drop. Then as more consumers delay or avoid care they will show up at your doors sicker and in need of more services. With the accountable care and medical home model building steam providing only acute services will be unacceptable because the theory and expectation is that you are tracking and caring for a population on an ongoing basis.

Providers need to educate the community about the need for proper testing and work with other non-hospital providers to do this. Community education programs need to move from being marketing adjuncts to the service flavor of the day you are marketing to true value-added programs that help people learn about their responsibility in taking care of themselves.

The knee jerk assumption too would be to think that the poor and uneducated are the targets here. If anything there are safety nets in place for them and they are growing. No it is the people like you and I, our neighbors trying to pay the bills, who will be the victims.

Increasingly, people will seek lower cost options. While hospitals missed the boat on retail clinics they still need to work with them to assure proper referrals for people who indeed need a more acute level of service.

Providers are still fairly clueless on the price issue. Literature is strongly urging consumers to negotiate with providers. Of course to do that they need to know and will demand to know the prices of care up front, especially in physician practices.

While the report suggests that the 7 percent of consumers who sought health care outside their local community is a small number, I think it is a significant number. See my thoughts on this in my last Hospital Impact blog.

This report seems to suggest a business as usual attitude on the providers' part.

I would suggest that there is nothing usual about how the market is shifting. And we need to be prepared for those who simply opt out, pay the penalty for not having insurance and then seek care when in acute need. Before that if they even seek the care, they will pay out-of-pocket and shop around for it.

So on the front end of the system, transparency in pricing and a willingness to embrace consumerism is needed. That may help you retain those seeking care to begin with. And on the back end of the care, the costly and increasingly unrewarded part, well you'll have to provide it while continuing to educate consumers about self-responsibility. And you will need to provide that care in the most exceptional way or risk losing patients to competitors you didn't know you had. That means niching yourself.

Don't forget the effect of planes, trains, and automobiles. Boomers will travel for care and as the caregivers to mom and dad they might take them along for the ride too.

Anthony Cirillo, FACHE, ABC, is president of Fast Forward Consulting, which specializes in experience management and strategic marketing for healthcare facilities.