Changes in consumer behavior, many of which were accelerated by the COVID-19 pandemic, are fueling a redesign of the health ecosystem. PwC's Health Research Institute (HRI) mined its proprietary survey data to uncover insights about how and why specific groups of consumers used health services during the pandemic - from mental health and telehealth to in-home care and other non-traditional care sites - and their willingness to use them again in the future. Even attitudes about how clinical research is conducted are changing. A health industry that closely monitors these consumer signals and designs accordingly will likely emerge more consumer-centric as the pandemic wanes.
The “house call” of the past is taking on new life as consumers get more familiar with receiving their care outside of the traditional doctor’s office during the pandemic. Just 4% of consumers responding to an HRI survey in 2020 indicated that they had had a doctor, nurse or other clinician visit their home to provide care, but consumer interest is growing. More than three-quarters of consumers said they are willing to get in-home care for anything ranging from a well visit to chronic disease management. At-home care may also help ease certain patients back into the health system after having deferred care during the pandemic. Thirteen percent of consumers said that being able to receive care in their homes, including virtual and in-home options, would make them feel most comfortable about rescheduling care they had put off.
With many introduced to virtual health visits for the first time during the pandemic, consumers are becoming increasingly willing to receive virtual care for a variety of services. Almost two-thirds (62%) of consumers would be willing to use virtual care in the future, according to an HRI survey.
However, HRI analysis found that provider executives and consumers are largely misaligned on the services they think should be offered virtually. For example, 37% of consumers said they would be willing to use virtual visits for ongoing treatment of a condition, such as a chronic disease, while only 17% of provider leaders said that virtual visits are effective for ongoing health management. This may mean a missed opportunity to serve consumers with complex chronic or chronic disease, especially those whose conditions may have worsened due to deferred care during the pandemic.
While most providers told HRI they are using virtual visits for follow-up appointments, 34% of consumers said that they would like to use them for an initial visit to assess a new health issue.
Consumers and provider executives are aligned, however, on mental telehealth, a promising sign considering that 32% of consumers told HRI that they have experienced anxiety or depression as a result of the pandemic.
The share of Americans using health settings outside of the traditional doctor’s office increased during the pandemic. According to a consumer survey conducted by HRI in September 2020, the share of consumers reporting they had used virtual visits doubled by September compared with before the pandemic. The share reporting they had used a retail clinic increased by 40% and the share reporting they have gone to an urgent care center grew by nearly one-fifth (18%) over that time period (see figure). Most (at least 75%) said they would use these sites again.
Who are these new users? The profile varied depending on the site. For example, men were much more likely than women to choose retail clinics and urgent care centers, as were younger groups. Consumers age 65 and older and those with complex chronic disease accounted for the largest share of virtual visit users; 92% of those 65 and older reported using them for the first time.
As the funnel of prioritized individuals widens for a COVID-19 vaccine, consumer preferences could become a major factor to help ensure vaccine uptake and minimize concerns over vaccine hesitancy or pandemic fatigue.
Nearly two-thirds (62%) of consumers surveyed said that they would get a COVID-19 vaccine within the first year it was available. Of them, while half (51%) said they preferred receiving it at their doctor’s office, a sizable share (38%) said that they would prefer to receive it in a non-traditional health setting, such as a retail clinic or urgent care center.
Preferences for the site of vaccination differed based on age and race. White consumers were twice as likely to prefer vaccination at a doctor’s office than Black and Latinx consumers (52% versus 27% and 28%, respectively). Non-white consumers preferred vaccination at non-traditional settings over a doctor’s office. Preferences also varied across age groups.
Already a crisis before the pandemic hit, the deteriorating state of mental health in America was fueled by the pandemic. Nearly one-third (32%) of consumers said they have experienced anxiety or depression as a result of COVID-19 in an HRI survey in September 2020. Americans between the ages of 18 to 24 were hit hardest at 48%. More than half (54%) of this age group said they sought out care for COVID-19-induced anxiety and depression.
About two-thirds (62%) of 18- to 24-year-olds responding to a separate HRI survey said that they sought mental health services in the last five years, higher than any other age group. One-quarter of them accessed these services for the first time during the pandemic.
How did 18- to 24- year-olds access the mental health system? Most frequently through their primary care doctor, but they were also more likely than any other group to choose mental telehealth as their first point of access. Notably, consumers between the ages of 18 and 24 were three times as likely to use emerging virtual mental health tools, like emotional support apps and online support groups, than the average consumer with mental health needs.
Decentralizing clinical trials—the exercise of moving them out of the hospital setting—may help boost enrollment, according to HRI research. The ability to conduct elements of clinical trials virtually or closer to home was attractive to most consumers. When asked which factors would make them more likely to participate, the ability to participate from home using telehealth was most influential in increasing the likelihood of participating. Sixty-two percent of consumers said the ability to do so would make them more likely to participate, followed by local travel to the clinical trial site (46%).
Running studies in unconventional locations closer to where patients live may serve to boost enrollment. HRI's survey found that as options for participating in clinical trials move closer to the home, consumers are more willing to say they'd participate. This was true across races; almost half (47%) of Black, 56% of Latinx and 66% of white consumers responding to HRI’s survey said they would be willing to participate in a trial from home.
Pharmaceutical and life sciences executives also believe that conducting elements of clinical trials virtually may improve the diversity of enrollment, according to a September 2020 survey by HRI. Eighty-seven percent of executives believe this could improve racial diversity, and 74% believe this could improve gender diversity.
This HRI survey insight is based on three online consumer surveys and one health executive phone survey conducted by HRI in 2020. The online consumer surveys represented a cross section of the population in terms of race, age, gender, income and geography. The April survey included a sample of 10,003 US adults, the May survey included a sample of 2,501 US adults and the September survey included a sample of 2,511 US adults. The US health executive survey, conducted in August and September, was based on a sample of 153 provider executives, 124 pharmaceutical and life sciences executives and 128 health plan executives. The surveys collected data on consumer and executive perspectives about the healthcare landscape before and during the COVID-19 pandemic, and their views about its post-pandemic future.