Seven Emerging Healthcare Consumer Markets in the U.S. Are Reshaping Primary Care

PwC, the international accounting firm, released a research report in November titled"Primary Healthcare Services in the New Medical Health Economy: The Beginning of Turning the Tide"。

The report highlights the critical functions of primary care, emphasizing that it is not a defender of the outdated and fragmented healthcare system. Instead, it serves to integrate existing healthcare systems, delivering high-quality, streamlined, cost-effective, and superior medical services to the public.

The Core of the Primary Care Market Is Undergoing Transformation: In Response to New Payment Systems and an Aging Population, Health Authorities Are Seeking to Reconstruct the Primary Care Ecosystem to Restore the Fundamental Belief That Healthcare Is About Healing.

In the United States, the government spends $3.2 trillion annually on healthcare, and by 2020, 8.1 million Americans are projected to suffer from chronic diseases. Digital technologies have expanded the scope of healthcare delivery, enabling non-medical personnel to engage in disease prevention and self-care, while also reducing costs.

In contrast to the fee-for-service system that has persisted for decades, primary care is boldly challenging outdated paradigms and gradually demonstrating its value. The PwC Health Research Institute (HRI) projects that the physician shortage could reach 90,000 by 2025. The new health economy places greater emphasis on delivering higher value to payers, which necessitates equipping healthcare professionals with a variety of virtual and remote tools to complement the limitations of existing medical services.

This report is based on interviews with 25 industry executives, including leaders from both the business and academic sectors, as well as surveys of 1,500 clinical practitioners and 1,000 consumers. The key findings are as follows:

1 Payers are looking to primary care to reduce costs. For example, 48% of U.S. employers offered telemedicine services to their employees in 2015.
2. The primary criterion consumers use when selecting primary care is its compatibility with their current lifestyle. Eighty percent of survey respondents expressed willingness to adopt innovative primary care services.
3. New entrants are reshaping the landscape and transforming the primary care model. These newcomers are providing convenient, high-value medical services to meet the needs of a broader user base,There are five main approaches: convenient patient services, physician consultations, private medical practice, digital healthcare, and nursing care.
4. Traditional practitioners are shifting their mindset to adapt to the changes of the new era: one-third of physicians report that they have transformed their business models to deliver entirely new healthcare services.
5 Seven Core Consumer Markets Are on the Rise: Companies must cater to seven major consumer markets—the elderly and frail, consumers with complex chronic diseases, patients with mental illnesses, healthy families, and adult groups who are either passionate about or skeptical of health.

HRI Proposes Three Major Recommendations for Existing Healthcare Departments:
1. Understand your areas of expertise and clearly define your target audience.Consumers currently have a demand for multi-dimensional interaction with expert panels; therefore, in the consumer market, it is essential to comprehensively consider factors such as users' health status, income, and age to match them with appropriate medical professionals.
2. Exploring New Roles.Nurses, pharmacists, behavioral health specialists, and other non-physician personnel are playing increasingly important roles in enhanced primary care services, while primary care providers are also assuming new roles to meet diverse needs;
3 Seek Collaboration Where It Adds the Most Value: One-third of physicians are gradually establishing collaborations with enterprises, manufacturers, and clinics. Market-tested strategies have been adopted to continue expanding market share, including by telecommunications and data companies. New partners also include community organizations and churches.

Here are the key points of the report:
36% of patients, even those with a primary care physician, choose to seek treatment for minor ailments such as earaches, sore throats, and abrasions at convenient clinics like CVS or Walgreens, or opt for remote chronic disease monitoring. 95% of patients expressed high satisfaction with these services. Approximately half of consumers indicated that it would be ideal to have a physician who could coordinate medical needs between patients and their families.

According to the report, primary care resources are not being fully utilized, with physicians spending one-third of their time on tasks other than delivering medical services. Discussing behavioral health issues, social difficulties, and handling administrative matters all consume valuable physician time. Only 23% of primary care physicians expressed satisfaction with their work pace and ability to complete their duties alongside training requirements. Meanwhile, 40% refer patients to specialists solely due to staffing shortages or time constraints, rather than for reasons related to medical specialization.

Family physicians, internists, pediatricians, and obstetricians are generally collectively referred to as primary care providers. Cardiologists and pulmonologists, who typically command higher treatment fees, also contribute 40% to primary care services, as they participate in the management of conditions such as diabetes, congestive heart failure, and chronic obstructive pulmonary disease (COPD).

Without the support of a primary care system, U.S. emergency departments—the most expensive segment of out-of-hospital care—would inevitably become overwhelmed. On average, 37% of these visits are not truly urgent; if these patients were treated at brick-and-mortar retail clinics or urgent care centers instead, the United States would save $4.4 billion annually.

The table below reflects the U.S. government’s fiscal expenditures aimed at enhancing innovation in primary healthcare services:


Moreover, new participants and innovators have emerged today, gradually replacing traditional healthcare pathways. Emerging primary care enterprises are disrupting the existing market system with their convenient, high-quality services and scientific technological approaches.

HRI investigated five types of emerging primary care models:
1. Convenient Medical Services
This practice has a long history and is deeply entrenched in public perception, with retail convenient-care clinics and urgent care centers even replacing the habit of regular visits to private physicians. From 2010 to 2014, visit rates at these clinics tripled, patient satisfaction reached as high as 95%, and continuous growth in traffic to related websites contributed to a sustained decline in emergency department volumes.

Cleveland Clinic, Texas Health Resources, and Kaiser Permanente have all partnered with retail clinics to extend their services into the community. These health systems leverage retail clinics for patient triage, thereby reducing costly medical expenditures; some have even collaborated on initiatives for the long-term management of chronic diseases.

2. Physician Consultations
Doctor house-call services have become increasingly modernized. For instance, by downloading a mobile app, patients can request on-demand home healthcare services akin to Uber. From the 1930s to the 1980s, the proportion of medical consultations conducted via house calls actually declined from 40% to 1%. Today, however, this model has not disappeared; instead, companies are rediscovering its inherent value, revitalizing an outdated healthcare delivery method by outfitting it with modern innovations and relaunching the service. Although surveys indicate that physicians remain hesitant about providing home visits, two-thirds of consumers have expressed considerable interest in such services.

3. Individualized Healthcare
This customized, individualized medical service model emphasizes personalized precision rather than incurring high costs for traditional care. It directly competes with conventional services by offering lower costs, time savings, and greater attention to individual differences. Operating on a team-based approach, it provides personalized services and leverages navigation technology to help users locate professionals such as nutritionists and diabetes specialists. For instance, One Medical’s comprehensive services include acupuncture and logistics therapy to complement standard medical care. The company also frequently partners with employers and insurance providers.

4 Digital Health
Digital health technologies have explored business models in virtual care, telemedicine, and home-based self-diagnosis. The telemedicine industry was projected to exceed $30 billion by 2020. Sixty percent of users reported acceptance of remote consultations. Companies such as PushCare, Teladoc, and Doctor on Demand are telemedicine service providers that enable users to conveniently access medical consultations simply by downloading a mobile app.

5. Nursing by Nurse Practitioners
If the country continues to deregulate, allowing nurse practitioners to practice medicine even without physician supervision, this market will maintain a sharp upward trend. Due to government-supported programs such as the Medicare Graduate Nurse Education Demonstration, the number of professionally trained nurse practitioners has doubled since 2012. By 2020, the number is expected to increase by 30%.



In fact, seven major consumer markets are emerging in the United States for both traditional enterprises and new innovative entrants:

1. The Elderly Market—Refers to individuals aged 75 and above who are in poor health or suffer from dementia. The government spends $9.2 billion annually on medical expenses for this population. Frail elderly individuals require intensive care management and coordinated services, including 24/7 remote monitoring, house calls by physicians, and the establishment of patient-centered medical homes or multidisciplinary teams comprising geriatricians and internists to provide comprehensive care for the elderly.

2 Chronic Diseases——Healthcare expenditures for the chronic disease population have remained persistently high. Therefore, this population is receiving greater attention and priority, enabling them to access professional nurse-led clinics and retail clinics for chronic disease management.

3 Healthy Families—Healthy families refer to households that need to raise children under the age of 18. Family members are in good health and generally only see a doctor for vaccinations or occasional colds and sinus infections. For these families, digital healthcare and convenient clinics are the primary service providers, focusing on prevention, healthcare, and on-demand services.

4 Complex Chronic Diseases——Patients with complex chronic conditions are those suffering from one or more chronic diseases simultaneously. They require in-depth care management and coordinated services, and ideally benefit from 24/7 remote monitoring, physician home visits, patient-centered medical homes, and nurse-managed clinics.

5 Mental Disorders—Individuals with depression and mood disorders, those with post-traumatic stress disorder (PTSD), and individuals with substance abuse issues or suicidal ideation are all considered patients with mental illness. A combination of home-based care, behavioral therapy, and telemedicine may prove effective in treating these conditions.

6. Positive and Healthy Adults—This group prioritizes regular exercise and is most likely to opt for digital technologies, convenient health clinics, and preventive healthcare services.

7. Skeptical Healthy Adults—This group is skeptical of the healthcare system and is unlikely to have health insurance. They prefer digital health tools for self-examination and diagnosis, and prioritize services offered by telemedicine companies, retail clinics, and house-call physicians.