How Patients Have Historically Been Routed Through Healthcare
For most of the modern healthcare system's history, patient entry into care has been shaped primarily by institutional structures rather than individual choice. Coverage design, referral patterns, and payer networks have played a greater role in determining where patients begin their care journey than brand preference or direct consumer engagement.
In the United States, the majority of individuals receive health insurance through employer-sponsored plans, with additional coverage provided by public programs such as Medicare and Medicaid (U.S. Census Bureau). Within these frameworks, access to care is governed by network participation, benefit design, and reimbursement rules. Physicians have traditionally acted as the primary navigators, directing patients toward providers or services within the constraints of coverage and referral requirements (Kaiser Family Foundation).
In this environment, patient choice was constrained rather than eliminated. Price visibility was limited, comparison shopping was uncommon, and patients often evaluated options only after their route into the system had already been determined. Marketing reflected this structure, influencing outcomes downstream of coverage and referral decisions rather than shaping them upstream.
This baseline matters because the changes now unfolding in healthcare do not dismantle these structures outright. Instead, they introduce new forces that increasingly influence how and where patients begin their journey.
New Forces Are Adding Routes Into the System
Traditional insurance-based routing remains dominant, but new entry points are beginning to shape patient behavior earlier in the decision process.
One of the clearest developments is the emergence of direct-to-patient access models across pharmaceutical and healthcare services. Reporting from Reuters documents how major manufacturers have launched cash-pay programs, discounted pricing portals, and direct fulfillment options in response to affordability pressures and coverage friction. While many of these initiatives target uninsured or underinsured patients, they also appeal to insured individuals facing high deductibles, prior authorization delays, or limited network flexibility.
Policy and regulation have reinforced this shift. Price transparency requirements have increased patient awareness of cost differences, while sustained political pressure around drug pricing has encouraged experimentation with alternative distribution models. Data from the U.S. Census Bureau and analysis from the Kaiser Family Foundation show that although more than ninety percent of Americans have health insurance, a meaningful subset of the population remains highly sensitive to out-of-pocket costs. For these patients, simplified access and clearer pricing materially influence where care begins.
These developments do not replace insurance-based routing. Instead, they introduce parallel entry points that coexist with traditional pathways. Patients may still rely on coverage for care delivery, but they are increasingly exposed to options before coverage rules or referral patterns fully narrow their choices.
As Klick has noted, direct-to-patient models remain early, but they add complexity to the system by creating additional routes through which demand can form.
Healthcare Is Becoming a Routing System
Taken together, these shifts suggest a structural change in how healthcare demand is formed. As additional entry points emerge, healthcare increasingly functions as a routing system rather than a linear funnel.
In a routing system, patients encounter multiple possible paths shaped by coverage rules, affordability thresholds, eligibility criteria, and digital access points. Some routes are effectively default, determined by insurance design or policy-backed affordability programs. Others remain discretionary, influenced by convenience, perceived quality, trust, and timing.
This does not produce a simple divide between insured and uninsured patients. Many insured individuals still face meaningful constraints, including high deductibles, narrow networks, or administrative friction. In these cases, routing is not predetermined. It is shaped by which options surface first and feel most viable when patients begin to engage.
Once a patient commits to a path, switching becomes costly due to coverage limitations, administrative burden, or perceived risk. As a result, the most consequential moment is no longer the final selection of a provider or product, but the point at which a patient is first guided toward one route over another.
As routes multiply, small differences in early routing can lead to meaningful shifts in where demand ultimately flows.
What Routing Changes About Healthcare Marketing
As healthcare begins to function as a routing system, the role of marketing changes with it. Growth is no longer driven primarily by messaging at the moment of choice, but by whether a brand can influence the path a patient takes before that choice is made.
In traditional models, marketing operated downstream. Awareness and reputation mattered after coverage rules or referrals had already narrowed the field. In a routing environment, patients are exposed to options earlier, often before a formal clinical decision has been initiated.
This shifts emphasis from broad persuasion to early relevance. When access, fulfillment, and basic digital experience become baseline expectations, competitive advantage increasingly comes from timing and context. Brands that surface early, feel applicable, and align with a patient's perceived constraints are more likely to shape the route that follows.
Industry research reflects this transition. Klick and other healthcare strategists note that simplified access and experience design are becoming table stakes. At the same time, research from McKinsey shows that healthcare consumers are increasingly willing to compare options earlier in their journey and act on perceived value when barriers to access are reduced.
Influence in a routing system is subtle. It is established through clarity, trust, and perceived fit rather than aggressive tactics. Brands that understand when patients are most likely to hesitate or seek alternatives are better positioned to guide those early decisions.
Why Patient Intent Becomes Foundational
In a routing system, influence depends on understanding intent before routes become fixed. Once a patient has committed to a path, opportunities to shape that decision narrow significantly.
Patient intent signals reflect readiness, constraints, and context. They indicate when a patient is beginning to evaluate options, what tradeoffs they are weighing, and how likely they are to act. In a system with multiple routes, these signals provide early insight into where influence is still possible.
Research on healthcare consumer behavior supports this shift. McKinsey has shown that patients increasingly seek information earlier, compare alternatives, and respond to experiences that feel relevant to their situation. Broad cohort-based approaches struggle to capture this nuance, as patients with similar diagnoses or demographics may face very different constraints.
Intent-based approaches help resolve this gap by focusing on individual-level signals rather than generalized segments. This does not replace traditional marketing or experience design, but it informs when and where those efforts are most effective.
In this context, intent is not a tactical optimization. It is a strategic input that determines which routing decisions can still be influenced.
Looking Ahead
Direct-to-patient models, price transparency, and policy-driven affordability programs are still evolving. None replaces the healthcare system on its own. Together, however, they introduce a lasting shift in how patients encounter care.
As healthcare adds routes rather than consolidating them, competition increasingly moves upstream. The brands that succeed will not be those that react fastest at the moment of purchase, but those that understand how patients begin their journey and which paths are likely to form.
Healthcare growth will be shaped less by what happens at the end of the journey and more by who understands the journey as it begins.