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Core Exchange: Healthcare Choice

What drives consumer healthcare choice?

What really matters to American healthcare consumers when selecting a healthcare provider? The answer may surprise you. Listen to our exploration of consumer healthcare choice drivers in six key areas.

You can listen to the episode using the player embedded here or you can read a full transcript below. Be sure to subscribe to Core Exchange on iTunes.

  • Core Exchange | Healthcare Choice

Episode Transcript:

Stephanie: Welcome to the Core Exchange, a podcast for healthcare marketers. I'm Stephanie Burton, director of healthcare marketing for Core Creative. At Core, we strive to stay on top of the latest trends impacting our profession, and one of the ways that we've done this this year is through a market research study impacting healthcare consumers. Joining me today on the phone is Cheryl Stone, who is president of the appropriately named Cheryl Stone and Associates. She is a well-known healthcare market researcher. You have worked with us for years and many of our clients and it is a pleasure to have you here. Thanks for joining us, Cheryl.

Cheryl: Thank you so much for giving me this opportunity.

Stephanie: Absolutely. So we have you here not only because we've done so much work together in the past with different health systems, but because you actually administered this healthcare research study about consumer drivers when it comes to health systems. Can you tell us a little bit about the methodology that was used as we initiated this research?

Cheryl: Sure. We were trying to get a national snapshot of what people think is important in making their choice of healthcare systems and healthcare providers at various levels and we wanted to find the most cost-effective way and comprehensive way to do this. So we did an online panel survey of adults across the US. We ended up talking online basically, online survey, of 1500 adults across the US, proportionally representing each segment of the US. We were looking at the broader census segments like northeast, Midwest, west and south to try to determine if there were any regional differences and then we wanted to get a proportional mix of ages and so forth.

Cheryl: We were actually very lucky in putting the survey together. I think you had a great idea of the types of things you wanted to ask, and some of them fit very well with areas of inquiry I've been doing for individual hospitals and health systems. So for me, it was exciting to be able to take this whole broad snapshot of the US and ask all these questions we had always wanted to ask, but didn't always fit with an individual organization's agenda. So we've got the online panel, maybe 20 minutes max of time spent on the survey, 10 minutes median, [crosstalk 00:02:42] some idea of the methodology.

Stephanie: Very good. And then the six key drivers of choice that we examine included performance and results, caring and compassion, personalization, which is uniquely different than caring and compassionate ... It kind of takes it to the next level. I refer to it kind of as the mint on your pillow approach ... wellness and prevention, access and convenience and then innovation. So we essentially pitted those drivers of consumer healthcare choice against each other, and I was a little surprised by the results. Were you?

Cheryl: Yes. I think there were certain drivers that I had been rooting for that I wanted to emerge. I saw them as kind of the underdogs of drivers and also under-leveraged potential drivers of choice. But we came up with something interesting, and I thought today of an actual connection between the beginning part of the survey about the drivers and then the end of the survey where we asked about satisfaction with their most recent provider experiences.

Cheryl: Also, we were trying to see if there were any correlations among the drivers so that we could come up with fewer explanatory variables for why people are different. Thinking about the six driver categories, there are some contradictions maybe between what people say they think is important to certain points in their care and what they say later on, and also between what they're expecting and what is really available to them. Performance and results was by far the strongest driver, actually closely followed by caring and compassion, personalized care, and wellness intervention. There were considerably lower values given for convenience, which does not mean that you should change your strategy to put urgent care centers on every corner.

Stephanie: Absolutely.

Cheryl: That's still important.

Stephanie: Absolutely.

Cheryl: And when it comes to the moment of making a decision, that can be very important. And then innovation, which I was somehow rooting for that. I don't know if you were also, but innovation was by far the least important. And I think in explanation, it's not unimportant, but there's kind of a hierarchy among these driver categories and there's also, I think, certain segments that are looking for innovation more than others and some of them kind of anticipate, and this is based on remarks in focus groups and elsewhere, that as soon as an innovation comes out, doesn't every hospital get it?

Stephanie: Sure.

Cheryl: Why would they not go with the latest and greatest? I trust my hospital to do that. So people don't think of looking for it, and I think that's important. We may be very proud of what we've innovated, especially in an academic medical center, but that might not be the thing that drives people to us.

Stephanie: Absolutely. Really important finding. And I think as we go, so innovation was at the bottom, but shockingly, access and convenience was also in the bottom, too. And we hear, wherever we go these days, it's all about convenience. Convenience is king in the healthcare world, and we certainly know that it is very important. I'm glad that you underscored the importance of convenience, but it wasn't necessarily a top driver for people who are choosing a health system or a healthcare provider. Can you talk a little bit more about that?

Cheryl: Yeah. I'd actually like to kind of flip it and talk about some of the things that were very important, because when people are at the point of choosing a health system, what information do they have to go on? They can look on the website, they can see whatever is advertised online, banner ads or as they drive through the market area, but the things they want to know most about the things that are most important are the hardest for them to feel until they actually experience the care. It's not like you can go in for a test drive of your doctor.

Cheryl: Performance and results were very important. We did a segment in the survey about whether people have gone online to look for price information or for quality performance and results information. The percentages overall were lower than I've seen in some very ... across the country overall, were lower than what I've seen in certain urban areas. I think it might be a very regionalized or localized kind of thing that people feel they have that information available, so they're looking for something that they can really get their hands on. It's like, what does the wine smell like when I can't open the bottle?

Stephanie: Sure. That's a great analogy. This is how consumers are smelling the wine. We learned, and my eyes kind of popped out of my head when I saw this, that consumers value external ratings as symbols of health system quality more than anything else. So the Healthgrades, the Leap Frogs, all of those ratings, US News and World Report, they matter. And that's coming from healthcare consumers after years of healthcare marketers and myself being one of them saying, "Consumers don't care about these. They don't know what they mean," and that may be true. They may not know what they mean, but they mean something. They mean enough to tell a consumer that, "Hey, this is a good health system." They've ranked somewhere on some list. Therefore, I can use that as an indicator of how they're performing as a health system.

Cheryl: It's not just professional ratings of Healthgrades or US News and World or something like that. There was a strong correlation between the people who highly value those ratings and the people who highly value consumer ratings that some hospitals are starting to put on their websites, and people will also go to Yelp and other kinds of sites looking for that. There's one segment that's especially focused on both kinds of ratings and I think that's a segment that's really important to reach out to.

Stephanie: Absolutely. The other thing as we take a look at caring and compassion, no doubt consumers trust their own judgment. It's a, "I need to see it or experience it before I could tell you whether you're truly caring and compassionate," but when that firsthand experience isn't possible, they do rely on consumer and patient ratings as the next best thing. So here we have two categories, and there were actually more where this emerged, where those external ratings matter, that suggests to us that if your health system isn't currently participating in online reputation management, you are missing the boat. The time is now and has never been more now than it is today and we have the data now to support that.

Cheryl: Right, right. I agree. I think the online reputation management and cultivation and really taking the lead there are very important. I also think at some point if we can segue into the use of online information in making a decision, I think that we're not giving people the performance and results information in a way that makes the most sense to them. A lot of people didn't go after it and a lot of people found it obscure, hard to find and just not meaningful to them, but they would love to have it.

Stephanie: Right, right, and in our defense as healthcare marketers, it is obscure, it is hard to find, because there is not one de facto standard survey that we are all relying on to determine the quality of a health system. CMS provides us with some information, but that tends not to be the sexy information that consumers are willing to go out and look through, whereas when a health system posts information on their own website, it often causes questions of credibility as well, even though that information may be entirely transparent, so definitely a struggle for the industry, certainly healthcare marketers to overcome there.

Stephanie: So wellness and prevention we saw was kind of in the middle of the pack, along with personalization. So caring and compassion, we had talked about is uniquely different from personalization, and I thought what was really eye-opening with regards to personalization, the way that the question was structured was we talked about how the hotel industry has done this, taking into account your preferences before you arrive, that sort of thing. More things that you want to say about how we structured that question about personalization before I dig into some of the results?

Cheryl: Yeah. For a lot of the areas that we were talking about, the categories, we had specific ratings of subcategories that make up that kind of category. For personalization, we weren't really sure how to begin, and we wanted to leave it open for people to imagine how they would like it, but we also felt like we needed to prompt them. Since we weren't able to interact with them, talk with them like in the phone survey, we gave them an example and asked what would make it feel personalized for them.

Stephanie: And so we compared it to the hotel industry, and well, 55% of our audience rated "a care experience that is personalized to meet your needs and preferences" as very important when selecting a provider. There was a lot of skepticism that this could really happen, that this is a possibility. We had comments related to, "Just spend some more time with me. Remember my name. Look at my records before you interact with me," and until we can really do that, tackle that caring and compassion driver, it's going to be difficult to get to that personalization driver. And in fact, some of the comments were really interesting as well saying, "I don't even need that." So what were your thoughts about some of the comments and the results that we saw from that personalization question?

Cheryl: As a frequent flyer in hotel visitor, I had my own concept about what that could look like. But people reverted back to things that I hear a lot when I do focus groups with patients, and these are things I've been hearing for many, many years. And it's unfortunate that we have a need for productivity, which means time value of physician and provider appointments, and if it's helps to give people the experience that they feel they deserve. People are still going to be talking about that. I also felt it was really wise that a number of people noted that this is more than they expect from healthcare because healthcare has not even met some of their more basic needs, like telling me what the out of pocket price will be and being on time and keeping me posted about waits and so forth. So I think there's a lot of catching up or house cleaning to do in healthcare while we, meanwhile, try to say ahead of the trends and also try to reach out to new audiences, so big to do list for marketing.

Stephanie: Absolutely. So when we look at the drivers of choice, performance and results ... this is just our recap ... performance and results emerged as the leader, middle of the pack, caring and compassion, personalization, wellness and prevention. The drivers that are least likely to influence consumers included access and convenience and innovation.

Stephanie: Let's stop on innovation for just a moment. You said that this was a driver that you were rooting for. And you know what? We don't need to stop on this because you already addressed it, so I won't to ask you to address it any further. You know what? We are, because we didn't really talk about how consumers are defining innovation. Certainly, consumers define innovation as the latest technology and advanced procedures. They need to know that health systems are offering innovation in that way.

Stephanie: And I thought this was interesting. "Unique services" are valued by consumers as well, so we heard things like holistic medicine, acupuncture, nontraditional services that people are associating with that word, innovation. The thing that didn't necessarily surprise me but is important for healthcare marketers to know is that consumers aren't universally wowed by your academic medical center affiliations. Is this consistent with what you see when you do surveying across the country with academic medical centers?

Cheryl: I would say it depends on geography, and Boston and New York City in particular are much more focused on access to an academic medical center and I think somewhat more open to the idea that, "Yes, I do want to be seen by people at all levels of training because it works both ways. It helps me have a part in their education and it helps me get more perspectives because I know I'm going to be seen by my designated physician, but I'm also going to have so much more hands on and so many more people thinking about it and working as a team."

Cheryl: I think that in some other markets, it is less valued, but not unvalued, I wouldn't say removed from consideration. A lot of the things that came out of our survey, I would say to an organization that's considering, let's say, rebranding or repositioning, go and do this research now in your market and see how it compares with the benchmarks we came up with. There may be areas you need to push on more or less.

Stephanie: Absolutely, and I think that's a really important statement. This consumer market research is not meant to be a replacement for any health system doing their own research. This is really a conversation starter or something that you can use if you aren't able to do immediate research today. So we encourage every health system to do that, because we know that there are certain variables in every market that are going to influence consumer choice, and the only way you could know is if you ask them and engage in that conversation.

Stephanie: The other important thing that came out of this survey, and this is one of those bits of information that I know a lot of healthcare marketers are clamoring for, is the value of an integrated health system. I know how many times marketing directors or CMOs are approached with the, "Can't I just market my hospital as the hospital and not as part of a health system?" And our survey said, "No, you can't." 82% of respondents feel that an integrated health system offers patients a big or moderate advantage, so linking our hospital, our service lines to a health system continues to be vitally important. Are you seeing some of that tension in the market when you are working with your clients?

Cheryl: Well, yes. I mean, I'm asked about that frequently, but I have done many, many surveys for a specific health systems or potentially coming together health systems, and I always find that it's highly valued by consumers. There's starting to be a very clear understanding about the value of a connected electronic medical records. Also, the fact that being an assistant means I might be able to access certain care close to home and then go to the mother ship or the academic medical center or something like that in the system when I need that level of care. So people are really starting to get that.

Cheryl: There is a few things within the symbols of quality in health systems that we tested that are important. The first is that the professional ratings are really important in signaling quality in a health system, not just the individual hospital. But beyond that, people have expectations, and this is something I hear in focus groups as well, that there are going to be certain similarities among the entities within this system, that they are going to use similar protocols, they are going to similarly put the same amount of effort into the look and feel of the facility and housekeeping and appearances and so forth. That's very important. If you have one hospital that falls way behind the others in terms of facility and first impression, that can really affect how people feel about the system as a whole, and it's very important to know and understand when you need to invest in that.

Stephanie: Absolutely. Great. So the final thing I'd like to discuss about this consumer market research study in particular are the additional comments that came out through the survey, and what we learned as well, we selected these key drivers of choice, consumers consistently throughout the survey regardless of question, expressed their concerns on whether a health system accepts my insurance, how much things are going to cost, what the health system's ratings are, and then those in depth provider profiles including outcomes information on providers. This is how they are seeking information. Is this a physician I would like to spend time with? Can you talk a little bit about that?

Cheryl: Yes. I would say first of all that this is totally consistent with what I see elsewhere. We tried very consciously not to focus on price and issues like that in the survey, but for virtually every driver of choice when it came to open-ended comments, and definitely at the end when we asked, "What else do you want to know?", the pricing, the insurance acceptance, the ratings and the provided information came up.

Cheryl: I've done a lot of work on the provider profile side of things, testing the usability of online doctor finders and things like that, and I'm finding that people really want to see a face and hear a voice, so these little videos that some organizations are recording for all of their providers are incredibly helpful in influencing the choice of the provider and ultimately the choice of the health system. People want them smiling, they want them positive, but realistic as well. I think more needs to be invested into that and into making it something that people can really find right away on your website.

Stephanie: Absolutely. Absolutely. Really great point. I will say it has been a pleasure, Cheryl Stone, president of Cheryl Stone and Associates. Thank you for working with us on this research study. I also need to give a huge shout out to someone who wasn't able to be here with us today, and that's Sue Spate, director of research and strategy here at Core Creative who was integral in this research. You can find the white paper at Download it. Tell us your insights. We'd love to hear from you. And Cheryl, how can our listeners learn more about you?

Cheryl: Oh, they can go to and find out all about us and get in touch, and Cheryl is C-H-E-R-Y-L.

Stephanie: Fantastic. Thanks again, Cheryl.


Stephanie Burton, APR is the Director of Healthcare Marketing at Core Health.

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