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How Do Healthcare Consumers Define Quality? Psychographic Insights on HCAHPS and HEDIS

how do consumers define healthcare quality

It can be difficult to determine healthcare consumers’ true feelings about the quality of care they receive. Most people are unlikely to complain aloud to a healthcare provider, especially when they’re still in the exam room. Online reviews are also biased, as the people who write them typically either had an incredibly good experience or an incredibly bad one. Hence, it’s important to look at responses on satisfaction surveys like HCAHPS or HEDIS when defining quality and measuring health outcomes


Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a patient satisfaction survey required by the Centers for Medicare and Medicaid Services for all U.S. hospitals. The Healthcare Effectiveness Data and Information Set (HEDIS), on the other hand, rates health insurance companies on member satisfaction across a variety of services and attributes. Both are vital measures that give healthcare providers telling insight into the feelings of healthcare consumers.

As good as these surveys are, they might not be entirely representative of patients’ priorities,  because they don’t ask healthcare consumers to indicate how important the measures they include are to the patient. So, these surveys could be asking about and measuring attributes that aren’t strong priorities for healthcare consumers.

Including Psychographic Segmentation

Psychographic segmentation is a means of classifying people based on their lifestyle, motivations and personalities. With the result of a simple, 12-question survey, people are divided into one of five categories that provide insight on their reasoning, preferences and motivations: Self Achievers, Balance Seekers, Priority Jugglers, Direction Takers and Willful Endurers.

By viewing HCAHPS and HEDIS results through a psychographic lens, healthcare providers can begin to understand more fully how and why patients feel the way they do about their healthcare. Each of the psychographic segments has different motivations, priorities and preferences. The segments place different levels of importance on various aspects of hospital stays and respond differently as customers of health insurance companies. Therefore, people in different segments define quality healthcare differently.

Psychographic Insight Into HCAHPS

In the 2018 PatientBond Consumer Diagnostic, a nationally-representative study on healthcare consumers in the United States, we asked, among many other questions, which HCAHPS attributes were priorities for these healthcare consumers. We then divided their answers by segment to find the top five healthcare priorities for each. These were the attributes that received the most Extremely or Very Important responses.

HCAHPS Importance

Balance Seekers and Priority Jugglers have the same top five priorities, but the rest of the segments had different responses. However, there were four attributes that overlapped for every segment:

  • The nurses treated you with courtesy and respect.
  • The doctors treated you with courtesy and respect. 
  • The doctors listened carefully to you.
  • The doctors explained things in a way you could understand.

Each segment had their own fifth priority. 

  • For Balance Seekers and Priority Jugglers, it was that nurses explained things in a way they could understand.
  • For Self Achievers, it was that their room and bathroom were kept clean.
  • For Direction Takers, it was that the nurses listened carefully to them.
  • Willful Endurers actually had two additional priorities because of equal importance scoring:  that nurses listened carefully to them and explained things in a way they could understand.

Every segment is different, and with this insight you can better understand how to improve the quality of care for each of your patients. Each segment responds to different key words and phrases that resonate positively or negatively, so how a provider engages a patient and exhibits “courtesy and respect” may vary by psychographic segment. “One-size-fits-all” approaches to patients do not engender the perceptions needed to drive high HCAHPS scores.

Psychographic Insight into HEDIS

As for HEDIS, the most important attribute for every segment was that the forms from their health plan were easy to fill out in the last 12 months. Features like whether they received information from their plan’s customer service, how often the customer service staff treated them with courtesy and respect and how frequently the customer service provided the help they needed were also deemed important. 

By looking at other plan attributes, you can learn more about the different segments. For example, Self Achievers, Priority Jugglers and Direction Takers all believe that their health insurance company is genuinely interested in keeping its members healthy. This can be reinforced in member communications to nurture loyalty. Willful Endurers and Balance Seekers believe their insurance company should take an active role in identifying care needed because of the personal data it has on members. Word of caution: Balance Seekers also equally believe that their insurance company is only out to save money for itself. Skepticism is a natural quality of Balance Seekers, so be ready to back your marketing claims with data, which this segment will readily examine. 

Self Achievers are the most likely to value their health insurance coverage as a Very or Fairly Good Value, followed by Direction Takers and Willful Endurers. That is also the order of segments most likely of recommending their current company or plan to others.

Implementing Psychographic Insight

As you can see, each segment has its slight preferences. A “one-size-fits-all” approach to patient engagement or service or product design will not optimize consumer satisfaction or needs. Everything needs to be tailored by segment to provide the best care (and perception of best care).

A segment-optimized approach leads to a higher likelihood of desired patient or member behavior activation, which in turn leads to better health outcomes. Beyond this, though, it will lead to improved market share through increased patient acquisition and loyalty.

Hospitals can use this information to know what attributes they should focus on for which patients. Obviously improving all attributes would be ideal, but this insight can help them prioritize. Health insurance providers can also use this information to tailor their communication based on the beliefs of the various segments. 

In any case, a message to a Self Achiever and one to a Direction Taker should not be the same. Healthcare communications don’t motivate or resonate with people in each group the same way. By using psychographic segmentation to understand survey results, you can more accurately communicate with consumers to make a positive impact on their health outcomes.

For more on psychographic segmentation and its effect on health outcomes, download our case study

How Psychographic Segmentation & Digital Engagement Improve Health Outcomes



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