What Do Healthcare Consumers Really Expect from Their Providers?
As reform has steadily reshaped the industry's landscape and healthcare consumers have had to take on more of their own expenses, they’ve become more particular about their experience with providers. They expect more than efficient and effective care. But more of what, exactly?
Healthcare is a unique environment that presents challenges for a consumer-directed market. There are several factors that blind both suppliers and demanders. These threaten to fetter what would otherwise be a simple transaction cycle: patient feels poorly, patient pays for treatment, patient feels better.
Let's talk about some of the hurdles the industry needs to overcome — or circumvent — if we want to build a healthcare marketplace that would operate under more classical conditions than it currently does.
Problem 1: Wary Consumers
Healthcare consumers often don't know what they need to purchase. They require advice from experts. Unfortunately, the expertise they seek comes from the very suppliers of the interventions they need to heal them. This creates a situation in which the advisors can have a vested financial interest in overselling. Consumers aren't stupid — they recognize a conflict of interest when they see one. The problem is that healthcare consumers really have no alternative, unless they pay for a consult from one doctor and receive the service from another doctor.
That, of course, is not financially reasonable. Moreover, liability laws prevent providers from performing any procedure, rendering medical management, or prescribing medications without performing his or her own exam. So no provider in his or her right mind would treat a consumer who requests a specific service solely on the advice of a paid, outside consultant.
The market is thus irregular and somewhat irrational, strictly in terms of economic theory. Patients face the dual problems of incomplete access to information and imperfect consumer insights when they need to make decisions. Some consumers accept this and move on. Others aren't so sure and stay away from the market entirely — this is one behavior indicative of a psychographic segment we call the "Willful Endurer."
Still others embark upon a frenetic, expensive and often self-defeating cycle of bouncing from provider to provider, seeking treatment upon treatment.
Problem 2: Doctors in the Dark
On the other side of equilibrium, doctors can have a hard time determining the real needs and desires of their patients. Providers are reliant, to a large degree, on patients self-reporting.
They're also reliant upon patient adherence to a prescribed regimen. If certain patients are unengaged or non-compliant, or if they feel too intimidated to seek care to begin with, a doctor's ability to affect change is hamstrung. The reputation of his or her service can suffer in the marketplace.
In truly classical market environment, in which providers are just as free to pick their patients as their patients are free to pick them, patient non-reporting, non-compliance and non-adherence wouldn't be major impediments to the reputation of the service: doctors could simply "fire" their patients.
The healthcare market, of course, doesn't work that way. Legally speaking, EMTALA and other regulations prevent US providers from turning down patients who present for treatment, regardless of reason or necessity.
Plus, the tradition of the Hippocratic oath prevents conscientious providers from doing so. Physicians are obligated to treat, even if they do not understand what exactly consumers want. And that can be immensely frustrating.
In an era when common performance metrics include subjective patient satisfaction scores and HealthGrades ratings, reputations must be carefully shaped, guarded and scrubbed. Doctors have just as significant a financial interest in discerning and serving their patients' arbitrary or irrational consumer desires as they do in treating actual illness.
So why must such barriers persist? Are there ways around them? Can we really change the strange ground rules within the healthcare marketplace?
Problem 3: Emotive Consumers
As Coughlin, et al., noted in the Deloitte Review, healthcare consumers' decisions are often made quickly, under duress in emotionally-charged circumstances. The failure to choose the most appropriate healthcare services at a given time can have more dire consequences than poor decisions might in a "normal" consumer market.
They're also not so great at doing their homework when initially choosing a doctor. Healthcare consumers are, in many cases, more likely to choose a provider based on convenience factors than they are based on a provider's record of outcomes.
That doesn't bode well for the overall improvement of outcomes, nor for reducing industry-wide costs. It also doesn't dovetail well with a value-based reimbursement system. But all isn't lost.
On-demand access is of paramount importance in this market.
A 2015 survey by performance improvement group The Advisory Board Company found that healthcare consumers ranked access and convenience ahead of provider continuity and provider credentials in importance when choosing care.
42% of respondents to the survey stated that distance was one of their top 3 reasons for choosing a specialist — just as a shopper might opt for cheaper, one-stop Wal-Mart rather than driving across town to a specialty retailer. Accordingly, many healthcare systems have begun meeting consumer expectations where they live with neighborhood-centered care clinics, retail clinics and other ready-access points. They're also beginning to experiment, successfully, with online access portals.
Doctor-to-patient communications, billing and even virtual doctor's appointments are now being offered online — one Idaho healthcare CEO noted that his own daughter switched pediatricians solely because a competing provider offered her online access to her children's medical records.
That's not to say that on-demand access is the only factor playing into consumers' choices. It's important to bear in mind that patient retention is very different from transient business.
Perception of care quality is more important than credentials and accomplishments.
Even though consumers are likely to base their initial provider choices on convenience, quality of care is a primary driver of return business — or of attrition.
In the Advisory Board Company's survey, the perception of good care quality was the most important factor that 47% of consumers said they would return to a provider. On the other hand, 43% of consumers reported that perceived poor quality of care was the main reason they would opt not to return to a provider.
In my previous career at P&G in its healthcare division, my team conducted extensive market research on healthcare consumers and what they sought from medical professionals. Patients assumed that, by virtue of the title “Doctor,” the person providing care had the necessary credentials. It was the doctor’s bedside manner, ability to communicate and respect for the patient as a person rather than a disease state that defined ‘quality’ to patients.
Once established with a practice, consumers resent being passed around among providers. According to the same Advisory Board Company survey, among the reasons consumers reported for seeking a new primary care provider (PCP): a policy requiring patients be treated by the first available physician, or scheduled visits being assigned by the practice to a mid-level practitioner such as a physician's assistant or nurse practitioner. Once a consumer has chosen a doctor, retention becomes relationship-based.
For healthcare consumers in an existing patient-provider relationship, there seemed to be more tolerance of medical mistakes than we might have imagined there to be. "Medical error" by the PCP ranked only 3rd among scenarios prompting a provider switch. Ahead of it? Issues relating to price sensitivity, such as a doctor no longer accepting the patient's insurance, or a rise in annual out-of-pocket costs to see the same provider.
Even if the doctor does everything right and the pricing stays constant, a rude staffer at an inopportune moment can cost a practice its good retention rate. Rude support staff ranked 7th overall as a reason a consumer would make a switch. After all, the staff is an extension of the physician’s, practice’s or institution’s “brand.”
Affiliation isn't as important as we might hope it is in provider choice… except when it is.
By and large, the Advisory Board Company found that patients ignore institutional affiliation, with some prominent exceptions. It seems as if it might all come down to the underlying reason for seeking care.
Although, for the general population of physicians, "affiliation with the perceived best hospital" ranked 19th ("affiliation with a university hospital" ranked 34th) for reasons a person would choose a provider, consumers reported they do consider affiliation strongly when considering a provider to treat serious conditions.
36% of consumers looking for an oncologist reported hospital affiliation as being of the utmost importance; pulmonology patients reported similar desires (32%). Only 4% of dermatology patients, though, reported that hospital affiliation was a factor.
All of this goes to show that healthcare consumer segmentation solely by demographic factors is far too simplistic a model. Healthcare providers must consider how factors such as specific illness, specialty need, communication preferences and lifestyle affect patient attitudes, choice and behavior. Psychographic segmentation helps you understand these influences to gain real insight into their expectations.