▪ research for your brand’s health klein & partners Another Kitchen Sink Survey from Klein & Partners: What consumers think about a plethora of healthcare

▪research for your brand’s health

k l e i n & p a r t n e r s

Another Kitchen Sink Survey from Klein & Partners:What consumers think about a plethora of healthcare topics…

Presented by:

Rob Klein, Founder & CEO

Klein & Partners

4th Quarter, 2014

Disclaimer: Please feel free to use these charts in any of your presentations; just cite Klein & Partners as the source of the information.



INTRODUCTION

Page 2



Background The purpose of this nationwide quantitative survey was to understand consumers’ current thinking on a wide

range of healthcare-related topics, including:

Methodology A national online survey was conducted among 407 heads of household, 18 or older who are most responsible for

healthcare decisions for themselves and/or the household. Interviewing was conducted from September 9 – 13, 2014. The sample frame used was Research Now’s online consumer panel. The final data set was weighted by geography, age, education, income, and ethnicity.

The total sample size of 407 yields a sample error of +/-4.1% at the 90% Confidence Level (CL). For example, if this study were repeated 100 times, in 90 times out of that 100 (i.e., 90% confidence level) we would find a total sample statistic of 50% to fall within approximately 46% and 54%.

Significant differences are called out in the charts using letters or arrows. Colors and bolding are used to highlight interesting patterns and/or findings.

Introduction

• Reactions to health reform• Perceptions of health providers• Tax exempt perceptions• Perceptions of healthcare costs and profits• Primary care physician• Electronic medical record• Medical home awareness and perceptions• Concierge medicine• Smart phone use

• Interest in new information sources• Communication methods used• Choosing a hospital• Websites visited• Retail clinics used• Online healthcare shopping behavior• Transparency/price shopping• Health insurance and getting care• Rural healthcare perceptions

Page 3



SO WHAT DID WE LEARN?

Page 4



This year’s theme?

Page 5



1) Patients are becoming customers in their expectations. Health reform is a major cause of this shift in attitude because most folks feel they are paying more now under reform.

2) Catch-22 regarding tax-exempt status most Americans don’t support you but they know they will pay the price if you lose your tax-exempt status.

3) Americans think hospitals make very large profits like health insurers. You are losing your ‘good guy’ status.

4) Fewer Americans are price shopping for healthcare services (hypothesis: they are not getting good answers so they are giving up).

5) Concierge medicine could create access problems and may create a moral challenge.

6) Why can’t I schedule a doctor’s appointment online when I can make a restaurant reservation with Open Table?

7) Trying to pick the best doctor remains a daunting task with little useful information available.

8) Medical Homes… What?

9) EMR gaining traction

10) Like us on Facebook? Not likely

11) What people say – I will seek out lots of sources of information before deciding which hospital to choose. What people actually do – What ever you say doctor.

12) Very few people actually look to HealthGrades or US News & World Report or any other online quality ranking sites when choosing a hospital.

13) Most hospital website visitors find the experience ‘adequate’ but not ‘exceptional.’ We need to think of our website as a ‘digital brand dialogue’ that impacts our overall brand relationship.

14) The new competitors Walgreens, CVS, Walmart, Target, etc. and they want primary care!Page 6

Top-10 (ok 14) key disruptive takeaways



TOP CONCERNS

Page 7



Economy/jobs

Health care

Taxes/spending

Education

Terrorism/Homeland Security

Energy

Immigration

Wars in Afghanistan and Iraq

Other

28%

22%

13%

11%

11%

4%

3%

2%

4%

39%

23%

12%

12%

4%

3%

3%

3%

1%

42%

27%

11%

7%

1%

2%

1%

2%

2%

40%

24%

11%

9%

3%

2%

3%

1%

3%

49%

23%

8%

3%

5%

1%

6%

3%

2%

Issues of most concern to Americans

2009

2010

2011

2012

2014

Page 8

Significantly higher among women, seniors, and those with HHI <$45K

Q1: Which one of the following issues is MOST important to you?



REACTIONS TO HEALTH REFORM

Page 9



Medical coverage

Network of available doctors

Network of available hospitals

Being seen by my doctor in a timely manner

Cost of insurance benefits

12%

10%

9%

8%

7%

39%

54%

61%

59%

30%

43%

27%

19%

24%

57%

6%

9%

11%

9%

6%

What’s getting better or worse for you under healthcare reform?

Getting better Remaining unchanged Getting worse Not sure

Q2: What do you feel is getting better or worse for you personally under healthcare reform? Page 10

And this is giving rise to the healthcare ‘customer.’



Page 11

Completely comfortable

Mostly comfortable

Mixed

Mostly uncomfortable

Completely uncomfortable

Not sure

2%

16%

38%

13%

22%

9%

How comfortable are you with an ACO managing your health and

wellness?

Significantly higher among college educated

Q3: Next we have a question about how health care eventually will be delivered under reform called an Accountable Care Organization or ‘ACO’.

Currently healthcare providers get paid when you, as a patient, receive care. Under reform, providers will be paid to manage the entire health of a population of people so they don’t get specifically paid when you need care, but they are paid a fixed sum to manage your health whether you ever get sick or injured or not. So their incentive is to keep you healthy and be cost effective in how they deliver care. And providers could include your local health care system of hospitals and doctors, a single hospital, even a large physician group, and they would be responsible for managing a large population of people in the community. Based on this basic description of healthcare under reform, how comfortable are you in having this ACO manage all aspects of your health and wellness?

2012

4%

15%

37%

17%

19%

8%



PERCEPTIONS OF HEALTH PROVIDERS

Page 12



Page 13Q4: Next is a list of people or organizations that have been in the news lately. Please tell us how favorable you are towards each using a scale of 1 to 10 where 1 means very unfavorable and 10 means very favorable. Of course, you may use any number from 1 to 10.

1

2

3

4

5

6

7

8

9

10

7.00 6.98 6.89

5.90

5.094.68

Favorability rating for people/organizations in the news

Don’t know enough to rate it

17% 14% 7% 23% 12% 9%



TAX EXEMPT STATUS

Page 14



Support or oppose hospitals be-ing exempt from paying state

and local taxes?

-100% -75% -50% -25% 0% 25% 50% 75% 100%

-26%

-16%

-18% 33%

8%

Somewhat oppose Strongly oppose Not sure Somewhat Support Strongly support

Support hospitals being tax-exempt

Page 15Q5: Do you support or oppose hospitals being exempt from paying state and local taxes?

42% 41%Support for tax-exempt status is not very strong

among Americans.



2014: Hospitals charged property and sales tax to increase revenue

2013: Hospitals charged property and sales tax to increase revenue

-100% -75% -50% -25% 0% 25% 50% 75% 100%

-34%

-29%

-40%

-39%

26%

32%

Q6: As you may or may not know, many local communities and states are looking for ways to increase revenue to meet rising demands for services. One way that has been proposed is to treat local hospitals just like any other business in the community and charge them property tax and sales tax. Do you think this is a good idea or a bad idea?

Charging hospitals property and sales tax

Page 16

Bad idea Not sure Good idea

But taxing hospitals isn’t necessarily a

good idea either.



Page 17

Hospitals earning tax-exempt status

Hospitals give away enough free services and health education to

justify tax-exempt status

-100% -75% -50% -25% 0% 25% 50% 75% 100%

-28%-14%

-24%

24% 11%

Probably not Definitely not Not sure Probably Definitely

Q7: Would you say that hospitals in your area do or do not provide enough free medical care and health education services in your community to justify their tax-exempt status? Would you say they…?

42% 35%Most Americans don’t think so.

How much money do you spend

each year trying to convince your

communities?



While hospitals may have once been charitable organizations that were run by churches or community organizations, they now are really just profitable enterprises and should be treated like any other business.

If we start taxing hospitals, it will just raise the cost of healthcare and hospitals will have to charge us more at a time when healthcare costs are already rising.

Hospitals are an important part of the community because of the vital services they provide and therefore, they should not be subject to any local taxes.

-100% -75% -50% -25% 0% 25% 50% 75% 100%

-11%

-8%

-15%

-20%

-6%

-23%

-4%

-2%

-5%

47%

31%

34%

19%

53%

23%

Views on hospitals

Q8: Do you agree or disagree with the following statements?

Strongly disagree Somewhat disagree Not sure Somewhat agree Strongly agree

Page 18

7% 20% 9% 40% 24%

4% 10% 6% 33% 47%

12% 21% 11% 35% 22%

2013

2013

2013

Classic Catch-22



PERCEPTIONS OF HEALTHCARE COSTS AND PROFITS

Page 19



Insurance company profits

The uninsured

Overuse and misuse of health care services

Poor health and wellness

Hospital profits

Cost of medical malpractice

Physician profits

The government

New technology

Other

Not sure

25%

19%

14%

12%

8%

6%

3%

2%

2%

2%

8%

Largest impact on health insurance costs

Page 20Q9: Which one of the following do you think has the largest impact on health insurance costs?



Page 21

Making a large profit; 40%

Making a small profit; 32%

Losing money; 6%

Not sure; 22%

Do you believe local hospitals are…

Q10: In the current healthcare environment, do you believe your local hospitals are…?



Health insurers Hospitals Doctors-100%

-75%

-50%

-25%

0%

25%

50%

75%

100%

-21%-35%

-53%

65%45%

29%

-2%

-5%

-10%

-13%

-16%

-8%

Paid too much

Paid appropriate amount

Paid too little

Not sure

Amount paid for services

Q11: For each of the following organizations, please check if you think they are paid too much, too little, or an appropriate amount for the services they provide in today’s healthcare environment? Page 22

Klein & Partners is seeing a shift in attitude towards hospitals. What were once viewed as altruistic organizations

in line with the virtues of doctors, hospitals are now more in line with the ‘profit-driven’ health insurers.



PRIMARY CARE PHYSICIAN

Page 23



Q12: Do you have a primary care or personal physician?Q15: Have you ever gone online to a social networking site and shared your experiences about a doctor or a hospital you recently visited? Page 24

Primary care physician

Primary Care Doctor

82%

Just 60% among

Millennials.Going online to rate a doctor or

hospital has doubled in the past few years:

6% in 20099% in 2011

14% in 201212% in 2013

12% in 2014



Don't feel the need (young, healthy)

Can't afford it

Don't have health insurance

Too hard to get an appt.

Easier to go to urgent care or ER

Can't find one close enough

Looking for one

Employer doesn't offer health benefits

Lost my job and health insurance

New to the area

Other

Not sure

33%

23%

13%

9%

9%

7%

6%

4%

2%

1%

3%

9%

Why no PCP?(among the 18% with no PCP)

Page 25Q13: Why do you currently NOT have a primary care physician? Q14: If you needed to see a primary care doctor where would you most likely go (or where have you gone) for care?

Walk-in to doctor's office

Urgent care center

Hospital ER

Virtual appointment

Free-standing ER

Other

Wouldn't go

Not sure

29%

26%

7%

7%

1%

5%

3%

23%

Where go for primary care?(among the 18% with no PCP)

Purple = No needGreen = Financial

Red = Access

Impacts access

Impacts costs



Page 26

Yes and I've used it; 2%

Yes but I have not used it; 5%

No I am not aware of this app; 93%

Aware of ZocDoc

Q16: Are you aware of an online physician office scheduling App called ZocDoc?

Recent focus group participant: “Why can I use Open Table to make a restaurant reservation but I have

to call and argue with my physician’s office to schedule an

appointment when I’m sick?”



Family/friend recommendation

Health insurer physician directory

Recommendation from another physician

Health insurer website

Google search

Online patient reviews (Angie's List, Yelp, etc.)

HeathGrades

Phone book/Yellow Pages

Hospital website

Someone from hospital

Interviewed doctor

Local publication

US News & World Report

Newsletter (healthcare org)

Social media site

CMS quality ratings

Direct mail

Advertising

Other

None

Not sure

39%

37%

22%

19%

10%

7%

7%

7%

6%

4%

4%

3%

2%

2%

2%

1%

1%

1%

2%

9%

8%

29%

18%

14%

6%

4%

3%

3%

1%

1%

1%

3%

1%

9%

8%

Most useful information sources for physician choice

Most usefulAll mentions

Page 27

Q17: Thinking back to when you were first looking for a new primary care physician, which of the following sources of information, if any, did you seek out to help you choose that physician?Q17a: Now, which one of these sources of information, if any, was most useful to you in choosing this physician?

*Word-of-mouth!

** *Significantly higher among Millennials

*

*



In health insurance networkConvenience of office location

Personal attention of physicianEasy to get in quickly

Reputation of physicianFocused on health and wellness

Doctor speaks English clearlyTime doctor spends with patients

Hospital affiliationTruly understands and responds to needs

Years as a physicianService level of office staff

Short/no wait timesGender of physician

Hours and days doctor's office openAcademic credentials

Nice officeExperience w/my condition

CostAccess to EMR

Can communicate via email/textOnline scheduling abilities

OtherNot sure

57%

55%

44%

37%

36%

33%

26%

26%

26%

23%

22%

22%

20%

19%

19%

16%

15%

15%

10%

8%

8%

3%

5%

4%

29%

5%

13%

3%

10%

4%

1%

3%

2%

4%

2%

1%

1%

5%

2%

1%

3%

2%

2%

1%

4%

4%

Most influential factors considered in physician choice

Most influentialAll mentions

Page 28

Q18: Think back to when you chose your current primary care doctor which of the following factors did you take into consideration when you were deciding on which doctor you chose?Q18a: And which one of these factors would you say had the biggest influence on which primary care physician you chose?



Personal attention of physicianIn health insurance network

Convenience of office locationTime doctor spends with patients

Truly understands and responds to needsFocused on health and wellness

Easy to get in quicklyExperience w/my conditionService level of office staff

Reputation of physicianDoctor speaks English clearly

Short/no wait timesHospital affiliation

CostHours and days doctor's office open

Gender of physicianYears as a physician

Nice officeCan communicate via email/text

Access to EMRAcademic credentials

Online scheduling abilitiesNot sure

60%

45%

42%

38%

37%

34%

29%

26%

26%

22%

22%

22%

21%

16%

16%

16%

15%

14%

12%

12%

8%

4%

7%

25%

19%

5%

3%

12%

6%

1%

7%

1%

3%

2%

1%

2%

1%

2%

1%

1%

1%

7%

Factors that influence staying with physician

Most influentialAll mentions

Page 29Q19: Now, which of the following factors influence whether or not you want to stay with this physician? Q19a: And which one of these factors would you say has the biggest influence on whether or not you want to stay with this physician?



Page 30

Personal attention of physicianIn health insurance network

Convenience of office locationTime doctor spends with patients

Truly understands and responds to needsFocused on health and wellness

Easy to get in quicklyExperience w/my conditionService level of office staff

Reputation of physicianDoctor speaks English clearly

Short/no wait timesHospital affiliation

CostHours and days doctor's office open

Gender of physicianYears as a physician

Nice officeCan communicate via email/text

Access to EMRAcademic credentials

Online scheduling abilitiesNot sure

13%

29%

5%

3%

4%

4%

3%

3%

1%

10%

1%

1%

2%

2%

2%

5%

2%

1%

2%

1%

4%

25%

19%

5%

3%

12%

6%

1%

7%

1%

3%

2%

1%

2%

1%

2%

1%

1%

1%

7%

Factors that influence choosing vs.staying with physician

StayingChoosing

Q18a: And which one of these factors would you say had the biggest influence on which primary care physician you chose?Q19a: And which one of these factors would you say has the biggest influence on whether or not you want to stay with this physician?


k l e i n & p a r t n e r sViews on physicians

Q20: Next, for each of the following statements please check if you…Note: * = Asked of all; ** = Asked only of those with a PCP Page 31

*

*

*

*

*

**

**

**

I am most responsible for my own health and wellness

You cannot really be sure you picked the right doctor until after you see them for an actual visit

My doctor respects my time as being as valuable as his/hers

I want my experience at the doctor’s office to be more like customers are treated at a favorite store

If I’m not in optimal health it is mostly my own fault

There isn’t a lot of good objective information out there to help you decide which physician to choose

Service at my doctor’s office has gotten so bad that I am considering changing physicians

My doctor doesn’t seem to know what is going on with staff and how they treat patients

-100 -75 -50 -25 0 25 50 75 100

-15

-15

-28

-33

-30

-35

-16

-19

-2

-2

-6

-7

-12

-14

-11

-16

-1

-3

-4

-3

-5

-11

-62

-55

32

35

36

33

37

32

10

5

50

46

26

25

17

8

2

5

Views on physicians

Strongly disagree Somewhat disagree Neutral Somewhat agree Strongly agree



ELECTRONIC MEDICAL RECORDS

Page 32



Page 33

Very interested

Somewhat interested

Not interested

Not sure what this is

Already have access to EMR

34%

36%

12%

4%

15%

48%

35%

11%

1%

5%

48%

35%

13%

1%

3%

47%

35%

14%

2%

2%

Interest in having online access to your electronic medical record

2010

2011

2012

2014

Receipt of test results

View health information

Renew prescriptions

Review info after seeing doctor

Look up info on medical condition

Manage appointments online

Message physician

Review preventive health screenings

Track and graph information

Request an eVisit

85%

79%

72%

71%

65%

61%

59%

57%

43%

32%

84%

71%

82%

67%

56%

76%

64%

50%

37%

41%

Very interested in accessing via electronic medical record

Especially 21-44

Q21: How interested would you be in having online access to your own personal health record – called an Electronic Medical Record (or Patient Portal) – to track your own health through a secure website that only you and your doctor and hospital can access? Q22: Which of the following features, if any, would you definitely be very interested in accessing or have accessed through your electronic medical record? [Among those very interested or already have access]

Use EMR – 12%Haven’t used yet – 3%

Men

Women



MEDICAL HOME AWARENESS AND PERCEPTIONS

Page 34



Very familiar

Somewhat familiar

Just heard the term

Not at all familiar

5%

8%

19%

68%

2%

8%

28%

62%

Medical Home familiarity

20122014

Page 35

5% believe they are part of a Medical Home with their physician (3% in 2012) which equals <1% of the adult population.

Consistent with other Klein & Partners research, half (55%)

learned about a ‘Medical Home’ after they chose that physician.

(53% in 2012).

And when asked if they see any difference in their relationship with

their physician because of the Medical Home program, 60% said

yes. (new Q in 2014)

Q23: Prior to this survey, were you familiar with the term ‘Medical Home’ or what also is called a ‘patient-centered medical home’ which is a team-based healthcare delivery model led by the physician?Q24: Are you part of a Medical Home through your primary care doctor?Q25: Did you choose your doctor because he/she was part of a Medical Home or did you learn about that after you choose your doctor?Q26: Do you notice any difference in your relationship with your physician because of the Medical Home program?



Comfortable for every situation

Comfortable for most situations

Comfortable with some situations

Comfortable for very few situations

Not comfortable at all

Not sure

14%

22%

26%

15% 14%

9%9%

30% 29%

14%11%

7%

Comfort seeing care givers other than your PCP

20142012

Page 36

Q27: As part of a Medical Home with your primary care physician, there may be times when you come in for an appointment and you will see one of the doctor’s team members who could be a Nurse Practitioner, Physician’s Assistant, or some other care giver. How comfortable are you or would you be in being seen by one of the care givers instead of your primary care physician? [Among those with a PCP]



CONCIERGE MEDICINE

Page 37



Page 38

Q28: Next, have you heard of a ‘concierge medical practice?’ Q29: If your primary care doctor told you that he/she was converting their practice to a concierge practice and offered you to stay for an additional annual fee like what was outlined above, what additional amount above and beyond what your insurance covers now would you be willing to pay annually to stay with your current doctor in this new concierge practice format?

Yes I have definitely heard of this but I am not in one; 24%

Yes I have definitely heard of this and I am currently in a concierge medical practice;

3%

No I have never heard of this; 62%

Not sure; 11%

Heard of ‘concierge medical practice’ Additional amount willing to pay to stay with doctor in new

concierge format:Less than $100: 2%

$100-$199: 3%$200-$499: 3%$500-$999: 1%

$1000+: 3%Would not pay extra: 58%

Not sure: 29%2013Yes, but not in one: 32%

Yes, and in one: 2%No: 62%

Not sure: 4%

Mean = $495



Page 39

Creates inequality in healthcare system so rich get better care and those who

can't afford it have less access to quality primary care; 33%

Don't really see any value in paying more for a level of service I should be receiving already;

32%

This has real patient benefit for those who can afford it; 16%

Not sure; 19%

Reaction to concierge medical practice

Q30: Whether or not you have heard of concierge medicine prior to this survey, which statement best describes your reaction to it?

Women more likely to feel this way

Seniors more likely to feel this way

Millennials more likely to feel this way

Those with no PCP more likely to feel this way



SMART PHONES‘Can you hear me now?’

Page 40



Look up information on health symptoms

Research a health topic

Visit health insurer's website

Visit hospital's website

Look up information on a particular doctor

Make an online donation to a charity

Participate in health and wellness program

Check lab results

Look at your electronic medical records

Watch a healthcare video

Read a health magazine

Schedule a doctor's appointment

Schedule a test or procedure

Text question to doctor

Check how busy an ER is

Have a smart phone but have not used it

Do not have a smart phone

22%

18%

12%

13%

13%

8%

6%

6%

6%

6%

5%

3%

2%

2%

2%

31%

22%

22%

22%

12%

13%

17%

7%

8%

6%

3%

5%

7%

9%

6%

4%

1%

26%

28%

26%

21%

11%

15%

17%

8%

8%

6%

3%

6%

7%

6%

5%

2%

1%

22%

38%

23%

20%

10%

10%

11%

5%

2%

2%

5%

3%

3%

2%

17%

49%

9%

9%

6%

5%

5%

2%

1%

1%

2%

2%

2%

1%

16%

65%

Current health-related smart phone uses

2010

2011

2012

2013

2014

Q31: Next, have you used a smart phone (e.g., Droid, iPhone, Blackberry, or any phone that can access the Internet) to go online and do any of the following…? Page 41

Any of these uses is significantly higher among

Millennials.

Americans are using their smart phones to

search for lots of information… just not

healthcare… yet



Make, change or cancel an appt

Check lab results

Renew prescription

Clinic appt check-in

Email doctor

Check medical records

Emergency room wait times

Where do I park

Doctor lookup (find-a-physician)

Pay medical bills

Wayfinding - directions within hospital

Wouldn't use any of these

58%

52%

51%

44%

39%

39%

35%

34%

31%

28%

25%

19%

68%

58%

66%

49%

44%

37%

38%

21%

39%

36%

25%

12%

Hospital Apps most likely to use(Among the 72% with a smart phone)

20122014

From a market segmentation standpoint, potential use for most of these Apps is higher

among Millennials.

Q32: If a hospital you used offered a mobile app for your smart phone, which of the following features would you MOST LIKELY USE? Page 42



INTEREST IN INFORMATION SOURCES

Page 43



WebMD

Google

Friend/Family

Health plan website

Called health plan directly

Books, magazines, newspapers

Hospital website

Called hospital directly

Consumer's Report

Health plan newsletter

Social media

Hospital newsletter

Newsletter at doctor's office

TV or radio programs

Online support group

A health resources center or library

YouTube

HealthGrades website

Yelp

CMS Hospital Compare website

Blog or microblog

Other healthcare website

JD Power

Angie's List

46%

36%

20%

19%

17%

12%

11%

8%

7%

6%

6%

5%

5%

5%

5%

5%

5%

5%

3%

2%

2%

1%

1%

1%

Sources of health-related information sought in past year

Page 44

Green = OfflineBlue = Digital

Q33: Besides your physician, which of the following have you sought health-related information from in the past year?



Learned about a specific medical conditionResearched symptoms experiencing

General health informationResearched medical procedures

Disease wellness informationRefilled a prescription

Directions to hospital/facilityChecked on a patient bill/paid bill

Read physician reviews/ratingsResearched/compared treatment options

Info to find a new doctorCompared health plans

Health and wellness programChecked lab or test results

Scheduled an appointmentChose a health plan

Disease management programsInstructions on how to prep for a test/exam/surgery

Sought consumer reviews onlinePre-registration for procedures or admissions

Read hospital reviews onlineSubscribed to an e-health newsletter

Price shopped costs of a test/procedure/visitRegistration for health/wellness classes

Asked a doctor/nurse for medical adviceVisited state exchange website

Had an email consultation with my doctorWeb nursery/birth announcements

Chose a hospitalCompared services offered at different hospitals

Checked ER wait timesHave NOT searched any health-related info on the Internet

37%33%

32%21%21%

19%19%

18%17%17%

16%16%

15%15%

14%11%11%

8%7%7%7%

6%6%

5%5%5%

3%2%2%2%2%

22%

Health related information sought on the Internet

Page 45Q34: And which of the following information, if any, have you done online?



Search symptoms when sick

Visited health insurer's website for health-related info

Participated in employer's wellness program

Completed an online health assessment

Accessed online personal health record to track own health information

Downloaded healthcare-related articles

Watched a video online on a healthcare topic or procedure/surgery

Participated in health plan's wellness program

Visited a hospital's website for health-related info

Viewed online animation of a medical procedure/surgery

Viewed hospital's health and wellness class schedule

Visited an independent healthcare rating organization's website

Listened to a Podcast on a healthcare topic

Followed a hospital's Facebook page

Watched a live healthcare webcast

Followed/Participated in a healthcare dialogue on someone's BLOG

Participated in an online patient support group

Followed a health plan's Facebook page

Participated in an online chat with a healthcare provider

Used cell phone to search healthcare-related info

Followed a hospital's BLOG or Twitter activity

Followed/Participated in a healthcare dialogue on Twitter

None of these

42%

20%

16%

16%

12%

11%

11%

10%

9%

6%

5%

4%

3%

3%

2%

2%

2%

1%

1%

0%

0%

0%

33%

Recent participation in online health-related activities

Page 46Q35: Which of the following online health-related activities have you participated in over the past few years?



COMMUNICATON METHODS

Page 47



Q36a: Which of the following communication methods have you used to communicate with your primary care physician?Note: Not sure/no PCP scores re-percentaged out

Phone call

In person

email

Going to a website

Through the mail

Through EMR

Using a smart phone online

Using an 'App' on a smart phone

Texting

Using online social media

Video chat (Skype)

71%

69%

10%

8%

2%

8%

3%

2%

2%

2%

1%

78%

66%

20%

14%

9%

7%

4%

2%

3%

2%

1%

80%

66%

15%

10%

11%

7%

3%

2%

1%

1%

1%

79%

68%

12%

4%

12%

1%

0%

2%

0%

Which methods do you use to communicate with your PCP?

2011201220132014

Page 48



Phone call

In person

Going to a website

Through the mail

email

Through EMR

Using a smart phone online

Texting

Using an 'App' on a smart phone

Using online social media

Video chat (Skype)

50%

38%

10%

5%

6%

5%

3%

1%

2%

1%

1%

57%

46%

12%

10%

8%

3%

2%

1%

1%

1%

1%

51%

41%

12%

13%

9%

4%

2%

1%

1%

1%

1%

54%

40%

11%

14%

6%

1%

1%

1%

0%

Which methods do you use to communicate with your hospital?

2011201220132014

Q36b: Which of the following communication methods have you used to communicate with your hospital? Page 49

Significantly higher level of ‘none of these/don’t have a hospital this year compared to last year (33% vs. 21%).



Page 50

Visited but haven't "Liked"

Visited and "Liked"

Have not visited

Not sure

3%

4%

90%

3%

3%

4%

90%

3%

Visiting/Liking health plan or hospital Facebook pages

Hospital Facebook page

Health Plan Facebook page

Q37: In the past year, have you visited and/or ‘Liked’ a health plan or hospital Facebook page?

2013

4%

3%

2%

3%

91%

91%

3%

3%

Facebook visitors are

almost entirely Millennials.



Page 51

Yes I have used a virtual doctor service; 2%

No I have not used a virtual doc-tor service, but am familiar with

them; 22%

No I have not used a virtual doctor service, and am not familiar with

them; 71%

Not sure; 5%

Ever had a virtual doctor visit?

Q38: Have you ever had a ‘virtual doctor visit’ where you talk with a physician face-to-face using a PC, tablet, or smart phone?

Opportunity or threat?



CHOOSING A HOSPITAL

Page 52



Physician

Health insurance website

Family/friend

Online search

Hospital's website

HealthGrades

Online patient support group

WebMD

Patient satisfaction ratings

Hospital advertising

Joint Commission

Consumer Reports

Social media sites

Consumer review sites (like Angie's List)

US News & World Report

Employer

Blogs about hospitals

CMS website

ANA Magnet Status

Hospital publications

Thomson Reuters Top 100

None of these

43%

14%

12%

6%

5%

4%

4%

4%

2%

1%

1%

1%

1%

1%

1%

0%

0%

0%

0%

0%

0%

38%

45%

24%

33%

15%

15%

9%

5%

10%

8%

2%

2%

9%

4%

4%

3%

11%

1%

5%

2%

6%

3%

23%

Hospital choice factors by hospital experience

Have not been to hospital (59%)

Been to hospital (41%)

Page 53

Q39: Have you personally been to a hospital for inpatient, outpatient, or ER care in the past 2 years?Q40: (Q39 Yes) Next, think back to when you were hospitalized and had to decide which hospital you should choose. Which of the following sources of information, if any, did you seek out to help you make that choice? (Q39 No) Next, if you had to be hospitalized and you wanted to gather information about which hospital you should choose, which of the following sources of information would you definitely use to help you make that choice?

Those who have not been to a hospital ‘think’ they would

investigate their hospital choice a great deal more than what actually

happens in a hospital choice scenario. The only real constant is

‘physician recommendation.’



Quality ranking organizations such as HealthGrades, US News

& World Report, Hospital Compare from the government

Consumer-driven quality rating organizations such as Angie’s

List, Yelp, Vitals, and other social media sites

Neither

Not sure

34%

16%

26%

24%

35%

15%

27%

23%

Most useful information for hospital decision

20132014

Q41: Now, if you were looking for information on hospital quality to compare different hospitals before you made a decision on which hospital to choose, which of the following sources of quality information, if either, would you more likely find useful in your decision-making? Page 54

Other Klein & Partners research has shown that consumers aren’t finding these sources useful yet because there are so few reviews for a particular

doctor or hospital. We are conducting further research

to find out how many reviews are needed for

source credibility.



WEBSITES VISITED

Page 55



Page 56

Q42: Have you been to a hospital website in the past 3 months?Q43: Think about the most recent hospital website that you visited. What were your main reasons for visiting this website?Q44: Overall, how well did this website meet your needs? Was this website visit…?

Excep-tional; 23%

Accept-able; 68%

Disap-pointing;

5%Not sure; 4%

Website met my needs

Schedule/cancel appt.

Get directions/contact info

Find info about particular health service

Find info on physician

View my test results

Pay/review bill

Apply for job/review job listings

Access hospital's patient portal

Look up info on specific condition

Learn more about the hospital

Look up info/sign up for class or event

Request medical records

Look up info on health and wellness

Connect to a service that provides patient updates

Pre-register for a test or procedure

Check ER wait times

31%

31%

24%

23%

20%

18%

14%

14%

13%

12%

10%

10%

9%

7%

6%

3%

Reasons for visiting websiteVisited a hospital website in the past 3 months: 11%



RETAIL CLINICS

Page 57



OTC medications

Shopping for food, beverages, cosmetics, etc.

Drop-off/pick up prescription

Medical products

Flu shot/other vaccinations

Urgent care visit

Primary care visit

Blood test

Other

Never shopped at this retailer

Retailer not in my area

Not sure

49%

41%

35%

23%

12%

4%

1%

1%

1%

15%

7%

9%

45%

56%

19%

22%

3%

1%

1%

1%

3%

16%

3%

8%

Retail healthcare services utilized

WalmartWalgreens

Page 58Q45: Next, we have a couple questions about getting healthcare services or products at a retail store. Have you been to a {RESTORE RETAILER} for any of the following?



Walgreens

Walmart

22%

12%

33%

23%

20%

20%

18%

35%

7%

10%

Comfortable going to retail clinic(among those who have shopped at that store before)

Very comfortable Fairly comfortable Not very comfortable Not comfortable at all Not sure

Page 59

Q46: If your doctor wasn’t available and you had a minor illness (e.g., cold, flu, stomach or ear ache, etc.) and you decided to find an urgent care center because you didn’t want to wait to see your doctor for care – how comfortable would you be in going to {RESTORE Q45 RETAILER} for this type of care compared to another type of urgent care facility?



ONLINE HEALTHCARE SHOPPING

Page 60



Page 61

Q47: In the past year have you purchased any healthcare-related products online? Q48: Why did you purchase these healthcare-related products online? Q49: What online site(s) did you purchase these healthcare-related products from?

Cheaper prices

Easy to purchase

Free shipping

Don't have to leave the house

Automated refills easier online

More selection

Lots of positive online reviews

My doctor recommended

Family/friend recommended

Faster than mail order

HCP (not doctor) recommended

Insurer requires it

56%

51%

47%

36%

25%

25%

10%

6%

4%

3%

3%

3%

Why purchased healthcare products online?

Amazon

CVS

Walgreens

Drugstore.com

Express Scripts

Walmart

Target

Other

Not sure

31%

20%

12%

12%

9%

7%

4%

25%

10%

Online sites purchased from

Purchased healthcare-related products online in

past year:

23%



PRICE SHOPPING

Page 62



Dental services

Lab services

Physician services

Outpatient surgery

Radiology

ER/Urgent care

GI procedure

Physical therapy

Inpatient surgery

Cardiac procedure

Other

30%

21%

37%

15%

15%

7%

2%

3%

4%

1%

18%

29%

20%

25%

15%

18%

5%

6%

9%

8%

2%

16%

26%

27%

36%

10%

31%

14%

7%

7%

7%

1%

20%

24%

31%

31%

15%

27%

10%

6%

10%

4%

0%

19%

35%

27%

35%

20%

21%

14%

9%

12%

9%

4%

8%

46%

43%

29%

25%

32%

12%

8%

10%

11%

3%

4%

48%

40%

33%

21%

18%

16%

10%

9%

5%

4%

3%

Health service price shopped

2008

2009

2010

2011

2012

2013

2014

2008 2009 2010 2011 2012 2013 2014

Households that have contacted a healthcare organization to ask the price for a specific visit, test, treatment, or surgery

33% 32% 32% 22% 28% 24% 16%

Chose the least expensive provider for one of these healthcare cases

36% 41% 31% 31% 33% 24% 44%

% of the total patient market 12% 13% 10% 7% 9% 6% 7%

Price check in aisle five!

Q50: Within the past year, did you or did a member of your immediate household contact any healthcare organization, hospitals, or physician offices to ask about the price for a specific visit, test, treatment, or surgery? IF YES…Q51: How did you check on pricing?Q52: What type of health service did you ask about pricing for?Q53: Did you end up choosing the least expensive provider?

Went online10%

Stopped in and spoke to someone

4%

Called86%

How did you check on pricing?

Called:2010/2011 71%

2012 72%2013 73%

Page 63



HEALTH INSURANCE AND GETTING CARE

Page 64



Page 65

Provided through work or union

Individual coverage from insurance company

Insurance through a state insurance exchange

Insurance through a federal insurance exchange

Insurance through a private exchange

Medicare (Part A or Parts A/B only)

Medicare (with a supplemental plan)

Medicaid

VA/CHAMPUS

No health insurance

Not sure

51%

5%

0%

2%

0%

6%

12%

6%

1%

10%

6%

48%

7%

2%

1%

1%

7%

13%

3%

2%

10%

6%

Current health insurance

20132014

Q54: What type of health insurance, if any, do you have currently?



1st Qtr 2009

4th Qtr 2009

4th Qtr 2011

4th Qtr 2012

4th Qtr 2013

4th Qtr 2014

20% 23%17% 17% 17% 15%

Had recent financial hardship due to medical bills

Q55: Have you experienced a significant financial hardship in the past year due to medical bills? Page 66

Especially among those <$45K HHI

(25%).



RURAL HEALTHCARE

Page 67



Primary physician care

Hospital care Outpatient care Urgent care-100%

-75%

-50%

-25%

0%

25%

50%

75%

100%

80% 80% 78%64%

-18% -18% -16%-31%-2% -2% -6%

-5%

Yes

No

Not sure

Adequate healthcare access in rural areas

Q56: Would you describe where you live as…?Q57:You checked that you live in a rural area. Do you feel there is adequate access to each of the following types of healthcare services close by where you live or not (i.e., without having to drive a far distance to another town or city)?

17% consider themselves to live in a rural community

Page 68



Primary physician care

Hospital care Outpatient care Urgent care-100%

-75%

-50%

-25%

0%

25%

50%

75%

100%

27% 25% 30% 21%

37%25% 20%

17%

-17%-27% -27% -35%

-12%-14% -15%

-19%-8%

-9% -7%

-9%

Excellent

Very good

Good

Fair

Poor

Adequate healthcare access in rural areas

Q56: Would you describe where you live as…?Q58: And how would you rate the quality of medical care provided by each of these healthcare services?

17% consider themselves to live in a rural community

Page 69



APPENDIX

Page 70



Demographic profile TotalFemale 54%

Children in HH 23%

EthnicityCaucasian

HispanicAfrican American

AsianOther/refused

62%171272

Age18-4445-64

65+Median age

46%3618

47

Median household income $54,600

Education LevelUp to high school

Some collegeCollege grad (undergrad)

Graduate degree

15%561811

Generally think of yourself as…Strongly Republican

Moderately RepublicanIndependent, lean Republican

IndependentIndependent, lean Democrat

Moderately DemocratStrongly Democrat

OtherNot sure

9%1310181413130

10

Page 71

32%

40%


k l e i n & p a r t n e r sAdditional information

If you would like additional information regarding this study, please contact:

Rob Klein

President

Klein & Partners

[630] 455-1773

[email protected]

Page 72

mailto:[email protected]

Documents

▪ research for your brand’s health klein & partners Another Kitchen Sink Survey from Klein & Partners: What consumers think about a plethora of healthcare