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

1. Another Kitchen Sink Survey from Klein & Partners:What consumers think about a plethora of healthcare topics… Presented by: Rob Klein, President Klein & Partners 4th Quarter, 2013 Disclaimer: Please feel free to use these charts in any of your presentations; just cite Klein & Partners as the source of the information.

2. Introduction

3. Introduction 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 401heads of household, 21 or older who are most responsible for healthcare decisions for the household. The interviewing was conducted from November 15-26, 2013. 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 401 yields a sample error of +/-4% 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 46% and 54%. • Significant differences are called out in the charts. Colors and bolding are used to highlight interesting patterns and/or findings.

4. So what did we learn?

5. Reactions to health reform

6. Q1: What do you think will get better or worse for you personally under healthcare reform?

7. Significantly fewer 21-44 year olds are confident! Q2: How confident do you feel in understanding what your health insurance options are under health reform?

8. Remember this was asked in mid-November of last year. Goes up significantly with age: 82% among those 65+ Q3: Now that the health insurance exchanges are up and running have you gone online or called to check out what your health plan options are through these exchanges?

9. 63% Q4: If you were offered a financial incentive to change a certain aspect of your lifestyle (e.g., stop smoking, lose weight, exercise, etc.), how likely would you be to change that behavior or lifestyle? Q5: And which of the following incentives would you be most interested in receiving for your healthy lifestyle choices? Assume each of these options would have a similar financial ‘value’.

10. Who sponsors the program? Employer – 42% Health plan – 33% Fitness club – 14% Hospital – 7% Where most likely sign up for program? Fitness club – 33% Health plan – 18% Employer – 10% Doctor – 8% Hospital – 2% Not interested (mostly seniors) – 15% Not sure – 14% Q6: Do you currently participate in a structured wellness program (i.e., a program provided by an employer, hospital, insurer, gym, etc.)? Q7a: Who is sponsoring this structured wellness program? Q7b:From which of the following would you most likely sign-up for a structured wellness program if they offered it?

11.  More likely in the South  More likely 21-44 year olds  More likely seniors Q8: When you think about your personal health and wellness, what would motivate you most to buy and act healthy?

12.  Especially women  Especially those 45-64  Especially higher socio-economic status  Especially seniors Q9: How often during the week do you take a 20-30 minute walk? Q9a: What keeps you from walking 20-30 minutes every day?

13. Especially those 21-44, college educated, and Hispanics Q10: If your employer offered all employees a wellness program that was structured and provided incentives for healthy choices, what would your initial reaction be?

14. Especially those 21-44 and college educated Especially those 21-44, <$45k income, and Hispanics Q11: Are you familiar with what a ‘charityathon’ is at a workplace? Q12:How likely would you be to participate in one of these charityathons through your employer?

15. Q13: Next how well do each of the following statements describe your employer? *Note: Among the 78% reportedly working outside the home.

16. Tax exempt status

17. Support of tax-exemption OpposeNot sure Support Q14a: Do you support or oppose the idea of hospitals being tax-exempt organizations? Q14b: Do you support or oppose hospitals being exempt from paying state and local taxes? Note: Question worded slightly differently and half sampled to determine if adults would react differently

18. Charging hospitals property and sales tax Bad idea Not sure Good idea Q15a/b: Many local communities and states are looking for ways to increase revenue to meet rising demands for services/to close budget gaps. 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?

19. Support tends to come more from seniors and those without college educations Q16: Do you think (your local) hospitals give away enough of these free services to earn that tax-exempt status? Q17: Do you think (your local) hospitals have enough uncollected bills which they write-off to earn that tax-exempt status?

20. Views on hospitals The classic ‘Catch-22’ Strongly disagree Somewhat disagree Not sure Somewhat agree Strongly agree Q18: Do you agree or disagree with the following statements?

21. Primary care physician

22. Primary care physician Nearly unchanged from past waves, more than eight in ten (82%)adults have a primary care physician. But it’s only 69% among those under 45. • Going online to rate a doctor or hospital has doubled in the past few years: • 6% in 2009 • 9% in 2011 • 14% in 2012 • 12% in 2013(especially 21-44, <$45k income) ZAGAT Primary Care Doctor Q19: Do you have a primary care or personal physician? Q20: Have you ever gone online to a social networking site and shared your experiences about a doctor or a hospital you recently visited?

23.  Not as much among 21-44  Especially among 21-44  Especially among 21-44  Especially among 21-44 21-44 year olds are feeling most disengaged with their PCP.  Especially among 21-44 Q21: For each of the following statements about your doctor’s office please check how much you agree or disagree.

24. Waiting in the doctor’s office – ’30 minutes and I’m gone’ 30% have left the doctor’s office because the wait was too long 29 minutes and they left 28 minutes and would leave 16 minutes Average wait time 21 minutes Maximum acceptable wait time (average) People will wait longer than they say Q22: On average, how long would you say you typically wait to see the doctor from the time you arrive t the doctor’s office for an appointment? Q23: And what is your maximum acceptable wait time to see the doctor once you arrive at the doctor’s office? Q24: Have you ever left a doctor’s appointment because the wait was getting too long and you couldn’t wait any longer? Q25: And how long did you wait before you left? Q26: How long would the wait have to be before you would leave and reschedule your appointment?

25. Familiarity goes up significantly with age. Q27: Have you heard of a ‘concierge medical practice’ where you pay a primary care doctor an annual fee (typically $3,000-$5,000) and then you have priority access to that doctor in person, via email, or on the phone whenever you need any type of care and there is no additional cost to you?

26. Airlines do it… hotels do it… why can’t doctors’ offices do it? Reactions to credit card/Hsa debit card number request

27. Providing credit card or HSA debit number to doctor’s office What reservations do you have? “Anyone could put any charge on the card. Just not fair.” “I am not sure what charges would be put on there, risk of mistakes.” “Do not like giving info by phone.” “Care should be covered by health insurance.” “I don’t trust them.” “Don't want to have to deal with identity theft.” “Do not want my personal credit card information out there.” “Don't like giving personal info over the phone.” “I feel uncomfortable with it, because they can steal my information.” “Prefer to pay when I’m done.” “Would not like to give up my personal freedom over an act that seems like a convenience for them.” “If something comes up and I am unable to make the appointment will they deduct.” “It is new and doesn't feel comfortable.” 21-44 year olds are much more trusting How would this make you feel about your doctor? “Uncomfortable.” “Leery, insulted.” “No different.” “I would change doctors.” “I would feel they were only worried about money.” “It’s smart business these days.” “I would think they don't trust me.” “I'd have a low opinion of him.” “I'm not sure. Doesn't seem like that big of a deal though.” “It would make me feel like just a 'number' - not a patient the doctor should care about.” “It would not change how I feel about my Dr. but it would change how I feel about the medical organization.” Q28:How would you feel if when you called to make an appointment at your doctor’s office that they asked for your credit card or your HSA debit card number (like when you make a hotel or airline reservation)? Q29: What reservations do you have about giving your credit card or HSA debit card information to your physician’s office when you call to make an appointment? Q30: If your physician’s office asked you for your credit card or HSA debit card information at the time of appointment, how would this make you feel about your doctor?

28. Trusting your doctor’s office with credit card/HSA debit card information Because this is what is getting stolen! Don’t trust at all Don’t have card Not sure Somewhat trust Completely trust Q31: Do you trust your physician’s office with your credit card information? How about your HSA debit card information?

29. W A I T ! Q32: If your doctor’s office asked for a credit card or HSA debit card number on the phone at the time of you making your appointment but also offered to let you pay for your co-pay by cash, check, or credit card/HSA debit card at the time of the visit, what do you think you would most likely do?

30. ‘Can you hear me now?’ Smart phones

31. Any of these uses is significantly higher among 21-44 year olds. Q33: Have you used a smart phone or any phone that can access the internet to go online and do any of the following…?

32. EMR is now an expectation not a cool differentiator. Any of these uses is significantly higher among 21-44 year olds. Q34: If a health plan you were part of offered a mobile app for your smart phone, which of the following features, if any, would you MOST LIKELY USE? (Asked of those who have a smart phone)

33. Communicaton methods

34. Q35a: Which of the following communication methods have you used to communicate with your primary care physician?

35. Q35b: Which of the following communication methods have you used to communicate with your hospital?

36. Q35c: Which of the following communication methods have you used to communicate with your health insurance company?

37. How much are we spending on having a Facebook page? Facebook visitors are almost entirely 21-44 year olds Q36: In the past year, have you visited and/or ‘Liked’ a health plan or hospital Facebook page?

38. Interest in new information sources

39. Those 21-44 are more interested in articles on: lifestyle advice, women’s health, healthcare reform and how it will impact their family, and emotional issues. Women are more interested in: articles on women’s health, articles personalized to your own health status, clinical information about specific health conditions, and articles on emotional issues. Q37: Which of the following healthcare topics would you be very interested in learning about?

40. Readership is tied strongly to college education and age (i.e., higher among 21-44 year olds). Q40: Have you purchased the US News & World Report ‘Best Hospitals’ publication that came out recently?

41. Q39: 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?

42. Choosing a health plan

43. W-O-M, the insurer’s website, employers, and physicians are the primary sources of health plan decision-making information. But when you add all forms of ‘online search’ that becomes the largest combined source of health plan information. Q38a-c: And if you were choosing a health plan and you wanted to gather information about which health plan you should choose, which of the following sources of information:

44. What can we learn from other industry brands? Searching out the best service

45. Q41: If {hospitals/health plans} could learn about customer service from companies in other industries, which of the following well-known brands do you feel {hospitals/health plans} could learn the most from in terms of how they treat their customers?

46. What hospitals/health plans can learn from brands – selected verbatims Ritz Carlton • “Because they do their best to get the job done with as little trouble as possible to the customer. The Ritz is an excellent example of what true customer service should be.” • “THEY COULD TREAT PEOPLE WITH MORE RESPECT AND UNDERSTAND THAT WE ARE PAYING A LOT OF MONEY FOR HEALTH CARE EVEN WHEN WE DONT USE IT AS MUCH AS WE PAY FOR IT AND NO ONE WANTS AN ATTITUDE WHEN THE INSURANCE COMPANY MESSES UP YOUR INFORMATION AND YOU HAVE TO SPEND HOURS TRYING TO FIX IT.” Apple Stores • “In person you are always greeted promptly. They offer online scheduling for help. All their associates are friendly and knowledgeable. They can communicate in layman's terms. Generally you get the impression that they want to help.” • “Keep it simple. Make use of your information intuitive, approachable to the lay customer, personalized and responsive to my needs. Apple Stores characterizes all of these things to me.” Nordstrom • “Focus is on experience and belief in their service and products and they stand by them both.” • “The customer is treated with respect and they value the customers’ business. The customer is always right attitude.” AT&T • “It's a family oriented environment...you have to market what you have... Health plans need to be flexible to allow choices... just like a rate plan with AT&T.” Home Depot • “At our Home Depot we are asked immediately what we need help with. Then we are shown exactly where to find what we need. If we are not sure what we need we can explain what we are trying to do then advice is given how we can do it.” • “Knowledgeable staff, ready and willing to help.” Disney • “They seem to always treat their customers with respect & kindness.” • “They bend over back wards for their customers to get the best experience.” • “Everything is clean. Very customer focused. Wants everyone to leave happy.” • “Honesty, consistency, use of plain language, no government involvement.” Amazon • “Always responsive and helpful without long delays. Always have customer service as a priority and good communication.” • “Amazon does a good job of communicating with it's customers and they follow-up with allowing customers to post reviews about their experience(s).” • “Organized and easy access to your info.” • “They are direct and straight shooters with a rating system afterwards.” Southwest • “Are very consumer oriented even when it impacts their bottom line negatively.” • “How to provide consistent quality service at a cheap price.” • “Excellent customer service!” • “Southwest usually goes the extra mile for it's customer service.” Walgreens • “I like being able to speak directly with a pharmacist & also open 24 hours if you need medication.” • “They are very friendly and knowledgeable.” • “At Walgreens I had an issue about purchasing some antibiotics . And the pharmacist actually took time to call the doctor for a different drug that works the same but it was a whole lot cheaper than the doctor prescribed me.” Q41a: What do you think {hospitals/health plans} could learn from {RESTORE Q41 RESPONSE} regarding how they treat customers?

47. Current vs. preferred relationship with health insurance company People want a relationship not a transaction. Q42a: When you think of your current relationship with your health insurance company, check one of the relationship styles below that best describes your current relationship, good or bad, with your health insurer. Q42b: Next, check one of the relationship styles below that best describes how you wish your relationship was with your health insurance company (i.e., your Preferred Relationship).

48. Price shopping

49. Price check in aisle five! Called: 2010/2011 71% 2012 72% Q43: 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… Q44: How did you check on pricing? Q45: What type of health service did you ask about pricing for? Q46: Did you end up choosing the least expensive provider?

50. Health insurance and getting care