The ratings culture in the US has exploded in the last decade with consumers turning to reviews for dining, shopping, vacationing, and even home improvements. Now, as they spend more of their own money on health and wellness, consumers are beginning to search for rating systems to guide their decision making. Suddenly consumers want to see stars, grades, and scores on their doctors, hospitals, and insurance companies.
At the same time, healthcare companies jockeying for an edge in this era of value are looking more comprehensively at the customer experience. Insurers that serve Medicare beneficiaries, for example, stand to gain more than $5 billion in bonus payments linked directly to patient feedback before 2014. Reimbursement for hospitals is shifting as well.
There's no shortage of health-related ratings vying for consumer attention, from commercial forums such as Yelp, Vitals, and Healthgrades to government-sponsored databases. But industry executives note that word of mouth still trumps reviews and ratings. No single trusted source has emerged in the health industry, creating an enormous market opportunity. Organizations such as the California Health Care Foundation and the Leapfrog Group are attempting to close the gap with more user-friendly data sites. Big-box retailers are beginning to apply their consumer expertise to better market health-related products and services.
PwC's Health Research Institute (HRI) surveyed 1,000 consumers in late 2012 to assess the state of healthcare ratings. While nearly half (48%) of consumers said they have read health-related reviews, only one-third has used reviews to make decisions on where to get care. The single largest source for information was Consumer Reports, identified by 43% of respondents who have read reviews.
Health industry leaders view ratings as a starting point for a longer journey that connects consumer experience to quality. Through internal surveys and observations, healthcare companies found that consumers care the most about topics such as the physician-patient relationship, understanding what to do after a clinic or hospital visit, and how to obtain more helpful service from their health plan. Over the long term, proponents hope greater customer engagement will translate into smarter care choices, healthier behaviors, and reduced costs.
Companies that translate consumer feedback into improved quality and a better overall experience stand to reap the rewards of their efforts. Some strategies for tapping the power of customer ratings:
The ratings culture in the US has exploded in the last decade with consumers turning to reviews for dining, shopping, vacationing, and even home improvements. Now, as they spend more of their own money on health and wellness, consumers are beginning to search for rating systems to guide their decision making. A single trusted source of reviews and ratings has yet to emerge in the health industry, but these measures are prompting healthcare companies to focus on experience that goes beyond satisfaction. Scoring healthcare continues the discussion from the first report in the customer experience series. Read the case studies on Consumer Reports, Room Key, and Mayo Clinic on this page.
Consumer Reports and healthcare: Not just washing machines anymore
Consumer Reports, well known for its expert ratings and reviews on cars, electronics, and other consumer products, has emerged as the most popular source of health ratings according to HRI’s 2012 consumer survey. The Health Ratings Center, formed in 2008, has published ratings on drugs, hospitals, health insurance, doctors, and diseases and preventive services. The popular consumer products organization moved into healthcare to “level the playing field” for everyday citizens who are inundated with ads and promotions, rather than facts, said John Santa, MD, director of the center.
A team of 10 people scours databases maintained by the government, industry groups, and independent societies. The company published its first top 50 rated US heart-bypass surgical groups in 2010. Two years later, Consumer Reports partnered with the Robert Wood Johnson Foundation and coalitions in Massachusetts, Minnesota, and Wisconsin to publish ratings of medical group practices. The ratings vary by state and include measures such as patient experience (Massachusetts), quality of care (Minnesota), and preventive care services (Wisconsin).
The ratings in the three states were read by 80% of people who subscribed to the magazine and have changed behaviors in the right direction in terms of improving quality, according to Santa. “Those products did very well on the newsstand,” he said. “Our readers gave those inserts very high scores and suggested that they would do something about it.” For example, in Massachusetts 26% of readers said that they were going to talk to their doctor about the ratings. In Minnesota, 18% of readers said they would discuss the ratings with their doctor, and 55% said they would share the information with family and friends.
Six to seven percent of Consumer Reports readers surveyed said they had plans to change hospitals after reading its recent hospital safety ratings story. Santa cites the importance of presenting information in a way that resonates with average readers. “It’s about looking at the right audience with the right approach and delivering it in the right way,” he said.
Consumer Reports also conducts focus groups on many of its presentations and uses the same symbols, conventions, and ratings table “look” that readers recognize. The one exception is the heart bypass surgeon ratings, which uses The Society of Thoracic Surgeons’ stars instead of Consumer Reports’ symbols at the request of the society. In that case, the company has provided education to help consumers differentiate between the stars and symbols.
Change won’t come quickly, Santa acknowledged. Even though consumers surveyed by HRI identified Consumer Reports as a source for health ratings, “It takes a while to create awareness even when you have a brand like we have,” he said.
Nevertheless, the goal is to fundamentally change market behavior, Santa said. “Otherwise the health industry will continue to be unsafe, unaffordable, and collapse of its own incompetence.”
A lesson on reviews from Room Key
Healthcare isn’t travel, but the consumer is the same person whether searching for a hotel room or picking a hospital. While healthcare decisions are clearly more critical than planning a vacation, there are lessons from the hotel search site Room Key that healthcare companies can learn from.
Founded in January 2012 by six major hotel chains, Room Key’s goal is to improve the search and booking experience. To do that, the company looked at what’s important to users. “Reviews have become integral and mainstream in the decision process,” said Stephany Verstraete, chief marketing officer of Room Key. “They are among the top three most important criteria to influence where consumers stay.”
When Room Key built its website, it recognized the value of a trusted source of referral and offering timely validated reviews. Although Room Key officials did not reveal how the company has fared, they offered these tips:
Credible sources drive awareness. When travelers search for hotels on any of the six hotel chain partner sites, the Room Key site pops up below the main web page. An important feature of Room Key is the blending of reviews and ratings from TripAdvisor®, which Verstraete credits as “one of the first stand-alone businesses of travel reviews that is trusted by consumers and has become the biggest in brand awareness.”
Data from HRI’s past research suggests consumers trust their physicians, hospitals, and people who are experiencing similar health issues. Healthcare should pair this knowledge with demographic differences on where people go for reviews (e.g. government vs. social media) to find the most effective communication path to consumers.
Reviews are the tie-breaker. Cost and location are often the top measures to narrow a set of hotel options. Once travelers establish a shortlist, shortlist, reviews and consumer feedback become an important—often decisive—ingredient. “Depending on a given traveler’s preferences, consumer reviews and feedback can be useful for that quick sanity check or for when the stakes are high,” said Verstraete.
As state exchanges open up competition among health plans, reviews by individuals who have purchased a particular plan and visited certain providers may tip the scales for future purchasers.
Consumers want validated reviews. Typically there are two types of reviews—general and validated—for making travel decisions. Validated reviews from actual travelers are considered higher quality, according to Verstraete. “Many hotel companies have recognized this and are incorporating reviews into the booking experience to help travelers make informed decisions without leaving their website,” said Verstraete.
Knowing that the reviews are validated by real patients and health plan members could help increase usage, based on Room Key’s experience. Health insurers are starting to build reviews by members and state exchanges will be required to report on quality and experience feedback starting in 2016.
Timeliness of reviews is critical. The travel industry has built up validated reviews by sending out emails to travelers within 24 hours of a stay. “Reviews have to be easy and convenient, and the more that you can make it part of the experience or very quickly after the experience, the more likely people will do it,” explained Verstraete. “The drop off after that is critical.”
Most providers send out feedback forms via mail 2–4 weeks after a visit, but some hospitals have started getting more real time feedback (e.g. through in-room TV monitors or in-person conversations) so they can talk to patients and their family members. This approach helps address issues immediately and may foster deeper relationships with consumers.
Mayo Clinic activates clinicians in the patient experience
Through the use of patient surveys, Minnesota-based Mayo Clinic monitors patient satisfaction data across all of its caregivers. “Achieving excellence across the spectrum of the overall patient experience is a key institutional priority, and will be of great importance as we continue to strive to deliver the highest level of care,” said Robert Brown, MD, chair of the Mayo Clinic Neurology Department and head of the clinic’s marketing council. “We are focusing on how we can foster an optimal patient experience both when the patient is here on site, and over the long-term, even after they are done with their direct care at a Mayo Clinic site.”
The survey includes eleven questions that address provider-specific issues and many others that measure patient satisfaction regarding their overall experience, including:
Patient satisfaction scores are provided regularly to all of Mayo’s physicians and mid-level providers so that they are aware of areas for improvement such as clarity of communication and empathy. “We want to hone in on the reasons why people aren’t rating us at the very highest levels in any aspect of their provider interaction and overall experience,” said Brown. “We strive for the absolute top score.”
Actions are prioritized into high impact areas such as patient-physician interaction, nurse-physician interaction, and helping patients understand the next steps in their care after their visit.
A few years ago, the neurology department found that the outpatient practice was scoring low on clarity of communication at discharge. To improve patients’ satisfaction in this area—and presumably patient health post-discharge—the department developed a comprehensive “check-out process.” This starts with an end-of-visit meeting with a clinical assistant or nurse to review a care plan. Specific instructions are written in a booklet, which complements the letter they receive in the mail a few days later. Since implementing the check-out process, patient satisfaction scores have markedly improved, according to Brown.