What, precisely, is the practical relationship between perceptions of quality and perceptions of price or convenience, on the part of healthcare consumers? And to what extent does the presentation of data influence healthcare consumer perceptions? Those were questions that researchers at Grand Rounds, a San Francisco-based healthcare technology company that helps employees identify and access quality physicians, wanted to explore, as they executed a consumer survey earlier this fall, the results of which they released on November 2. In fact, what the Grand Rounds researchers found was that survey respondents who typically prioritize appointment availability were four times more likely to sacrifice availability in favor of clinical expertise when presented with information in physician profiles in provider listings that were contextualized rather than simplistic.
In announcing the results of the survey on Nov. 2, Nate Freese, Grand Rounds’ senior director of data strategy, said, “This survey shows that if presented with contextualized information about a physician, people will choose a more qualified physician over one that is more convenient, in a significant way. Further,” Freese added, “based on our findings, traditional metrics like patient ratings, prescribing rates, and volume of patients seen were not nearly as compelling to respondents as more qualitative, contextualized statements about a doctor’s clinical expertise. Understanding how people choose their doctors is critical to our mission of matching people with high-quality providers for their needs,” continued Freese. “If consumers are willing to sacrifice convenience for the sake of quality, there is an opportunity to help them understand when it may be worth traveling further or waiting longer to get the best possible care.”
In the survey, conducted online and via email during September, 1,100 Grand Rounds covered members were broken into two cohorts: one that reviewed traditional physician profiles and one that viewed novel, more contextualized profiles. The version of profiles seen had a profound impact on people who said they typically choose doctors based on appointment availability or travel convenience. Of people who said they typically prioritize availability, only 14 percent made their physician choice based on clinical expertise if they saw the traditional profiles. In contrast, 69 percent of these same people made their choice based on clinical expertise if they saw the contextualized profiles. In fact, the switch to contextualized profiles made these respondents almost as likely to prioritize expertise as respondents who, when initially asked what matters to them when looking for a doctor, cited strong credentials/training.
One example of the different types of listings was provided in the blog that Freese wrote about the survey results. In that blog, he gave contrasting examples of “traditional profiles,” versus “profiles in context.” The sets of profiles involved the fictional “Dr. Williams” and “Dr. Harris.” In the traditional profiles, Dr. Williams was described as being 10 minutes, or 5 miles, away from the consumer, while Dr. Harris was 20 minutes, or 12 miles away. Under the “clinical expertise” category, Dr. Williams’ profile read, “Headache patients: Dr. Williams sees more headache patients than 60 percent of other similar doctors. Opioid prescribing: Dr. Williams writes 15 opioid prescriptions per 100 patients seen. Meanwhile, for Dr. Harris, the clinical expertise description read thus: “Headache patients: Dr. Harris sees more headache patients than 80 percent of other similar doctors. Opioid prescribing: Dr. Harris writes 5 opioid prescriptions per 100 patients seen.”
Meanwhile, the “profiles in context” read very differently. For Dr. Williams, the “clinical expertise” description read thus: “Low expertise: Dr. Williams sees headache patients regularly. However, she frequently prescribes medications that can actually make symptoms worse.” For Dr. Harris, it read, “High expertise: Dr. Harris sees headache patients regularly and uses treatments that are known to be the most effective at treating headache symptoms.”
Following the release of the survey results, Freese spoke with Healthcare Informatics Editor-in-Chief Mark Hagland regarding those results, and their implications for healthcare leaders. Below are excerpts from that interview.
To begin with, could you explain a bit more about Grand Rounds and what your organization does, to our audience?
Yes. Grand Rounds uses data to connect patients to highly qualified doctors. Using data to match that member to a doctor who specializes in care for that particular type of patient. We’re all about helping patients to find the highest-quality doctor for them.
So your firm acts as a service provider to employers?
Yes, we’re a benefit to employees. We help to support employees/plan members who have questions about their healthcare benefits.
Can you comment on the differences between the contextualized and the traditional profiles?
Yes, It’s obviously a subjective term. But the traditional approach was simply to provide objective numbers and ratings. Where a rating fits. Contextualizing means taking a more qualitative stance. Rather than just volume of patients seen, adding in whether that is a valuable metric or not. And rather than just showing a prescribing rate, instead of just prescribing rate, also other data.
So let’s take an example from the survey itself. A traditional approach to the prescribing of opioids would be the rate per 100 patients of a doctor’s prescribing opioids. The patient’s question there is, so what? So, what we did was saying that prescribing above a certain threshold, we said, this doctor prescribes above the norm. For your reference, in the blogpost, we have profiles displayed.
And, as you and your colleagues found, in shifting to providing contextualizing profiles of the physicians, the percentage of consumers who are willing to sacrifice convenience for a perceived clinician quality differential goes from 10 percent to 69 percent. What does that say?
That percentage change is related to the patients who had said that appointment availability mattered more than quality. The traditional narrative would be that patients optimize for convenience, not quality. But this shows that even those patients who optimize for convenience, will go for quality, if there’s a substantial payoff for quality; but traditional metrics have not been able to elicit those responses.
The emergence of the empowered healthcare consumer has been heralded for quite some time now. I wrote a cover story 20 years ago saying the empowered healthcare consumer was right around the corner. Will it happen now?
Yes, I think that there’s a huge shift about to occur, but it won’t occur overnight. Simply getting people to look for information is the biggest challenge. What we found here is that when patients see the information, they will react to it. Now, we regularly survey consumers; and they’re consistently looking for consumer reviews.
One fascinating aspect of all of this is that many outcomes measures have been published publicly for a number of years now, for example, hospital outcomes posted on state hospital association websites. But until recently, consumer behavior doesn’t seem to have moved significantly because of that. But is it your sense that these kinds of information might now make that difference?
That’s right; take that example of hospital ratings. The healthcare system naturally gravitates towards hospital ratings, given that hospitals are large institutions. From the researchers’ perspective, it’s easier to manage data on hospitals, because the databases are bigger, and easier to work with. But patients want to know about their own providers—the specific OB they would use, for example. And so it’s not that patients aren’t willing to travel for quality; it’s just that those hospital-level metrics don’t resonate with them.
What needs to happen to activate healthcare consumers, in this context?
At the simplest level, we need to provide consumers with metrics that will resonate with them.
What needs to happen in the industry next, in terms of motivating healthcare consumers?
I think the biggest difference in the situation now is the movement towards value-based care, which is about incentivizing the provider side of the industry to do the right thing. Here, we’re talking about… consumers aren’t incentivized on their own to see the providers who provide the highest-quality care. You’re really talking about the element of behavioral change, or meeting patients where they are. I look at where patients naturally go to find doctors. It’s, ask a friend; or go to your company’s website, and there’s a doctor-finder. And there’s a huge opportunity to change the information that’s offered at that doctor-finder website. That’s the biggest thing that will lead to consumer change.
What should healthcare IT leaders be thinking now, as they consider these evolving changes in consumer-facing data and information?
First, there’s the message that people are willing to sacrifice convenience for quality. That’s a controversial assertion. To the extent people are, that’s an opportunity to really guide them towards high quality. I think the biggest thing that will be difficult for your audience, and really for everyone, is that moving towards more qualitative and subjective statements, in a public domain, isn’t going to be easy. It’s totally defensible to put up objective numbers. Saying that these prescribing actions might not be in the patients’ best interest, might be challenged. You have to be cautious; on the other hand, there’s a huge opportunity cost to simply sticking with the status quo.