Right Place, Right Time

Executive Summary

When and where do consumers seek out health care information?

What special barriers do vulnerable consumers face seeking health care information?

How can health care information be made more accessible and useful?

Consumers have an increasing responsibility for understanding their own health care, but health care information is often complex and difficult to understand. The Right Place, Right Time project investigates how vulnerable consumers search for and use health care information, and how that information can be made more useful and accessible. This report focuses on the needs of lower-income consumers, Medicaid beneficiaries, the uninsured, caregivers, and Spanish speakers, and how health care information can be delivered at the right place and right time to maximize consumer value. A complementary report* explores similar issues from the perspectives of payers, providers, and other health care marketplace organizations.

Our survey results find that most consumers seek health care information from providers, friends and family, and online searches. Of all information types, consumers are most dissatisfied with health care cost information. This is especially true for lower-income and uninsured consumers. Consumers believe online booking, easy comparisons of procedures and facilities, and plain language explanations would be especially useful improvements to their health care experiences. Consumers’ views on health care information differ significantly based on income level, insurance status, and caregiver status; these differences can guide future decision-making on how best to provide vulnerable consumers with the information that they need. This report includes detailed results by consumer demographic group and by different patient decisions, such as how consumers seek information when deciding if care is needed, or when deciding where to seek care, choosing a doctor, or using online resources.

Methodology

Altarum conducted this research with support from the Robert Wood Johnson Foundation and Oliver Wyman. Altarum conducted interviews and focus groups with 65 consumers and a nationally representative mail and web survey of 4,068 consumers, fielded in June through August, 2016. Results are weighted to be nationally representative based on US census demographic characteristics. Detailed methodology, including specific survey questions, responses, and definitions, is available at the end of this report.

Summary of Results

Key Findings

Key Finding 1: Consumers demand cost information and mobile-friendly websites

• About 50% of consumers are not satisfied with the availability of health care cost information. Lower-income consumers are significantly more dissatisfied than middle-income consumers.
• 94% of consumers under the age of 40 use their mobile phones for internet access most days or every day, and for many, mobile phones are their primary source of internet access. Consumers report that mobile-friendly websites are more accessible than mobile apps.
• Across all health care information types (e.g. cost, quality, treatment information), frequently consulted sources include asking providers, searching online, visiting specific health websites, and asking friends and family.
• Lower-income patients are less likely to consult all types of health information.

Key Finding 2: Consumers prioritize improvements to information about cost of care, accessibility, and comparisons

• Consumers’ top priorities for improving their health care experiences overall are having the ability to easily see costs before a visit, and having more doctors covered by their insurance.
• The uninsured especially prioritize seeing costs before a visit (71%), while Medicaid beneficiaries and Spanish speakers prioritize more doctors being accepted by their insurance (64%) and (59%).
• Consumers report that services they would find especially useful are easy online booking; easy comparisons of procedures and facilities, including price and quality; and plain language explanations.

Key Finding 3: Caregivers use the most health care information but struggle to find resources to help themselves

• Caregivers, especially of children with complex medical needs, are superusers of health care information tools. They rely on information resources at double to triple the rate of non-caregivers.
• Caregivers feel overburdened and stressed; 16% of caregivers of adults rate their stress as “10 out of 10” while 24% of caregivers of children with complex medical needs rate their stress as “10 out of 10.” This is double and triple the rate for non-caregivers, respectively.
• Lower-income caregivers find information about caregiver resources much more difficult to access than middle-income caregivers. Information on financial support is 67% more difficult to find for lower-income caregivers.

Key Finding 4: The uninsured report greater difficulty accessing health care information

• The uninsured are the least satisfied (70% dissatisfied) with cost of care information.
• The uninsured are less likely to search for all types of health information, including general information on managing health.
• The uninsured’s top sources of information on insurance are friends and family, followed by healthcare.gov.

Key Finding 5: Spanish speakers struggle with language barriers, and rely on friends and family to offer advice and remedies

• Language, education, and culture can be barriers to receiving medical care. Spanish speakers may be new to American health care concepts as well as the English language.
• Feelings of shame may prevent some Spanish speakers from requesting Spanish language resources. Making Spanish language information available without requiring a request can make information more accessible.
• For Spanish speakers, friends and family are especially important sources of health care information, and are considered to be as accurate as medical websites like WebMD or Mayo Clinic. Spanish speakers are twice as likely to believe in the accuracy of friends and family (42%) as English speakers (22%).
• Spanish speakers often have relatively high trust in health care information, including information from doctors, insurers, friends and family, employers, documentaries, social media, and may be more receptive to health information through advertisements, social media, or television. Trust in accuracy for Spanish speakers is often twice as high as for English speakers.

Key Finding 6: Patients who feel disrespected by providers are less likely to trust health care information or follow medical advice

• Many consumers feel disrespected by providers, especially the uninsured (32% feel disrespected), those who are in poorer health (22% feel disrespected), and those with lower incomes (18% feel disrespected).
• 35% of lower-income consumers who are in poorer health with private insurance feel disrespected by providers.
• Consumers who feel disrespected by providers are three times more likely to not believe doctors are accurate sources of information than consumers who do feel respected.
• Consumers who feel disrespected by providers are twice as likely to not be adherent to their medication protocols. Diabetics who do not feel respected are one third more likely to have poorly controlled diabetes than diabetics who do feel respected by providers.

Consumer Decisions

• When deciding whether to seek care, consumers most commonly seek information from the internet. When deciding where to seek care, friends and family are the most commonly used source of information.
• When choosing between urgent care clinics, consumers place little value on information compared to when they are choosing between primary care physicians, retail clinics, telemedicine services, or emergency departments. Consumers may not view urgent care clinics as being meaningfully different from each other.
• Across all health care visit types, consumers value cost information the most when researching retail clinics. Additionally, when seeking information about retail clinics, consumers place little value on insurance acceptance. This suggests consumers may see retail clinics as more of an economic transaction than other care types.
• When deciding where to seek care, lower-income consumers are especially likely to value cost information. Middle-income consumers place more value on quality information.

Choosing a doctor

• Referrals from friends, family, and providers are the most important sources of information when choosing a new doctor, followed by online patient reviews.
• Consumers are more likely to value patient reviews of providers rather than reviews of facilities.
• Lower-income consumers are more likely to find reviews unintentionally while searching for other information on the internet. Middle-income consumers are more likely to intentionally search for patient reviews.
• While only 42% of consumers overall say they have used online patient reviews of doctors, of those that did, 83% say it influenced their choice of doctor. This suggests reviews will become more influential as more consumers use them.
• More than half of middle-income patients under the age of 50 use online reviews to choose doctors.
•  When choosing a doctor, consumers consider provider respect and shared decision making to be just as important as a doctor’s professional skill, but say information on respect and shared decision making is especially difficult to find.

Implications

Financial transparency is a top patient priority

• Consumers consistently rank clearer patient cost information as their top priority for improving health care overall. This is especially true for lower-income and uninsured consumers. Providing greater patient cost transparency should be a top priority for all health care stakeholders, including payers and providers.

Consumers want simpler, more direct health care language

• Many consumers are frustrated with the complexity of health care information, both medical and administrative. Information must be presented simply to be accessible. To give patients control over their health care choices, provide simple explanations alongside more complex information.

Consumers want mobile-friendly information

• Many consumers rely on mobile phones for internet access, especially if they are lower-income, young, or racial minorities. Make web resources mobile-friendly to ensure maximum accessibility. Consumers find mobile-friendly websites more accessible than apps, which they use infrequently.

Consumers want quality information, but aren’t using comparison tools

• Consumers rarely search for formal quality comparisons, but they do seek out informal quality information through online patient reviews and referrals from family, friends, or providers. Consumers are rarely aware of official quality comparisons, such as safety or patient satisfaction ratings. This is especially true for lower-income consumers. Stakeholders can better provide comparisons at the right place and right time to support patient decisions. For example, a health plan could send quality comparisons of providers and facilities to a patient before an upcoming procedure.

Caregivers are superusers of health technology, but need more support

• Caregivers, especially caregivers of children with serious medical needs, make heavy use of portals, apps, and other information resources, but struggle to find resources for themselves as caregivers, and are at risk of unsustainably high levels of stress. Help caregivers by including information about caregiver resources, tools, and support in the clinical workflow.

Friends and family are key health care information sources

• Among some consumers, friends and family are go-to sources of health information. The uninsured use friends and family to learn about insurance, and Spanish speakers rate friends and family to be just as accurate as medical websites. To reach the uninsured, Spanish speakers, and other groups, payers and providers should communicate directly through social networks and community organizations, such as schools, churches, and employers.

Spanish speakers are reluctant to ask for resources in their language

• Some consumers who do not speak English as their primary language may be hesitant to make a special request for resources in their language. If not offered outright, these consumers may seek out a different care provider who supports their language more directly. Payers and providers can make health information more accessible by providing alternate language resources without requiring Spanish-speaking consumers to specially request them.

Patient-provider relationships are paramount in health care

• Uninsured, sick, and lower-income patients are much more likely to feel disrespected by doctors than their peers. Good patient-provider relationships are not just part of good bedside manner; perceived respect has a strong correlation with whether patients trust doctors to be accurate and whether patients are adherent to their medications. Positive patient-provider relationships should be considered a medical priority, and should be encouraged through training, education and, potentially, compensation changes.

Patients seek clues to provider warmth through online patient reviews and provider pictures

• Patients value providers treating them with respect, but information about provider respect can be difficult to find. When personal referrals are not available, many patients turn to online reviews and pictures of providers to gauge a provider’s bedside manner. Ensure provider descriptions, pictures, and videos communicate warmth and respect.

These implications can have a significant impact on how healthcare stakeholders should think about engaging all consumers, and especially vulnerable consumers. Specific implications and recommendations are included throughout this report and in summary at the end of the report.

Related Publications

1.  Right Place, Right Time: Health information and vulnerable populations, Oliver Wyman http://www.oliverwyman.com/our-expertise/insights/2016/jun/oliver-wyman-_-altarum-institute-study.html
2. Knowledge is power: Improving health care information for the most vulnerable, Health Affairs http://healthaffairs.org/blog/2016/05/25/knowledge-is-power-improving-health-care-information-for-the-most-vulnerable/
3. Overcoming lower-income patients’ concerns about trust and respect from providers, Health Affairs http://healthaffairs.org/blog/2016/08/11/overcoming-lower-income-patients-concerns-about-trust-and-respect-from-providers/