What do patients really want from you?

A national survey tracks patients' consumer habits, from "content and compliant" to "sick and savvy."

By Emily Berry — Posted April 27, 2009

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After 23 years in family practice in Topeka, Kan., Douglas Iliff, MD, said that despite what he reads about consumerism being the wave of the future -- or the present -- patients usually want him to tell them what to do.

Even the patients who ask the most questions -- typically those who have high-deductible plans paired with health savings accounts -- honestly want his recommendation, not just coaching or a list of options, he said.

"Since the Internet revolution came along, yes, patients ask more questions, and ask more intelligent questions. But they'll come to me with those questions asking what I think."

Research by consulting firm Deloitte supports Dr. Iliff's observation that most patients do like what it terms an "authoritarian" or "traditional" physician. But it also suggests that a growing number of patients is seeking more details from doctors, in terms of both costs and treatment.

Paul H. Keckley, PhD, is executive director of the Deloitte Center for Health Solutions, which conducted the nationwide survey of 4,001 adults in the fall of 2008. He said the survey, released this spring, supports his contention that physicians need to adjust to patients who are more likely to want choices and detailed information from doctors, not just a prescription or a referral.

"The good news is, most consumers are generally happy with the physicians they see, and they are still trusting in the recommendations of those physicians," Keckley said. "The challenging news would be they're becoming a bit uncomfortable with the lack of information they'd like to get from physicians."

Patient personality types

As in Deloitte's first consumer health care survey, released a year ago, respondents were split into six personality segments based on their answers.

The largest group, 28.5% of respondents, was "content and compliant," characterized by satisfaction with the current health care system and preference for traditional approaches in medicine. Nearly as common, 27.6% of the respondents were defined as "casual and cautious," defined by disengagement in health and treatment, disinterest in options and a weak sense of quality differences.

Another 25.3% of respondents, however, were "sick and savvy" -- very aware of quality differences and likely to participate in health care decisions.

"Out and about" patients, who made up 8.2% of respondents, were interested in nontraditional medicine and were least likely to trust doctors' advice. The 8% of patients described as "online and onboard" were characterized as most likely to shop around for doctors, ask for drugs by name and to participate in wellness activities. The smallest category, "shop and save," encompassed 2.4% of respondents. These patients were likely to change physicians or health plans to save money, but also likely to not fill a prescription because of cost.

Although nearly a third of respondents remain in the "content and compliant" category, Keckley said those patients are older. He said that population is, to put it bluntly, dying out.

The respondents in the most recent survey were incrementally more likely than those in the 2008 survey to be in the "sick and savvy," "online and onboard" or "shop and save" categories. Those patients are active and engaged in choosing physicians and hospitals, asking for reliable medical advice, and seeking quality and cost information.

Keckley said physicians need to change their practices now to be ready for the future.

"For a patient to leave the doctor's office newly diagnosed with a condition without a referral to a trusted Web site to find more information is simply a mistake," Keckley said. Physicians who want to get ahead in their markets need to use the Web to interact with patients between visits via a personal health record connected to patients' homes, he added. Physicians who "are not tech-savvy are physicians who are going to be paid less, and they're going to regret it."

Adopting the patient-centered medical home model is one way physicians can create a practice that caters to different types of patients, like those in the "complex mosaic" outlined by Deloitte, said Lori Heim, MD, president-elect of the American Academy of Family Physicians.

The medical home is generally defined as a base from which health care is coordinated. A physician has an ongoing relationship with a patient and helps coordinate the patient's health and treatments across the entire health care system.

Dr. Heim said running a practice as a patient-centered medical home would help a physician care for every patient, whether they are "content and compliant" or "shop and save" patients.

"I think the successful physician, just like the successful person, is someone who can adapt their style to be the most effective with the patient," she said.

Cultural shift on costs

The Deloitte report also suggested that the cost of seeing doctors and getting treated for illnesses or injuries could be behind a continuing shift from a more passive patient population to a more active one. Sometimes patients decide to ignore a doctor's advice altogether if it's deemed too expensive.

So what can physicians do to keep savvy patients engaged but also discourage them from skipping needed care?

David C. Scroggins, a Cincinnati-based practice management consultant and principal with Clayton L. Scroggins Associates, said physicians should talk to patients about what can and cannot be postponed when money is tight, and they should remind patients that even cut-rate insurance plans often cover preventive visits.

"Then, when they have to make choices when they've got money to spend, they think, 'Maybe I will spend it on my health,' " he said.

Dr. Iliff said he is skeptical of surveys like Deloitte's that ask consumers what they want in an ideal world, or what they would do under certain circumstances. What matters to his practice, and where he said "the system is falling apart," is what people actually do, not their intentions or wishes.

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Searching for cost, quality

A Web-based survey by Deloitte finds patients are increasingly seeking information about both cost and quality of care. Among the 4,001 respondents:

13% looked online, in the previous 12 months, for cost information.

27% looked online, in the previous 12 months, for information about the quality of care provided by specific doctors.

57% would use quality rankings to compare doctors and hospitals in their community.

58% are interested in using cost information.

Source: Deloitte, "2009 Survey of Health Care Consumers: Key Findings, Strategic Implications" (link)

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6 kinds of consumers

As part of its most recent public survey, consulting firm Deloitte broke down respondents into six categories, based on their satisfaction with the health care system, use of health services and behaviors around health care. The categories that exemplify health care consumerism grew slightly since the 2008 survey, while those representing more passive, less engaged patients shrank. Here's how the 4,001 respondents filled out the Deloitte-named categories:

Content & Compliant

2008: 29.3% of respondents
2009: 28.5% of respondents
System use: Medium
Care preferences: Traditional, most likely to prefer authoritarian doctors
Satisfaction: Most satisfied
Adherence: Most compliant
Information: Least likely to seek information and compare alternatives
Switching: Least likely to switch physicians or plans
Innovation: Most likely to prefer standard approach
Other: Most confident in effectiveness of medications

Sick & Savvy

2008: 24.3% of respondents
2009: 25.3% of respondents
System use: Highest
Care preferences: Traditional, but want to be engaged in decision-making
Satisfaction: Satisfied
Adherence: Compliant
Information: Strongest sense of quality differences; likely to seek coverage details, trust Web sites, have personal health record
Switching: Likely to ask for drug by name, less likely to switch physicians, plans
Innovation: Most receptive to new treatments and devices
Other: Most prepared financially; mental/behavioral health coverage is important; want enhanced plan

Online & Onboard

2008: 7.3% of respondents
2009: 8% of respondents
System use: High
Care preferences: Traditional, but open to nonconventional (e.g., retail clinics)
Satisfaction: Satisfied
Adherence: Compliant
Information: Most likely to compare doctors, use cost/quality info, trust Web sites, have personal health record
Switching: Likely to ask for drugs by name, switch plans, switch doctors
Innovation: High interest in innovative devices
Other: Likely to participate in wellness and contact plan for advice; want enhanced plan and mental/behavioral health coverage

Shop & Save

2008: 1.6% of respondents
2009: 2.4% of respondents
System use: Medium
Care preferences: Traditional, but open to nonconventional, seek lower-cost doctors
Satisfaction: Less satisfied
Adherence: Less compliant
Information: Likely to compare doctors, use cost/quality and coverage info, have personal health record
Switching: Most likely to switch plans, change insurance, switch doctors
Innovation: No strong preference
Other: Likely to participate in wellness, not fill prescriptions due to costs, contact plan with question or complaint

Out & About

2008: 9.1% of respondents
2009: 8.2% of respondents
System use: Medium
Care preferences: Alternative, prefer holistic approaches and natural remedies, open to nonconventional
Satisfaction: Least satisfied
Adherence: Least compliant
Information: Least likely to trust doctor's advice
Switching: Likely to switch doctors
Innovation: Receptive to new treatments
Other: Likely to delay doctor's recommendation, most open to traveling out of U.S., want enhanced plan

Casual & Cautious

2008: 28.4% of respondents
2009: 27.6% of respondents
System use: Lowest
Care preferences: Disengaged, but lean toward traditional, seek lower-cost doctors
Satisfaction: Less satisfied
Adherence: Less compliant
Information: Weakest sense of quality differences, less likely to seek information
Switching: Less likely to switch physicians or plans
Innovation: Likely to prefer standard approach
Other: Least prepared financially for future costs

Source: Deloitte, "2009 Survey of Health Care Consumers: Key Findings, Strategic Implications" (link)

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Costs count

A survey of health care consumers found that financial concerns were changing their behaviors, pushing them to delay care or, in some cases, to not follow doctors' advice or not fill prescriptions. Among the respondents to Deloitte's survey:

84% believe current economic conditions will make it harder for consumers to pay medical bills.

35% of those who skipped filling a prescription did so because of cost concerns.

30% would be likely to use a retail clinic if it cost them 50% or less than a visit to a doctor's office.

28% had problems paying medical bills in the past year.

24% decided not to see a doctor or get health care services when they were sick or injured. These decisions occurred most often among people who were uninsured or age 18-28. Among those who skipped care, 38% cited cost concerns.

15% delayed or decided against treatments recommended by their doctor; among those, 2 in 5 said costs were too high.

Source: Deloitte, "2009 Survey of Health Care Consumers: Key Findings, Strategic Implications" (link)

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