July 22, 2020

Why your patients are still avoiding care (and what to do about it)

Daily Briefing

    While many consumers seem willing to go to stores or out to eat amid the Covid-19 epidemic, they are not as willing to return to health care settings to see their doctors. Some are even unlikely to visit the ED if they have symptoms of a heart attack or appendicitis. How can health care leaders re-engage and communicate with their patients to alleviate their fears?

    Listen to the episode: How Covid-19 has changed consumer behavior and preferences

    In this episode of Radio Advisory, host Rachel (Rae) Woods sits down with consumerism experts Rebecca Tyrell and Colin Gelbaugh to talk about the results of Advisory Board's newest consumer survey and how patient preferences should impact health system's communication strategy.

    Read a lightly edited excerpt below, and download the podcast to hear the full conversation.

    Rachel Woods: Now, in terms of helping organizations re-engage patients, sometimes it's helpful to tell organizations what they shouldn't do, or at least what should be at the bottom of their to-do list. I'm curious, Becky, based on your analysis, what doesn't work when it comes to re-engaging patients?

    Rebecca Tyrell: I don't think we can say what doesn't work, but we can say what is likely to be less impactful. So, on that point, consumers don't seem to care much at all about visitor policies, regardless of how they're framed. They also don't seem to place as much value on things like contactless check-in, the availability of hand sanitizer, and verbal Covid-19 screenings, meaning the ones that just involved questioning and not an actual physical test that they complete.

    But the one that surprised me the most is that consumers don't seem to care as much about where services are provided as much as they care about who is providing the care and the safety precautions that those people are taking.

    Woods: Let's talk a little bit more about this, because I'm also surprised that in this ranking, consumers undervalued questions about where services are provided. What does the data actually tell us?

    Tyrell: I think if a consumer feels confident that the providers who will be providing care to them are wearing masks at all times, that they're being tested daily before they report to work, and that they're not interacting with or treating patients who have Covid-19, they don't really care where that clinic is located. So is it a freestanding facility? Is it on the hospital campus? It's more about, "who am I personally going to be interacting with during that experience?" that seems to matter most.

    Woods: This is interesting because it comes back to where we started, and that perhaps patients, consumers, have kind of blanket fears when it comes to interacting with a health care organization in general, because the data is telling us that consumers aren't ranking differently a standalone building of clinic versus a hospital. Do you agree?

    Colin Gelbaugh: I think it makes sense that patients would be fearful of all health care settings, but when forced to choose between a physician office setting and an urgent care or a hospital, physician office comes on top, probably because that's  what consumers were used to before all of this happened. There's a level of familiarity with that setting. I get to see my own doctor, they know my conditions, there's a continuity of care there.

    But I would bet there's another factor here about perception of urgent cares and EDs as places of sick care—when you sit in a waiting room at an urgent care or ED, you're probably likely to be next to someone or hear someone coughing, which is not to say that doesn't happen in a physician office setting, but there's the perception of it being more places of sick care.

    Woods: And I'm guessing one of the hard things right now about trying to understand what're consumers looking for and how do I re-engage them with my health system? That's hard because Covid-19 cases look pretty different state to state right now. How much do individual market dynamics actually play into patient preferences?

    Tyrell: So I expected that those market dynamics would be huge in influencing what makes people feel comfortable returning for care in one area versus another, but what we actually found is that factors like hospitalization rates or death rates or even current infection levels in a state, really don't matter to consumers, at least relative to other things. And actually, in general, all consumers, no matter how you slice and dice the data, care about the exact same clinic safety protocols that we talked about—and also getting that vaccine.

    Woods: Yea, that is surprising and, dare I say, disappointing that consumers didn't value those very serious state dynamics. And I know that our survey did not ask consumers about their preferences with going to a restaurant, but maybe this tells us a little bit of why beyond just the quarantine fatigue and Covid-19 fatigue, of why people are increasingly willing to leave their houses.

    Tyrell: I think that's a great point, and I think that because those statewide numbers feel so abstract and perhaps even unreliable, people are more focused on the things that they can see with their own eyes that are being done to keep them safe in the moment, as opposed to these larger ideas about safety in a given state.

    Woods: I also think that usually there's this reaction or desire to take these types of surveys and break them down into demographic patterns. First of all, I'm curious if that is the right answer at all?

    Tyrell: In this case, we didn't see major differences in grouping folks based on demographics. So the factors that we looked at that didn't seem to influence those rankings that we've been talking about are gender, income, again those local disease prevalence statistics we talked about, or even knowing someone who was impacted by Covid-19—none of those things seemed to matter in terms of the rankings.

    What did matter to some extent was age and also the type of health care user. So for example, are you a person with chronic conditions who requires a lot of frequent care? Or are you somebody who tends to try to avoid the health care system as much as possible? There were some subtle differences in groups like that.

    Woods: But I'm guessing that where demographics maybe plays a little bit more of an importance is on the communication side. Colin, are you seeing any helpful examples of that custom level of communication?

    Gelbaugh: Yes, I think there definitely are some messages across the board that will resonate with all demographics. But when I think about the types of segments that you might craft custom communications around, one of them is medically vulnerable patients, so patients with cancer for instance. There are effective messages out there about how cancer doesn't wait and neither should you. Speaking directly to how the disease manifests itself and what the patient has to deal with on a day-to-day basis, it's not something that can wait.

    Another segment is the elderly population, who I think is the most reticent to come back, they're the most high-risk. So, just the frequency of communication to them and the assurances that you make have to really be targeted towards this population.

    A third one is the pediatric population; this is actually an area that a bit surprising to me, but it's the slowest to come back. So having special accommodations for these pediatric patients, especially drive-in vaccine options, could be helpful. And then a last segment I would call out specifically is the uninsured or the underinsured population, which,if we're talking about deferring care, will be really important going forward.

    Woods: And that sort of brings me to one of my final points: When I'm having conversations with leaders, I'm getting this feeling that everyone is collectively throwing spaghetti at the wall. Everyone wants to get patients to come back in, and they're trying all of these different tactics, whether it's actual safety precautions or communication strategies to try to encourage patients to come back in. But when it comes to re-engaging patients, is there a specific approach that leaders should be taking?

    Tyrell: I would really focus on regaining the trust of patients who have clearer health needs and who were generally engaged in their care prior to Covid-19. And I say that because the consumers who describe themselves as never using the health care system or trying to avoid it whenever possible seem to want slightly different things from their providers right now. So, they were tough to engage before, they're going to be even tougher to engage now. And rather than following some of their more niche preferences, it makes sense to focus on the needs of the people who like you, who have care that you want them to be seeking right now, and who probably want to come back in but just need that reassurance that it is safe and good to do so.

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