Personal Health Management: Empowered Consumers Want Convenient Care
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Understand what consumers value most when managing their health and how much additional responsibility they’re willing to take on to reduce the cost of their healthcare.
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Personal Health Management: Empowered Consumers Want Convenient Care
- 1. Personal Health Management The rise of the empowered health consumer April 2015 www.pwc.com
- 2. Contents • Study Introduction • Major trends in healthcare we focused on • What consumers told us: Survey results & insights • What it means (payers/providers) - Get smarter about consumers - Offer next-gen services • What it means (new entrants) - Alternative care providers - Wearable manufacturers • Segmentation overview • Comparing the plan groups • Meet your plan members - Private/Single - Private/Family - Medicare Advantage - Exchange • Appendix: Segment profiles 2Personal Health Management
- 3. Survey Method Introduction Understand what consumers value most when managing their health and how much additional responsibility they’re willing to take on to reduce the cost of their healthcare Study Objective 4 Consumer Groups Surveyed ~2300 people Private Insurance (Single People) ~690 respondents Private Insurance (Families) ~640 respondents Medicare Advantage ~560 respondents Health Insurance Exchange ~410 respondents A B C D Survey Section 1 (Standard) Captured respondent’s demographic profile, health behavioral tendencies, & current healthcare satisfaction levels Survey Section 2 (Conjoint) Trade-off exercise to determine what features respondent’s most value in their healthcare coverage, what those features would cost Understand the Industry Survey Healthcare Consumers Identify Experience Improvements Customer Segmentation Identify the major trends currently shaping healthcare Determine how these trends are influencing consumer approaches to healthcare Using survey data, recommend how to improve the health CX & how new entrants can be more disruptive 1 Analyze each of the plan groups to identify unique customer segments 2 3 4 Analysis Framework 3Personal Health Management
- 4. ConsumerBehaviors Care as commodity: A new generation of value-conscious consumers are treating healthcare like any other purchase – seeking out the “best deal” w/ little loyalty to specific brands/providers More empowered health consumers: They track their vitals, research symptoms online, and self-diagnose rather than rely solely on providers to diagnose and treat illnesses Higher share of cost burden: Healthcare is getting more expensive and consumers are paying for more of it – changing healthcare from a given to a cost/benefit analysis for many consumers Technology Alternative care services from non-traditional players: Telemedicine start-ups, retail clinics, at-home medical kits, etc. – consumers have more options than ever to handle their care Proliferation of health-tracking technology: The exploding wearables industry is allowing consumers to analyze their health with a level of precision traditionally reserved for doctors, and is changing the definition/capabilities of Remote Patient Monitoring (RPM) IndustryChange The ACA: Millions of first-time customers are now buying insurance, creating an opportunity for established payers/providers to grow their customer base, but also for non-traditional companies to disrupt the industry by offering innovative services at compelling price points Increased demand for primary care: As more new doctors choose specializations over general medicine, the demand on PCPs’ time has never been higher, forcing states to expand PCP laws to include RNs & Pharmacists who can now diagnose illnesses & prescribe treatments Major trends in healthcare we focused on 1. Understand the Industry 4Personal Health Management
- 5. What consumers told us: Survey results & insights Consumer health intelligence is rapidly increasing, and the traditional notion of passive, qualitative “wellness” is being replaced by a proactive/quantitative approach we call “Personal Health Management” (PHM), with data- enabled consumers taking more responsibility in their healthcare. 83% weight What do you track monthly? 55% 24% steps blood pressure 55% caloric intake 30% sleep patterns Consumers like the people/institutions involved with their healthcare, but they’re unimpressed by the advice they receive and the overall experience. Plus, brands get little credit for great care, but most of the blame when it’s poor. 80% 69% 72% 75% 75% 59% 74% 41% Primary Doctor Specialists Pharmacists Drug Efficacy Pharmacies Hospitals Insurance Advice Received Consumer Satisfaction w/ Healthcare • Multiple key health statistics are now regularly monitored by consumers • 3 in 5 push themselves with challenging health goals, and half (46%) frequently reach those goals • Personal satisfaction (89%), being able to quantitatively track their progress (71%), and validation from their doctor that they’re on the right track (69%) – these are what consumers value most when trying to reach a health goal KeyStatsKeyStats • Nearly half (45%) have never had a great healthcare experience • Positive experiences are overwhelmingly credited to the person who administered care (63%), while poor experiences are blamed on the institution – either the company itself (44%) or the fees charged (38%) • Only 2 in 5 are satisfied with the actual medical advice they receive Passive is out – proactive is in Customer satisfaction is fragile and brands get blamed 2. Survey Healthcare Consumers Impacting Trends: Impacting Trends: 1 2 5
- 6. What consumers told us: Survey results & insights Most consumers are cost-conscious when it comes to care (56%). However, a sizable portion of the population is willing to pay for the highest quality care they can get (38%). When asked to create their ideal healthcare plan, consumers agreed on the most important feature: being able to see a doctor within 24 hours of getting sick. However, they also showed a willingness to take on more risk/responsibility in managing their health in exchange for a lower premium (~5% average savings per consumer) What they want… See a doctor in 24 hrs Get care in a doc office from reputed health co. Pick any doctor I want Receive health advice only when requested What they don’t want… Retail brands/facilities replacing docs/hospitals Limits on which docs they can pick for care Unsolicited health alerts/warnings from doc Trend Watch: Care Apathy 9% of consumers don’t engage in preventative care, and 7% of Exchange consumers avoid care altogether because of the costs involved. As the cost of healthcare becomes increasingly prohibitive, the care-apathetic population is likely to grow quickly. KeyStat • People are willing to accept more invasive diagnostic testing and virtual consultations for follow-up appointments & prescription refill requests (in place of in-person visits) in exchange for a discount on their insurance premium KeyStat • Consumers fall into two camps when handling a health issue: most go straight to their doctor (48%), but nearly a third (32%) research their symptoms online first before seeking medical care Consumers agree on what they can/can’t accept in healthcare… …but are split on how to approach it 2. Survey Healthcare Consumers Impacting Trends: Impacting Trends: 3 4 6
- 7. What consumers told us: Survey results & insights Less than 10% of consumers surveyed own a wearable, but of those who don’t, 1 in 5 have considered buying one, drawn to their fitness and overall self-improvement features. In addition, while 84% of those interested would prefer a value-focused, sub-$100 model, 15% would be willing to pay $200 for a more stylish model with advanced features. Alternative care customers love the experience (most popular type: walk-in clinics), but more than half the country (53%) has never used one. Awareness is the primary culprit as only 1 in 5 customers learn about alt care from marketing - word-of-mouth (40%) and online research (28%) were by far the most commonly cited sources. How many feel alternative care is the same or better than typical doctors/hospitals in these categories? 94% Proximity 91% Cust Service 89% Convenienc e 82% Cost 81% Aesthetic s 88% Quality Trend Watch: Digitally Savvy Public 83% of consumers say they have some comfort with mobile technology, 74% are online multiple times a day, and a majority consider themselves active mobile users (52%). Across all demographics, public digital intelligence continues to rise. Wearables & Alternative Care: Just outside the mainstream 2. Survey Healthcare Consumers Impacting Trends:5 Alternative Care Services Wearables 7Personal Health Management
- 8. Make their life easier What it means (payers/providers): Get smarter about consumers Learn from retail Payers/Providers looking to create the next- generation patient experience need look no further than their local walk-in clinic for best practices on how to engage and simplify life for customers What Although retail clinics have not yet gone mainstream, consumers who’ve used them rave about their value, quality, aesthetics, service, and convenience Why Streamlined paperwork Transparent costing Upscale design/fixtures Responsive cust service Strong brand partners How B Consumer satisfaction in healthcare is fickle and doesn’t translate into loyalty towards a brand – so focus less on winning loyalty and more on having world-class tools and customer service Consumers give little credit to healthcare institutions for good experiences, but most of the blame for bad ones. One poor interaction can ruin their perception of an entire brand. Care about each customer Move away from a one-size-fits-all approach to care and use our segment insights to identify the specific needs of your individual customers While some consumer segments have similar healthcare preferences, the underlying motivations, priorities, and decision-making rationale that inform those preferences are often very different What Why How What Why How A C 3. Identify Experience Improvements Related Findings Related Findings Provide tools for PHM Automate common tasks Simple issue resolution Identify your segments Understand priorities Create relevant services Tailor offers/marketing Related Findings 8
- 9. Self-service: And not Or What it means (payers/providers): Offer next-gen services RPM 2.0 Leverage rise of PHM and increasing capabilities of wearables to incorporate voluntary remote health monitoring into treatment/wellness programs; let early adopters drive mainstream adoption What More frequently engage patients, proactively identify/manage issues before they become chronic, more accurately track treatment adherence, and create a more educated/informed consumer base Why How E Consumers are NOT ready to accept a fully automated/self-service driven care model even if it saves them money; instead, offer self-service tools as supplement to existing care options Consumers want peace of mind of being able to reach a person/doctor when needed, likely because of the devastating potential consequences of poorly administered care What Why How D 3. Identify Experience Improvements Give consumers choiceF Give consumers more customization options when picking an insurance plan, specifically the ability to decrease their coverage levels in exchange for a discount Consumers show a willingness to take on more risk/responsibility in healthcare and lead a healthier lifestyle in exchange for a premium discount, when given the chance What Why How Insight on tracked data Voluntary opt-in/out Target PHM evangelists Incentivize milestones Subsidize devices Related Findings Related Findings Related Findings Automate basic tasks Incentivize tools Maintain human services Prepare for new entrants Diversify plan options Create discount tiers Enable plan customization Promote cost savings 9
- 10. What it means (new entrants): Alternative care providers Get the message right Educate the public Alternative care providers have a chance to become the solution of choice for basic illnesses for a large portion of the population if they can increase their visibility in the market What Alternative care providers enjoy stellar reviews from those who’ve used their services; however, most consumers simply don’t know that these services exist or what solutions they offer Why How B A value prop of doctor-quality service with retail- quality convenience/value/support would prove compelling to a large segment of the population, especially those w/out chronic issues Americans value speed & quality most in healthcare, while things like location and brand take on lesser importance (except for those on Medicare Advantage) Go beyond primary care There are large potential customer bases for non- industry players offering services that supplement traditional care Strong public interest in non-care health services: tools to analyze personal health data, track progress against health goals, share status with friends/family, earn incentives for reaching What Why How What Why How A C Related Findings: 3. Identify Experience Improvements Improve marketing Increase local presence Tailor offers to segments Partner w/ payers Articulate value prop Related Findings Related Findings Related Findings Tout credentials of docs Co-brand w/ health co’s Emphasize cost savings Address quality concerns Remote health analysis Progress tracking Data sharing Incentivize milestones Integration w/ clinics 10
- 11. Price it right What it means (new entrants): Wearable manufacturers Look beyond Millennials Wearables have the potential to be very attractive to Gen X’ers and Baby Boomers if they are positioned as essential personal health management tools – align device marketing w/ priorities of generation What Many older consumers are digitally savvy, prioritize managing their health, and regularly monitor health stats like weight, steps taken, caloric intake since they are at increased risk for chronic issues Why How F Offer budget devices at a sub-$100 price point t0 appeal to most consumers, but also higher-end models w/ advanced features to appeal to early adopters – they will drive mainstream adoption Nearly a fifth of the country is interested in a Wearable - 85% want a sub-$100 model, 15% want an advanced model and are willing to pay for it ($200) What Why How E 3. Identify Experience Improvements Millennials: Gamification Gen X: Health Mgmt Boomers: Disease Mgmt Related Findings Lower barrier to entry Partner w/ payers Integrate w/ treatment Expand product line Related Findings 11Personal Health Management
- 12. Segmentation overview The four targeted plan groups were compared against each other to identify group-specific trends Private Insurance (Single People) ~690 respondents A Private Insurance (Families) ~640 respondents B Medicare Advantage ~560 respondents C Health Insurance Exchange ~410 respondents D The groups were then analyzed individually to identify specific customer segments 4 segments 5 segments 4 segments 4 segments 1 2 4. Customer Segmentation 3 For each segment, we determined how they currently manage their health, what they value most in healthcare, where they’re willing to take on more risk, and what customer experience features would most resonate with them (See Segment Scorecards in Appendix section) Example of Segment Scorecard Demographic Profile Key Statistics Behavioral Tendencies “How to reach them”“Willingness to Save” 12
- 13. 13 Comparing the plan groups 53 47 69 57 Median Age Likely Income $25-$50K $100K $50-$75K <$50K While many of the groups had similar characteristics, subtle differences in demographic profiles and healthcare management approaches emerged when the groups were compared… 4. Customer Segmentation Chronic Illness Sufferers 46% 42% 61% 43% Who are they? How do they behave? Likely Satisfaction w/ Current Care Somewhat Satisfied Ambivalent Indifferent Very Satisfied Healthcare Approach Cost Conscious Quality Seeking 60% 52% 52% 63% 29% 44% 43% 33% Private/Single Private/Family Medicare Advantage Exchange Own or Considering Wearable 31% 32% 21% 25% 13
- 14. Meet your plan Members Private/Single Fitness-focused Fey Wary Walter Trusting Terri Preoccupied Paulo 27% 25% 24% 23% Fitness-focused Fay Wary Walter Trusting Terri Preoccupied Paulo Who are they? • Age: 18-34 (Mil) • Ethnicity: Black • Education: Grad Degree • Makes: $50-$100K • Lives In: Major Metro/South • Health: Healthy • Gender: Female • Age: 55+ (Boomer) • Ethnicity: White • Education: HS Diploma • Makes: $25-$50K • Lives In: Rural town • Health: Chronic Illness • Gender: Male • Age: Neutral • Ethnicity: Asian • Education: Grad Degree • Makes: $75-$150K • Lives In: Suburbs/West Coast • Health: Healthy • Gender: Neutral • Age: 45-54 (X) • Ethnicity: Hispanic • Education: College Degree • Makes: $0-$50K • Lives In: Midwest • Health: Healthy • Gender: Male How do they behave? Healthy & cost- conscious • Diligently tracks health stats • Digitally savvy & uses wearable • Enjoys current healthcare • Disappointed with clinics • Sets ambitious fitness goals • Wants cheapest care possible • Prefers to self-treat health issues Focused on managing illness • Tracks his vitals periodically • Uses web but not mobile savvy • Satisfied with current care • Clinics not suited for his illness • Sets reasonable fitness goals • Wants best care to avoid issues • Trusts and consults doc always Healthiness = Happiness • Monitors health carefully • Strongly considered wearable • Highly pleased w/ healthcare • Not impressed w/ clinics • Highly motivated to reach goals • Wants best care insurance offers Healthy but at risk • Doesn’t monitor health • Doesn’t like current healthcare • Dissatisfied w/ insurance • Uses clinics now for most issues • Doesn’t set health goals • Health/fitness not a priority How much less does their preferred plan cost than the base plan? 2.8% 4.4% 4.6% 4.2% 4. Customer Segmentation 14Personal Health Management
- 15. Meet your plan Members Driven Darin Conventional Carl Try-it-out Tori Savvy Sam 24% 23% 22% 17% 14% Driven Darin Conventional Carl Try-it-out Tori Savvy Sam Novice Natalie Who are they? • Age: 35-54 (X) • Ethnicity: Asian • Education: Grad degree • Makes: $150K • Lives In: Suburbs/South • Health: Healthy • Gender: Male • Age: 55+ (Boomer) • Ethnicity: White • Education: Grad degree • Makes: $25- $50K • Lives In: Small town/Midwest • Health: Chronic (Easy) • Gender: Male • Age: 45-64 (X, Boomer) • Ethnicity: Black • Education: 2 yr college degree • Makes: $25- $75K • Lives In: Suburbs/West Coast • Health: Healthy • Gender: Neutral • Age: 25-34 (Mil) • Ethnicity: Asian, Black • Education: Neutral • Makes: $25- $50K • Lives In: Moderate City • Health: Healthy • Gender: Neutral • Age: 18-24 (Mil) • Ethnicity: White • Education: College Degree • Makes: <$25K • Lives In: Town/Northeast • Health: Healthy • Gender: Female How do they behave? Willing to pay for quality • Tracks health stats closely • Digitally savvy & interested in wearables • Generally happy with current care • Finds alt care better than doc • For goals, key is encouragement • Wants best care possible • Prefers to lookup issues online first Tough & “Old school” • Doesn’t track his vitals regularly • Not tech savvy • Extremely happy with current care • Very dissatisfied with alt care • Hardly ever sets health goals • For major issues, seeks out best care possible • But for most issues, will just let them pass Healthy but apathetic • Tracks health sporadically • Somewhat digitally savvy • Unimpressed with current care • Very happy w/ alt care services • Not easily motivated, sets easy and infrequent goals • Wants cheapest care possible • Highly religious Trend-setter • Tracks stats that effect appearance • Uses wearable to maintain fitness • Mildly satisfied with current care • Ambivalent about alt care • Values “social” aspects of fitness – sharing, incentives, competition, etc. • Isn’t sick often, so approach is unclear Stressed student • Only tracks calories closely • Digitally savvy, uses wearable to track fitness • Fairly satisfied w/ current care, • Not thrilled w/ alt care services • Sets easy goals, values “social” aspects of fitness • Cost-conscious w/ care, will research illness online first How much less does their preferred plan cost than the base plan? Novice Natalie 4.2% 5.2% 5.8% 3.6% 4.2% Private/Family 4. Customer Segmentation 15
- 16. Meet your plan Members Healthy Hogan Disengaged Dani Chronic-care Cam Spiritual Sai 41% 21% 20% 18% Healthy Hogan Disengaged Dani Chronic-care Cam Spiritual Sai Who are they? • Ethnicity: White • Education: College Degree • Makes: $50-$65K • Lives In: Moderate city suburb/Midwest • Health: Healthy • Gender: Neutral • Ethnicity: White • Education: Some college (no degree) • Makes: <$50K • Lives In: Small town/Northeast • Health: Chronic Illness (easy) • Gender: Neutral • Ethnicity: White • Education: Some college (no degree) • Makes: $65-$95K • Lives In: Moderate city/South • Health: Chronic illness (difficult) • Gender: Neutral • Ethnicity: White • Education: Neutral • Makes: $95K+ • Lives In: Major metro/West Coast • Health: Neutral • Gender: Neutral How do they behave? Low maintenance • Diligently tracks many health stats • Digitally savvy • Ambivalent about current care • Highly impressed by alt care services • Sets some goals, values analyzing data, encouragement • Has simple health needs, prefers to self-treat issues and avoid costs Apathetic chronic illness sufferer • Doesn’t monitor health at all • Uses web, but not mobile savvy • Ambivalent about current care • Never used alt care • Low motivation to pursue health goals, picks easy ones • Wants cheapest care option available Focused on disease • Track health stats to manage condition • Digitally savvy, see value in Wearables • Highly satisfied with current care • Alt care not suited for their illness • Health goals tied to disease, value seeing data, sharing status • Cost-conscious with healthcare, given complexity of needs Value quality to ensure happiness • Not big on tracking stats except steps • Love all aspects of their current care • Have no use for alt care, go straight to their doc for issues • Highly religious, see health as path to happiness, set goals accordingly • Want high quality care, will pay for it How much less does their preferred plan cost than the base plan? Medicare Advantage 8.7% 10.9% 8.2% 8.1% 4. Customer Segmentation 16Personal Health Management
- 17. Meet your plan Members Premium Paul Struggling Sue Restarting Rita Aspirational Annie 31% 26% 24% 20% Premium Paul Struggling Sue Restarting Rita Aspirational Annie Who are they? • Age: 55+ (Boomer) • Ethnicity: White • Education: Grad Degree • Makes: $80K+ • Lives In: Small town/Northeast • Health: Healthy • Gender: Male • Age: 18-34 (Mil) • Ethnicity: White • Education: College Degree • Makes: $35-$50K • Lives In: Neutral • Health: Chronic Illness • Gender: Female • Age: 45-54 (X) • Ethnicity: White • Education: Technical Degree • Makes: $0-$50K • Lives In: Suburbs/Midwest • Health: Healthy • Gender: Female • Age: 25-34 (Mil) • Ethnicity: White • Education: Grad Degree • Makes: $50-$100K • Lives In: Near moderate city/South • Health: Healthy • Gender: Female How do they behave? Successful in life, wants the best • Retired but not yet eligible for Medicare • Actively tracks health stats • Digitally savvy • Paid for premium coverage, loves his current care • No need for alt care • Fitness-focused, self-motivated • Goes straight to his doctor for any issues Focused on managing illness • Tracks certain vitals to manage condition • Mobile user, has considered wearable • Satisfied with care received, but dislikes insurance • Disappointed by alt care services • Sticks to easy health goals due to illness • Values sharing, encouragement Many competing life priorities • No time/energy to track health stats • No interest in wearables • Unimpressed by current care, dislikes insurance • Never tried alt care • Cash-strapped, so will deal w/ most health issues herself • If care is needed, wants cost-effective option Wants to improve • Actively tracks health stats • Mobile power user, very interested in wearables • Ambivalent about current care • Impressed w/ alt care services • Struggles to meet health goals, values encouragement • Wants cheapest care option, will research symptoms first How much less does their preferred plan cost than the base plan? Exchange 5.9% 3.7% 2.8% 3.9% 4. Customer Segmentation 17Personal Health Management
- 19. For a discount, Fey would… Fitness- focused Fay (27%) Who she is… Private/Single 4. Customer Segmentation 1.4X likely to be healthy w/ no chronic issues✜ 20-50% more likely to be somewhat satisfied w/ current care 50% more likely to be cost-conscious with care$ 2.8%cost difference between preferred plan and base★ How she behaves… Race African American Gender Female Age Millennial (18-34) Education Grad Degree Region Major southern city Employment Newly employed Salary $50-$100K Digital Literacy High Religious No Health Tracking • Passionate about maintaining a healthy lifestyle, good fitness • Frequently tracks calories & steps taken, monthly sleep, BMI Satisfaction w/ Current Care • Generally happy with her doctor, specialists, pharmacists, and local drug store (very happy with her hospital) Alterative care experience • Tried a walk-in clinic on the recommendation of family, but was disappointed by it’s cost and aesthetics Reaching Health Goals • Sets challenging health goals and often reaches them • Uses a wearable to track her health, likes it’s social features Healthcare Approach • Very cost-conscious with care • Prefers researching symptoms online before seeking care How to reach her… • Make it easier for her to track her fitness and know if she’s on track with her goals – remote monitoring of her wearable data • Empower her with self-diagnosis tools that help her determine if she needs to seek in-person care for her illness (vs. her making that decision on her own) • Give her more self-service & telemedicine options to perform common health related tasks as simply/quickly as possible (Rx refills, follow-ups, etc.) • Allow her to opt-in to more comprehensive/proactive disease testing in exchange for a discount on her premium Use telemedicine tools for follow-up visits and Rx refills Submit to more invasive, proactive disease testing & lab work 19
- 20. For a discount, Walter would… Wary Walter (25%) Who he is… Private/Single 4. Customer Segmentation 3.1X likely to have a difficult to manage chronic condition✜ 40-90% more likely to be very satisfied w/ current care 70% more likely to want the highest quality care possible$ 4.4%cost difference between preferred plan and base★ How he behaves… Race Caucasian Gender Male Age Baby Boomer (65+) Education High School Degree Region Rural Town Employment Retired Salary $25-$50K Digital Literacy Low Religious Yes Health Tracking • Tracks weight, blood pressure every day to manage illness • Occasionally tracks calories when urged by doctor Satisfaction w/ Current Care • Extremely satisfied with doctors, specialists, pharmacists, drug efficacy, hospitals, health insurance, and advice received Alterative care experience • Has never used them since they aren’t equipped to handle a complex chronic condition like his Reaching Health Goals • Focused on illness, only periodically sets/reaches health goals • Values analyzing his vitals and encouragement from doctor Healthcare Approach • Goes straight to the doctor when he has an issue • Despite limited means, wants the best quality care possible How to reach him… • Make it easier for him to manage his chronic illness and know if his tracked vitals are within healthy limits – possibly with simplified wearable tech • Offer him more frequent check-ins with a doctor via telemedicine to promote better adherence to treatment plans and provide positive encouragement • Give him more self-service options to perform common health related tasks as simply/quickly as possible (i.e., Rx refills) • Offer him more comprehensive/proactive disease testing in exchange for a discount on his premium in order to better prevent additional chronic issues Use telemedicine tools for follow-up visits and Rx refills Submit to more invasive, proactive disease testing & lab work 20
- 21. For a discount, Terri would… Trusting Terri (24%) Who they are… Private/Single 4. Customer Segmentation 1.5X likely to be healthy w/ no chronic issues✜ 20-50% more likely to be somewhat satisfied w/ current care 20% more likely to want the highest quality care possible$ 4.6%cost difference between preferred plan and base★ How they behave… Race Asian Gender Neutral Age Neutral Education Grad Degree Region West coast suburb Employment Neutral Salary $75-$150K Digital Literacy High Religious Yes Health Tracking • Track weight & calories weekly, steps & BMI regularly • Carefully manage health, very interested in wearables Satisfaction w/ Current Care • Love/trust their doctor - satisfied with advice received, treatments prescribed, specialists referred to Alterative care experience • Tried on advice of doctor, but saw no difference in cost & convenience and felt quality was worse than regular doc Reaching Health Goals • Often reach their health goals - value the encouragement of friends/family/doctor and being able to track their progress Healthcare Approach • Their health has major effect on their happiness, so they seek out best care available when faced with an issue How to reach them… • Subsidize wearables so that health tracking is integrated into their regular fitness/wellness routine and the data is made available to their doctors • Provide proactive health warnings/alerts based on their activity data so they can prevent potentially damaging lifestyle choices • Give them more telemedicine options so they can more conveniently/easily connect with their doctors when needed and complete simple tasks (i.e., Rx refills) • Offer them more comprehensive/proactive disease testing so they can continue maintaining their healthy lifestyles Use telemedicine tools for follow-up visits and Rx refills Submit to more invasive, proactive disease testing & lab work Accept proactive health warnings from doc based on activity data 21
- 22. For a discount, Paulo would… Preoccupied Paulo (23%) Who he is… Private/Single 4. Customer Segmentation 1.5X likely to be healthy w/ no chronic issues✜ 60-100% more likely to feel ambivalent about current care 66% are cost-conscious with care$ 4.2%cost difference between preferred plan and base★ How he behaves… Race Hispanic Gender Male Age Gen X (45-54) Education 4 Year College Degree Region Midwest Employment Employed Salary $0-$50K Digital Literacy Low Religious Neutral Health Tracking • Doesn’t have the time/energy to track health (occasionally checks weight) – focused on staying afloat financially Satisfaction w/ Current Care • Very ambivalent about people/institutions involved w/ care • Dissatisfied w/ insurance, so reluctant to engage in care Alterative care experience • Loves proximity & cost of urgent care clinics – uses them to handle most issues after being recommended by family Reaching Health Goals • Doesn’t have time or energy to set health goals, and doesn’t value motivating tactics like encouragement, incentives, etc. Healthcare Approach • Is healthy but generally avoids care b/c of costs involved • Low priority of personal health could lead to chronic issues How to reach him… • Offer him cost-effective and simple options for engaging in preventative care, possibly by offering coverage of his visits to walk-in clinics or remote support • Give him low/no-cost self-service resources that improve his health intelligence and help him manage his lifestyle w/ minimal time commitments • Sell him on the cost/speed benefits of telemedicine so that he becomes a more engaged customer and makes his a health a life priority • Explain to him the long-term cost benefit of comprehensive/proactive disease testing and avoiding complex chronic conditions Use telemedicine tools for follow-up visits and Rx refills Submit to more invasive, proactive disease testing & lab work 22
- 23. For a discount, Darin would… Driven Darin (24%) Who he is… 4. Customer Segmentation 1.2X likely to be healthy w/ no chronic issues✜ 20-30% more likely to be somewhat satisfied w/ current care 30% more likely to want the highest quality care possible$ 4.2%cost difference between preferred plan and base★ How he behaves… Race Asian Gender Male Age Gen X (35-54) Education Grad Degree Region Southern suburb Employment Employed Salary $150K+ Digital Literacy High Religious Ambivalent Health Tracking • Often tracks weight, blood pressure, steps, sleep, calories • Very interested in a wearable for self-improvement Satisfaction w/ Current Care • Fairly satisfied w/ total health experience – likes the doctors he sees, the institutions he visits, and the advice he receives Alterative care experience • Fairly satisfied w/ alt care – feels cost, convenience, and customer service are better than typical doctor/hospital Reaching Health Goals • Desires encouragement and ability to analyze health data • Social incentives, progress sharing have little value Healthcare Approach • Will research nonthreatening issues online, but when care is needed he wants the highest quality available How to reach him… • Show him how to extract maximum value from a wearable as a tool to help monitor his health stats and achieve his health goals • Allow him to automatically share his activity data with his doctor for more precise health coaching, feedback, & guidance and proactive/persistent alerts • Give him robust self-service & telemedicine tools that make it quicker/easier for him to access his PCP when needed and perform common tasks • Offer him more comprehensive/proactive disease testing so that he feels he is doing everything he can to maintain his health and avoid chronic issues Private/Family Use telemedicine tools for follow-up visits and Rx refills Submit to more invasive, proactive disease testing & lab work Accept proactive health warnings from doc based on activity data Allow his tracked activity data to be automatically shared w/ doc 23
- 24. For a discount, Carl would… Conventional Carl (23%) Who he is… 4. Customer Segmentation 1.6X likely to have an easy- to-manage chronic condition✜ 20-30% more likely to be very satisfied w/ current care 30% more likely to want the highest quality care possible$ 5.2%cost difference between preferred plan and base★ How he behaves… Race Caucasian Gender Male Age Baby Boomer (65+) Education Grad Degree Region Midwestern town Employment Retired Salary $25-$75K Digital Literacy Low Religious Ambivalent Health Tracking • Not concerned with or interested in tracking health stats • Occasionally tracks blood pressure to manage his condition Satisfaction w/ Current Care • Traditionalist – prefers using regular health care for issues • Very satisfied w/ all aspects of care (doctors, hospitals, etc.) Alterative care experience • Not surprisingly, finds alternate care to have worse quality and customer service than traditional care Reaching Health Goals • Doesn’t set many goals – if he does, it’s for his own personal satisfaction, nothing else Healthcare Approach • Old-school, prefers to let non-emergency issues pass • If he needs medical attention, he seeks out the highest quality How to reach him… • Give him simple self-service tools and easily accessible telemedicine support resources for managing his condition and reaching his doctor when needed • Engage him in health education around the importance of maintaining his fitness to avoid further complications from his chronic condition • Make it easier for him to check if his vitals are within healthy limits, possibly with simplified wearable tech • Offer him more comprehensive/proactive disease testing in exchange for a discount on his premium in order to better prevent additional chronic issues Private/Family Use telemedicine tools for follow-up visits and Rx refills Submit to more invasive, proactive disease testing & lab work 24
- 25. For a discount, Tori would… Try-It-Out Tori (22%) Who they are… 4. Customer Segmentation 1.2X likely to be healthy w/ no chronic issues✜ 20% more likely to be satisfied w/ current care 30% more likely to be cost-conscious with care$ 5.8%cost difference between preferred plan and base★ How they behave… Race African American Gender Neutral Age X/Boomer (45-64) Education 2 Year College Degree Region Midwestern suburbs Employment Employed Salary $25-$75K Digital Literacy Moderate Religious Yes Health Tracking • Check blood pressure sporadically and occasionally monitor their sleep patterns, but don’t focus on tracking their health Satisfaction w/ Current Care • Are fairly ambivalent w/ their current care, and in some cases, unsatisfied when compared to other segments Alterative care experience • Love the experience, find the quality, cost, proximity, aesthetics, and customer service all better than regular doctor Reaching Health Goals • Don’t set many health goals, if they do they’re easy to achieve and they don’t need any support to meet them Healthcare Approach • When facing a medical issue, they seek out the most cost effective treatment possible How to reach them… • Give them simple, low-cost self-service that will empower & encourage them to more closely monitor their health – possibly w/ subsidized wearables • Adopt the convenience and customer service features of retail clinics to improve provide a compelling experience that can win them back as customers • Give them more telemedicine options so they can more conveniently/easily connect with their doctors when needed and complete simple tasks (i.e., Rx refills) • Offer them more comprehensive/proactive disease testing in exchange for a discount on his premium to help prevent chronic issues from developing Private/Family Use telemedicine tools for follow-up visits and Rx refills Submit to more invasive, proactive disease testing & lab work 25
- 26. For a discount, Sam would… Saavy Sam (17%) Who they are… 4. Customer Segmentation 1.2X likely to be healthy w/ no chronic issues✜ 20-50% more likely to be somewhat satisfied w/ current care 58% are cost-conscious with care$ 4.2%cost difference between preferred plan and base★ How they behave… Race Asian Gender Neutral Age Millennial (25-34) Education 2 Year College Degree Region Moderate-sized city Employment Neutral Salary $25-$50K Digital Literacy High Religious Neutral Health Tracking • Track stats that effect appearance (weight, steps, BMI, etc.) • Uses wearable to be precise w/ monitoring and for “coolness” Satisfaction w/ Current Care • Somewhat satisfied to ambivalent with current healthcare experience – especially like their local pharmacy and hospital Alterative care experience • Tried on recommendation of doctor - liked aesthetics of facility, but otherwise indifferent about experience Reaching Health Goals • Value incentives, peer competition, encouragement, and the ability to analyze their wearable data when reaching goals Healthcare Approach • No chronic conditions and rarely get sick, so their approach to treating health issues is unclear How to reach them… • Allow them to automatically share activity data with their doctor for more precise health coaching, feedback, & guidance and proactive/persistent alerts • Provide simple tools for self-reporting key health metrics to their doctors for improved wellness tracking and proactive issue resolution • Give them robust self-service & telemedicine tools that make it quicker/easier for them to access their PCP when needed and perform common tasks • Offer them more comprehensive/proactive disease testing in exchange for a discount on their premium to better prevent future chronic conditions Private/Family Use telemedicine tools for follow-up visits and Rx refills Submit to more invasive, proactive disease testing & lab work Accept proactive health warnings from doc based on activity data Auto-share activity data w/ doc and self-report key health stats weekly 26
- 27. For a discount, Natalie would… Novice Natalie (14%) Who she is… 4. Customer Segmentation 1.5X likely to be healthy w/ no chronic issues✜ 20-30% more likely to be somewhat satisfied w/ current care 20% more likely to be cost-conscious with care$ 3.6%cost difference between preferred plan and base★ How she behaves… Race Caucasian Gender Female Age Millennial (18-24) Education Some college Region Northeast Employment Student Salary <$25K Digital Literacy High Religious No Health Tracking • Focuses on regularly tracking calories, checking weight/BMI monthly to ensure healthiness – interested in a wearable Satisfaction w/ Current Care • Somewhat satisfied with her doctor and pharmacy, but doesn’t have many comparison points given her age Alterative care experience • Has used urgent care clinics after recommendation of family/friends, but felt cost & aesthetics were worse than regular doc Reaching Health Goals • Sets easy fitness goals - values incentives, competition, encouragement, sharing her progress to keep her motivated Healthcare Approach • Researches her symptoms online before seeking care • If she needs treatment, wants the cheapest option possible How to reach her… • Subsidize wearables so she can better track her fitness and allow her to share that data with her doctor for better health coaching, proactive alerts • Empower her with self-diagnosis tools that help her determine if she needs to seek in-person care for her illness (vs. making that decision w/ online research) • Give her more self-service & telemedicine options to perform common health related tasks as simply/quickly as possible (Rx refills, follow-ups, etc.) • Allow her to opt-in to more comprehensive/proactive disease testing in exchange for a discount on her premium Private/Family Use telemedicine tools for follow-up visits and Rx refills Submit to more invasive, proactive disease testing & lab work Accept proactive health warnings from doc based on activity data 27
- 28. Medicare Advantage 4. Customer Segmentation For a discount, Hogan would… Healthy Hogan (41%) Who they are… 1.4X likely to be healthy w/ no chronic issues, but occasionally sick ✜ 20% more likely to be somewhat satisfied w/ current care 54% are cost-conscious with care$ 8.7%cost difference between preferred plan and base★ How they behave… Race Caucasian Gender Neutral Age Baby Boomer (65+) Education 4 Year College Degree Region Midwestern suburb Employment Retired Salary $50-$65K Digital Literacy High Religious Neutral Health Tracking • Focus attention on tracking their BMI, steps taken, and especially caloric intake (which they monitor daily) Satisfaction w/ Current Care • Are ambivalent w/ their current care, and only somewhat satisfied by their primary hospital and advice they receive Alterative care experience • Have used Urgent Care Clinics and found the experience to be the same or better than traditional doctors in all aspects Reaching Health Goals • Want to meet their health goals and consider access to their health data very important to confirm their goals Healthcare Approach • Rely on online research to resolve non life-threatening issues and avoid major medical costs How to reach them… • Make it easier for them to track key fitness metrics by subsidizing and integrating wearables into their wellness program • Give them low/no-cost self-service & telemedicine tools that make it easier for them to access health resources, diagnose issues, and contact their doctor • Consider offering coverage for walk-in clinics to help reduce their bill and generate loyalty for covering a service they really enjoy • Offer them more comprehensive/proactive disease testing in exchange for a discount on their premium to prevent the development of chronic issues Use telemedicine tools for follow-up visits and Rx refills Submit to more invasive, proactive disease testing & lab work 28
- 29. Medicare Advantage 4. Customer Segmentation For a discount, Dani would… Disengaged Dani (21%) Who they are… 1.2X likely to have an easy- to-manage chronic condition✜ 60% are generally satisfied w/ current care 30% more likely to want cheapest care option possible$ 10.9%cost difference between preferred plan and base★ How they behave… Race Caucasian Gender Neutral Age Baby Boomer (65+) Education Incomplete college Region Northeast rural town Employment Retired Salary <$50k Digital Literacy Moderate Religious Yes Health Tracking • Don’t invest much effort into monitoring their health as they never track BMI, steps taken, sleep patterns, or weight Satisfaction w/ Current Care • Are ambivalent w/ their current care, and only somewhat satisfied by their primary hospital and advice they receive Alterative care experience • Given the low priority they give health, they have never tried alternative health care services Reaching Health Goals • Occasionally set and reach easy health goals • Rely solely on personal satisfaction for motivation Healthcare Approach • Typically deal with a chronic condition that is easy to manage and look for the cheapest health care options available How to reach them… • Give him low/no-cost self-service resources that improve his health intelligence and help him manage his condition w/ minimal time commitments • Engage him in health education around the importance of maintaining his fitness to avoid further complications from his chronic condition • Sell him on the cost/speed benefits of telemedicine so that he becomes a more engaged customer and makes his a health a life priority • Explain to him the long-term cost benefit of comprehensive/proactive disease testing to avoid further complications from his chronic condition Use telemedicine tools for follow-up visits and Rx refills Submit to more invasive, proactive disease testing & lab work 29
- 30. Medicare Advantage 4. Customer Segmentation For a discount, Cam would… Chronic-care Cam (20%) Who they are… 1.2X likely to have a difficult to manage chronic condition✜ 20-60% more likely to be somewhat satisfied w/ current care 20% more likely to be cost-conscious with care$ 8.2%cost difference between preferred plan and base★ How they behave… Race Caucasian Gender Neutral Age Baby Boomer (65+) Education Incomplete college Region Southern midsize city Employment Retired Salary $65-95K Digital Literacy High Religious Neutral Health Tracking • Track their weight daily and make sure they stay active • Use tech/mobile often and would be interested in wearables Satisfaction w/ Current Care • Happy with the care they receive to manage their illness • Satisfied with both doctors/pharmacists and their advice Alterative care experience • Do not use alternative care services since they need specialist care to manage their chronic condition Reaching Health Goals • Value being able to analyze their health stats to ensure treatments are successful and share them with loved ones Healthcare Approach • Given their expenses, they seek out the most cost-effective treatment options covered by their insurance How to reach them… • Make it easier for them to manage their chronic illness and know if their tracked vitals are within healthy limits – possibly with subsidized wearable tech • Offer them more frequent, lower cost check-ins with a doctor via telemedicine to check progress against health goals • Give them more self-service options to perform common health related tasks as simply/quickly as possible (i.e., Rx refills), and to share their progress w/ family • Offer them more comprehensive/proactive disease testing in exchange for a discount on their premium to prevent complications from their chronic issue Use telemedicine tools for follow-up visits and Rx refills Submit to more invasive, proactive disease testing & lab work 30
- 31. Medicare Advantage 4. Customer Segmentation For a discount, Sai would… Spiritual Sai (18%) Who they are… 58% have a chronic condition ✜ 20-30% more likely to be very satisfied w/ current care 20% more likely to want highest quality care possible$ 8.1%cost difference between preferred plan and base★ How they behave… Race Caucasian Gender Neutral Age Baby Boomer (65+) Education Neutral Region Western metro region Employment Retired Salary $95K+ Digital Literacy Moderate Religious Yes Health Tracking • Do not actively track much health data, but they do ensure they maintain an active lifestyle by monitoring steps monthly Satisfaction w/ Current Care • Very satisfied with their care, especially the quality of their specialists, medical advice, and health insurance Alterative care experience • Given how happy they are with their care, they go straight to their doctors and do not use alternative care services Reaching Health Goals • Value encouragement from their doctors and the ability to analyze their health data to ensure they are on track Healthcare Approach • Usually seek out the highest quality health care from their doctors and don’t use alternative care services How to reach them… • Educate them on the value of regularly tracking health stats as a means of better monitoring their chronic condition – possibly recommend wearables • Offer them more frequent check-ins with their doctor via telemedicine to check progress against health goals and encourage healthy behavior • Give them more self-service options to perform common health related tasks as simply/quickly as possible (i.e., Rx refills) • Offer them more comprehensive/proactive disease testing in exchange for a discount on their premium to prevent complications from their chronic issue Use telemedicine tools for follow-up visits and Rx refills Submit to more invasive, proactive disease testing & lab work 31
- 32. Exchange 4. Customer Segmentation For a discount, Paul would… Premium Paul (31%) Who he is… 1.2X likely to be healthy w/ no chronic issues✜ 20-50% more likely to be very satisfied w/ current care 30% more likely to want highest quality care possible$ 5.9%cost difference between preferred plan and base★ How he behaves… Race Caucasian Gender Male Age X/Boomer (55+) Education Grad Degree Region Northeastern town Employment Retired Salary $80K+ Digital Literacy Moderate Religious No Health Tracking • Is comfortable with mobile technology and uses it to check his weight and frequently monitor/log his steps taken Satisfaction w/ Current Care • Loves the hospital he visits, the doctors/specialists he sees, the advice he receives, and the treatments they prescribe Alterative care experience • Is content with the care he receives and sees no need to visit an alternative care facility Reaching Health Goals • Commits to his fitness and does not need much outside motivation Healthcare Approach • Goes straight to his doctor to determine the best treatment option when any issues arise How to reach him… • Show him how to extract maximum value from a wearable as a tool to help monitor his health stats and achieve his health goals • Offer him more frequent check-ins with his doctor via telemedicine to check progress against health goals • Give him more self-service options to perform common health related tasks as simply/quickly as possible (i.e., Rx refills) • Offer him more comprehensive/proactive disease testing to help prevent any future chronic issues Use telemedicine tools for follow-up visits and Rx refills Submit to more invasive, proactive disease testing & lab work 32
- 33. Exchange 4. Customer Segmentation For a discount, Sue would… Struggling Sue (26%) Who she is… 1.2X likely to have an easy- to-manage chronic condition✜ 20-40% more likely to be somewhat satisfied w/ current care 64% are cost-conscious with care$ 3.7%cost difference between preferred plan and base★ How she behaves… Race Caucasian Gender Female Age Millennial (18-34) Education 2 or 4 Year Degree Region Neutral Employment Neutral Salary $35-50K Digital Literacy High Religious Neutral Health Tracking • Monitors blood pressure and weight given her condition • Does not have time to track fitness-oriented metrics Satisfaction w/ Current Care • Happy with level of care she receives from her physicians • Dissatisfied with her insurance plan due to limited coverage Alterative care experience • Uses various walk-in clinics to alleviate costs but is disappointed with the experience Reaching Health Goals • Given her condition, she has to set simple/easy fitness goals • Relies on family/friend encouragement for motivation Healthcare Approach • Has limited options when trying to deal with health issues due to small income and basic insurance means How to reach her… • Subsidize wearables so she can better and more easily track her fitness and progress against health goals specific to managing her condition • Offer her more frequent, lower cost check-ins with a doctor via telemedicine to check the status of her condition • Give her low/no-cost self-service tools that make it easier for her to access health resources, diagnose issues, and determine if she needs to seek in-person care • Offer her more comprehensive/proactive disease testing in exchange for a discount on her premium to help prevent complications from her chronic issue Use telemedicine tools for follow-up visits and Rx refills Submit to more invasive, proactive disease testing & lab work 33
- 34. Exchange 4. Customer Segmentation For a discount, Rita would… Restarting Rita (24%) Who she is… 1.2X likely to be healthy w/ no chronic issues, but occasionally sick ✜ 20-40% more likely to be ambivalent about current care 20% more likely to be cost-conscious with care$ 2.8%cost difference between preferred plan and base★ How she behaves… Race Caucasian Gender Female Age Gen X (45-54) Education 2 Year College Degree Region Midwestern suburbs Employment Employed Salary $0-50K Digital Literacy Moderate Religious No Health Tracking • Has little free time to actively track her health, so she tries to at least track her weight monthly Satisfaction w/ Current Care • Very dissatisfied with her insurance coverage, the limited options it provides, and the doctors she is forced to see Alterative care experience • Never tries a walk-in clinic because it is not covered by her insurance and she must limit out-of-pocket expenses Reaching Health Goals • Given her economic condition, health and fitness goals are not a priority right now and therefore, non-existent Healthcare Approach • Wants to save money, so she either deals with the illness herself or reaches out to friends/family How to reach her… • Engage her in health education around the importance of tracking her fitness as she gets older and is at greater risk for chronic issues • Give her low/no-cost self-service and telemedicine tools that make it easier/cheaper for her to access health resources and diagnose issues on her own • Consider offering coverage for walk-in clinics to give her a low-cost option for seeking care for non-emergency issues (vs. avoiding care altogether) • Offer her more comprehensive/proactive disease testing in exchange for a discount on her premium to help prevent any future chronic issues Use telemedicine tools for follow-up visits and Rx refills Submit to more invasive, proactive disease testing & lab work 34
- 35. Exchange 4. Customer Segmentation For a discount, Annie would… Aspirational Annie (20%) Who she is… 1.5X likely to be healthy w/ no chronic issues, but occasionally sick ✜ 30-80% more likely to be ambivalent about current care 14% more likely to be cost- conscious with care$ 3.9%cost difference between preferred plan and base★ How she behaves… Race Neutral Gender Female Age Millennial (25-34) Education Grad Degree Region Southern city/suburb Employment Neutral Salary $50-100K Digital Literacy High Religious No Health Tracking • Actively tracks weight, steps taken, and sleep pattern • Estimates are imprecise so she is looking for a wearable Satisfaction w/ Current Care • Is unimpressed by the doctors and specialists she has seen and the hospitals and pharmacies she has visited Alterative care experience • Tried after seeing an ad and was impressed by the customer service and value as compared to her regular doctor Reaching Health Goals • Has historically struggled to meet her health goals • Values encouragement from friends/family/doctor Healthcare Approach • Extremely cost-conscious with managing her health • Will try to handle it herself or will go to local clinic How to reach her… • Subsidize wearables so she can better and more easily track her fitness and progress against her personal health goals • Offer her more comprehensive/proactive disease testing in exchange for a discount on her premium to help prevent any future chronic issues • Give her low/no-cost self-service and telemedicine tools that make it easier/cheaper for her to access health resources and diagnose issues on her own • Give her the option of seeing a Nurse or PA as her primary care giver for non-emergency issues in exchange for a discount on her premium Use telemedicine tools for follow-up visits and Rx refills Submit to more invasive, proactive disease testing & lab work See a Nurse or Physician's Assistant first before seeing a doctor 35
- 36. Personal health management: The rise of the empowered consumer is a consumer study prepared by PwC to investigate how behavioral, regulatory, and technological disruptions are changing consumers’ approaches to managing their health. How we developed our insights Our findings are based on an assessment of the needs and preferences of healthcare consumers across the United States. Our methodology combined primary market research, conjoint-based trade-off analysis, consumer segmentation analysis, and industry knowledge to gain insights into what consumers value most when managing their health, and how much additional responsibility they’re willing to accept in exchange for reducing the cost of their healthcare. Who we surveyed PwC surveyed approximately 2,300 consumers over the age of 18 across the United States. The survey was administered online in June 2014. Why these consumers? Respondents were chosen based on their inclusion in one of four distinct consumer groups: Single people who have private insurance plans, families with private plans, seniors with Medicare Advantage plans, and individuals who purchased health insurance on an exchange such as HealthCare.gov. The distribution of the respondent pool mirrors percentages drawn from the 2010 US Census in terms of age, income, education, region, urbanicity, and other demographic categories. About our research
- 37. This publication has been prepared for general guidance on matters of interest only, and does not constitute professional advice. You should not act upon the information contained in this publication without obtaining specific professional advice. No representation or warranty (express or implied) is given as to the accuracy or completeness of the information contained in this publication, and, to the extent permitted by law, PricewaterhouseCoopers LLP, its members, employees and agents do not accept or assume any liability, responsibility or duty of care for any consequences of you or anyone else acting, or refraining to act, in reliance on the information contained in this publication or for any decision based on it. © 2015 PricewaterhouseCoopers LLP. All rights reserved. In this document, “PwC” refers to PricewaterhouseCoopers LLP which is a member firm of PricewaterhouseCoopers International Limited, each member firm of which is a separate legal entity. PwC's Experience Radar A different class of insights To learn more about our detailed analysis of healthcare consumers and how PwC can apply this knowledge or our Experience Radar methodology to your business, contact one of our customer experience practice leads: Paul D’Alessandro Healthcare Data Science and Consumerism Leader +1 312 298 6810 pmd@us.pwc.com Ceci Connolly Managing Director, Health Research Institute +1 202 312 7910 ceci.connolly@us.pwc.com For more information on the Experience Radar and survey methodology, visit: http://www.pwc.com/us/en/advisory/customer/pwc-experience- radar.jhtml Contributors Pradeep Giri Manager Nick Bafaloukos Manager Anirban Bhaumik Senior Associate Apoorv Singh Associate
Editor's Notes
- Front cover slide with image
- Rename “cohort” – it’s too wonky….need to call them “Groups” or “Plan Types”
- Care as commodity: A new generation of value-conscious consumers are treating healthcare like any other purchase - shopping around for the best value, regardless of provider/brand Alternative care pathways from non-traditional players – Telemedicine start-ups, retail clinics, at-home medical kits, etc. – consumers have more options than ever to receive care outside a doctor’s office that provides similar quality with “retail-level” convenience and experience features (less paperwork, shorter wait times, faster service, cheaper costs) Escalating costs and higher share of cost burden – Consumers are bearing more and more of the cost burden in healthcare, creating a growing population of consumers who value cost over quality in healthcare/insurance coverage and, in some cases, forgo care altogether because of the cost implications The ACA and its coverage mandates - Millions of new customers are entering the insurance market for the first-time, creating an opportunity for established payers to grow their customer base, but also for non-traditional companies and start-ups to disrupt the industry by offering innovative services at compelling price points to consumers who have no ties/loyalty to traditional healthcare More empowered, informed health consumers – They track their vitals, research symptoms online, and self-diagnose rather than rely solely on providers to diagnose and treat illnesses Proliferation of health-tracking technology – The exploding wearables/fitness tracking industry is allowing consumers to track their health and generate insight with a level of precision that used to be reserved for med professionals only and is changing the definition and capabilities of Remote Patient Monitoring (RPM); plus strong gameification features have increased the “fun” factor associated with health monitoring Shrinking number of primary care doctors – As more new doctors choose the lucrative world of specialization over general internal medicine, existing PCPs are finding their schedules increasingly tight; thus, states are turning to RN’s and trained pharmacists to fill the gap and serve as PCPs that can diagnose and prescribe treatments for most common illnesses
- A “how to read this” guide
- “So what?” section – Payers, providers, Wearables industry Our thoughts on major industry developments based on the data Wearables Alternative Care Self-service Telemedicine/Remote care Non-traditional brands - Look at final PDF for Grocery (SMI) How does this matter to various industries? Creating the marketing version of deck “Two critical findings emerged that should affect every company’s customer service strategy. First, delighting customers doesn’t build loyalty; reducing their effort—the work they must do to get their problem solved—does. Second, acting deliberately on this insight can help improve customer service, reduce customer service costs, and decrease customer churn.” - http://hbr.org/2010/07/stop-trying-to-delight-your-customers Add in data facts to support insight
- 88% think quality was same/better, 82% think cost was same/better (28% better), 94% think proximity was same/better (44% better), 89% think convenience was same/better (44% better), 81% think aesthetics were same/better, 91% think customer service was same/better
- Learn from Retail: What: Providers looking to create the next-generation patient experience need look no further than their local walk-in clinic for best practices on how to create a compelling customer experience Why: Although retail clinics have not yet gone mainstream, consumers who’ve used them rave about their value, quality, aesthetics, service, and convenience How: Providers can either look to incorporate the streamlined paperwork, transparent costing, and “creature-comfort” aesthetics of retail clinics into their existing offices, or partner with Payers/Retailers to open branded-clinics that meet the market’s demand for this type of a service and create new revenue streams for incumbent players Don’t confuse satisfaction with loyalty: What: While consumers are mostly satisfied with their current healthcare, that satisfaction is fragile and doesn’t translate into loyalty towards a given provider – so focus less on winning loyalty and more on improving experience Why: Consumers credit good experiences in healthcare to the person who administered their care, while poor experiences are blamed on the provider/institution; thus, one poor experience can taint their perception of an entire brand How: Providers need to train staff in retail-quality customer service principles, ensure effective mitigation strategies are in place to quickly resolve issues/complaints, and strive to streamline/automate the most common consumer tasks (booking appointments, completing paperwork, accessing health records, etc.) Understand your customers’ values (they’re not all the same): What: Move away from a one-size-fits-all approach to care and identify the specific needs of your customer segments Why: While some consumer segments have similar healthcare preferences, the underlying motivations, priorities, and decision-making rationale that inform those preferences are often very different How: Identify what customer segments you serve and use our behavioral insights to offer your customers relevant services that align with their priorities and needs (for example offering extended weekend hours for couples with kids) Commit to cost transparency: What: Providers that are fully transparent with consumers up front about the estimated cost of their services and enable them to better manage their personal budget will be best poised to earn their business Why: Modern health consumers are empowered, digitally savvy, and treat healthcare just like any other purchasing decision – they shop online, compare prices, and seek out the highest-quality and/or most cost-effective care they can find How: Create online pricing tools that allow consumers to easily research/compare the estimated costs of different services
- Roll-out Next Generation Services Hook customers with technology: What: Take advantage of the public’s digital savviness, increased desire to quantify their fitness, and the growing capability of wearable technology, to incorporate continuous health tracking into treatment and wellness programs Why: Payers/providers can more frequently engage their patients, proactively identify and manage issues before they become chronic, more accurately track treatment adherence, and create an overall more educated/informed consumer base How: Allow customers to voluntarily opt-in to continuous monitoring from their doctor – where their wearable data (or other regularly logged health data) is shared with their PCP in return for regular analysis and recommendations, either for general wellness or as part of specific treatment plans Reaching specific treatment/wellness milestones could even be incentivized with rewards; however, the opposite is not true (for example, consumers reject the idea of receiving a discount up front on their medical bills and getting penalized with a fee every time they don’t reach a milestone (loss aversion)) Forge partnerships with manufacturers to potentially subsidize and distribute devices directly to patients, and ensure data tracking software/platforms are optimized to capture and report on the metrics providers care about Sell consumers on the health/wellness benefits of this enhanced oversight to combat potential “invasion-of-privacy” complaints, and ensure that all messaging is couched in terms of “warnings” or “suggestions” to ensure consumers Self-service cannot stand alone: What: Consumers are NOT ready to accept a fully automated/self-service driven care model even if it saves them money Why: They want the peace of mind of being able to interact with a doctor when needed, likely because of the devastating potential consequences of poorly administered healthcare How: Consumers will happily use self-service options for basic tasks (i.e. Rx refills), so introduce automated options for specific, basic use cases to get customers comfortable with the idea of doing health-related tasks on their own Payers/providers will need to heavily incentivize self-service/remote care options if they want to replace any aspects of in-person care (i.e. telemedicine for check-ups) More than likely, widespread adoption of self-service/telemedicine will come from disruptive non-industry players who focus solely on providing convenient options for basic care at a compelling price point, but stay away from complex conditions
- Alternative Care Providers Make your presence known: What: Alternative care providers have a chance to become the solution of choice for basic illnesses for a large portion of the population if they can increase their visibility Why: Alternative care providers enjoy stellar reviews from those who’ve used their services; however, most consumers simply don’t know that these services exist or what solutions they offer How: Alt care providers need to educate the public on their value proposition, greatly increase their visibility in local communities, and effectively tailor their marketing according to their target segments; also, if alt care providers can partner with payers to get at least partial coverage under plans, adoption will surge Get the message right: What: A value proposition that offers doctor-quality service with retail-quality convenience, value, and support, could prove incredibly compelling, especially to those without complex, chronic conditions Why: Americans value speed and quality most in their healthcare – they want to be able to interact with a doctor within 24 hours of getting sick – while things like location and brand take on lesser importance (except for those on Medicare) How: Emphasize the credentials of doctors on staff in marketing, partner with well-known hospital/health groups to co-brand services, explicitly cite the cost savings of your services as compared to a typical doctor/hospital in marketing To ease any concerns that cheaper costs mean inferior quality (especially for Private/Family group), possibly stress in marketing that doctors and hospitals are expensive because they have to be prepared to handle a wide range of issues (i.e. “a buffet” of medical services); alt care clinics, on the other hand, offer the same quality but for a specific set of use cases (i.e., “a la carte” services) – thus costs are lower because consumers only pay for what they need Think beyond primary care: What: There are large potential customer bases for non-industry players offering services that supplement traditional care Why: Consumers have shown strong interest in complimentary health services like tools to analyze personal health data, tracking progress against health goals and sharing with friends/family, incentives for reaching milestones, etc. How: Example – Offer health data monitoring services which allow customers to have their wearable/logged health data analyzed remotely by a medical professional who in turn sends regular reports with insights/recommendations, including if they have any issues that require in-person care; this could be offered as stand-alone service, perk of using company’s health consult services, etc. – plus, the health reports could be made available to clinic doctors when the customer visits
- Wearables Look beyond Millennials What: Although millennials are often the marketing targets for wearables, wearables could potentially be very attractive to Gen X’ers and Baby Boomers if they are positioned as essential personal health management tools Why: Many middle-aged and elderly consumers are digitally savvy, highly prioritize managing their health since they are at increased risk for chronic diseases, and regularly monitor health stats like weight, steps taken, and caloric intake to ensure they’re within healthy levels – thus, tools that help them monitor their stats more easily would be highly coveted How: Leverage a deeper understanding of customer segments to improve the precision and intelligence of marketing (i.e. move beyond the one-size-fits-all approach of hawking wearables as “cool gadgets”): Millennials: Continue to emphasize the gamification/social/community aspects of owning a wearable (sharing progress, earning incentives for hitting milestones, leaderboards and friend competitions, etc.) Gen X: Position the devices as serious health management tools with powerful features that help track/analyze both fitness and lifestyle data (sleep patterns, eating habits, etc.) and improve your wellbeing; co-brand with established medical groups/health brands to further bolster health credentials (put their badges on product packaging); invest in fashion-forward industrial design to offer a line of premium/luxury devices that appeal to the 15% interested in a style-oriented device and willing to pay a premium for it Baby Boomers: Emphasize the disease management capabilities of devices, their ability to monitor leading indicators for numerous chronic diseases (caloric intake, weight, steps taken, etc.); invest R&D in developing the next-generation of wearables capable of tracking health measures critical to this group like blood pressure, heart rate, etc. Hit the pricing sweet-spot – for ALL consumers! What: Manufacturers need to offer value-oriented devices at a sub-$100 price point t0 appeal to most consumers, but also higher-end models that appeal to early adopters who extract max value from the device and lead adoption for the gen public Why: Nearly a fifth of the country is interested in a Wearable - 85% want a sub-$100 model, 15% want a style-model How: Example – Strip out advanced sensors meant for niche use cases to lower component costs and offer models with the features most users care about (activity tracking, analytics tools, social tie-ins, etc.), but no unnecessary bells and whistles Partner with payers, providers to incorporate wearables more closely into health/medical programs, and get them subsidized (or partially reimbursable) by insurance as a medical device Leverage economies of scale to drive down overall component costs and lower barrier to entry for consumers
- Who She Is Fay is an ambitious, digitally savvy African-American millennial living in a major southern city. She’s new to the workforce, but her graduate-level education helped earn her an initially high salary ($50-$100K) as she starts her career. Tracking her health: Fay is passionate about maintaining a healthy lifestyle, and is hyper-vigilant about ensuring she maintains good fitness. Thus, she tracks her food intake every day, and measures her steps taken at least weekly. She even looks at her sleep patterns and monitors her BMI to ensure she stays on track. Current satisfaction: Fay is generally satisfied with her current healthcare, enjoying the service she receives from her doctor, specialist physicians, pharmacists, and local drug store, and has been very pleased with her local hospital. Alterative care experience: Fay tried using an Urgent Care Clinic because it was recommended by her family and was closer to her home, but was disappointed by it’s cost-value and aesthetics. Reaching her goals: Fay likes to push herself physically, setting challenging health goals and often reaching them. She uses a wearable to track her progress against those goals and likes the gameified rewards/incentives it offers. Plus, as an active mobile user, she likes that the wearable lets her easily share her progress online. Facing health issues: Fay is healthy and rarely gets sick, so she prefers trying to solve any health issues on her own by researching her symptoms online. In the rare event that she needs care, she’ll seek out the cheapest option available.
- Who She Is Fay is an ambitious, digitally savvy African-American millennial living in a major southern city. She’s new to the workforce, but her graduate-level education helped earn her an initially high salary ($50-$100K) as she starts her career. Tracking her health: Fay is passionate about maintaining a healthy lifestyle, and is hyper-vigilant about ensuring she maintains good fitness. Thus, she tracks her food intake every day, and measures her steps taken at least weekly. She even looks at her sleep patterns and monitors her BMI to ensure she stays on track. Current satisfaction: Fay is generally satisfied with her current healthcare, enjoying the service she receives from her doctor, specialist physicians, pharmacists, and local drug store, and has been very pleased with her local hospital. Alterative care experience: Fay tried using an Urgent Care Clinic because it was recommended by her family and was closer to her home, but was disappointed by it’s cost-value and aesthetics. Reaching her goals: Fay likes to push herself physically, setting challenging health goals and often reaching them. She uses a wearable to track her progress against those goals and likes the gameified rewards/incentives it offers. Plus, as an active mobile user, she likes that the wearable lets her easily share her progress online. Facing health issues: Fay is healthy and rarely gets sick, so she prefers trying to solve any health issues on her own by researching her symptoms online. In the rare event that she needs care, she’ll seek out the cheapest option available.
- Who She Is Fay is an ambitious, digitally savvy African-American millennial living in a major southern city. She’s new to the workforce, but her graduate-level education helped earn her an initially high salary ($50-$100K) as she starts her career. Tracking her health: Fay is passionate about maintaining a healthy lifestyle, and is hyper-vigilant about ensuring she maintains good fitness. Thus, she tracks her food intake every day, and measures her steps taken at least weekly. She even looks at her sleep patterns and monitors her BMI to ensure she stays on track. Current satisfaction: Fay is generally satisfied with her current healthcare, enjoying the service she receives from her doctor, specialist physicians, pharmacists, and local drug store, and has been very pleased with her local hospital. Alterative care experience: Fay tried using an Urgent Care Clinic because it was recommended by her family and was closer to her home, but was disappointed by it’s cost-value and aesthetics. Reaching her goals: Fay likes to push herself physically, setting challenging health goals and often reaching them. She uses a wearable to track her progress against those goals and likes the gameified rewards/incentives it offers. Plus, as an active mobile user, she likes that the wearable lets her easily share her progress online. Facing health issues: Fay is healthy and rarely gets sick, so she prefers trying to solve any health issues on her own by researching her symptoms online. In the rare event that she needs care, she’ll seek out the cheapest option available.
- Who She Is Fay is an ambitious, digitally savvy African-American millennial living in a major southern city. She’s new to the workforce, but her graduate-level education helped earn her an initially high salary ($50-$100K) as she starts her career. Tracking her health: Fay is passionate about maintaining a healthy lifestyle, and is hyper-vigilant about ensuring she maintains good fitness. Thus, she tracks her food intake every day, and measures her steps taken at least weekly. She even looks at her sleep patterns and monitors her BMI to ensure she stays on track. Current satisfaction: Fay is generally satisfied with her current healthcare, enjoying the service she receives from her doctor, specialist physicians, pharmacists, and local drug store, and has been very pleased with her local hospital. Alterative care experience: Fay tried using an Urgent Care Clinic because it was recommended by her family and was closer to her home, but was disappointed by it’s cost-value and aesthetics. Reaching her goals: Fay likes to push herself physically, setting challenging health goals and often reaching them. She uses a wearable to track her progress against those goals and likes the gameified rewards/incentives it offers. Plus, as an active mobile user, she likes that the wearable lets her easily share her progress online. Facing health issues: Fay is healthy and rarely gets sick, so she prefers trying to solve any health issues on her own by researching her symptoms online. In the rare event that she needs care, she’ll seek out the cheapest option available.
- Who She Is Fay is an ambitious, digitally savvy African-American millennial living in a major southern city. She’s new to the workforce, but her graduate-level education helped earn her an initially high salary ($50-$100K) as she starts her career. Tracking her health: Fay is passionate about maintaining a healthy lifestyle, and is hyper-vigilant about ensuring she maintains good fitness. Thus, she tracks her food intake every day, and measures her steps taken at least weekly. She even looks at her sleep patterns and monitors her BMI to ensure she stays on track. Current satisfaction: Fay is generally satisfied with her current healthcare, enjoying the service she receives from her doctor, specialist physicians, pharmacists, and local drug store, and has been very pleased with her local hospital. Alterative care experience: Fay tried using an Urgent Care Clinic because it was recommended by her family and was closer to her home, but was disappointed by it’s cost-value and aesthetics. Reaching her goals: Fay likes to push herself physically, setting challenging health goals and often reaching them. She uses a wearable to track her progress against those goals and likes the gameified rewards/incentives it offers. Plus, as an active mobile user, she likes that the wearable lets her easily share her progress online. Facing health issues: Fay is healthy and rarely gets sick, so she prefers trying to solve any health issues on her own by researching her symptoms online. In the rare event that she needs care, she’ll seek out the cheapest option available.
- Who She Is Fay is an ambitious, digitally savvy African-American millennial living in a major southern city. She’s new to the workforce, but her graduate-level education helped earn her an initially high salary ($50-$100K) as she starts her career. Tracking her health: Fay is passionate about maintaining a healthy lifestyle, and is hyper-vigilant about ensuring she maintains good fitness. Thus, she tracks her food intake every day, and measures her steps taken at least weekly. She even looks at her sleep patterns and monitors her BMI to ensure she stays on track. Current satisfaction: Fay is generally satisfied with her current healthcare, enjoying the service she receives from her doctor, specialist physicians, pharmacists, and local drug store, and has been very pleased with her local hospital. Alterative care experience: Fay tried using an Urgent Care Clinic because it was recommended by her family and was closer to her home, but was disappointed by it’s cost-value and aesthetics. Reaching her goals: Fay likes to push herself physically, setting challenging health goals and often reaching them. She uses a wearable to track her progress against those goals and likes the gameified rewards/incentives it offers. Plus, as an active mobile user, she likes that the wearable lets her easily share her progress online. Facing health issues: Fay is healthy and rarely gets sick, so she prefers trying to solve any health issues on her own by researching her symptoms online. In the rare event that she needs care, she’ll seek out the cheapest option available.
- Who She Is Fay is an ambitious, digitally savvy African-American millennial living in a major southern city. She’s new to the workforce, but her graduate-level education helped earn her an initially high salary ($50-$100K) as she starts her career. Tracking her health: Fay is passionate about maintaining a healthy lifestyle, and is hyper-vigilant about ensuring she maintains good fitness. Thus, she tracks her food intake every day, and measures her steps taken at least weekly. She even looks at her sleep patterns and monitors her BMI to ensure she stays on track. Current satisfaction: Fay is generally satisfied with her current healthcare, enjoying the service she receives from her doctor, specialist physicians, pharmacists, and local drug store, and has been very pleased with her local hospital. Alterative care experience: Fay tried using an Urgent Care Clinic because it was recommended by her family and was closer to her home, but was disappointed by it’s cost-value and aesthetics. Reaching her goals: Fay likes to push herself physically, setting challenging health goals and often reaching them. She uses a wearable to track her progress against those goals and likes the gameified rewards/incentives it offers. Plus, as an active mobile user, she likes that the wearable lets her easily share her progress online. Facing health issues: Fay is healthy and rarely gets sick, so she prefers trying to solve any health issues on her own by researching her symptoms online. In the rare event that she needs care, she’ll seek out the cheapest option available.
- Who She Is Fay is an ambitious, digitally savvy African-American millennial living in a major southern city. She’s new to the workforce, but her graduate-level education helped earn her an initially high salary ($50-$100K) as she starts her career. Tracking her health: Fay is passionate about maintaining a healthy lifestyle, and is hyper-vigilant about ensuring she maintains good fitness. Thus, she tracks her food intake every day, and measures her steps taken at least weekly. She even looks at her sleep patterns and monitors her BMI to ensure she stays on track. Current satisfaction: Fay is generally satisfied with her current healthcare, enjoying the service she receives from her doctor, specialist physicians, pharmacists, and local drug store, and has been very pleased with her local hospital. Alterative care experience: Fay tried using an Urgent Care Clinic because it was recommended by her family and was closer to her home, but was disappointed by it’s cost-value and aesthetics. Reaching her goals: Fay likes to push herself physically, setting challenging health goals and often reaching them. She uses a wearable to track her progress against those goals and likes the gameified rewards/incentives it offers. Plus, as an active mobile user, she likes that the wearable lets her easily share her progress online. Facing health issues: Fay is healthy and rarely gets sick, so she prefers trying to solve any health issues on her own by researching her symptoms online. In the rare event that she needs care, she’ll seek out the cheapest option available.
- Who She Is Fay is an ambitious, digitally savvy African-American millennial living in a major southern city. She’s new to the workforce, but her graduate-level education helped earn her an initially high salary ($50-$100K) as she starts her career. Tracking her health: Fay is passionate about maintaining a healthy lifestyle, and is hyper-vigilant about ensuring she maintains good fitness. Thus, she tracks her food intake every day, and measures her steps taken at least weekly. She even looks at her sleep patterns and monitors her BMI to ensure she stays on track. Current satisfaction: Fay is generally satisfied with her current healthcare, enjoying the service she receives from her doctor, specialist physicians, pharmacists, and local drug store, and has been very pleased with her local hospital. Alterative care experience: Fay tried using an Urgent Care Clinic because it was recommended by her family and was closer to her home, but was disappointed by it’s cost-value and aesthetics. Reaching her goals: Fay likes to push herself physically, setting challenging health goals and often reaching them. She uses a wearable to track her progress against those goals and likes the gameified rewards/incentives it offers. Plus, as an active mobile user, she likes that the wearable lets her easily share her progress online. Facing health issues: Fay is healthy and rarely gets sick, so she prefers trying to solve any health issues on her own by researching her symptoms online. In the rare event that she needs care, she’ll seek out the cheapest option available.