Patients become consumers in new models of health financing

November 15, 2014

Ministry communicator says spirituality, not Catholic identity, resonates with health care consumers


CHICAGO — In shaping health reform, health policy makers built in economic incentives and disincentives intended in part to give rise to an informed and value-conscious health care consumer. While many experts in the business of health care already have shifted to calling patients "consumers," health care "shoppers" say health care providers aren't doing enough to make it easy for them to compare medical services, and access them easily.


That's the thread that runs through the 2014 Klein & Partners national "Kitchen Sink Survey" of health care consumers. Rob Klein, president of that Chicago-area branding and marketing research company, detailed the findings at a joint meeting of CHA's advisory committees last month at the Chicago Westin O'Hare. Along with Klein, presenters in the session, "Having our say: Communicating Catholic health care's contribution s to the nation's health and wellbeing," included Abby Lowe McNeil, system director of communications and public affairs for Irving, Texas-based CHRISTUS Health; and Brian Reardon, system director of communications and public relations for Springfield, Ill.-based Hospital Sisters Health System.

Klein said an average member of the public spends more time researching a television purchase than comparing the services of competing hospitals before selecting one. They may be too stressed for research, or they may find it too difficult to locate credible, clear comparison information on health care pricing or quality. The upshot is that most patients still rely on their doctors' recommendations or the positive reviews of family and friends in selecting a hospital.

Consumer pushback
Klein & Partners conducted its online survey in September, drawing responses from a representative sample of 407 adult heads of household — individuals who identified themselves as being most responsible for personal and family health care decisions.

Based on survey results, Klein said that almost six in 10 Americans report that their insurance costs have gone up since the passage of the Affordable Care Act, and the majority of Americans feel that their access to health care and quality has not improved commensurate with the rising bite health care takes out of the family budget.

Four in 10 survey respondents thought that hospitals make a large profit — 30 percent profit was the average guess in other research Klein & Partners has conducted in the past. And 45 percent of respondents in the current survey said hospitals are overpaid. The survey showed tepid support for tax exemption for nonprofit hospitals — only 35 percent of respondents thought that nonprofit hospitals gave away enough charity care and community benefit to earn their tax exemption. "The only thing between you and losing the tax-exempt status is (consumers) think they will pay for it" through increased health care costs, Klein told the audience. "That is not a great place to be."

Accentuate the positive
Survey respondents signaled that when it comes to shopping for health care — from insurance coverage to a new primary care doctor — they are frustrated over rising out-of-pocket costs, a lack of pricing transparency and barriers to access such as long lead times for appointments with their doctors. They are put off when a doctor's front office staff is inefficient and less than cordial. Klein said, "consumers are saying you need to start acting like The Ritz or the Apple Store" and deliver exceptional customer service.

Respondents were asked on a one to 10 scale to rate the favorability of health care providers and insurers. Catholic hospitals had a rating of 5.9, behind academic medical centers with a 7.0 rating, nonprofit hospitals with a rating of 6.98 and physicians with a 6.89 rating. For-profit hospitals drew a 5.09 favorability rating and health insurance companies 4.68.

"The fact that these means are that low is very concerning to me," Klein said, especially the 5.9 for Catholic hospitals. "What I'm seeing and hearing in the focus groups is more women than men have negative perceptions of Catholic hospitals, and that voice is growing." Klein said in a later interview that women's reservations about Catholic health care have to do with perceived limits on reproductive health services.

He told the audience, "You'll have to have very strong messaging. No brand ever wins by telling people they are wrong," but ministry hospitals can make sure they are getting the right message out in saying "here is what we do and allowing them to draw their own conclusions."

Spirituality matters
Reardon said that earlier this year, Hospital Sisters Health System conducted qualitative and quantitative research on what Catholic identity means to consumers in its 12 small and midsized markets in Wisconsin and central and southern Illinois. The health system surveyed 4,500 people. Based on responses in focus groups, Reardon said spirituality matters to people of all religions. But participants told the researchers that they were "put off" by messaging around the Catholic tradition of caring. "That's not to say we have to downplay our Catholic identity, but we have to be careful how we communicate that," Reardon said.

He said one of the biggest challenges Catholic hospitals face is in answering community and press questions related to the Ethical and Religious Directives for Catholic Health Care Services. Reardon said that in recent weeks reports have surfaced that Hospital Sisters Health System is pursuing an investment in a multispecialty physician group in Springfield. That led to a number of questions from the press about the potential impact on patients' relationships with their physicians should the doctors be required to abide by the ERDs. He said he wasn't sure how to answer those questions.

"It's more clear cut in a hospital setting," Reardon said. "There are certain things we are not going to do. As a Catholic health care provider, the sanctity of life is very important. But when we get into the doctor-patient relationship, it gets a lot more tricky. I think it is something as a Catholic health care community we really need a lot more discussion around so we have the right answers, and consistent answers, because we are walking a fine tightrope between sending a signal to the community that we are going to somehow limit their access to care, but then again we don't want to run afoul of our bishops."

Playing the 'Catholic card'
Reardon said Hospital Sisters Health System has been criticized for being too Catholic and not Catholic enough. For instance, some conservative Catholics took umbrage with the system's "Real men wear pink" cancer fundraising campaign because the health system partnered with the American Cancer Society "and the cancer society may at some point have given a grant to Planned Parenthood." Critics are also "playing the Catholic card" to oppose the system's decision to build a replacement for its aging Belleville, Ill., hospital in another nearby community rather than in downtown Belleville.

McNeil said when CHRISTUS closes a hospital or services and gets pushback questioning its allegiance to Catholicity and mission, it shapes its response in terms of a family's budget decisions. McNeil said the public understands the need for fiscal responsibility and to plan for the future.

McNeil said that the lines between communication, marketing and operations are blurring for hospitals. "It matters less what we say in our advertising message, and it matters more how they are treated in our hospitals. Our patients don't have a way to rate technical quality of their care; they rate us based on service. We treat everyone with dignity and integrity because that is who we are. We know you want to be treated as a person and you want us to understand how difficult the hospital patient experience is or how hard it is to get in and see your doctor."

At the close of the session, Sr. Carol Keehan, DC, CHA president and chief executive officer, told the audience that all patients regardless of economic status want and deserve a good consumer experience. Convenient scheduling and reasonable wait times can be most important to the working poor, who often have less flexibility in their work schedules than people with higher incomes. "Create the experience that everybody wants, and we can serve the poor much, much better and we will attract the paying customer" and physicians, she said.


Copyright © 2014 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2014 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.