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Welcome to this week in Health It, where we amplify great thinking to propel Healthcare forward. My name is Bill Russell, former healthcare, CIO, coach, consultant, and creator of this week in health. It. , a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders.

Speaking of developing the next generation of healthcare leaders, uh, we want to thank Sirius for supporting our mission and the mission of our show. Their weekly support of the show this year has allowed us to expand and develop our services to the community. All right. Today we're joined by James Beam, the managing director of JD Power Healthcare Intelligence, and I'm excited about having this conversation.

And so within healthcare, we've been measuring healthcare customer satisfaction over a period of about 20 years now, starting with our largest portfolio, which is looking at private health insurance, but we also measure Medicare Advantage, manage Medicaid, telehealth, dental Vision, group life. We collect that data and we benchmark close to 200 healthcare firms nationally and understanding who is best in class around, you know, customer satisfaction.

So let's talk about this study specifically. So you took a look at telehealth satisfaction. What was the methodology? How did you determine participation timeframe, data collection, those kind of things? Yeah, so we looked at just about 5,000 US consumers that had a telehealth experience in the prior year.

We run them through a series of qualifications. The work that we conduct is online surveys, which I in total last about, uh, 40 minutes. And the way we divided the work was between payer sponsored telehealth and direct to consumer, meaning consumers that are. Stepping outside of managed care and working with one of the large telehealth systems.

Especially around the provider space, I would think. Clearly we know that Covid drove the numbers, uh, pretty far off the methodology change going into next year. Will you expand the numbers in some way or, or just focus a little bit on different areas? Yeah, yeah. One of the things that we have in our portfolio is we measure pharmacy.

One interest of mine is the, you know, intersection pharmacy, retail, pharmacy and primary care or health and wellness. And so we know from that, we know from that specific research that consumers place a high preference and a high degree of trust when they're dealing face-to-face with medical teams, whether that be a pa, np, md.

And so we believe we are seeing the same level of confidence and trust in telehealth. Where if consumers have a face-to-face interaction, whether that's over the phone or visually or some sort of assisted chat, but they're dealing face-to-face with a, a qualified, you know, physician satisfaction scores tend to trend very high.

So it's in our interest to be able to understand the provider side and how they're introducing telehealth from their systems. Yeah, be on the lookout for that. So you have, you know, this, the report's broken down into a handful at at least the summary report that I'm looking at, broken down into trends, drivers and, and drivers of satisfaction, and then avenues to increase loyalty and advocacy.

Telehealth and they're, they're moving towards a, a digital platform or a telehealth platform, largely because we didn't, we see that people probably did not wanna go into the floor, you know, four walls of an exam room and found it easier to take care of, you know, whatever condition they had in telehealth.

And we're seeing that, we're seeing that in the numbers this year where they're, they've hit a ceiling and if they find that they can't get more complex care through a telehealth provider, turns them off in a, you know, small way. So. Interesting. You know? So did you, so you did some work around generational, 'cause that comes up a lot with technology solutions.

Is, is the older generation going Mm-Hmm. going to adopt it. I know that my mom is 82 years old and she is a telehealth fan. My father-in-law is 88 years old and he is not a fan. I'm a fan at my age, which I'm not gonna share. Do the demographics break down like we think they would. Yes, but there's minor differences.

So universally mo, most of the US consumers we spoke to have a high interest and will consider telehealth when it comes to actual utilization. That's where it starts to break down, but just a little, so Gen Z, gen Y exceed 10% usage, but the differences between them and boomers and pre boomers is only by two or three percentage points.

What we saw when we started to understand satisfaction scoring by population was that the Medicare population actually had the highest degree of satisfaction when using a telehealth service than other populations and other age and gender mixes like that. That was one of the interesting scores here, was that even though the Gen Gen Z tend to be over utilizing telehealth, the highest degree of satisfaction comes with the the, uh, Medicare segment.

We see more classic clinical conditions being sought after. Yeah. Some of that's generational, right? So. The older generation maybe doesn't even believe in behavioral health, whereas the younger generation, it's just a different demographic. Right. So when you look at the things that people are doing across telehealth, are any rising or falling in terms of urgent care, primary care visits?

And again, we're not talking during covid, we're talking just prior to Covid, right? Yeah, and this is one of the themes that we, we also measure telehealth within our private commercial health insurance portfolio. And we have been doing that for a couple of years as well. And one of the areas around telehealth adoption and engagement, uh, that we see that's almost sequel and urgent care is around, you know, convenience, cost, and whether or not the member has enough information from the payer.

In terms of being driven to that particular, you know, place of service. We often see with consumers, they have a high interest in the service, whether that be urgent care or telehealth, but that connection between the consumer and the ultimate visit is, um, complicated by the managed care benefit, um, network design element of health insurance.

And so one of the things we've been promoting with our clients and, and nationally. Not only, not only commercial health insurance, but Medicare Advantage and manage medi manage Medicaid is the payers really have a, uh, huge role in telehealth, and that's helping them understand the copay differential, helping them understand how to get access to a telehealth provider, making it more transparent and clear for them.

We saw this early in the covid research that we were doing in in, in healthcare during the spring. Where as Covid and the pandemic started to increase in terms of time, the total awareness of telehealth started to rise. The problem was that the same efforts that were being conducted by health insurance companies around helping consumers into a telehealth experience did not rise.

And I think that's one of the things that we see with complete similarity between urgent care and telehealth. It's really that steerage of the member steerage of the consumer. And so, uh, you actually touched on this earlier, uh, most important reasons. People using telehealth, safety catapulted up there, uh, for obvious reasons.

Care at a distance, keeping yourself safe. Uh, but then the traditional ones were still there. Convenience, speed. Do you anticipate that safety will continue to drive telehealth? I'm, I'm asking you to interpret the results a little bit here, but it's pretty interesting. On the study in the rank used to be number 11 for safety, and it's now number one.

Is that, do we anticipate that's gonna be the primary driver moving forward? No, I, I guess if I'm speaking from a, you know, position of looking at this from a futurist type of type of position, I think what's going to happen is that the technology will advance, the promotion of the service will advance.

Providers, payers, digital health companies, will be offering consumers more complex services under telehealth, which may trump even cost convenient safety. I would tend to think that health insurance plans may be developing or even disruptors, some sort of telehealth entry, managed care entry using telehealth, some sort of digital platform, health insurance company where.

The services are routed outside into the community post telehealth visit. The future's un unwritten here. What I can tell you is that of everything that we measure in healthcare, there's a high degree of satisfaction with the telehealth service. 48% of those we've we've spoke to this year and last year.

I had a pretty seamless experience without any technical problems, without any consultation problems. It's amongst some of the most highly satisfying things that we see in healthcare, all the way from managed care up through pharmacy, up through dental, vision, services, telehealth at the top and it's, it's higher when it's being delivered by a health system or a provider.

So keep that in mind. Same thing in pharmacy, when a provider is directing the care. Consumers put more trust in that particular party. That's fascinating. Alright, let's jump into, uh, drivers of, of satisfaction, uh, around this. What are the primary drivers of satisfaction? What leads people to say, Hey, this is really good.

This is something I want to see. Continuing healthcare. Yeah, so we design a number of KPIs around telehealth and the number one driver that we saw. Which the universally consumers were very much, uh, embracing and applauding was that they were able to spend enough time with a provider that was number one, that made the experience different than driving 20 miles.

So, so they, so they feel, do they feel rushed when they do a physical visit? Is that it or is it just the whole process of going and waiting in a waiting room, getting ushered into a room, then waiting for the doctor? Just the, just the contrast of those two things. No, it's about healthcare literacy, healthcare engagement, spending enough time with a provider to ask the question and get answers for their clinical conditions.

We see the same thing in pharmacy when pharmacy members are able to spend quality time with a pharm D. It's the same element that we see here in telehealth. Is that clear, transparent, understanding. The direction that they need in order to satisfy their, their particular condition. That's very important to the consumers in telehealth here, these run many of the KPIs are, isn't there a, a risk here?

Uh, what, what we've heard from providers over the years, and, and this is potentially providers that weren't excited about new modalities and, and just adjusting their practices and whatnot, but they were essentially saying, look, there's a lot of things you can't do over telehealth. , but I would assume if we're running into roadblocks and we're not able to do the things we need to do over telehealth, that would be a huge dissatisfier.

Are are people experiencing that or are they essentially saying, no, we're really, we're getting to resolution through these telehealth visits? When you look at sort of the satisfaction on telehealth, you sort of have to compare and contrast the drivers of satisfaction with what is one of the major issues with telehealth.

And so the top issue that consumers have in a, in a telehealth consultation, again, it's not the technology, it's not the claim, the reimbursement aspect of it. It is really about the ability to understand the medical professional. And so if that's not achieved in the telehealth visit, there's significant declines in satisfaction.

And so the more time you're able to spend with a provider and being able to get a close diagnosis to what your condition is. That is a huge driver of the overall satisfaction. It's we, we see this in other areas of healthcare that we measure. It's really around the authentic experience between the patient or the consumer and the practitioner of healthcare.

Do you get any indication as what drives the authentic experience? Certainly. If a person, if a telehealth provider is not good with people face to face, they're probably not good with them. Over a telehealth VI visit, all you've done is just changed the medium. But are there certain factors in, in a telehealth visit that people said they made eye contact, they communicated clearly?

They clearly one of 'em was they spent quality time with me on, on the call. So are there other factors like that? Yeah. Fewer than two thirds of the consumers we spoke to experienced a consultation that had courtesy respect. They were listened to carefully. Things were, things were explained carefully. I.

Gave them the, gave them the perception that there was, you know, value in the actual consultation. So these soft skills, we were not measuring them as hard as we thought we should have. And that's really, that's really being elevated. When we first started to conduct the study, we thought it would be about the technical requirements or the cost or the copay mechanisms.

We're seeing this in a lot of our healthcare. It is around the authentication between a. Provider again, MD PharmD, NPPA and the actual consumer is where there's a high degree of value, you know, based on your research, do you think there's going to be, uh, potentially when I'm making a decision next year on what plan to choose, do you think part of that is going to be the telehealth option that I'm gonna be, I'm gonna wanna be able to check that box and have that be a part of my plan?

Do you think that will happen? I think it's early, but I think that we know that when a, when a health insurance benefit is offered in, in parallel with a telehealth offering, it does provide the consumer a sense that they're getting more value. One of the things that we have measured in our managed care research for decades here at JD Power is.

The definition of a health insurance member is much different than in other industries. So consider the fact that if you are a banking customer and you have a dissatisfying experience with a bank, you have complete freedom to move to a new bank the next day. And commercial health insurance, Medicare Advantage manage Medicaid, even pharmacy to some degree.

Someone else is making a formulary decision, a benefit decision, and making a decision about how you get your healthcare. And, uh, if you have a poor experience with them in June, you may have to wait until October and understand what your, what your, uh, new benefit plan is under your employer. So it's a, it's a healthcare's far different than other, than other industries when it comes to consumer satisfaction.

And we urge health insurance companies that they need to bring more value to the partnership that they hold with health insurance members because of those inherent barriers. You looked at two segments direct to consumer and then you looked at payers. Are there any clear cut leaders at this point in those two spaces?

So actually the payers significantly jumped year over year in overall satisfaction. That's being driven by their expertise around enrollment, billing, and payment. However. The direct to consumer segment is still leading in terms of consultation. Again, those sort of soft skills that we saw before, extending more time with the patient in totality that are both highly satisfying experiences, both direct to consumer and payers.

Interesting. Uh, well, you know, let's go to loyalty and advocacy as we, uh, you know, get towards the end of this, how it's, I wanna look at what's around the telehealth visit. We talk a lot about the physician experience, uh, the physician patient consultation and spending time with them. And I know all that's extremely important.

We've already established that. But what about the complexity of the ? The overall process, the technology aspect of it, the payment aspect of it, the follow up and connectivity into the workflows afterward, did that lend itself to either being, uh, dissatisfier or satisfier? Yeah, so the way that JD Power conducts all of their business around rankings and awards and research, research data and analytics is through our modeling.

So we have a JD Power Index model that is a, uh, proprietary built. Driver of satisfaction where we, we understand the, you know, consumer satisfaction and, and, and sentiment. When we started the telehealth work, we started to feel the responses. That's when we go through sort of our data processing and we understand what are the drivers of satisfaction.

Then our models are built on that credibility of what the, you know, crowd is telling us. So for telehealth, we break it up. 42% of our model is driven by the customer service element of it, which is what is the overall technology experience, the phone, the video, and then the second most important thing, as I mentioned earlier, what consumers are telling us is the actual consultation, the experience that they have with the provider there.

We're looking for the quality of the service, timeliness, convenience. What was the dialogue and the experience between the consumer and the provider? And then it's getting into the traditional payer side, which is the actual level of enrollment. How easy was it to find a physician? How easy it was it to actually conduct the visit, and what was the appearance of the website or the app, the speed of the pages, loading, things of that nature.

And then finally, billing and payment, which is the clarity of the billing process, the amount of time given to your bill. All of those elements go up into the total satisfaction. And as I mentioned before, the model is heavily built right now around customer service and consultation. And so as time goes on and consumers tell us there's more important things than others, we will weigh the actual credibility of the model.

So right now, I mean, again, it's focusing on the actual consultation experience and then the customer service element of it. So I, I think, and that really interests the question of how do you drive loyalty and advocacy? Well are loyalty and then people advocating for your program, consumers actually telling other consumers about your program and, and you're saying focus in on those core areas and that is how you drive loyalty and advocacy.

Is that accurate? Exactly, and I would say one major significant finding that we found last year, and we found this year, is the differences in satisfaction between consumers who tell us that their healthcare is poor, and the consumers that tell us that their healthcare is excellent. So we ask a series of questions around their clinical condition and on a thousand point scale, those that said they had a poor condition, rated the telehealth experience at a 7 83.

Those that said they had an excellent healthcare or excellent health, their ratings were 900. So we see 117 point difference between those that are high risk and those that are low risk. And so again, what we know in healthcare is managing poor health populations require more time, more literacy, more engagement, and so I think telehealth has a profound opportunity here to reach into those populations that need greater access around resources, time, education, and overall healthcare literacy.

So. That was one major point of our data that stood out last year, and it stands out this year as well. How do people get access to this, to, to your report and to your data? Yeah, you could find us under JD Power, then look for JD Power Healthcare and there's some links in there and other information, and you'll come.

Also find my email in there as well. So, James, you have an interesting background. I, I, I want to hit on this before we close. You've had a front road seat in a lot of different things. Can you give us a little bit of your healthcare background, how you got to where you're at today? Yeah, so I've been in healthcare about 25 years.

Started in the traditional managed care health insurance, financial underwriting, actuarial path. I worked at Aetna, I worked for the University of Michigan Health System for a health insurance plan. There. And then I was a market chief financial officer at Humana and right after ACAI was offered a role within Walgreens as a vice president of outcomes and analytics where I helped them divest themselves from their PRI from the primary care space, which is interesting given where CVSA and Walmart are these days.

And yeah, I had a front row seat for, you know, that they shift in retail pharmacy over to primary care. And then I was offered a role after IBM entered into healthcare. I was offered a role to become a partner for the newly launched IBM Watson Health. So I got a lot of experience on the provider side dealing with clinical data, dealing with all of the intricacies that come with things that we know right now in digital healthcare.

One of the things that I was working on at IBM, which held a lot of interest for me was. Moves around trying to understand the consumer from a data and analytics perspective. And what I found was there was very little understanding and very little data about understanding consumer satisfaction with either pharmacy or Medicare Advantage or Medicare.

And it brought me to JD Power and one of our central Thesises are here is that, you know, there's a lot of decisions made between payers, providers, digital health companies, you know, venture capitalists. There's not a lot of knowledge, not a lot of data around what.

And we have this massive opportunity in the future around the ambulatory care space and a lot of consumer, uh, a lot of consumer decisions are gonna be made, are gonna be made outside of the traditional incumbent landscape that we have today. So that's what brought me to JD Power, and that's what sort of holds my interest in healthcare.

Healthcare consumerism. Well, fantastic. I, I wanna thank you for your time. We'll have to make this an annual visit. You can give us an update. On, uh, where this is heading. That's all for this week. Don't forget to sign up for CliffNotes. Send an email, hit the website. We wanna make you and your system more productive.

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