Core Exchange: Rob Klein – National Consumer Insights Study, Primary Care.

Consumer perspectives on primary care

In this episode of the Core Exchange, our good friend and frequent research partner, Rob Klein of Klein & Partners, joins Laila Waggoner, VP of Strategic Partnerships, for a conversation about Klein's unique BRANDengine℠ research model for healthcare systems, and they discuss the findings related to primary care from the recently completed National Consumer Insights Study. This jointly-conducted national survey of more than 1,000 healthcare decision makers reveals insights about what today's consumers expect from primary care, their attitudes about relationships with primary care clinicians and providers, the relative importance of various decision drivers (including ratings and reviews), and more. Rob and Laila also explore some of the differences among age group and life stages for consumers in how they think about the role of primary care in their lives.

You can listen to the podcast episode by clicking here, or you can read the full transcript below.

Episode Transcript:

Laila Waggoner:

Welcome to The Core Exchange, a podcast for healthcare marketers. I'm Laila Waggoner, Vice President Strategic Partnerships with Core Health, Core Creative's specialized healthcare marketing practice. We are really excited to have our friend, Rob Klein, CEO and founder of Klein & Partners, with us today to talk about a study we worked on together that Rob likes to refer to as NCIS, National Consumer Insights Study. Rob, welcome to The Core Exchange.

Rob Klein:

Thanks Laila. It's so great to be here with you.

Laila Waggoner:

I've been lucky enough to know and work with you for a really long time, Rob, and I've loved getting to work with you over all of these years. But for those out there, there may be a few of you out there who are not familiar with Rob and his organization. So, could you just tell us a little bit about yourself, your background, and Klein & Partners?

Rob Klein:

I'm happy to, and we started when we were 10, so we're not as old as the number of years we've known each other would indicate.

Laila Waggoner:

That's right.

Rob Klein:

But thank you for having me on your podcast. I'm really looking forward to sharing this information. So, just a quick background on Klein & Partners, I've had Klein & Partners for, gosh, 18 years now, and I've been in healthcare market research for going on 40. So, it's been an amazing journey. Our practice really is about helping our clients find their brand voice. So, a lot of the work we do is to understand what makes a consumer attracted to an organization? What makes a patient love or hate the organization that they're using for their services. So, along with that comes understanding the changing needs and expectations of consumers. As we're going to see or hear in our podcast today, today's consumer is very different than yesterday's consumer.

Laila Waggoner:

Yeah. That's really so true. I just have loved working with you and your organization over the years. I've had the opportunity to work with you as an agency partner originally, then as a direct client when I was at Bon Secours Mercy Health, and now again on the agency side at Core Health, we're getting to partner and doing some really great research together. I've just always really appreciated your philosophy and your approach to market research for healthcare organizations and how you're really focused on exploring more than just what a lot of people think of as the basics, which are awareness and preference, because that really doesn't go far enough. Can you just talk a little bit more about that BRANDengine℠ model that you've developed and what it measures?

Rob Klein:

It's based on the theory of commitment. We all know that the one thing that all strong brands have in common is that their customers love them. There's an emotional bond or an emotional attachment. We all use human terms like, oh, I just love Starbucks, which I say all the time, or I hate this brand, but it's too hard to switch. So, we use those human relationship terms describing brands that we work with. So, our model is really understanding what drives attachment to a brand or lack of attachment to a brand. Consumers, their needs are very fickle and they're changing and they're looking for that relationship.

The one thing also that strong brands have in common is they listen to their consumers. We all say this. Oh, they hear me. They get me. They listen to me. We all want to be heard. It doesn't matter if you're buying a car, a cell phone, something at the retail store, or healthcare. We want to be listened to. That's the one emotion that I'm really seeing registering higher than it ever has before is a strong brand I feel listened to. So, what that means in our research is finding out what does listened to look like to consumers? If I'm heard, what am I saying to you that you're responding to?

Laila Waggoner:

Yeah. That's just so really important, we think. The reason we really appreciate it is that in our work as we're trying to translate that data into insights and then strategy and then creative that really resonates with consumers, it has to be meaningful and relevant. It can't just be the basics. So, your work really gives us that insight into what is it that people ... Your two words that you use I think translate really well into the healthcare model, which is attraction. What makes a brand attractive? Meaning how are we going to deal with things like patient acquisition? How do we communicate in a way that makes people want to do business with us? Then the attachment piece is really what a lot of people refer to as brand loyalty, or patient retention is the language I think that gets used. So, really, those pieces combine in forming that brand equity and building that brand over time. As you said, brands that do that well and can really listen to their consumers can really differentiate themselves in the market in a meaningful way. So, we really appreciate that work.

Rob Klein:

Yeah. Laila, if I can add, it's not just enough to listen to them. You have to actually do something about it. So, I like to call it listening and responding.

Laila Waggoner:

Amen. Amen. That's right. It's not enough to listen. In fact, we usually say if you're not going to be willing to do something different, you may really want to even think about doing the research to begin with because nothing's worse than getting asked and then not seeing any sort of movement in a direction.

Rob Klein:

It's worse than not asking at all.

Laila Waggoner:

That's right. That's right. Well, thanks so much for that overview. It really helps, I think, give our listeners a good understanding of the way that you approach market research, which is such a critical aspect of healthcare marketing. So, let's dive into some of the research that we worked on together and what we found. There's a lot here. This is your annual study that we've worked with you to expand a little bit and make sure that we could survey a national audience. There's definitely more than we can cover in one episode of the podcast. But let's start with, we kind of talk about this in chapters. There's a whole bunch of chapters to this research. I thought maybe before we get going, we'll do a quick snapshot of the methodology, just so that people understand what we did. But then let's dive in on the chapter on primary care, if that's all right.

Rob Klein:

Absolutely. So, methodologically, how we made the donuts, as I like to say. So, this was an online survey among a thousand consumers who were healthcare decision makers for the household, and it was nationally representative geographically as well as demographically. So, we're able to cut the data in many, many different ways. We're going to focus mostly at the total level, but we're also going to dive a little bit into some differences by age. I'm really finding that age is a big predictor of changing needs and requirements, as is ethnicity and then gender. Those three really form where we need to understand the changing expectations of those three groups.

Laila Waggoner:

Yeah. That's great. One point I want to make for our listeners, if there is particular data in here that you're hearing about or there's an area that you would like to talk about a little bit further and maybe have a little bit of a deeper dive, Rob and I are both really happy to chat further with you. So, feel free to contact us and say, "You talked about this. Is there more?" Because there's so much data here, we can't obviously cover it all. But there are some really interesting findings. So, let's talk about primary care because there's nothing really changing about that in the marketplace, is there? Ha!

Rob Klein:

Oh, no. Not at all. Not at all. So, let me just give you some of the data, the numbers, and then talk about what it means for us as we brace for the new world order, as I call it. I always tell people as marketers, put your seat belts on because it's going to be a bumpy ride. We're facing more disruption in the coming year or two than we've faced in the past 20 years. So, 80% of adults nationwide said they have a primary care physician. No big deal. We probably know that number. That in and of itself hasn't changed a lot over many, many years.

What's interesting is if we look at it by age. So, we like to look at it by the age groupings, Gen Z, millennial, Xers, boomers, and Silent. No surprise, silent is 100%, Gen Z is 78%. So, what I have found, and also too just for our listeners, I do so much research, not just with this omnibus, so I'm going to throw in a few things that maybe I have seen in my other research that I'm doing around the country. So, one thing I've noticed with Gen Z, especially when I'm doing focus groups, and I ask them about their primary care, many of them, they'll show me their phone and say, "Oh, my PCP is here," meaning I've got a virtual visit doctor. Maybe I do something with Walgreens or CVS with a virtual app.

So, they have primary care, it's just not the traditional PCP as we're looking at it. So, I think that's the first big aha for health systems is primary care is not what it used to be. It's not just the PCP, going into the office. Primary care still exists, but how we address what primary care is and how younger people seek primary care is a whole different ballgame. So, we just have to change the way we look at what used to be just the primary care physician. So, a first thing is we just have to look at the same things, but differently now.

Laila Waggoner:

Right. So, there's definitely that shift. We're happening to look at the graph, which maybe we'll try to put an example of this in the show notes and on our website when we post the podcast. But you see the likelihood of having a PCP really does increase significantly as people age, even though 78% is still a significantly higher number than I might have guessed. But your point is really well taken that what we call a PCP or what we think of as our primary care provider is really changing. Another aspect of this is the relationship that people want to have with their primary care physician. You had some interesting findings here because you asked about a current relationship as well as a desired one. Talk a little bit about that.

Rob Klein:

Yeah. So, I've got kind of a fun question. Again, people have relationship with their brands just like humans have relationships. So, we asked them what kind of relationship do you have and what would you want it to be? So, we have answers like teammates, casual acquaintances, equal partners, best friends, it's a marriage of convenience, parent and child, boss and employee, business rivals, or just none. What's interesting is a lot of folks said currently, they don't feel like they have any relationship with their physician in terms of a relationship style. So, what it means is they're feeling very transactional vs. I have an emotional relationship. What do they want? They want to be teammates, equal partners, or best friends.

Laila Waggoner:

Which is really interesting.

Rob Klein:

Think of the teammates. Teammates like in sports. We share a common goal, we have good communication, and we've got each other's backs. I'll tell you, other research I'm doing, consumers are coming out of COVID, not a passive patient, but a very active demanding consumer. I know we always bristle when we talk about patients vs. customers. As doctors, if you don't want to call, oh, my customers are coming in, I know that bristles a lot of providers. Even if you don't call them that, thinking about them as a customer means I know you have a choice and if I don't perform and become your partner, then you can go elsewhere vs. oh, you're my patient, I own you. You're submissive, I'm dominant.

That's why that equal partners, the word equal is so important because consumers are afraid to get a cold now because they think it's COVID, they think it's monkeypox, they think I've got some crazy disease, I'm going to die. I've never seen consumers more interested in health and wellness than now. So, we need the dust off our population health playbooks that have been collecting dust, and now is the time to work with patients/customers to help them on their wellness, not just fixing them when they're sick. They've never been more open to it as they are right now. Best friends, you think about your best friend, you look forward to going in to being with them because you know they have your best interest at heart. Not, "Oh, I'm sorry, I can only see you 8:00 to 5:00 or 9:00 to 5:00 because I have banker's hours," to, "You know what, Rob? I know sometimes you get sick on the weekends or at night. We're going to make sure we're going to get you in when it works for you."

Laila Waggoner:

Yeah. I think in another chapter, we talk a little bit more about that decision making process and the patient's role changing, but that really does have an implication here from a primary care perspective. So, I'm really glad you brought that up.

Rob Klein:

To go back on age, what factors influence loyalty to a primary care physician? It is significantly different, the loyalty factors by, say, Gen Z. That's our new up and coming customer group. They may not get sick like the older ones, but you have to invest in them before they invest in you. In fact, I have all my Rob-isms. That's one I haven't mentioned a lot, but it's so true. For brands to create that strong bond with their customer bases, the brand has to invest in the potential customer before that customer invests in them. It's not the other way around. So, we've got to build a relationship with people before they even may need us for the expensive profitable stuff.

Laila Waggoner:

Yeah. That's right again.

Rob Klein:

So, Gen Z there, here's the things that really drive their loyalty to a primary care physician, whatever that looks like. Easy to get in quickly and make an appointment, short, no wait times at the office, and the hours and days the doctor's office is open to see me. Access, access, access. You remember my other Rob-ism of “time is the new currency.” We can make more money, but we can't make more time. We've all just lost two years of our lives that we'll never get back, and consumers are no longer patient with healthcare's excuses like, "Oh, we can't get you in. We can't do online scheduling." They don't want to hear that anymore. They're like, "Don't make me waste my time sitting for two hours in your office because you can't get your scheduling organized." So, the “retailization” of healthcare is here and we have to address it. The frontline is the primary care office or relationship or experience.

Laila Waggoner:

Yeah. Another question that you asked in this study that I find really intriguing and interesting and particularly the differences in how people answered this, the question itself was for each of these following statements, let us know if you agree or disagree and on a scale, and the topic area's how much do you agree or disagree with this statement about your relationship with your PCP? This was just really fascinating to me too. Let's pick a few of these to really talk through. So, the first one, I found really such a high level of agreement with, which is you cannot really be sure you picked the right doctor until after you see them for an actual visit. This one was huge. Talk about it.

Rob Klein:

Yeah. 80% agree with that, and now we're going back to our classic business MBA class of cognitive dissonance. So, I need verification that I've made a good decision here and I can't get it until I go in and I get sick and I have that first visit. What if I don't like them? What if we're not a match? Because remember, they want a relationship. If I'm going to pick Dr. Smith, I'm going to want a relationship. So, I'm telling clients you need to be able to put on your FindaDoc, whether it's the website or some way, you need to put videos of the doctors to show their personality. Not just, oh I have this degree, this years of experience, all the brag, I call the brag points.

Laila Waggoner:

That's right.

Rob Klein:

People are like, "Yeah, yeah, yeah, you went to medical school, you're a doctor. That just makes you equal with everyone else." Clinical skills are now just an expectation. They're not a differentiator for most, especially for primary care. The differentiator is that bedside manner, that personality. So, I'm telling our clients, you really got to get your doctors to express their personality so someone can have at least some idea like, okay, this person's really dry and serious, but so am I, or this one's got a sense of humor. Look at all the sports they play, they love dogs, whatever. I like that too. Because remember, they either want to be teammates or best friends or equal partners. You can't understand that dynamic by looking at a resume basically.

Laila Waggoner:

That's right. That's right. The other piece that comes into this, and we'll talk about this in a separate chapter as well, is that role of online ratings and reviews, not just for hospitals, but for providers and how important that becomes.

Rob Klein:

Absolutely. Yeah. Yeah.

Laila Waggoner:

... as part of the decision making.

Rob Klein:

Yeah. Absolutely. The one that really got me is the one that's at the bottom of the chart.

Laila Waggoner:

Talk about it.

Rob Klein:

22%. This number, you may say, oh, it's only 22%. Let me put it in context. Here's the statement that we showed them. Service at my doctor's office has gotten so bad that I am considering changing physicians. 22%. One in five of Americans said they're thinking of switching. Now, let me put this in context. Five years ago when I measured this nationally, it was 10%. So, in five years, it has more than doubled. That number should scare you because it does me. What it means is people are not as loyal to their doctor so that they'll put up ... It's not that the service maybe has gotten worse, it's that they're no longer putting up with it because they don't have to. There are so many disruptors that are giving them nontraditional options. I wouldn't be surprised in five years if someone says, "Oh, I've got an Amazon doctor." So, it is changing. I have a CVS doctor.

Laila Waggoner:

That's right? Or I don't even refer to it as the doctor. It's not necessarily a branded thing. So, it's just a really interesting evolution, I guess, that we're undergoing.

Rob Klein:

Absolutely. Millennials were most likely to say I'm getting fed up with my relationship. Millennials are right in the middle there where they're transitioning from the younger ones that maybe weren't as traditionally brand loyal that we think of, to I'm starting to get sick. Things are happening to me.

Laila Waggoner:

That's right.

Rob Klein:

So, if anybody is right in the transition phase, it's millennials.

Laila Waggoner:

That's right.

Rob Klein:

They're struggling the most coming out of COVID, emotionally and physically. If we're not really meeting them where they are, we're going to see a lot of problems as providers.

Laila Waggoner:

Yeah. Then once they've selected that, so there's a lot more there. As you know, if people download the study they'll see all the detail there. But another thing is that once they've chosen a physician or if they have a PCP, those factors that have the most influence on a patient's loyalty, this also had some interesting things that go right to your point about it's not just about credentials, it's about that personal relationship. The one that tops the list, along with insurance network, which continues obviously to be a critical factor, but still, only that 30% in terms of the most influence because again, more and more providers are available to folks. But the personal attention of the physician and even the bedside manner if we want to call it that was at that top of the list.

Rob Klein:

Absolutely. It's about that personal relationship with the quarterback of your care. PCPs are still at the top of the sales funnel. The narrower that sales funnel, the less that's coming down into the brand family members, the hospitals and the outpatient surgery, and you'll pick a different facility. But it all starts with that primary care, as I call them the quarterback. If they send you out of the brand family, you're not coming back in later in the sales funnel. So, it is so critical. That bedside manner, that relationship is absolutely critical, and you're right about in health insurance. That's a table stake. If you're not in the network, then people can barely afford in-network coverage, they're not going out of network unless it's time to mortgage the house, and then I'm going to one of the major national tertiary referral centers. That's a rare exception.

Laila Waggoner:

Right, and more for acute care than for-

Rob Klein:

Primary care.

Laila Waggoner:

... primary care. Yeah. Exactly.

Rob Klein:

People are looking to choose a doctor. Basically, what they do is they go to their insurance network book and they say, "Okay. Who's in my network, who's taking new patients and who's close to me?"

Laila Waggoner:

That's right.

Rob Klein:

So, those are the first three hurdles to get past. They haven't even gotten to do I like them or what are they like? Who are they as a person? What's their skill? They have to get three or four layers deep before they even get to the doctor themselves, if you think about it.

Laila Waggoner:

That's right. So, for those who don't have a doctor, which again, is only about 12% of the total on the big picture, there were some interesting, I think, reasons that drove that decision. In this case, it's interesting because health insurance is not at the top of the list, although it was significant. 16% said I don't have a PCP because I don't have health insurance. But the number one reason cited was I'm healthy, so I don't feel the need to have one. That's an interesting perspective. I'm guessing, although I'd love for you to confirm this, that that was even more true of the younger generations. Yes?

Rob Klein:

Oh, yeah. Because they make up a greater percentage of that 12%. They make most of it, because remember, Silent was 100% and boomers were almost 100%. So, yeah. So, by definition, this 12% is mostly younger. We all remember when we were in our 20s and 30s, oh, I'm going to live forever. I'm not going to worry about it. Even one of my favorite Who songs.

Laila Waggoner:

That's right.

Rob Klein:

Hope I die before I get old, and now even Roger Daltrey's like, "God, I want to keep living. So, what was I thinking?"

Laila Waggoner:

Ha. That's right.

Rob Klein:

Yeah. It's that lack of perceived need. So, the question is for marketers, how do we meet them where they are? Because they want to be healthy. Just because I feel I'm healthy doesn't mean I'm not going to get the flu or a cold or something that needs some type of medical attention. That's why they're comfortable going to urgent care centers or having a virtual visit, because they know what they've got is not life threatening, but it's like, okay, I'm going to need something to get me past this. I know that. So, what's the path of least resistance? What's easy to get in, what's either on my phone because I'm a virtual first baby, and who makes service really good?

That's why a lot of our clients are partnering with national urgent care brands, whether it's AMD or ones like that because they've got the service down, they've got access down, and they know that younger people are very likely to be using them. So, they're building an experience around that younger mindset, which is digital and in person. So, we also said what do you do for routine care, and the number one response by far, 36% said, "I just go to an urgent care center."

Laila Waggoner:

That's right.

Rob Klein:

14% said, "I go to a retail clinic." 10% said, "I go to an ER," which that concerns me because we're so overloaded in the ER that we need to keep people out that really, it's not an emergency. From a health equity standpoint, we found that that ER usage was significantly higher among African Americans. So, we don't want that to become their primary care. So, as we focus as we should on health equity, what can we do to help everybody, no matter who they are, where they come from, to be able to get ... If they don't have a primary care, what can we do to help them get primary type care?

Laila Waggoner:

Yeah. That goes right back to access to addressing social determinants of health and to really taking a holistic look at the big picture of how people want to access, where they access, convenience, all of the things that we've talked about and that we've seen. So, this is really a changing landscape, for sure. Primary care is going to continue to evolve.

Rob Klein:

Well, and think back to the article you sent me on Uber and health care. Part of their reasoning is to bring care to those that maybe don't have the same access. I thought that was an interesting way that Uber is talking about their brand.

Laila Waggoner:

Right. Exactly, and thinking about transformation in just new ways. So, it's really how do we look at the barriers and address the barriers before even thinking about the care itself. So, it's, like I said, very much an evolving landscape and it's going to be fascinating to see how this continues, and we'll continue certainly in the research that we're going to continue to do together to look at this and track it and see how it evolves over time. I think this will continue to be a really important area for people as they're making decisions about not just what they do with their primary care offering, but how do they partner with others who are offering primary care to make sure that we're filling the need for consumers and for patients?

Rob Klein:

What you said is really important. It's not that we need to work and improve clinical care. We're really good at that. It's access that we really are struggling as an industry. So, we're focused so much on finding the next cure and the next drug when people are like, "You know what? You're pretty good at that. But if I can't get in to get that great care, what's the point?" Yet, we still seem to be whistling past the access graveyard, not wanting to address it when that's what consumers are yelling at us for.

Laila Waggoner:

That's exactly right. Rob, I really want to thank you for taking the time to talk about this with us today.

Rob Klein:

Oh, my pleasure. It was a lot of fun.

Laila Waggoner:

Yeah. We'll look forward to some additional conversations. We have more chapters to come, so stay tuned for that. You can get more information on Klein & Partners at kleinandpartners.com.

Rob Klein:

Nice and short, isn't it?

Laila Waggoner:

That's okay. That's okay. We'll obviously have a link to the full study results as well on our website. A reminder to our listeners to subscribe to The Core Exchange on Apple Podcasts and sign up for our newsletter at corecreative.health. Rob, I'm looking forward to the next time we talk, which will probably be really soon.

Rob Klein:

Can't wait. Thanks again, Laila.

Laila Waggoner:

All right. Thanks so much.