Telehealth Satisfaction from the Patients Perspective with J.D. Power

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Bill Russell / James Beem

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October 23, 2020: What are the trends and drivers for telehealth adoption and satisfaction? James Beem of J.D. Power runs us through their 2020 US Telehealth Satisfaction Study. They collected data from 200 healthcare firms nationally to understand who is best in class around customer satisfaction. Are there any clearcut leaders? What are the primary drivers of satisfaction? Is patient safety still number one? How do you increase consumer loyalty and advocacy? What are the telehealth demographics pre and post COVID? Can telehealth satisfaction really compare to traditional face to face medicine?

Key Points:

  • People did not want to go into the four walls of an exam room [00:08:00]
  • What happens if patients want to get more complex care and go deeper than what telehealth can provide? [00:08:25] 
  • Satisfaction scoring by population [00:09:40] 
  • Younger generations seek telehealth for clinical conditions that trend more towards mental health and behavioral health [00:10:10] 
  • Older populations seek telehealth for more classic clinical conditions [00:10:25]  
  • It’s really around an authentic experience between the patient or consumer and the healthcare practitioner [00:17:35] 
  • Teladoc, Livongo, MDLIVE and Amwell [00:21:25] 
  • https://www.jdpower.com/business/healthcare/us-telehealth-satisfaction-study

Telehealth Satisfaction from the Patients Perspective with JD Power

Episode 319: Transcript – October 23, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

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[00:02:32] [00:02:30] Welcome 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 podcasts, videos and collaboration events dedicated to developing the next generation of health leaders.

[00:02:47] Speaking of developing the next generation of healthcare leaders, 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 [00:03:00] the community. All right today, we’re joined by James Beem the Managing Director of JD power, healthcare intelligence.

[00:03:06] And I’m excited about having this conversation. They did a 2020 US telehealth satisfaction study and just collected a ton of information. And the thing I liked the most about it as James and I were talking earlier, Everybody focuses on the payer and the provider, J.D Power focuses on. The consumer on how people, how patients, howour communities are [00:03:30] experiencing telehealth, so excited for this conversation, James, welcome to the show.

[00:03:34] James Beem: [00:03:34] Thank you Bill. I appreciate it. Thanks for having me. 

[00:03:37] Bill Russell: [00:03:37] Yeah. So you know, JD Power. Yeah. Clearly we know that we know the name. You guys do a lot of work. Give us a little background on your work in healthcare. 

[00:03:47] James Beem: [00:03:47] Yeah, so JD power, our business has been in existence since 1968 where, traditionally we focused on the auto segment. And if you think about where the auto, where the auto industry was in 1968 and [00:04:00] where it is today, much of the quality of improvement and much of the advancement auto was driven by consumer preference sentiment, their collective satisfaction levels.

[00:04:11] So JD power, over time has started to move that lens into other industries which is banking, finance, auto insurance, energy, utilities, and finally healthcare. And so within healthcare we’ve been measuring healthcare customer satisfaction over a period of about 20 years now, [00:04:30] starting with our largest portfolio, which is looking at private health insurance, but we also measure Medicare advantage, managed Medicaid, telehealth dental vision group life.

[00:04:40]We collect that data and we benchmark close to 200 healthcare firms nationally and understanding who is best in class, around customer satisfaction. 

[00:04:51] Bill Russell: [00:04:51] 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, [00:05:00] timeframe, data collection, those kinds of things?

[00:05:03] James Beem: [00:05:03] Yeah. So we looked at, just about 5,000, US consumer 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, in  total lasts about 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 [00:05:30] of the large telehealth systems.

[00:05:32]So we have not focused yet on the provider segments. That’s something we’re going to be evolving into one of the tricky parts of this last year. when we launched the work in 2019 was finding it’s finding population that had utilized telehealth. We believe that obviously that’s going to change going forward and we’ll be able to draw more consumer sentiment, than we did in the past. 

[00:05:54] Bill Russell: [00:05:54] Yeah. Especially around the provider space, I would think. Oh, clearly we know that COVID drove the numbers pretty [00:06:00] far up, the methodology change going into next year, will you expand the numbers in some way or just focus a little bit? 

[00:06:08] James Beem: [00:06:08] Yeah. Yeah. One of the things that we have in our portfolio is we measure pharmacy. And one interest of mine is the intersection of retail, pharmacy, and primary care or health and wellness. And so we know from that, we know from that specific reason research that consumers place a high preference and a high degree of trust when they’re [00:06:30] dealing face to face with medical teams, whether that be a PA and P M D.  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 chat, but they’re, dealing face to face with a qualified physician, satisfaction scores tend to trend very high. so it’s in our interest to be able to understand, [00:07:00] the provider side and how they’re introducing telehealth, from their systems. yeah, be on the lookout for that. 

[00:07:06] Bill Russell: [00:07:06] All right. So you have the reports broken down into a handful, at least the summary report that I’m looking at, broken down into trends, drivers, and drivers of satisfaction and avenues to increase loyalty and advocacy. Let’s just start with trends. what are some of the trends that we saw, as a result of your study? What are some trends that you picked up on? 

[00:07:27] James Beem: [00:07:27] Yeah. So last year was the first year we [00:07:30] ran the study in 2019 and we just launched the 20, 20 version a couple of weeks ago. A couple of trends that we’ve saw was the first thing last year the issue of safety was not as high of a degree of satisfaction or choice when it came to picking a telehealth provider, post COVID that’s become a number one, two, three area of concern for telehealth members and and they’re moving towards a digital platform or a telehealth platform. Largely because we didn’t, we [00:08:00] see that people probably did not want to go into the floor four walls of an exam room and found it easier to take care of whatever condition they had in telehealth.

[00:08:09] The other trend that we’re seeing is that, and this started in 2019 was we were getting a degree of, interest and a degree in, and in some regards and dissatisfaction with members or telehealth patients that wanted more complex services as part of their, and they wanted to go deeper into other [00:08:30] complex areas, such as, treatment for mental health conditions 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 small way.

[00:08:46] Bill Russell: [00:08:46] So interesting. Yeah. So did you, so you did some work around generational because that comes up a lot with technology solutions is, is the older generation code to adopt it. I know that my mom is 82 years old and she is [00:09:00] a telehealth fan. My father in law, I was 88 years old and he is not a fan, I’m a fan at my age, if I’m not going to share. Did the demographics break down like we think they would? 

[00:09:13] James Beem: [00:09:13] Yes. but there’s minor differences. Universally most of the U S consumers we’ve 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 exceeds, [00:09:30] 10% of usage but the difference is 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 Y gen Z tend to be [00:10:00] over-utilizing telehealth, highest degree of satisfaction comes with the Medicare segments. One thing we saw last year when we did the 2019 work, which is threading through 2020, is that for those younger generations, gen Y gen Z, the clinical conditions that we saw when we asked them about why they’re seeking a telehealth visit tended to trend more towards mental health, behavioral health. And we don’t see that in the older populations, we see more classic clinical conditions being sought after. 

[00:10:30] [00:10:29] Bill Russell: [00:10:29] 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. . 

[00:10:40] 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? 

[00:10:55] James Beem: [00:10:55] Yeah. And this is one of the themes that we also measured [00:11:00] 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 that we see that’s almost equal in urgent care is around convenience cost and whether or not the member has enough information from the payer in terms of being, driven to that particular place of service.

[00:11:26] We often see with consumers, they have at high [00:11:30] interest in the service. whether that be urgent care or telehealth. But that connection between the consumer and the ultimate visit is complicated by the managed care benefit, network, design elements of health insurance. And so one of the things we’ve been promoting with our clients and nationally with not only, not only commercial health insurance, but Medicare advantage and managed Medicaid.

[00:11:57] It is the payers really have a [00:12:00] 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 healthcare during the spring.

[00:12:17] Where, as COVID and the pandemic started to increase in terms of time, the total awareness for telehealth started to rise. The problem was that the same efforts that were [00:12:30] 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.

[00:12:46] Bill Russell: [00:12:46] And so you actually touched on this earlier, most important reasons, people using telehealth safety, catapulted up there for obvious reasons, care to distance, keeping yourself safe, but then the traditional ones were [00:13:00] still there. Convenience, speed  do you anticipate that safety will continue to drive telehealth? 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 going to be the primary driver moving forward? 

[00:13:22] James Beem: [00:13:22] No, I, I guess if I’m speaking from a position of looking at this from a futurist type of, type of position, I [00:13:30] think what’s going to happen is that, the technology will advance, the promotion of the service will attempt.

[00:13:36] Providers payers, digital health companies will be offering consumers more complex services under telehealth, which may trump even costs convenience and 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 tele out some sort of digital platform, health [00:14:00] insurance company, where the services are routed outside into the community post telehealth visits.

[00:14:06]The future’s on 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 spoke to this year and last year, had a pretty seamless experience, without any technical problems, without any consultation problems.

[00:14:26]It’s amongst some of the most highly satisfying [00:14:30] things that we see in healthcare, all the way from managed care up through pharmacy, up through dental vision services at the top, and 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. 

[00:14:51] Bill Russell: [00:14:51] tThat’s fascinating. alright let’s jump into a drivers of satisfaction around this. What are the primary drivers of satisfaction? [00:15:00] what leads people to say, Hey, this is really good. This is something I want to see continue in healthcare. 

[00:15:05] James Beem: [00:15:05] Yeah. So we designed a number of KPIs around telehealth and the number one driver that we saw, which universally consumers were, very much embracing and applauding was that they were able to spend enough time with the provider that was number one that made the experience different than driving 20 miles. 

[00:15:24] Bill Russell: [00:15:24] So they feel, do they feel rushed when they do a physical visit? Is that it, or is it just the [00:15:30] whole process of going and waiting in a waiting room, getting ushered into a room then waiting for the doctor? Just that, just the contrast of those two things. 

[00:15:39] James Beem: [00:15:39] No it’s about healthcare literacy, healthcare engagment, spending enough time with a provider to ask the question and get it 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 [00:16:00] is that, a clear, transparent understanding of the direction that they need in order to satisfy, their, their particular, condition. it’s very important to the consumers and telehealth here. these are run many of the KPIs. 

[00:16:14] Bill Russell: [00:16:14] All right isn’t there a risk here? What we’ve heard from providers over the years, and this is potentially providers that weren’t excited about new modalities and just adjusting their practices or whatnot. But they were essentially saying, look, there’s a lot of things you can’t do over telehealth. [00:16:30] 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, or our people experiencing that. Or are they essentially saying no. We’re really, we’re getting to resolution through these telehealth visits? 

[00:16:46] James Beem: [00:16:46] When you look at sort of the satisfaction on telehealth, you sorta 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 [00:17:00] 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 professionals. And, so if that’s not achieved in the telehealth visit, there’s significant declines in satisfaction.

[00:17:16] 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 [00:17:30] 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.

[00:17:40] Bill Russell: [00:17:40] Do you get any indication? Is 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 visit. all you’ve done is just changed the medium, but are there certain [00:18:00] factors in a telehealth visit that people said, they made eye contact, they communicated clearly. They, clearly one of them was they spent quality time with me on the phone. Cool. So are there other factors like that?

[00:18:14] James Beem: [00:18:14] 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, and gave them a gave them the [00:18:30] perception that there was 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 authentic consultation between a provider, again, MD pharm D [00:19:00] NPPA and the actual consumer is where there’s a high degree of value. 

[00:19:05] Bill Russell: [00:19:05] Now, based on your research, do you think there’s going to be 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 going to be, I’m going to want to be able to check that box and have that be a part of my plan. Do you think that will happen? 

[00:19:25] James Beem: [00:19:25] I think it’s early, but I think that, we know that, when I’m [00:19:30] in 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 J.D 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 [00:20:00] experience with a bank, you have complete freedom to move to a new bank the next day and commercial health insurance, Medicare advantage, managed 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 if you have a poor experience with them in June, you may have to wait until October and understand what your what your new benefit plan is under your employer. so it’s, it’s a [00:20:30] healthcare are 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.  

[00:20:46] Bill Russell: [00:20:46] you looked at two segments direct to consumer, and then you looked at payers, are there any clearcut leaders at this point, in those two spaces, 

[00:20:55] James Beem: [00:20:55] so actually the payers, significantly jumped, year over year in [00:21:00] overall satisfaction. that’s being driven by, their expertise around enrollment, billing and payment, however, the direct to consumer segment, it’s still meeting in terms of consultation. Again, those sort of soft skills that we saw before extending more time with the patient in totality that they’re both highly satisfying experiences, both, direct to consumer and payers. 

[00:21:22] Bill Russell: [00:21:22] Yeah. in the direct to consumer space. we have, the Teladoc Livongo mergers, top of mind, you have MD live, you have Amwell. We use them. Do you live? I think. [00:21:30] at the health system I was at. How do these, is there a clear cup winner in that group or is it pretty close when you’re looking at it? 

[00:21:39] James Beem: [00:21:39] And so in the 2020 JD power rankings, Amwell, was number one, and our, direct to consumer segment and Cigna was number one in our payer segment, we saw some challenges with scale and the differences between 2019 and 2020. A little bit more of the technical, hardships in 2020 then in the 2019. [00:22:00] but and in totality the service levels, seem to be equal but Amwell this year took the top prize. They had a big, significant chunk over last year. I think, in some regards they may have been more suited for scale.

[00:22:15] Bill Russell: [00:22:15] Interesting. Let’s go to loyalty and advocacy as we get towards the end of this. how it’s, I want to look at what’s around the telehealth is, we talk a lot about the physician experience, the physician, patient, [00:22:30] 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 the, into the workflows afterward. did that lend itself to either being a dissatisfier or satisfying.

[00:22:55] James Beem: [00:22:55] Yeah. So the way that JD power conducts all of their business around rankings [00:23:00] and awards and, research, research data and analytics is through our modeling. So we have a JD power index model that is a proprietary built. Driver of satisfaction where we, we understand that consumer satisfaction and sentiment. And we started to telehealth work. We started to feel the responses. That’s when we go through sort of our data processing, we understand what are the drivers of satisfaction that our models are built on that credibility of what the crowd is telling us. [00:23:30] So for telehealth, we break it up 42% of our models 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 were looking for the quality of the service, timeliness, convenience, what was the dialogue and the experience between consumers, the provider, and then it’s, getting into the, the [00:24:00] traditional payer side, which is the actual level of enrollment, how using was it to, find a physician? How use was it to actually conduct the visit? What would 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.

[00:24:24] And as I mentioned before, the model is heavily built right now around customer service and consultation. [00:24:30] and so as time goes on and consumers tell us, there’s more important things than others. we will weigh the actual credibility, the model. so right now, again, focusing on the actual, consultation experience and then the customer service element of it. 

[00:24:46] Bill Russell: [00:24:46] I think and that really interests the question of how do you drive loyalty and advocacy? Why are loyalty? And then people advocating for you, your program consumers actually telling other consumers about your program. And you’re saying focus in on [00:25:00] those core areas. And that is how you drive loyalty and advocacy. Is that accurate? 

[00:25:05] James Beem: [00:25:05] 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 [00:25:30] core condition rated the telehealth experience at a 783. 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, or health populations require more time or literacy, more engagement. And, finding telehealth, has a [00:26:00] 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 put out last year and it spans out this year as well. 

[00:26:17] Bill Russell: [00:26:17] How do people get access to this, to your report and your data? 

[00:26:22] James Beem: [00:26:22] Yeah, you can find us under JD power. then look for JD power healthcare, and there’s some links in there and other information. And, you [00:26:30] can also find my email, in there as well. 

[00:26:33] Bill Russell: [00:26:33] So James, you have an interesting background. I want to hit on this before we close. You’ve had a front row seat and 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?

[00:26:44] James Beem: [00:26:44] 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 [00:27:00] market chief financial officer at, Humana and, I’d after ACA, I was offered a role within Walgreens as a vice president of outcomes and analytics where I helped them divest themselves from their PR from the primary care space. which is interesting given where, CVS that Ned Walmart out of these days. and, yeah, I had a front row seat, for. Yeah, that they shift in, retail pharmacy over to primary care. and then, I was offered a role, after IBM entered into healthcare. I was [00:27:30] offered a road 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 these massive chess moves around trying to understand the consumer from a data and analytics perspective. And, what I found was that was very little [00:28:00] 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 thesis, these are here is that, Yeah, there’s a lot of decisions made between payers, providers, digital health companies, venture capitalists. there’s not a lot of knowledge, not a lot of data around what drives satisfaction, what a consumer is really looking for and we have this massive opportunity in the future around the ambulatory care [00:28:30] space and, a lot of consumer. A lot of consumer decisions are going to be made, are going to 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 and, healthcare, healthcare consumerism.

[00:28:47] Bill Russell: [00:28:47] Oh, fantastic. I want to thank you for your time. We’ll have to make this an annual visit. You can give us an update on where this is heading. 

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