Healthcare continues to play catch-up in an online, convenience-obsessed, and increasingly consumer-focused world. Results of Kaufman Hall’s 2019 Healthcare Consumerism Survey and Index highlight the challenges legacy healthcare providers face in trying to grasp a firm handhold on the ever-rising bar of consumer needs and expectations. The Index provides a lens to industry performance related to consumerism, based on survey responses from hospitals and health systems nationwide. Top performers kept pace with previous years, while many underperformers fell further behind (Figure 1).

  • For the second consecutive year, only 8 percent of respondents rated as Tier 1 performers 
  •  Only about a quarter of organizations rated as Tier 2, similar to 2018
  • Organizations in Tier 3 declined 13 percentage points, to 39 percent from 52 percent in 2018
  • Those in Tier 4 increased 12 percentage points, from 17 percent to 29 percent over the same period
healthcare consumerism index overall performance

Falling scores in the area of “access” contributed to much of the backsliding from Tier 3 into Tier 4. It is not that these organizations reversed course on consumer initiatives, but rather that they struggled to adjust to continually changing expectations for what defines “great access.”

Hospitals and health systems continue to emphasize building facilities over creating convenience. As with previous years, the majority of respondents said they offer widespread urgent care (61 percent), ambulatory surgery centers (51 percent), and free-standing diagnostics facilities (41 percent). By comparison, nearly half said their organizations had no retail clinics.

Looking at access initiatives aimed at increasing convenience for consumers:

  • A third offer widespread online self-scheduling for existing patients, but few offer this service for new patients
  • Same-day appointments, and extended and walk-in hours are common access strategies
  • Thirty-eight percent of respondents offer widespread “Save a Spot” urgent care

Read the full 2019 State of Consumerism in Healthcare Report

While still in its early stages, demand for virtual healthcare services is growing as consumers, payers, and employers look for ways to increase access and lower the cost of care. Survey responses revealed limited offerings to date:

  • Site-to-site specialty care—such as telestroke care—is the most prevalent virtual offering, with 30 percent citing such services as widespread or best-in-class at their organizations. 
  • More than three-quarters of respondents said they have limited or no direct-to-consumer video or telephone offerings at their organizations. 
  • Off-site telehealth kiosks are particularly limited—with 78 percent of respondents citing them as unavailable, and 17 percent indicating they have limited availability.

Hospital and health system executives nationwide agree that the nature of healthcare competition is changing. Rather than vying for inpatient business with the health system across town, legacy providers today are battling tech giants, industry behemoths, and innovative, targeted healthcare providers seeking to disintermediate legacy organizations from critical shares of outpatient business. 

Eighty-eight percent of respondents agree or strongly agree that hospitals and health systems are vulnerable to consumer-friendly offerings from non-hospital competitors. When asked to rank potential competitors, survey respondents cited UnitedHealth Group/Optum, CVS Health/Aetna, and Amazon as posing strong or extreme threats (Figure 2). Respondents view companies with less of a healthcare focus—such as Google and Apple—as less of a threat. Ninety-eight percent said their organizations’ digital experience is either somewhat or significantly worse than Amazon.

new competitors in healthcare




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