* The following transcript is computer generated and may contain errors.

Stewart Gandolf
Hi everyone, I'm Stewart Gandolf. Welcome to our meeting. We're going to get started now because we have a lot to talk about today and I'm excited about it. And apparently my new computer has alerts going off every 30 seconds. I don't know what that is. I'll try to turn that off when Rob starts talking. I'm one of the new Macs, which is very pretty, but the sending is exactly the wrong time.

Stewart Gandolf
A lot of alerts anyway. So as we have our regular webinar series, we do webinars about once every three or four weeks. Many of you probably follow our series as you know, usually either I or my team are doing most of the talking. Today I have the pleasure of having a guest star into the meeting to the end.

Stewart Gandolf
So I'll be the I'll be the sidekick. The day Rob is going to be leading most of it, I'll be adding a lot of color commentary. I first met Rob Klein at Schismatic, I don't know, years ago, and Rob and I are like, We're born within a couple of days of each other and we have we look at the world pretty much the same, which is confusing and a little scary.

Stewart Gandolf
But Rob is very, very insightful. Rob is one of the leading researchers in health care. And like I said, I became friends with Rob. Rob and I actually both have houses in Palm Springs. And so we're both mid-century modern fans, music fans and health care marketing fan. So I think you'll find Rob is a very insightful expert in our category and in our field.

Stewart Gandolf
So Rob, go ahead and introduce yourself.

Rob Klein
Thanks, Stewart, and thanks for having me on this morning. I really appreciate the opportunity. I'm so excited to share some insights that we've learned in our in our study. So as Stewart said, I am I am CEO of Klein and prior, as we are in national health care market research firm, we work with hospitals and health systems of all shapes and sizes around the country, really helping them to optimize their brands.

Stewart Gandolf
VOICE Very good. And by the way, as the night is right, I meant to say that. So Netanya was which our webinar time today is at this moment is 10 a.m. Pacific will be finishing at 11 about what we said earlier. So okay not a two hour webinar from I love to, but I think we'd all be tired.

Stewart Gandolf
Rob, you want to just get started?

Rob Klein
Absolutely. Let's let's get started. And also, I'm actually doubly excited to be here today. I want to apologize upfront to everyone. I just had nose surgery, so I've still got the stitches and I may be having to move off camera to sneeze or something, so I apologize, but I wasn't going to miss today for anything. Even even no surgery.

Rob Klein
Couldn't get me down here.

Stewart Gandolf
The man.

Rob Klein
And yes, I looked the same. So it was purely purely for a deviated septum. I'm this is as good as I'm going to look.

Stewart Gandolf
So that's what they all say.

Rob Klein
Rob it out. All right. Let's jump in. First of all, let me just give a quick background on the methodology of the research and then we'll jump in to all the cool findings. So this is a national study I do every year. It's I call it my MCI study because it's got to have a pithy, cool name, of course.

Rob Klein
And so we talked to a thousand consumers head of household around the country, fielded it last summer, and we just asked them a series of questions. I kind of jokingly call it my kitchen sink survey. So a lot of times I'll just I'll just ask friends like Stewart, what are some of the hot topics this year that we should include in our study?

Rob Klein
In fact, I'm getting ready to do my next one in another month or so. So that's really kind of the impetus I've been doing for like 12 or 15 years. So there's a lot of a lot of questions we've asked over the years. And anywhere that you see arrows or letters, that indicates a statistically significant difference. I'll note that when we get to it.

Rob Klein
But just want to let you know also at the bottom of every chart is the actual question wording. So I'll take a chapter by chapter. Let's start off with when I call Kobe Bryant. No, I don't mean that clinically, but what we have found is that Kobe brain is real. It's impacting people's of memory, their attention span, their patients and their brand linkage.

Rob Klein
And so I think we've all had moments where we just can't remember things. You know, I think we call it series Get Up and we'll go to a store and like, I forgot this or forgot to lock the door. We are really struggling with remembering things. Our attention span. We aren't paying attention to things as much as we used to our patients.

Rob Klein
Unfortunately, that is playing out in too many e.r. ERs and in too many flights where people we just all of a sudden social graces have just gone away. And that makes it hard to deliver an exceptional experience because our staff, especially nurses, are frustrated. They're exhausted. Patients are coming in loaded for bear. It's a bad recipe. And then brand linkage as marketers really, people aren't paying as much attention to our ads as they did in the past.

Rob Klein
So we've really got to make sure that the advertising we do that the brand is the star. And so as health care marketers, our mantra must be as we're developing any type of communication, whether it's a TV ad, whether it's a digital ad, whether it's our website that our messaging must be simple, engaging, repetitive, and the brand must be the star Geico is the king at this type of advertising because people aren't paying attention to insurance ads.

Rob Klein
And so Geico has done a really good job of having a simple message. It's definitely repetitive. They've been doing 15%. Look, even the billboard says, Need I say more? We're to the point now we can complete that for them because they just drilled it into our brains and it's engaging or catchy. I'm not saying, you know, in advertising and health care needs to be catchy or kitsch and have a brand character like they can do in insurance.

Rob Klein
But our messages are so complicated. I've had clients say, there's whitespace on this print ad, let's throw in another message, you know, or Let's fill up all the space on our computer screen for our website. Whitespace is not the enemy. We need more of it. We need less is more. In today's consumers clogged mind. Remember, our brains are like CPU's and they're overheating.

Rob Klein
And so we as marketers, we have to make things easier for them to remember. So make sure your brand is the star. Don't do a TV ad in the brain and the brand comes at the last second in 3 to 4 seconds. You've lost them. So your brand has to be the star. Whether it's a print ad, don't make the logo little, make it large.

Rob Klein
Be proud of who you are. Make sure they connect the message with who's delivering the message. Absolutely. The most important thing we can we can take away probably from this study is we have to change the way we communicate with people.

Stewart Gandolf
I would just add that, you know, it's always been important to be timely, but it's just it's I don't know. We're back in high school reading Alvin Toffler's Future Shock, which was about the pace of change, is going to become overwhelming for people eventually. And that's kind of where we are today. So now you have all these things competing for your attention and so it's just the idea of being very clear very fast is more important than ever.

Stewart Gandolf
And our data shows and I know, Robb, you have a whole special product to evaluate websites, but when we're looking at our clients websites, we've got two or 3 seconds to engage them or they bounce. And so it just has to be and this was, you know, a decade ago is 6 seconds. It's just it's a never ending journey to trying to be as clear and as fast and as precise as possible.

Stewart Gandolf
Even more nowadays.

Rob Klein
Well, you know, Stewart, you remember and I'll we'll both show our age. Remember when we had the MTV generation that people said, the MTV is making all these fast videos. And so people are going to spend a couple of minutes and it's ruining traditional messaging. Well, now that's that's a lifetime. Now we have the Instagram generation where in 2 to 3 minutes I can flip through 100 videos.

Rob Klein
Right? I wonder if Instagram is actually creating ADHD.

Stewart Gandolf
Yeah.

Rob Klein
Because I know I love Instagram, I've got ADHD and it fits what I want. I want ten, 15 seconds of something fun and then I move on. But it never ends and there's no end to it. So I really wonder what will. Howard, where are we changing brains or have brains changed? And we're adapting to them. That's the quandary.

Rob Klein
So we also asked what kind of ads do you want? Do you want ads that appeal to the brain or to the heart? And this has been this has been the case forever. People want to emotionally connect with a brand. Most people want a relationship, not a transaction. And so advertising that appeals to their emotion. In fact, I do a lot of ad testing the ads that score the best in my database all have one thing in common.

Rob Klein
They connect at the emotional heart level, not the the what I call the attribute gutter. We're bigger, faster, better. We've won all these warts, We've done this, we're bigger, we have more locations. It's the we, we, we bragging. And nobody wants to hear that advertising has to be in acknowledging people's challenges and then suddenly how your brand is the solution for those challenges.

Rob Klein
We've kind of gotten away from that. And in a lot of cases where we're so bragging about how great we are and, you know, it's like if you have to tell people you're funny, you're probably not. If you have to brag about how good you are, how trustworthy you are, consumers are like, No, no, I'll tell you if you're that or not, don't you tell me.

Rob Klein
And so appealing on an emotional level and I'll tell you, too, the thing that consumers want most is they want a brand that is authentic or genuine. That's why people are buying tops or bombas socks and those that you have a you have something that's bigger than you that that's important to you as a in your brand's DNA because.

Rob Klein
All right, So we'll start at the top here, how Americans are feeling. We're not feeling so great post-COVID, you know, I one of my if you get to know me, I've got my Rob isms and Stewart's heard them all. But one of my newer ones is time is the new currency. COVID has stolen two years of our lives that will never get back.

Rob Klein
You could always make more money, but you can't make more time. What's the one thing we do a lot of in health care over the past 100 years? We take people's time because we build things around us. come in early. And then you sit for a half an hour because the doctors running behind those are the most dreaded words at a doctor's office.

Rob Klein
The doctor is running behind. You know, it's like a broken record and consumers are not going to put up with that anymore. So us managing their time is absolutely paramount now because they have a lot of choices. The days of us competing against other competitors that are like us are coming to an end. Our biggest competition is from the disruptors, but we're going to talk a lot more about that in a minute.

Rob Klein
But you can see most people do they feel their physical and mental health is just kind of it's just kind of good, which is like a seat that's just average. We have a mental health crisis in this country that we have to address in my brand trackers when we ask about care settings they visited in the past year, mental health visits are approaching 20%.

Rob Klein
It was like nothing several years ago. So that is skyrocketing. Just like virtual visits went from low single digits up into the twenties. Now the same thing is happening with mental health visits and they can be virtual as well. Disruptors are happening in that in that category as well. So let's talk about attitudes and health. So we asked people to agree or disagree with several statements.

Rob Klein
So the first one, when it comes to my health, I rarely plan ahead. I tend to put my health care needs last about my family, even though I know I should take better care of myself. And oftentimes that is the household CEO, which is the female, the mom, the wife women put themselves last far too often, but when they come in for health care visit, they mean it and they want to be taken seriously.

Rob Klein
They want to feel rushed. They want their time to say, this is what's going on. Listen to me. Don't make me feel rushed. So how we create experiences in health care. Absolutely varies not only by age but also by sex. Be a major hassle for me to have to switch to another health care provider. That's the challenge. Why a lot of switching doesn't happen because people are just like, you know what?

Rob Klein
This was a hassle. I don't want to go through this again. No one goes home and say says, Ooh, I get to pick a new doctor today. Those words are never said. That's not something we look forward to. So once they pick people put up with a lot. But I'm going to show you that's starting to change. Plus, they don't even know how to judge who's the best.

Rob Klein
We don't do a good job of telling them why we're better. Our websites need to function much better as a sales tool than they do. We bragged in our websites. I had a client say, we have over 70,000 pages of information. And I went, And you're proud of that. I bet you 69,950 don't ever get looked at.

Rob Klein
So we are overwhelming people with B.S. that they don't want they don't want to hear or read. Advertising helps me learn 50%. I'm very comfortable searching online. So advertising still is something, especially younger people are very open to all forms of advertising, especially especially digitally. So advertising still is an important medium. What you know, a lot of people say, advertising never I never listen to advertising, yet they'll spit back what we've just told them in the ads.

Rob Klein
So whether people admit it or not, advertising is as effective in setting the tone of your brand as it is always. But I trust most people still trust their health care provider to keep their information secure. But four in ten said, Yeah, I'm hearing a lot lately about all these data breaches. We're going to reach a tipping point where they just don't they don't trust us, of course.

Rob Klein
Is there going to come a point when they're like, You know what? Everybody's information was stolen. Why care anymore? And I really wonder where that tipping point is going to happen. 73% agree how a hospital system treats its employees has the biggest impact. People know how you're treating your employees because they will mention it, whether they think anyone's hearing them or they think that they're they're out of earshot.

Rob Klein
Remember other work I've done, too? When someone's in a hospital bed, they may be sick, but they're hearing become superhuman. They can hear a pin drop because they have nothing else to do. So they can hear staff members talking out in the hall. When staff members don't think they can be heard. 46% also think that you're more focused on making money than taking care of patients.

Rob Klein
That's the challenge we're facing. We are up against real for profit brands like pharmaceuticals, durable medical equipment, health insurers. They think that we're for profit, too, even though the vast majority of us aren't. Are. Years ago, I asked people What profit margin do you think hospitals make? The average was 30%. Now pick your jaw off the ground because we know a two or 3% profit margin is woo woo time.

Rob Klein
But the problem is consumers think we make a ton of money. That's a real tough message to try to counteract because we're stuck with all the others that have no problem making a lot of money and talk about.

Stewart Gandolf
That's a really ironic thing that we talk a lot about with other health care leaders, which is the particularly the big hospital systems where they're losing $1,000,000,000 this year. And that's in a man you guys are making a lot of money off of coal is, you know, unfortunately just woefully, you know, off base. And it's a challenge and it's like hard to say, what are you going to do, run ads saying we don't make as much money as you thought we'd.

Rob Klein
Be.

Stewart Gandolf
Somewhere We're losing $1,000,000,000. We're here for you here. It's a top dog.

Rob Klein
It is. And I agree. I do not have a magic bullet answer for you. It's it's how do you come back when people are absolutely wrong, but they are convinced that they're right? Yeah. Particularly a brand. No brand ever won by telling its constituents they're wrong. Right? You know what I mean? You just don't.

Stewart Gandolf
Especially now, right? People have their own set of facts. It's just kind of.

Rob Klein
You're you're almost admitting you're almost better off admitting a fault that you don't have. And then saying, here's what we're doing to correct it Sometimes, Mayor Kopa, even though you didn't do anything wrong. But that's a that's a discussion for a bigger discussion for another time.

Stewart Gandolf
I was like, if that sounds like a better discussion.

Rob Klein
Yeah, exactly. Over drinks, unfortunately. So, you know, it's important to me get all my care from one well organized and coordinated system, 74% with if I've been in this game a long time. Back in the mid-nineties I was doing system research nationally and the two top things people wanted for a system back that have value to them. I want a single bill and I want the left hand to know what the right hands are doing.

Rob Klein
We haven't figured either of those out 2530 years later. So that's a challenge. And we're going to we're going to talk a bit more about the whole billing thing, because that's a that's a problem in and of itself. But they want us you know, we've spent 30 years saying, hey, we're a system. You can get everything in one place, and yet the left hand doesn't know what the right hands doing.

Rob Klein
And so that's on us. To truly act like a system will make no matter how they or where or when or with whom they connect with us. It should be a single type of visit. Everyone should know they're coming and everybody should be coordinated. Half the folks want like this local. As mergers happen, M&A is just crazy. Right now.

Rob Klein
We are becoming an oligopolies industry, just like banking and airlines. We're not there yet, but it's happening very quickly. The bigger we get, the harder it is for us to act local and to really have that personalized care. A lot of national brands are really struggling right now with how people are perceiving them, and only half think that medical information is written in a in a consumer friendly.

Rob Klein
That means half don't think it is. There's still opportunities for us to speak to them in language that they understand, not try to wow them with all the syllables in the words that we use. One of the things I'm doing website consulting. First thing I do, I go on their website and I type in four, find a doc, I'll type in foot doctor.

Rob Klein
And then it's amazing how many times it comes up. Nothing. I know that's simple and kind of silly, but it's my, it's my go to to see how bad their, their wording is and then I'll type in, you know, podiatrist and then it pops up. So it's little things like that that we don't speak how consumers speak. And our website is as much a sales tool as anything else.

Stewart Gandolf
But they have just jumped off that page was it's important for me to get my care from one well-organized, coordinated health system, primary care, urgent care. And that's a huge issue of health care, consumerism. And I have a doctor that I left recently not because I didn't like him or didn't think he was great. It's because his system had horrible, urgent cares and didn't have everything was in the wrong side of town.

Stewart Gandolf
There was an altogether. And meanwhile, the competitive system is like that and that really matters. And I still sometimes wonder if I made the right decision there because I really liked him. But the the convenience today is so important. And that's you can see where health care consumerism matters, where people have those higher expectations today than they used to.

Stewart Gandolf
Nobody would even think of that as an option. Right? I like go. Of course you have this litany of, you know, disorganized individual policies, but you can that's a big number. Three quarters want that happen though understand that enough to want that is a big deal. I think.

Rob Klein
Now. So let's talk about trust. Trust is not great in health care right now on a 0 to 10 scale. It you know, it's even with scale creep that we see a lot with these 0 to 10 scales like in customer sat, this is really pretty low. And you can see we asked them across all of these different types of organizations in health care.

Rob Klein
In fact, for most of them it's down from 2022. So you can see the only ones that are even in the kind of the okay range are children's hospitals and physicians and all of the disruptors. Apple, Walmart. Look who's at the bottom. They're always at the bottom. Pharmaceutical companies, you know, they just don't seem to care. They keep raking in all the cash.

Rob Klein
U.S. News and World Report is not that trustworthy. You know, there's a lot going on with U.S. news. My my big prediction is I'll go on a limb. I think in 5 to 7 years, they won't even be around. They are really, really struggling. They're making a lot of changes and they're reacting to everything. Heck, they're getting sued by the san francisco d.a.

Rob Klein
For their methodology. So there's a lot going on. People are pulling out, and i think we're going to see a big change there. And i'll show you what really is replacing them in a minute. Disruptors. So, like, we're going to send you to the deck. I think some of you have that in the Q&A will send the deck out.

Rob Klein
But these are disruptors we tested with consumers about their interest. And so about one in five said, I would absolutely use that. And the top ones are COVID has taught us that you can get everything delivered to home, so why not health care? So why can I have hospital care at home? You just get sick in a hospital.

Rob Klein
How about urgent care at home, look at dispatch health, and then I want chronic care management at home. We've got a client that's got a Nassau like command center at their at their facility, and they can monitor their patients worldwide. It's unbelievable. I mean, it really looks like a command center at Nassau. And it's it is so amazing what they're able to monitor with their patients wherever they go in the world.

Rob Klein
So technology and I if used properly, is really changing is really changing our world. And COVID really was the catalyst for all the bad things it did. It's forcing us to change the way we deliver care. The last thing I want to do is spend half a billion dollars to build a big brand new hospital. Unless you got 100 year old hospital is falling apart.

Rob Klein
But for the most part, I want to spend my money on bringing care to people, whether it's more urgent care locations or our freestanding ERs or virtual type visits or home care, having things delivered to home. That's that's where we're heading in our world. And that's where people want that's the type of care that they want. Most people don't need a hospital because most, you know, two thirds of the folks never they just are fortunately healthy enough.

Rob Klein
They never need to go to a hospital unless we make them go in for an outpatient type treatment that they could have gotten at an outpatient center. But we really need to change the way we have to innovate, where we're being disrupted by all these different organizations coming in. And I'll say Amazon's not going to give up. They may be learning hundreds of ways how not to do health care, but they've got more money in most countries and they're not going to give up till they figure it out.

Rob Klein
CVS, CVS CEO just came out last year and said, We want to own the entire patient journey. Just a few years ago, they said we just want to own primary care and urgent care. That was a scary enough shot across the bow. Now they want to own the entire patient journey. Five years ago, I would never make the statement.

Rob Klein
I'll make it now. I would not be shocked to someday see a CVS hospital or a CVS physician network. Urgent Care Centers. I could see an Amazon hospital. I could see Amazon Doctors. That's that's heresy a few years ago. But things are changing. We have awakened in a new world now. And what was incomprehensible five years ago is absolutely plausible in the future.

Rob Klein
I know a guy, I'm going to skip a couple of those sites so we get to this next one. I've always been talking with clients that we have spent so much time in a siloed. Each service line has to be its own PNL, and that's not how other organizations think. I was lucky enough in a prior before I started my company, I worked for a large research firm and our one of our biggest clients was P&G.

Rob Klein
So I spent a lot of time down in Cincinnati working with that organization and how they look at things and how they they value. They look at lifetime customer value, and we don't really think those ways. In health care, I'm able to show here that if a woman has an exceptional maternity experience, she is very likely to want to pick a pediatrician for her child within the same system, bring their child to the hospital within that system, and then if she or her husband or partner gets sick later on, you have right of first refusal for that care.

Rob Klein
So the the halo effect on maternity is huge. So when clients say to me, you know, we really don't make any money on maternity. My answer is, who cares? Stop looking at it as an isolated, siloed PNL and maybe it's a loss leader. Retailers 100 years ago figure it out. Loss leaders and cross-selling. Those are not dirty terms.

Rob Klein
Those are terms we need to be looking at. If OB can become a loss leader for 30 years of future revenue, then that's huge and you can cross-sell other types of services. So we've got to start taking a more holistic approach to how we present our service since they don't work in isolation. They can work together. We've just separated them and that's our own doing.

Rob Klein
No one's made us do that. All right, let's get on to primary care at the top of the sales funnel. That's where most of the interactions happen with our health care systems, especially with a lot of our pediatric clients, We're able to show them that 80% of their parents have basically all healthy children. They don't need serious, acute or chronic care management.

Rob Klein
So if all the business you're getting as a pediatric hospital is all the serious stuff, you're very much in a passive reaction type of strategy. You're more B2B and B2C. So working your way up the sales funnel for more of the primary care, that's when you take more control of your share of wallet and your future growth. So still, 88% of adults have a primary care provider.

Rob Klein
We also changed it this year where we sort of saying primary care physician, we said provider and we said that can mean anybody doesn't have to be a doctor. So when we ask them who that provider is, 18% said my primary care provider is a or nurse practitioner. More than ever, consumers are open to not seeing a doctor, especially Gen Z.

Rob Klein
They're not enamored with the lab coat, so they are more about access and convenience and service. And if it's an MP or a I don't care, that doesn't mean anything to me at all. So that's an opportunity for us as we all suffer with access challenges, we have to look at ways how do we get people and even if they can't see their own doctor, they are willing to see another type of care provider or go to another office.

Rob Klein
It's all about us providing solutions as opposed to excuses. And you can see having a PCP increases by age. Only 70% of Gen Z say they have a primary care provider. Thanks a lot times I'm doing qualitative. Who's your PCP right here? And they show their phone so that is that's a big change too is with digital. Think about it.

Rob Klein
If I if I'm sick, I can search my symptoms online on my phone. I can schedule an appointment on my phone. I can have that appointment on my phone. I can get follow up instructions on my phone and order our and have it sent to me. And I can pay my bill on my phone. I literally can go through the entire journey of sick care stem to stern, and I've never put my phone down.

Rob Klein
I mean, that's just amazing. Are we set up to be with them throughout that journey or do we come in and out and other other players come in? What services? Yeah, annual physicals. More and more people want physicals because Covid's taught us. I'm afraid to get sick. I bet everybody on this call has had a time when you've got a cold.

Rob Klein
What's the first thing you say, honey? Where's the COVID kit? We assume that when we get a sniffle, it's got to be COVID. We just our brains have gotten conditioned that way. It's a little, you know, crazy. But we're we're all just paranoid about Colvin when there's so many other things that can happen to us. We still get flu and and other illnesses outside of COVID.

Rob Klein
But we immediately think take a COVID test. So annual physicals are becoming more and more important. It's also one of the frustrating things people are saying, I can't get in to get a physical or I can't I can't get in for a follow up visit because of access. So then we ask them to agree or disagree with statements about their relationship with their with their PCP.

Rob Klein
And Stewart, if you could check the Q&A for me to keep up with that. I saw another one came out. I don't want to derail, but if there's something interesting, just interrupt me. So let's let's go to the bottom here. There isn't a lot of good informed, objective information out there to help me choose a physician. 43% or like I our our find the doc pages on our website.

Rob Klein
That's where a lot of people will go. We've got to make that easy for them. It's not just about giving facts. They want to get to know the physician. Most people choose a doctor based on are they in the network? Are they close by and are they accepting new patients? Those are all market factors. There's no brand factor there.

Rob Klein
There's no. Do I like this physician? Will I want to go to them? All that's missing. That's why choosing a physician has a huge level of cognitive deficits in it. People are like, I'm not sure I chose the right doctor until I get sick and I go see them and then it's too late. So what can we do for that person to get to know the physician as a human being?

Rob Klein
Part of that is having the doctor right there intro having the doctor do a video. If the doctor's funny and tell jokes, if they're not funny, don't make them try to be funny. If they have a sport they love, talk about that. People want to get to know the doctor as a human being and what their bedside manner is going to be like.

Rob Klein
And we are just so based on they've had this many years experience. Look at the credentials they have. People are like, Yeah, yeah, yeah, yeah. They all are good, especially Gen Z. They expect clinical competence. They are making decisions based on service and access and bedside manner. Yeah, I don't feel as loyal to my doctor as I have in the past.

Rob Klein
29%. So here's where that vulnerability comes in I was talking about earlier. Look at the last one. This should be the one that we pay the most attention to. 23% said service, that my doctor's office has gotten so bad that I'm considering changing physicians. That was 10% just six years ago before I called it. So people are no longer can the doctor say, well, they love me so much.

Rob Klein
They put up with all the the junk in my in my office, and that's not my job anyway. Well, yeah, it is. You're the captain of your ship. People think the office is an extension of you as a physician. And so we have got to make that office experience better from beginning to end. And again, experience work that I've done.

Rob Klein
I will talk about a little bit here. But people are mad before they even see the doctor because they've had so many barriers just to sit on that table and wait for the doctor. So by the time they see the doctor, they're already seeing red information sources. So help family and friends, especially for boomers, is still the number one source.

Rob Klein
But look at online search with Google Online reviews from other patients, especially millennials and Gen X. Look, we're U.S. news is way at the bottom. So people want to look at what other people like them have to say about the doctor or the hospital or whoever in health care. The days of that expert independent brand being the be all end all has has really declined for most people that let's let's talk about that.

Rob Klein
So online ratings people want at least four stars and that's up from a year ago. And more and more people are saying stars play a role in the decision making. So if we ask them, if you were picking a hospital now, are you more likely to look at consumer driven reviews or quality organizations like a U.S. News? And you can see it's much higher.

Rob Klein
39% said I want the consumer driven. In fact, they're just as likely to say neither as they are. U.S. News. So do you want to reach Gen Z to Gen X along with Hispanics and parents? Consumer driven is even higher for them. And which is more important? You know, it's either reviews or it's both because they want to read what people have to say.

Rob Klein
Anybody can click a star and then move on. But if you take the time to talk about your experience, that's where people really learn to learn. That's why, like, gosh, when I'm when you're on Amazon, they're like, read all our reviews. What people have to say. Those are infinitely more useful than just looking at We have 4005 star reviews.

Rob Klein
Okay, here's the other kicker that's interesting. In the lower right, we asked them how many ratings and reviews do you want? You know, it's around 500 when I ask this question, ten, 12 years ago, people were like, you know, I'd be happy if they had 15 to 20 reviews. It just shows you how quickly our expectations have changed because everybody's talking about thousands of reviews that they have.

Rob Klein
So we have to keep up with the Joneses. So it's not just having good reviews, it's having a lot of them because they're like, if you don't have a lot of reviews, what are you hiding? So we are being compared to the Amazons of the world that have thousands and thousands of ratings. So it's as much a quantity game as it is a quality game.

Rob Klein
There's talk about primary care access. The majority of folks said I've had problems at least a little bit getting access. And the biggest access issues they've had is getting in for an annual physical or a follow up visit, like I just mentioned earlier. So access is probably the most important category problem, not just brand problem, but everybody is struggling with.

Rob Klein
And I know we're struggling hiring doctors. We can't keep staff. I get it. We're in a financial crisis. We've got to get creative with our solutions. We can't hire more doctors then can we use CRM to get to know our our patients better and say, you know, Robb, Dr. Smith can't see you for a week, but we know where you live and we know Dr. Jones is only a mile away.

Rob Klein
Dr. Jones can see you today, or the nurse practitioner or the VA can see you today, or would you rather wait for a week to see your doctor? Smith Instead of saying, Hey, Dr. Smith is busy, you know, like it or lump it, we can offer a solution. It may not be perfect, but at least what it's telling people is we are trying to get in.

Rob Klein
Does this work now? You've put the choice back in their mind, and then when they make that choice, they've had a choice and they feel better about that choice as opposed to being mad that the doctor can't see them. So it's about providing solutions is what consumers are looking for us to do. So we've got to get creative in our solutions.

Rob Klein
So this is just saying how long was this appointment? How many days did it take? How many should it have taken? If you look across the top and the red. Most of the urgent care, which you always get in immediately, that's the whole point of it. Everybody waited longer than they felt they should have by, you know, upwards of a week or almost two weeks.

Rob Klein
So we're making people wait and they're getting tired of that. They're like, you know what? There's an alternative here. I don't have to stay with you. I can find somewhere else that can get me in faster so it behooves us to keep our patients by getting them in, by offering solutions. As I mentioned earlier, you know, people are open to seeing a nurse practitioner or a pay they might need.

Rob Klein
They want it in the same office. If you think about it, if I can't see my doctor, at least I'm in my familiar office. But I know how to get to. If I have to go to another office, then you need to do a good job. Tell me where that office is so I don't get I don't get lost.

Rob Klein
So it's about having a really good handoff to them. Big section here. I'm not going to go through the whole thing. There's more detail in the full report, but we did a little primary care journey mapping and fact I'm going to skip. Let me go to this one. So what we did is we we divvied up all the different stages of a primary care visit from calling, scheduling, arriving, things like that, you know, the waiting room, exam room all the way through.

Rob Klein
And then for each one we said, does this part, this touchpoint, we use that word, but I'm using it with you did this touchpoint, were there any problems there that you feel need improving? And if they said yes, then we're like, okay, we had a list that I've put together over the years. I'm doing a lot of this work, and we let them pick which ones they felt needed improvement within that area, and then we just put the top three here.

Rob Klein
I've got more detail, but just to kind of summarize, here's the biggies. I also if if I made the box in red, if these were if this was a touch that had a much higher level of need for improvement than average. So you can see as we start the journey and we go to the right and we curve around to the left, all these boxes are red up until the provider's bedside manner, then it turns green.

Rob Klein
That's what I was alluding to early earlier that they've got they've got half a dozen contact points that they think need a lot of improvement before they even see the doctor. This is why a quarter of people saying, you know, service has gotten so bad that I'm kind of considering switching. They're loaded for bear before they even see the doctor.

Rob Klein
And the doctor has no idea that they have had these experiences. So, again, you can dig a little deeper at your at your leisure. We could spend the whole hour really picking this apart and looking at it. There's a lot of meat in here, in this in this section for you. But you can see. Yeah, go ahead.

Stewart Gandolf
I was going to say I'd like to women were carrying this flag for years with our company. And the thing is, if you look at a lot of those red boxes or before they committed to becoming a patient. So it's like if you're looking to get patients and that's the most frustrating part of their journey, that's a problem.

Stewart Gandolf
It's slow and that, you know, the the part of the health care consumerism, going back to what you said a moment ago, is there's a tendency in health care to think that it's just that little green box. It's about the doctor. It's like that's a relatively small part of the entire experience. And so this is I love this slide was a favorite of this.

Rob Klein
We're hang our hat on on one element that is no longer especially for younger people. This is no longer the box that can save you. Yeah. Yeah. And then, you know, the maximum time to be seen and to get lab results. Two days. Think about it. Because someone is sick, especially if it's serious. And we take weeks to get lab results, their life kind of stops while they're waiting, so they don't understand why we can't get lab results immediately.

Rob Klein
You know, it's like in banking when they when they say, you put your check in, this could take seven days to clear. We all know now that it takes 7 seconds because it's automated. They're using the money for flow. So at least be honest with us and say why it's taking this longer time to to get to get cleared.

Rob Klein
So tell it. Keep us posted. It's going to take two days. Here's why. You know, now with the mandate that you've got, as soon as the results are available, they have to go into my chart, even if the doctor hasn't seen them. A lot of our clients are scrambling with how do we communicate that with people so they don't panic before the doctor seen it.

Rob Klein
We legally have to let them have access to it even before the doctor sees it. But we need to manage the expectations for people that go in and maybe the results weren't good. Maybe they're they're mis interpretable, maybe they're borderline. So how do we communicate with that? But with people want answers now. Women want to be seen quicker than men.

Rob Klein
Remember, they are the household CEO 70% of the time. They're the health care decision maker for the household. So they feel rushed. So what do we do to help them really, that we understand And we know they have busy lives, They're juggling everything. What can we do to help them get the information they need as quickly and efficiently as possible?

Rob Klein
Overall satisfaction? Yeah, pretty much it was. It was it was very good, but it wasn't exceptional. And if people have a PCP, they're significantly more likely to be happy. So and again, that doesn't have to be a primary care physician. But having a quarterback helps people feel connected to your brand and look at the satisfaction decline significantly with younger folks.

Rob Klein
And it goes up as people age. So these younger Gen Z, they're just not that feeling that great about their experience because we're trying to give them a one size fits all. How do we customize a routine or primary or sick care visit by age? How do we offer different things? So younger people go the virtual route, older people go the in-person route.

Rob Klein
Just as a real quick example. But one size doesn't fit all, especially with primary care. We have to look at things by sex and age. Those are the two biggest targeting variables on the type of care that someone wants to receive. And we can't just have a one size fits all anymore. That just doesn't work.

Rob Klein
Pricing and billing. I call my trouble book and children. I've done so much research on this. A quarter of people price shopped and if they do price shopped, almost six in ten are going to pick the lowest option. Here's recently someone said in a focus group think and I'm going to paraphrase their words here So my, my, my doctor says, I need to get an MRI and I want I want the price shot where to go to the hospital that he's that he's part of the MRI was I can't remember what they said, let's say 6000 dollars.

Rob Klein
But then their outpatient center, the MRI was only, let's say 800. What are they trying to pull out of me? So the person hasn't even had their visit with you and they don't trust you. And I know we have legitimate reasons why it's more expensive. The hospital consumers are saying, I don't care. You want to be a system, you need to have single pricing.

Rob Klein
It shouldn't matter where I access you. So we have got to figure out how to have single pricing if we truly want people to think we are a system before they even use us. And you know, they want to pay their bill online because they do that with so many other categories and we make it hard for them to pay online.

Rob Klein
In fact, as Stewart alluded to earlier with my by my website research that we do on experience that bill paying is one of the biggest pain points that people have. They're like, You're forcing me to pay online and you make it impossible. What's wrong with you? So they don't trust us when it comes to the bill. Here's the kicker Most people want a single bill and they want it within one month of delivery or they shouldn't have to pay it.

Rob Klein
How's that for the new consumer? Think about that. Consumers and focus groups have been saying to me, I'm tired of being there. Accounting department. I know they have people that have to pay that are part of them. I don't care. That's their problem. Send me one bill and you figure out how to pay these other people. And if you can't give it to me in a month, I shouldn't have to pay it.

Rob Klein
You know, I've done hundreds and hundreds of focus groups over the past 20 years, and I try to remember interesting things that people say. One sticks with me in particular was about five, six years ago, and I will never forget it. So I want to share it with you. This summarizes everything I've been saying about billing. I was doing it about experience and this woman saying to my right next to me and she's just waxing poetic about the amazing experience she had with this health system.

Rob Klein
And I can feel the warm, fuzzy of the clients behind the mirror. I bet they're like high fiving. And then the bomb drops, she says. And then I got the bill. Then she proceeds to say, I thought I got all my bills for this procedure. And then six months later, I'm planning our family budget because we're on a limited budget.

Rob Klein
So I have to plan. And I saved enough money so we could have a family vacation. Then I get another bill from these people. But you know, someone's mad when they say these people. That's very derogatory. So she her tone turned dramatically and she says, I dug into it and I found out I did all this bill. They just never sent it to me.

Rob Klein
And she said, So I had to pay it and I had to cancel our family vacation. Then she turns to me and says, And now I hate them. I will never forget the emotional reaction and her facial expression and literally sticking a finger in my face. So we need to understand that as we are working on billing, that we could be ruining someone's family vacation because most people are on a budget.

Rob Klein
So if we take our sweet time and get a bill out six months later because, we had to wait for the insurers, consumers are like, I don't care, you're the good parent. They're the bad parent. I expect that behavior from a health plan, but I don't expect it from you, my provider, because you're the good parent. And that's how they talk about us providers.

Rob Klein
You're the good parent. Insurers are the bad parent and they're the children. They don't like getting stuck in between mommy and daddy fighting that. That's the type of language and the reaction they have when we get into spats or we have problems with our insurers, they expect us to do the right thing and fix it. So that's a big responsibility for us, but it's a critical one if we want to be their preferred brand.

Rob Klein
These are the types of things we have to do and it has nothing to do with getting them healthy, getting a bill figured out right away. That's a business thing. That's a brand relationship, and it just shows you if they have the most amazing experience, but you blow it with the bill, you undo everything. So if we don't fix upfront pricing and back end billing, trying to fix the patient journey is a waste of time.

Rob Klein
And I know that's a big statement to make, but it's but it's true. These are difficult asks. But that's what consumers are expecting from us to do. And then lastly here I have some points to ponder. You know, these are going to be sent to you. I've just verbally said every one of these, so I'm not going to sit here and read this tea.

Rob Klein
I would say when people read slides to me. So this is more for you to take away and digest. And as I said, Stewart, I'll make sure you've got the the full report that has a lot more detail on the journey mapping and so everybody can take the time to digest it. And as always, that's my contact info.

Rob Klein
If you want to chat more and there's Stewart. So Stewart, I think we've got some time to do a little Q&A. If there's any more questions, I would love to address them.

Stewart Gandolf
Well, that that was excellent as always. And I think just one of the comments that I held back on is the you mentioned urgent care earlier and the OBGYN side of the business where they're looking at the hospitals are looking at, you know, it's just like any money. And I can think of another department like that where one of our clients has a health system and their the doctors are looking at it in terms of like, why are we doing urgent care anyway?

Stewart Gandolf
It's like this is a loss later. All right. So no loss there. It's called lost loses this money. We should just do other stuff like. But you're trying to be relevant to your community. That's for the community comes. It's like having that kind of marketing viewpoint of everything we do and to look back and with reality check like it's not just about how we feel, it's about how they feel, it's about how we're serving the community, how what the experience is like once we're inside, as opposed to making it efficient for ourselves.

Stewart Gandolf
And that's the challenge with health care, because that people do hold providers, health systems, hospitals, multi-location groups, etc., at a much higher standard. And so I think that everything you talk about is perfect and consumerism is, is really, really important. So we have a couple of questions here. One was since you had to switch back to Slide 20, I'm not sure what it's referring to.

Stewart Gandolf
It says that the metrics.

Rob Klein
Will go back to slide.

Stewart Gandolf
Want to refer to PCP, correlate with employment rates. Meaning is if unemployment goes up as PC visits go down.

Rob Klein
If unemployment goes up to say.

Stewart Gandolf
Yeah, it says yeah.

Rob Klein
that's a that's a really good question. And I mean, now we're talking about the social determinants of health and I haven't, I haven't asked that question, but all the data I've seen and conversations I've had with clients, absolutely. As people are struggling that one of the first things to give is taking care of myself. Whereas before I'd go to a doctor or have a doctor, I might not have as good insurance, I might not have insurance.

Rob Klein
And so I'll just take Tylenol or I'll take DayQuil and try to get through what what I'm experiencing. Absolutely. I think social determinants of health are are massive. And I don't think we give enough attention to that. But absolutely, as unemployment goes up, I think I think taking care of ourselves with the basics, you know, primary care, sick care, I think that I think that goes down.

Rob Klein
I've heard it in focus groups. I just did some groups last year with a lot of single moms and they're like, I can barely afford to get care for my kids. I'm put myself last. So when I go into the doctor, I'm up sick as a dog and I just can't take it anymore and I'll figure out how to pay for it.

Rob Klein
So we don't realize after COVID how many people are hurting financially. And a lot of people said, Sorry, stupid. I think this is important too, from a financial is that when it comes from affordability, so many people are now on hourly wages. They have to clock out when they go to the doctor's office. So we think of costs as deductibles, co-pays, there's things like that.

Rob Klein
They also think about, I had to I had to clock out of work to come to the sick visit because I still had to go to work because I can't afford to be sick. But you made me wait an hour. So now I just lost two or 3 hours of work that I'll never get back. So not only did you cost me a $10 co-pay, let's say, but I just lost 3 hours of hourly wage.

Rob Klein
Say I'm making 15. So this this visit just cost me $10 co-pay and I lost $45 that I had to clock out of our hourly wage. So this was a $55 visit. We don't equate it that way. We look at, your cost is $10. Time is the new currency, literally and figuratively. So we have to look at it that way, that the more we make people wait, it's hurting them in a lot of ways.

Rob Klein
We aren't thinking about.

Stewart Gandolf
You know, by way of going back to cost. You said earlier about that a hospital bill, unexpected bill, could ruin a vacation. It could ruin a life. Depending on the right, the stakes are high. So it's important to remember how this actually impacts real people. And one of the questions was, and I'm not sure what it means, so we'll do the best we can.

Stewart Gandolf
It says, Do you think that there's an element of, well, I can take COVID tests at home, but not flu RSV test. So I didn't notice that question until later. It is an interesting fact. Like maybe, Rob, you might have just a comment on this broad topic. And I literally went through this process where we were sick. We didn't think we had COVID.

Stewart Gandolf
It turned out we didn't. We didn't. I thought, well, of course we can find out if it's a flu test. And they didn't offer it at CBS. They're under our urgent care. So I guess maybe broadly that you don't have data on that, but just broadly, you know, how do you feel consumers think about these kinds of thing testing at home or testing for flu or for COVID?

Stewart Gandolf
Is there any insights from your recent research that would cover that?

Rob Klein
Yeah, you know, I haven't I was doing so much COVID research during the height of it that kind of people were getting sick of talking about it. And I think we feel like let's stop talking about it and it'll go away. But, you know, it's kind of like that, that nagging pain that just won't that just won't quit.

Rob Klein
And so I don't I don't have direct results. I, I do think that one thing COVID has taught us is we can we can innovate and we can do a lot more testing at home. So I think expectations are changing. Like, why can't I have a flu test at home? Why can't I do this test at home? So I think it's incumbent upon us to continue making tests that are consumer friendly, that don't require.

Rob Klein
Now, that's a change of, you know, physicians are going to say, hey, I need these people to come in for volume. But then they're like, but I'm two weeks out. I'm so booked up. So how we manage this change of what requires an in-person versus what you can do at home, I think that's changing quite a bit. I think what the test is that's up for debate.

Stewart Gandolf
Well, it's a times of or we don't have time to go into this, but there's tons of disrupters out there, including some of our clients that are doing exactly that, you know, either bringing home visits or urgent care or telehealth or remote system monitoring or and even for very specific niche areas like we have one for cardiac rehab.

Stewart Gandolf
So we have different niches that are evolving very, very quickly out there. The one last question is, I know we both have to run to the next thing as well as I'm sure a lot of our guests on the webinar. If some remove this shorter term, it's of health barriers. Wouldn't that lower the overall costs of health care, freeing up money for prevention?

Stewart Gandolf
So I'm not sure how to answer that, but perhaps you are.

Rob Klein
Well, if I if I interpret it correctly, it I like where they're going. To me, what I'm hearing is that if we can help people to have access to things like everyone else does, that there are no things like, well, my health is worse because you can't keep a job. Or I, I struggle with having a home or, you know, mental stress can cause a lot of physical issues that people with means just don't experience.

Rob Klein
So I agree. I think we would actually reduce the amount of people that have to come in for care if we could help them to live a healthier life. That's why a lot of safety net hospitals when a person this is an extreme example, but I had it with a client, you know, a woman comes in with a broken arm.

Rob Klein
Well, you can fix the broken arm. But they spent more time finding out why she had the broken arm. Turns out she was beat up by her husband. So how can that provider help her get to a healthy place so that she doesn't have to come in for things like that? I know that's an extreme example, but why don't hospitals?

Rob Klein
Why don't we offer financial consulting? Why don't we have more emotional consulting, work more closely with AA or with drug clinics? Because mental health is one of the biggest causes of homelessness. And so why don't we work outside our comfort zone to help people to heal the whole person? You know, a lot of our are more, you know, Catholic or faithful clients say, you know, we heal the whole person.

Rob Klein
Do we really.

Stewart Gandolf
Get. Good point. One last comment and one or two quick comments. Yes, there'll be a recording again. We'll send an email out that has that and don't post all of the slide decks. This one we will. So that'll be on our web page as well. The other thing is just on the social determinants of health, that's a big topic.

Stewart Gandolf
I talk with a lot of my doctor friends, for example, asthma, the kids in the emergency room every other week and they have, you know, cats at home and dogs at home and dusty places to live. There's there's ways of being more effective for sure. Rob, as always, it was fantastic and fun talking to You will have a expensive dinner with a cocktail or two sometime in the next month or two.

Stewart Gandolf
Next time around. We'll try to make it work. By the way, Rob and I have got to do Halloween together. This last time is up. No community labs. So anyway, it was awesome having you. Rob, as always, thank you for listening. And we'll see you our guests again and Rob will have some fun together in a few weeks.

Rob Klein
So awesome. Sounds good. Thank you, everyone. Have a great day.