Case Study

Results of National Bureau of Economic Research. “We study how privately insured individuals choose lower-limb MRI scan providers. Despite significant out-of-pocket costs and little variation in quality, patients often received care in high-priced locations when lower priced options were available. The choice of provider is such that, on average, patients bypassed 6 lower-priced providers between their homes and treatment locations.”

NBER Working Paper No. 24869
January 2019

Summary

The Persona^tm research surveyed current price shopping behaviors by employee segment and the needs and attitudes that motivate it. It identified significant opportunities for increases in healthcare shopping engagement. Our goal here is to demonstrate how employers can use the Persona^tm research to achieve that increased engagement through Persona insight-based communications that change employee behaviors more than one-size-fits-all email or other media.

Price shopping background

When high deductible plans were new, the promise of reducing healthcare expense through healthcare shopping programs was high. The assumption was that HDHPs’ higher deductibles and higher out-of-pocket expenses would cause consumers to reduce their expenses by price shopping healthcare. To enable these behaviors, many employers fielded price transparency solutions.

Yet, research such as that from the National Bureau of Economic Research (shown to the left) indicate that consumers don’t shop healthcare to save money. Instead they reduce out-of-pocket and deductible expenses, despite the risk to their health, by curtailing the amount of healthcare they use across the spectrum of health care services (e.g. visits, tests, medication), including preventive services.

Our Case Methodology

Our case method is to understand what drives healthcare shopping behaviors, identify target employees who do not yet price shop but say they would under the right circumstance, identify the scope of the opportunity, and then identify how to use attitudinal insights to inform communications that will engage the target groups.

Current shopping behaviors

The chart below maps self-reported healthcare shopping behaviors, by Persona segment, using a research question, q30_3 (“Before seeing a doctor or filling a prescription, I compare the prices of my options”). By example, the left hand-most bar in the chart reports that 34.7% of Segment 2 members agreed with the q30_3 statement.

What drives these behaviors?

The question of, “what drives these behavior variations by segment” is answered by the chart below, called “Comparison of HSA Ownership to Healthcare Shopping Behavior”. It superimposes the responses from q30_3 (above) on a chart that divides all employees by plan choice.

In this chart, the vertical bars represent plan ownership – light blue at the bottom of each vertical bar represents HSA plans ownership. Light polka dots at the top of each bar represent all other plan types. The chart suggests that plan choice is an important motivator of healthcare shopping behaviors. With their generally higher out-of-pocket costs and higher deductibles HDHP/HSA plan owners are motivated to look for ways to save money such as price shopping healthcare.

Price shopping healthcare is not new. What is the ongoing potential?

In the chart, below, called “Healthcare Shopping Behaviors”, the vertical bars represent by-segment responses to the Persona^tm survey statement, “If I needed an MRI, I would shop for the lowest price if someone showed me how” (q20_14). They range from 35.1% to 68.2% of the segments. The line across the chart represents responses from q30_3, above, “Before seeing a doctor or filling a prescription, I compare the prices of my options”. These are the respondents who regularly price shop their healthcare.

The juxtaposition of these question responses on this chart demonstrates that a substantially larger number of respondents in every segment would price shop their healthcare if they knew how to do it.

Calculating the Opportunity

The table below demonstrates the data in the chart just above, but also calculates an “uptake opportunity” by segment. The opportunity is the difference, in each segment, between the percent who now price shop (q30_3) and the percent who would price shop if they knew how (q20_14). The opportunity by segment ranges from a a low of 13.2% of Segment 2 to a high of 39.8% in Segment 1.

Question/Segment	2	4	5	6	3	1	7
Would shop for MRI (q20_14) if knew how	47.9%	62.0%	35.1%	58.1%	38.0%	68.2%	61.5%
Now shop before seeing a doctor (q30_3)	34.7%	36.1%	17.1%	36.8%	13.3%	28.4%	32.6%
Uptake opportunity	13.2%	25.9%	18.0%	21.3%	24.7%	39.8%	28.9%

The potential for education in increasing price shopping

The table seems to indicate that education in price shopping is the key ingredient in capturing the potential. The chart below validates this insight by reporting responses to q20_11 (“I don’t know how to shop for healthcare”). There is an 79.9% correlation between the uptake opportunity shown in the table above and the lack of knowledge about shopping for healthcare, shown in the chart below. This indicates that education could have a meaningful impact on increasing employee healthcare shopping behavior.

How to use attitudinal insights to inform communications that will engage the target groups.

These Persona^tm insights point to opportunities to increase healthcare shopping behaviors in every segment. Opportunities in some segments (like Segment 1) are larger than others. Using Persona^tm, every individual in every segment is accessible for communications. Communications programs can focus on one or more of these segment opportunities.

The Persona^tm insights include highly detailed descriptions of the personalities of every segment. In these, Persona^tm users can find financial and health character traits and preferences that are used to create highly personalized messaging most likely to motivate employees or consumers.

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