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To keep patients from leaving, remember why they stay

The following article appeared in Becker’s Hospital Review, November 2017. To view the publication, click here.


What is your organization doing to keep patients coming back?

As a recent study conducted by NRC Health Market Insights shows, probably not enough.

The study found that 48% of customers feel frustrated with their current healthcare providers. One in three would switch providers right now, if they could find an affordable alternative. Even more conservative industry estimates of 7-10% customer attrition represents as much as $100 million in lost revenue opportunity per hospital.

Shocking as these figures may be, they are part of a larger trend. The creation and sustainability of loyalty is a problem that has bedeviled the healthcare industry for years. Solving it will require a new commitment to understanding how consumers approach their care.

The frugal—and fickle—healthcare consumer

A patient is earned by an election of trust. We know that patients don’t return when providers break that trust, or fail to live up to their expectations.  Two concurrent trends have driven these expectations higher than many organizations are prepared to manage.

  1. A surge in out-of-pocket costs

The Kaiser Family Foundation reports that over the past two decades, the cost burden associated with healthcare has shifted. Regulatory changes and price inflation have foisted a large share of the financial load directly onto the consumer.

Previously, insurers or government programs assumed more responsibility for costs, and consumers didn’t apply as much scrutiny to their care options. But now, because their money is at stake, consumers pay keen attention to the value they receive. They demand high-quality care, ease of access, and high-end amenities, all at a reasonable rate.

These high standards put immense pressure on providers to continuously improve their operations. If patients can’t find a good value with their current provider, they’ll look for it somewhere else.

The second trend simplifies the process by which patients seek out these alternative options.

  1. Digital empowerment

Technology has permanently transformed the way patients pursue care. Specifically, the Internet has allowed for unprecedented levels of transparency and choice. These changes have already revolutionized several industries, and healthcare is finally following suit. Accustomed to quick and convenient comparisons of hotels and restaurants, consumers have begun to expect the same from healthcare providers.

If a provider does not meet expectations, consumers now understand that they have a wealth of choices at their disposal. This makes it easy for them to simply walk away from care experiences that present them with difficulties, frustration, or confusion.

Loyalty growth opportunity remains. Are you missing it?

Healthcare leaders can be encouraged by another important fact revealed by the Market Insights study: consumers prefer to be loyal.

According to the study, 58% of consumers say they’d prefer to receive all of their care from just one health brand. A comprehensive range of healthcare services, convenient (if not preferred) access, consistency of experience, and seamless personal health information sharing are all elements associated with consumer-friendly health systems.

Consumers don’t want to take a piecemeal approach to their health, or to fret about network coverage or referral pathways. They want streamlined, full-service care from one health brand, and they want to feel authentic engagement with that brand throughout their daily lives.

If consumers actually crave loyalty to health brands, then why do providers fail to create strong bonds with them?

The answer may lie, in part, in misguided marketing analysis.

A holistic view of loyalty resists simple measurement. Retention data does not tell the complete story. Consumer loyalty, after all, is as much about relationships as it is about volumes and revenue.

This subjective, emotional side of loyalty has proven difficult for providers to track and quantify. Historically, healthcare leaders have relied on a proxy that they can measure: the positive patient experience.

Patients will remember—and return to—providers who treat them well. Experience can’t be discounted. It is a key aspect of loyalty in the consumer journey, and it’s critical that organizations get the experience right. But healthcare’s a unique industry—there can be long gaps between individual episodes of care. Therefore, if an organization is only building loyalty while the patient is in the building, it’s missing many opportunities to engage and influence loyalty in the interim.

Most healthcare leaders now agree that loyalty is more than the sum of a patient’s positive experiences, and that further understanding is necessary to engender it. Loyalty is a construct, built from a wide variety of interactions that a consumer has with a health provider. To nurture loyal feelings, healthcare organizations need to understand what these interactions are, how they intersect, and the impact each individual interaction has on the next; they need to grasp the constituent components of loyalty.

How loyalty is built


Drawing from a national database of more than 300,000 healthcare consumers across the country, NRC Health’s Market Insights research team has identified seven components of loyalty that healthcare organizations should consider:

Brand score. This is loyalty’s first, most fundamental factor. Consumers must be aware of and think favorably about your organization in order to choose you for care. If they’re aware of your organization’s brand, consumers will have a set of predispositions toward it. Brand score is a cumulative result of marketing efficacy, news events, local/environmental factors, and word of mouth.

Engagement. Do consumers read and share your brand’s social-media posts? Do they visit your local events? Interactions like these strengthen a sense of familiarity and trust with your consumers—whether they’re actively pursuing care or not.

Need. Every consumer has unique health issues and needs. Naturally, they will favor those organizations that are best equipped to provide care based on personal need.

Access. As already mentioned, today’s consumer has high expectations and a correspondingly low threshold for frustration. Barriers to care, confusing bureaucracies, or excessive wait times sour a patient’s opinion about an organization. Access, also known as Customer Effort Score (CES), is a critical element to ensuring that those consumers who know, prefer, and need your services are actually able to access care on their own terms.

Motivation. Most consumers can find multiple providers near where they live who offer a wide variety of similar, if not identical, services. If the choice is made to pursue care, consumers will likely choose only one such provider at a time. Consumer motivation measures their stated degree of preference for any one provider or brand.

Experience. This factor comprehends considerations such as: How well does the provider care for the patient? Does the consumer feel delighted with the organization’s service?

Net Promoter Score (NPS). Premised on a single question—“Would you recommend this provider to your friends and family?”—the NPS is a time-tested means to measure and indicate future utilization of your brand.

What gets measured gets improved

Throughout their lives, consumers of every kind are on a continuous journey of discovery, needs assessment, engagement, and experience. Unique to the healthcare industry—and few others—is that almost everyone will most assuredly become a consumer of its services in their lifetime. Every step along these many consumers’ individual journeys provides an opportunity to better understand and engage with those you hope to serve now and into the future.

To help healthcare leaders understand what matters most to consumers and how this journey is managed, NRC Health has developed the Loyalty Index.

The NRC Health Loyalty Index is the industry’s first holistic measure for loyalty in healthcare. It captures how patients rate a health brand for each of the above-mentioned aspects of loyalty. These individual aspects of loyalty, trackable and comparable over time individually, are also combined to create a composite score for each brand. This gives healthcare marketers and administrators the first-ever unified metric capable of assessing strengths, weaknesses, and gaps relating to the creation of loyalty among consumers.

The Loyalty Index provides a scientific means to address one of healthcare’s most enduring challenges. In doing so, this data-driven innovation promises to help demystify consumer loyalty.

Complementing the comprehensiveness of the Loyalty Index is its utility in simplifying analysis for healthcare marketing teams. It functions as an intuitive and complete tool, bringing clear focus to high-impact areas deserving of energy and resources to increase the rate of organizational growth.

The Loyalty Index enables healthcare marketers to prove marketing ROI, demonstrate the value of new programs, and gain buy-in from leadership using simple, concrete figures. Ultimately, the Loyalty Index takes the guesswork out of generating consumer loyalty.

Start the loyalty conversation

In order to achieve the level of loyalty that consumers desire and healthcare organizations require, a new way of thinking is needed. Loyalty is a broad issue, and healthcare leaders need local answers on all—not just some—of the ways to best engage their consumers. NRC Health’s Loyalty Index is designed to illuminate each step of the healthcare consumer’s journey in each of the largest 300 markets in the country, representing more than 3,000 hospital and health system brands.

Illuminate the path of your consumer, and discover the impact of improved consumer loyalty within your health system.

To learn more about the Loyalty Index, please visit nrchealth.com/loyalty.