Astound Commerce HLS Report

Astound Commerce HLS Report - Page 1

06 KEY TAKEAWAYS 07 SURVEY METHODOLOGY 08 HEALTHCARE CONSUMER PROFILE 09 HEALTHCARE CONSUMER DEMOGRAPHIC COMPOSITION 11 CURRENT HEALTHCARE SENTIMENT 12 CONSUMER HEALTH 15 MENTAL HEALTH 16 DIGITAL HEALTH 18 TELEHEALTH 21 DIGITAL THERAPEUTICS 22 AT-HOME CARE 24 THE PATIENT AND HEALTHCARE PROVIDER RELATIONSHIP 29 PATIENT PAIN POINTS 32 APPENDICES: 33 EUROPE 34 MIDDLE EAST/NORTH AFRICA 35 NORTH AMERICA 36 SOUTH AMERICA 37 UNITED KINGDOM 39 REFERENCES 41 ABOUT ASTOUND HEALTH™ 42 ABOUT ASTOUND COMMERCE 3

Astound Commerce HLS Report - Page 2

In Astound Commerce’s 2021 report Transforming the Healthcare Consumer Journey: Now and Beyond COVID-19, we analyzed the immediate shifts in patient behavior directly related to the onset of the COVID-19 pandemic. From that analysis it was evident that the outbreak had accelerated a digital- first mindset among consumers. What was less clear, however, was whether the seismic effects of the global health crisis had impacted the relationship between patients and healthcare providers (HCPs). To answer that, this year’s report takes an in-depth look at healthcare delivery beyond the pandemic, to better understand the patient’s healthcare journey in the current landscape. We look at the technologies patients are using with the intent to stay healthy, and we examine the complex relationship between patient and HCP, focusing on key factors such as trust and communication. 4 5

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      KEY TAKEAWAYS — Compared to 2020, patient interest grew for all telehealth appointment types in 2021, with the highest growth rates occurring in higher engagement appointments—specifically for receiving treatment for a minor illness, such as a cold We surveyed 1,000 global consumers in North (up 21 percent) and receiving various types of digital therapy America (Canada and the United States), Europe (up 21 percent). (Italy, Germany, and Switzerland), the Middle East — Nearly one-third of patients have postponed a necessary and North Africa region (or MENA, consisting procedure in 2021, citing safety concerns, up 17 percent of Abu Dhabi, Dubai, Egypt, and the Kingdom from 2020. of Saudi Arabia), South America (Colombia), and — 30 percent of patients strongly agree they would find a new the United Kingdom. Participants were required healthcare provider if they had a bad experience with their to be at least 18 years old. Respondents who current one. reported being currently employed in the healthcare industry were advised to complete the survey — More than 40 percent are at least minimally concerned about from the perspective of a healthcare consumer. the security of their personal health information. All data shown represent the average of all global consumers, with demographic analysis presented — A strong gap was found in the perception consumers have for further insight. A snapshot view of the research regarding what can be considered easily obtained care by region is included in the subsequent appendices versus their actual health insurance coverage benefits. to this report. — Physical therapy is the one form of digital therapy for which customer preference declined YoY (by 25 percent globally), with a particularly steep drop in preference by 44 percent of consumers ages 45 to 54. SURVEY METHODOLOGY 6 7

      HEALTHCARE CONSUMER DEMOGRAPHIC COMPOSITION Male 49.9% Female 48.9% Non-binary/gender 0.6% non-conforming/other * Transgender Male * 0.4% Transgender Female * 0.2% Figure 1. Gender Identification. Specific demographic stats for transgender female, transgender male, and non-binary respondents are not shown in the segmented analyses as they are not statistically visible (each representing less than 1 percent of the study population). Currently, 78 percent of global patients report having health insurance and 30 have experienced a change in their healthcare coverage in the last 12 months. Changes in coverage are reflected in the following graph (see Figure 2): Health insurance 56% coverage has improved Currently have health insurance, whereas 33% previously did not HEALTHCARE Health insurance 8% coverage has weakened No longer have health 3% CONSUMER insurance Figure 2. Change in Patients’ Health Insurance Coverage. Patients were asked to state (a) whether their insurance coverage changed compared to 2020 and (b) if so, how their PROFILE current coverage compares to their coverage from 12 months prior. 8 9

      With nearly 8 out of 10 global consumers noting they currently have CURRENT health insurance, only 45 percent feel strongly that they have adequate In a rural area access to healthcare (see Figure 5). This disparity between actual 15% HEALTHCARE coverage and adequate access indicates a strong gap in the perception SENTIMENT consumers have regarding what can be considered easily obtained care versus their coverage benefits. Residents of the MENA region show the largest gap between having healthcare coverage (93 percent) and adequate healthcare access (36 percent) at 57 percent. In an urban 55% area or city 30% In a suburban area Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree Have access to adequate healthcare Figure 3. Distribution of Respondents by Area Believe the healthcare system where they live could be improved Type. Respondents indicate their area of residence. Believe all citizens where they live have access to adequate healthcare Postgraduate (master’s or doctorate) 13% Some postgraduate 9% Are able to afford any healthcare emergency costs that may arise Undergraduate 23% Figure 5. Global Patient Healthcare Sentiment. Patients state their level of agreement with the proposed sentiments on the nature of the healthcare system. Some undergraduate 16% Trade/technical/vocational training 8% Secondary (graduated high school) 23% Furthermore, nearly one in four consumers feel strongly surveyed cohorts ages 18 to 24 and 45 to 54 are reported that the healthcare system in their region could be to be the most vulnerable, with only 26 percent and improved. Therefore, it’s critical that stakeholders in the 17 percent of each demographic, respectively, indicating Some secondary (high school) 6% healthcare industry work to bridge the divide between strong confidence in their financial capability. These two access and coverage, or more pointedly, perception and cohorts in particular will be most sensitive to healthcare Grade school or middle school 1% reality, to cultivate patient satisfaction, loyalty, and—most costs. Total transparency is paramount when engaging importantly—outcomes. these consumers on price—as well as the transparency Prefer not to answer 1% Financial resources are clearly a huge factor in existing around the value that will be derived from a given service. healthcare disparities across populations. When it comes Consumers are more knowledgeable than ever on the Figure 4. Distribution of Respondents by Education Level Completed. to the ability to afford emergency healthcare costs, costs of all services, from engaging in comparison pricing Respondents indicate the highest level of education they have completed. to doing their research online. 10 11

      CONSUMER HEALTH 2–1 (Poor/worst possible health) 3 (Average health) 5–4 (Best/good health) The global health crisis evidenced Figure 6. Personal Health Assessments how elusive good health can be, Grouped by Quality. Respondents were asked to categorize their overall physical health by thus resulting in a more health- envisioning a stepladder with rungs numbered from 5 to 1, where 5 represents the best possible health conscious consumer. Industry and 1 indicates the worst possible health. has followed suit—consulting firm McKinsey values the global health and wellness market at US$1.5 1 trillion . From digital workout gear to vitamins and supplements, the Notably, just over two in five consumers are also of the October 2021 Facebook whistleblower market to help consumers look good, increasing the frequency by which they employ revelations, detailing the harmful impact certain feel good, and stay in shape has coping mechanisms for stress and anxiety (see social platforms can have on the self-esteem and boomed, as further evidenced by Figure 7). Taking a digital detox, or refraining from overall mental health of younger users. McKinsey2. And these investments digital devices and/or social media for an extended in wellness are working. Our data period of time, has increased in frequency, with Sufficient sleep has been elusive for many show that 63 percent of consumers 30 percent of consumers engaging in this practice. during the pandemic—26 percent of consumers report being in at least good health The negativity often seen on social media has report they don’t get enough sleep as often as physically (see Figure 6). become a central issue for US lawmakers in light they should. 12 13

      More often About the same Less often MENTAL HEALTH Coping with stress/anxiety In its 2021 recap, Google announced its most searched-for phrase of the year was “how to heal,” perhaps unsurprising after the year that was 2020. “Maintaining mental health” also trended heavily on the search engine in 2021, appearing more frequently Doing a digital or social media “detox” than in any previous year. The pandemic continues to generate high demand for mental health services while simultaneously creating challenges for 3. Our research reveals the ways in patients to receive care Drinking enough water which patients are managing their stress and anxiety, with most engaging in activities such as meditation and exercise (see Figure 8). 22 percent of global consumers report they do not engage in any of these behaviors to help mitigate their stress or anxiety, nor Eating healthy do they manage their stress/anxiety at all—a potential growing threat to their overall mental health. Engaging in hobbies or other mindfulness activities Engaging in certain activities to help cope with stress, such as meditation, acupuncture, exercise, and so on Exercising Taking days off from work/school when feeling stressed/anxious Getting enough sleep Using apps to help with stress/ anxiety management Having a support group of people Taking vitamins and/or supplements they can talk to when needed Using herbs/supplements that Figure 7. Patient Frequency of Healthcare Behaviors. promote relaxation Respondents indicate the level of frequency by which they engage in certain healthcare habits. Seeing a counselor/ therapist in person Consumers are taking sufficient measures to help maintain their well-being, but the persisting pandemic will likely have an adverse Seeing a counselor/therapist online effect in the long run if these underlying chronic conditions aren’t properly addressed. Figure 8. Patients’ Methods for Stress/Anxiety Management. Patients state the ways in which they manage levels of stress and/or anxiety. 14 15

      Half of global consumers currently use a health wearable, such as 4 an Apple Watch or Fitbit . This type of health tech has enormous popularity. Nearly one-third note that wearables assist them with maintaining a healthy lifestyle. As 2020 ushered in widespread digital-first consumer behaviors, there has also been increased adoption of health and fitness apps to help consumers manage their well-being. 23 percent of global consumers use apps to help cope with stress and anxiety (see Figure 8), and generationally, mobile app usage tends to skew younger overall—though nearly one-fourth of adults ages 45 to 54 report using apps to assist with weight loss (see Figure 9). 18–24 25–34 35–44 45–54 Attend a virtual appointment with 8% 14% 8% 3% a counselor or therapist Better understand sleep patterns 26% 28% 28% 15% Lose weight (i.e., calorie tracking, 38% 36% 23% 23% nutrition, and so on) Maintain fitness goals (i.e., workouts, 40% 40% 31% 21% coaching, and so on) Manage stress/anxiety 29% 27% 23% 20% Track daily habits (i.e., drinking water, 28% 24% 20% 9% steps taken, and so on) Track fertility or other general women’s 28% 30% 20% 6% health matters Figure 9. Patient Mobile App Usage for Health-Related Behaviors Grouped by Age Demographic. Patients reveal their usage of mobile apps to assist in their engagement of certain healthcare behaviors. However, a major implication of using third-party apps for health-related behaviors is that data can be shared unbeknownst to the consumer, raising serious privacy concerns. Therefore, the need for compliant consumerism becomes more DIGITAL HEALTH urgent, as mobile health apps continue to proliferate and gain greater consumer adoption. 16 17

      TELEHEALTH Telehealth use garnered great momentum in 2020 for obvious reasons, as patients looked to maintain their course of care amid the disruption caused by the pandemic. Our survey results indicate 45 percent of global patients used telehealth in the past 12 months, up 10 percent from 2020. Figure 10 indicates the purposes for which patients were inclined to use this virtual health delivery model in 2021 compared to 2020. For about half of global consumers, preventative health measures are the predominant driver of telehealth appointments, slightly ahead of illness-related concerns. 2020 2021 % change 2021 2020 A follow-up appointment 60% 63% 5% Other An assessment to determine if emergency care is needed 52% 56% 8% Prescription refill only An initial consultation 60% 64% 7% Has a few questions they need answered 64% 70% 9% Illness for you or someone in your family Monitoring of their current health condition/illness 54% 59% 9% Preventive medicine Preventative medicine (i.e., annual checkup or exam) 52% 57% 10% (annual checkup/visit) Figure 10. Year-over-Year Comparison of Therapy (i.e., physical, occupational, counseling, 42% 51% 21% Reasons Why Patients Use Telehealth. Growth addiction, mental health, and so on) is seen in patients’ use of telehealth for certain appointment types from 2020 to 2021. Treatment for a major illness (i.e., concerns related to COVID-19, cancer, MS, lupus, and so on) 42% 44% 5% Treatment for a minor illness (i.e., a cold, an earache, 53% 64% 21% Nearly three out of five consumers say they would health-related questions, which remains the case strep throat, and so on) generally consider using a virtual healthcare visit, in 2021. However, while consumer interest grew for Treatment for a moderate illness (i.e., the flu, digestive led by 82 percent of MENA consumers. In our all telehealth appointment types year over year, the issues, a sprain, and so on) 49% 56% 14% 2020 survey, we saw a majority of global patients highest growth rates are seen in higher-engagement state their propensity for potential virtual visit use as interaction methods, specifically for receiving Figure 11. Year-over-Year Comparison of Patients’ Likelihood to primarily for lower-engagement appointments treatment for a minor illness and receiving therapy, Use Telehealth for Specific Appointment Types. Patients indicate the like an initial consult or getting answers to certain both up 21 percent from 2020 (see Figure 11). degree to which they are likely to use telehealth for various reasons, all of which increased from 2020 to 2021. 18 19

      Optimizing telehealth technology execution, DIGITAL The aforementioned consumer affinity for mobile apps as a tool guiding patients through the telehealth process for maintaining a healthy lifestyle helps lay the foundation for the to ensure they are comfortable, and expanding THERAPEUTICS emerging field of digital therapeutics. As consumers look to gain telehealth offerings beyond consultative more control over their health, these clinically proven therapies appointments can help propel this delivery model can afford patients more effective treatments for better outcomes. forward. Virtual visits may not provide patients with Comparatively, consumer willingness to use digital therapeutics the maximum service benefit depending on the has grown, as 17 percent more global patients were open to this appointment type (for example, physical therapy), form of therapy in 2021 than in 2020. Inversely, key indicators thus healthcare organizations must determine that would inhibit patients from using this digital delivery remained how to best use telehealth in a more strategic statistically unchanged between 2021 and 2020, with the issue omnichannel approach to care. of affordability declining by 42 percent (see Figure 13). One important metric is patients’ unwillingness to discuss their mental LEARN MORE health concerns with others, which also decreased from 2020. This bodes well, as healthcare stakeholders must help to dispel the societal stigma that patients often feel around speaking publicly about their mental health. Although 84 percent of patients expressed 2020 2021 % change some level of satisfaction with their telehealth experiences (see Figure 12), there is room for improvement. Investments in telehealth grew 169 Can only pay in cash/don’t have a credit card 6% 6% 0% percent year over year in the second quarter of 5 2021 alone, according to CB Insights . Concerned with cost/affordability 19% 11% -42% Don’t have any issues that require this form of therapy 28% 16% -43% Don’t have insurance 7% 7% 0% Don’t have the technology needed to use it 10% 10% 0% Don’t want another login/password to remember 18% 19% 6% Prefer not to discuss their mental health with others 14% 12% -14% Too difficult to log on 10% 8% -20% Highly Somewhat Neutral Somewhat Highly Would rather communicate with someone in person 51% 50% -2% satisfied satisfied unsatisfied unsatisfied Figure 12. Patient Satisfaction Rating of Telehealth Experiences. Figure 13. Year-over-Year Comparison of Factors That Inhibit Patients from Using Patients rate the degree to which they are satisfied with their collective Digital Therapeutics. Patients reveal the reasons why they would not use digital telehealth engagements. therapeutics, with a year-over-year comparison between 2020 and 2021 showing declines for the majority of stated factors. 20 21

      Ongoing caregiver shortages, an aging population that prefers to remain at home, and the growing presence of chronic diseases globally will drive the need for at-home care technologies such as RPM. Patients indicate they are comfortable with these in-home treatment models—58 percent of global patients indicated at least minimal comfort with RPM (see Figure 14), which is very likely to grow—market research firm Research and Markets projects the global remote patient market will be worth more than US$1.7 billion by 2027. Very comfortable Somewhat comfortable Neutral Somewhat uncomfortable Very uncomfortable Using a SMART DEVICE that will collect their data in real time, which is then stored in an app and sent to the HCP Using a SMART DEVICE to monitor their healthcare needs in real time in between HCP visits Using a VIRTUAL ASSISTANT to monitor their healthcare needs in real time in between HCP visits, as well as advise on a treatment plan The pandemic has brought the necessity of at-home care to the fore. AT-HOME Naturally, home has become a healthcare setting for patients—from CARE health and wellness to healthcare engagement via virtual visits and remote patient monitoring (RPM), consumers are embracing new Using a SMART DEVICE to aid in your treatment and/or recovery technologies that can enable their continued course of care at home. from an injury, illness, or disease In particular, at-home testing has now gone mainstream, as diagnostic COVID-19 tests have been distributed for free across several countries— including the US with an announcement by the government in December 2021 that it would offer 500 million free at-home COVID-19 tests in an Using an at-home diagnostic test 6 effort to combat the Omicron variant of the virus . The demand for at- home diagnostics will continue to accelerate, a trend that was already well underway before the pandemic. Figure 14. Patient Comfort Level for Using At-Home Diagnostics and RPM. An indication of the degree to which global patients are comfortable using certain emerging healthcare technologies. 22 23

      In 2020, as coronavirus cases exploded and created severe backlogs of elective medical procedures, 27 percent of global patients reported they had postponed a procedure citing safety concerns; in 2021, that figure rose to 32 percent for the same reason. This indicates that consumers are still apprehensive about in-person healthcare appointments amid continued surges in COVID-19 cases. Of this subset of patients, more than one-fourth still had not had the necessary procedure, or at best, had had it rescheduled at the time this survey was deployed. As the pandemic enters its third year, it remains to be seen when patient comfort levels will return to pre- pandemic levels—and when healthcare delivery systems will return to equilibrium. Unable to schedule a timely in-person appointment with their HCP Inability or a delay in scheduling a medical procedure Shortage of a prescribed medication THE PATIENT- Delay in receiving medical equipment or medical supplies Inability to reach their HCP for health-related HEALTHCARE questions/concerns Figure 15. Healthcare Circumstances Did not receive a call-back from their HCP Experienced by Patients in the PROVIDER Last 12 Months. Patients indicate whether they have experienced any of the Did not receive the results of a diagnostic test/ specified healthcare RELATIONSHIP OR the results were delayed occurrences. 24 25

      The following data points serve as important indicators to measure the efficacy of the relationship patients have with their healthcare providers in general. In a broad sense, global patients have a high level of trust in their network of healthcare providers—69 percent say they trust their physicians to make the best decisions regarding their health (see Figure 16). 56 percent of consumers also have a positive sentiment regarding collaboration among their network of physicians and receipt of personalized care, albeit down from 66 percent in 2020. Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree Provide them with personalized care tailored to their specific needs Would find a new healthcare provider if they had a bad experience Collaborate with each other to coordinate their course of care Have visited the same healthcare provider for as long as they can remember Trust the doctors/healthcare providers in their network make the best decisions possible regarding their health Find it difficult to get in touch with my healthcare provider Figure 16. Patient Sentiments Involving Their Healthcare Provider Network. Figure 17. Patient Sentiments Involving Their Healthcare Patients indicate their level of agreement with the proposed statements regarding Provider Network. Patients rate their level of agreement regarding aspects of the patient and healthcare provider network relationship. the proposed statements. The amount of trust patients have in their network of physicians When consumers seek advice on issues related to could be due to the relationship they have cultivated with their their health, universally, only 15 percent state that healthcare providers, with a majority of consumers indicating they their healthcare provider is their initial resource have visited the same healthcare provider for a significant period of to solicit help (see Figure 18). Figure 17 reveals time (see Figure 17). That said, 70 percent of consumers at least that contact capability is also a potential hurdle, somewhat agree they would find a new healthcare provider in the with 40 percent at least somewhat agreeing that event of a bad experience. they have difficulty getting in touch with their healthcare provider. 26 27

      Talk to family and/or friends PATIENT PAIN The benefits digital channels can offer patients are undeniable— access, the convenience of virtual engagement, speed of service, POINTS and so on. But to not acknowledge digital’s potential pitfalls Research the issue online via medical would be naive. Universally, 43 percent of patients say they are websites (i.e., WebMD.com, NHS.uk, at least somewhat concerned about the security of personal ec.europa.eu, and so on) health information. The strain on healthcare systems across the globe has not been caused exclusively by the pandemic; it is Call/visit their healthcare provider also due to the increased threat from cyberattacks that have been attempted during this time. According to the CyberPeace Institute, ransomware attacks in particular have occurred at a Research the issue online via Google rate of 3.5 per week between June 2020 and December 2021 7 in 35 countries . Research the issue online via non- medical websites, such as blogs or Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree social media platforms Visit a pharmacy/clinic to speak to someone Can easily access their medical records whenever needed Other Figure 18. Patients’ Primary Resource for Health-Related Concerns. Of the stated resources, patients choose their initial preference for getting advice on their personal health questions. Are concerned about their medical information being hacked or shared without their knowledge Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree Figure 20. Patient Sentiments Regarding Their Health Information. Patients rate their level of agreement on statements regarding their personal health information. Often read medical information and health tips sent by their HCP Sophisticated, opportunistic cybercriminals look to take increasing digital integration, and relentless opportunists advantage of healthcare organizations at their most imply that these types of threats will not cease any vulnerable moment—during an international health crisis, time soon. with many employees working from home on less secure Furthermore, modifications to the Health Insurance networks. Several significant attacks occurred in 2021— Portability and Accountability Act are expected to go into in July, UC San Diego Health saw its employee email effect in 2022. As consolidation within the healthcare Feel knowledgeable when making account hacked, resulting in the exposure of patients’ industry continues and patient data is simultaneously decisions about their health personal data. Ireland’s Health Service Executive, which amassed, compliance is critical. IBM Security estimates operates healthcare delivery across the country, fell victim the total cost of data breaches in the healthcare and to a major cyberattack on May 21, 2021, consequentially pharmaceuticals industries at more than US$9.2 million delaying or cancelling important services. Experts warn and US$5 million, respectively—but the cost to patient Figure 19. Patient Sentiments Regarding Their Health Knowledge. that medical device security will likely be a target for 8 Patients rate their agreement on statements involving healthcare cybercriminals in the near future. An enduring pandemic, privacy and delivery of care is immeasurable . knowledge and information. 28 29

      Scheduling difficulties, long wait times, and cost Communication via phone is the top favored engagement transparency—where in the US the No Surprise Act, mode for global patients for the second year of our which went into effect January 2022, bans patients survey, ahead of face-to-face and email; thus, it is not from receiving surprise medical bills when they seek likely to fade anytime soon. However, healthcare providers unplanned care out of their network—are typical must address all systematic touchpoints, as consumer frustrations patients experience that must be addressed. experience frustrations can inhibit the execution of even However, the major pain point of in-person appointments simple tasks, as well as overall patient satisfaction— centers on scheduling, with three out of five patients not to mention the time spent from an administrative stating that speaking with an administrator to schedule perspective. Consumer preference for online patient an appointment is somewhat time-consuming portals when making appointments represent a good (see Figure 21). opportunity to alleviate this particular pain point. Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree Patient lives far away from office/patient has difficulty getting to the appointment Patient is typically unsure of out-of-pocket costs of healthcare appointments Limited time to discuss patient’s needs during the appointment/patient feels rushed CONCLUSION The pursuit of sustained, positive health outcomes for all patients remains the key goal of the healthcare industry, but each individual’s journey toward that outcome has fundamentally changed. Patients have adopted digital into their healthcare Usually a long wait time before the physician sees them for the scheduled appointment journey, search engines display thousands of outputs from health-related search queries, and digital devices and mobile apps relay biometric data in real time. Consumer expectations have been shaped by sophisticated algorithms that only reveal Difficulty in scheduling appointments around patient’s own schedule localized, contextual information in response to searches, and retailers promise to deliver products in two days or less. The healthcare industry must acknowledge that a patient Patient’s healthcare provider seems to have very limited appointment availability is a consumer. Antiquated delivery models and generic communication methods are no longer viable for patients in an ever-changing, digital-first world. Patients demand valuable healthcare experiences, because their health depends on it. Typically uses the online patient portal to make healthcare provider appointments The healthcare industry, historically resistant to change, is in the midst of a once-in-a-generation transformation. Industry disruption—from mergers and acquisitions, data sharing and privacy regulations, healthcare workers exiting the industry, Speaking with an administrator to schedule the appointment is time-consuming increased competition from retailers, and patient demands, to name a few—is reaching critical mass. Digitally compliant solutions, which will enable more accessible, cost-effective, Figure 21. Patient Sentiment Involving In-Person Appointments. efficient strategies to serve all patients at each touchpoint in their Patients state their level of agreement with the proposed sentiments healthcare journey, are needed now more than ever. as it relates to in-person appointments. 30 31

      EUROPE Healthcare Sentiment Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree Believe the healthcare system where they live could be improved Have access to adequate healthcare Patient Experience in the Past 12 Months 21% 19% 9% 11% Were unable OR had Were unable to schedule Did not receive Were unable to reach a delay in scheduling a timely in-person visit a call-back from their HCP for health- a medical procedure with their HCP their HCP related concerns The Patient-Provider Relationship Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree Are concerned about their medical information being hacked or shared without their knowledge Would find a new healthcare provider if they had a bad experience Trust the HCPs in their network make the best decisions regarding their health Are satisfied with the level of service and attention they receive from their HCP 32 33

      MIDDLE EAST/NORTH AFRICA NORTH AMERICA Healthcare Sentiment Healthcare Sentiment Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree Believe the healthcare Believe the healthcare system where they live system where they live could be improved could be improved Have access to Have access to adequate healthcare adequate healthcare Patient Experience in the Past 12 Months Patient Experience in the Past 12 Months 13% 26% 12% 17% 19% 26% 14% 14% Were unable OR had Were unable to schedule Did not receive Were unable to reach Were unable OR had Were unable to schedule Did not receive Were unable to reach a delay in scheduling a timely in-person visit a call-back from their HCP for health- a delay in scheduling a timely in-person visit a call-back from their HCP for health- a medical procedure with their HCP their HCP related concerns a medical procedure with their HCP their HCP related concerns The Patient-Provider Relationship The Patient-Provider Relationship Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree Are concerned about their medical information being hacked or shared without their knowledge Are concerned about their medical information being hacked or shared without their knowledge Would find a new healthcare provider if they had a bad experience Would find a new healthcare provider if they had a bad experience Trust the HCPs in their network make the best decisions regarding their health Trust the HCPs in their network make the best decisions regarding their health Are satisfied with the level of service and attention they receive from their HCP Are satisfied with the level of service and attention they receive from their HCP 34 35

      SOUTH AMERICA UNITED KINGDOM Healthcare Sentiment Healthcare Sentiment Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree Believe the healthcare Believe the healthcare system where they live system where they live could be improved could be improved Have access to Have access to adequate healthcare adequate healthcare Patient Experience in the Past 12 Months Patient Experience in the Past 12 Months 30% 33% 16% 22% 26% 29% 13% 18% Were unable OR had Were unable to schedule Did not receive Were unable to reach Were unable OR had Were unable to schedule Did not receive Were unable to reach a delay in scheduling a timely in-person visit a call-back from their HCP for health- a delay in scheduling a timely in-person visit a call-back from their HCP for health- a medical procedure with their HCP their HCP related concerns a medical procedure with their HCP their HCP related concerns The Patient-Provider Relationship The Patient-Provider Relationship Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree Are concerned about their medical information being hacked or shared without their knowledge Are concerned about their medical information being hacked or shared without their knowledge Would find a new healthcare provider if they had a bad experience Would find a new healthcare provider if they had a bad experience Trust the HCPs in their network make the best decisions regarding their health Trust the HCPs in their network make the best decisions regarding their health Are satisfied with the level of service and attention they receive from their HCP Are satisfied with the level of service and attention they receive from their HCP 36 37

      REFERENCES 1. Callaghan, Shaun, Martin Lösch, Anna Pione, and Warren Teichner, “Feeling good: The Future of the $1.5 Trillion Wellness Market,” Mckinsey & Company, April 8, 2021, https://www.mckinsey.com/ industries/consumer-packaged-goods/our-insights/feeling-good-the- future-of-the-1-5-trillion-wellness-market. 2. McKinsey & Company, “The Future of Wellness: Connected and Customized,” The Next Normal, July 21, 2021, https://www. mckinsey.com/~/media/McKinsey/Featured%20Insights/The%20 Next%20Normal/The-Next-Normal-The-future-of-wellness. 3. World Health Organization, The Impact of COVID-19 on Mental, Neurological, and Substance Use Services: Results of a Rapid Assessment, Geneva: World Health Organization, 2020, https://www. who.int/publications/i/item/978924012455. 4. Astound Commerce, 2021 Health and Life Sciences Consumer Research Study, unpublished study. 5. CB Insights, The State of Telehealth Q2’21 Report: Investment & Sector Trends to Watch, July 29, 2021, https://www.cbinsights.com/ research/report/telehealth-trends-q2-2021/. 6. The United States Government, “Fact Sheet: President Biden Announces New Actions to Protect Americans and Help Communities and Hospitals Battle Omicron,” The White House, December 21, 2021, https://www.whitehouse.gov/briefing-room/statements- releases/2021/12/21/fact-sheet-president-. 7. The CyberPeace Institute, Addendum to the Strategic Analysis Report “Playing with Lives: Cyberattacks on Healthcare are Attacks on People,” November 12, 2021, https://cyberpeaceinstitute.org/ publications/sar001-healthcare-addendum/. 8. IBM Corporation, Cost of a Data Breach Report 2021, July 2021, https://www.ibm.com/security/data-breach. 38 39

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