1. research for your brand’s health Another Kitchen Sink Survey: What consumers think about a plethora of healthcare topics… Presented by: Rob Klein, President Klein & Partners, Inc. 4th Quarter, 2012 Disclaimer: Please feel free to use these charts in any of your presentations; just cite Klein & Partners as the source of the information.

2. research for your brand’s health INTRODUCTION Page 1

3. research for your brand’s health Introduction Page 2 Background  The purpose of this nationwide quantitative survey was to understand consumers’ current thinking on a wide range of healthcare-related topics, including: Methodology  A national online survey was conducted among 404 heads of household, 21 or older who are most responsible for healthcare decisions for the household. The interviewing was conducted from September 25-October 5, 2012. The sample frame used was Research Now’s online consumer panel. The final data set was weighted by age, education, income, and ethnicity.  The total sample size of 404 yields a sample error of +/-4% at the 90% Confidence Level (CL). For example, if this study were repeated 100 times, in 90 times out of that 100 (i.e., 90% confidence level) we would find a total sample statistic of 50% to fall within 46% and 54%.  In the charts, letters (e.g., A, B, C ) and arrows indicate a statistically significant difference at the 90% Confidence Level. Colors and bolding are used to highlight interesting patterns and/or findings. Top concerns Reactions to health reform Hospital safety Primary care physician Medical Home Mobile messaging Smart phone Electronic medical record Communications preferences Websites visited Interest in new information sources Factors influencing hospital choice Transparency/Price shopping Quality perceptions Advertising Getting care in these economic times

4. research for your brand’s health...AND NOW THE REST OF THE STORY Page 3

5. research for your brand’s health TOP CONCERNS Page 4

6. research for your brand’s health Page 5 Q1: Which of the following issues is MOST important to you? Significantly higher among African Americans and non-seniors Significantly higher among women, seniors, and <college degree

7. research for your brand’s health REACTIONS TO HEALTH REFORM Page 6

8. research for your brand’s health Page 7 Q2: If you currently have health insurance, do you think there will or will not be a specific benefit to you with this new healthcare reform?

9. research for your brand’s health Page 8 Q3: Do you expect to see lower healthcare costs for you if health reform passes in Washington?/… now that health reform has passed?

10. research for your brand’s health Page 9 Q4: If you had a choice to buy health insurance through you employer, individually, or through an exchange, which do you think you would prefer?

11. research for your brand’s health Page 10 Q5: What do you think will get better or worse for you personally under healthcare reform? (18% in 2010) (17% in 2010) (14% in 2010) (11% in 2010)

12. research for your brand’s health Page 11 Q6: Who do you really trust to help you figure out and navigate the new healthcare system that will emerge through healthcare reform in the coming years? 2010 41% 24% 18% 21% 15% 13% 10% 11% 6% 9% 4% 19% 8% 2010 41% 24% 18% 21% 15% 13% 10% 11% 6% 9% 4% 19% 8% ACOs???

13. research for your brand’s health Page 12 Q7: If you were offered a financial incentive to change a certain aspect of your lifestyle (e.g., stop smoking, lose weight, exercise, etc.), how likely would you be to change that behavior or lifestyle? Sometimes we just need the right carrot! Especially African Americans and Hispanics.

14. research for your brand’s health Page 13 Q8: Based on this basic description of health care under reform, how comfortable are you in having this ACO manage all aspects of your health and wellness? Significantly higher among African Americans, seniors, and men

15. research for your brand’s health HOSPITAL SAFETY Page 14

16. research for your brand’s health Page 15 Q9: Do you perceive there to be a problem at hospitals today regarding patient safety in terms of preventable medical errors? Q10: In the past 3 years, have you personally or someone in your immediate household experienced any serious quality issues or medical errors while being treated at a hospital? Q11: If you were going to be hospitalized for care, how important to you would it be to receive a copy of the hospital’s patient safety practice guidelines before you go to the hospital? In late 2009, 16% of people said they had experienced a serious quality issue or medical error at a hospital in the past 3 years. In 2011, that number was 12%. Now, in 2012, the number is 18% (mostly non-seniors). Seven in ten (71% vs. 75% in 2011) folks across the country say it would be important to them to receive a copy of the hospital’s patient safety guidelines before going to the hospital (38% very important + 34% somewhat important).

17. research for your brand’s health PRIMARY CARE PHYSICIAN Page 16

18. research for your brand’s health Page 17 Q12: Do you have a primary care or personal physician? Q17: Have you ever gone online to a social networking site and shared your experiences about a doctor or a hospital you recently visited? Nearly unchanged from past waves, more than eight in ten folks have a primary care physician (83%). But only 68% among those under 45. Going online to rate a doctor or hospital has more than doubled in the past few years: 6% in 2009 9% in 2011 14% in 2012 Going online to rate a doctor or hospital has more than doubled in the past few years: 6% in 2009 9% in 2011 14% in 2012 Primary Care Doctor ZAGAT (especially women, younger, <$45k income)

19. research for your brand’s health Page 18 Q13: In the past 12 months or so if you have needed to see your primary care physician, was there ever a time when you had problems access your physician? If so, what was the issue that made it difficult to access or kept you from accessing your physician? Q14: Think back to times when you were sick and your doctor’s office either was closed or you called during office hours and couldn’t get a timely appointment. What did you do for medical care? Especially those 21-44 (45%) Plan B

20. research for your brand’s health Page 19 Q15: When you were first looking for a new primary care physician, where did you look or who did you talk to about finding a new doctor? Word-of-mouth! Significantly higher among African Americans and Hispanics (23% vs. 3% Caucasians)

21. research for your brand’s health Page 20 Q16: Now, when you chose your current primary care doctor which of the following factors had the biggest influence on which doctor you chose? These are game changers! Increases with age More imp to women

22. research for your brand’s health MEDICAL HOME AWARENESS AND PERCEPTIONS Page 21

23. research for your brand’s health Page 22 Q18: Prior to this survey, were you familiar with the term ‘Medical Home’ or what also is called a ‘patient-centered medical home’ which is a team- based healthcare delivery model led by the physician? Q19: Are you part of a Medical Home through your primary care doctor? Q20: Did you choose your doctor because he/she was part of a Medical Home or did you learn about that after you choose your doctor? 3% believe they are part of a Medical Home with their physician which equals 1% of the adult population. And consistent with other Klein & Partners research, half (53%) learned about a ‘Medical Home’ after they chose that physician.

24. research for your brand’s health Page 23 Q22: How comfortable are you or would you be in being seen by one of the mid-level care givers instead of your primary care physician? Q23: Given this explanation of a Medical Home, would you switch primary care physicians to receive care like this? Would you…? Other Klein & Partners research indicates a growing comfort with mid-levels as long as the physician has introduced the mid-level as a key care team member and defined their role properly for the patient.

25. research for your brand’s health MOBILE MESSAGING Page 24

26. research for your brand’s health Page 25 Q24: How interested would you be in receiving MOBILE MESSAGING from these caregivers about your own health? Interest is significantly higher among women and those 21-44. Source: Fast Company March 2012.

27. research for your brand’s health Page 26 Q25: What type of health-related information would you most like to receive via mobile messaging from a caregiver? Klein & Partners hears this a lot in focus groups also.

28. research for your brand’s health SMART PHONES ‘Can you hear me now?’ Page 27

29. research for your brand’s health Page 28 Q26: Have you used a smart phone or any phone that can access the internet to go online and do any of the following…? Not too surprisingly, use of a smart phone declines significantly with age across all of these health- related uses.  Significantly higher among women

30. research for your brand’s health Page 29 Q27: If a hospital you used offered a mobile application for your smart phone, which of the following features would you MOST LIKELY USE? From a market segmentation standpoint, potential use for most of these Apps is higher among women, those 21-44, and those with lower incomes.

31. research for your brand’s health ELECTRONIC MEDICAL RECORDS Page 30

32. research for your brand’s health Page 31 Q28: How interested would you be in having online access to your own personal health record called an Electronic Medical Record to track your own health through a secure website that only you and your doctor and hospital can access? Q29: Which of the following features, if any, would you definitely be very interested in accessing through your electronic medical record? Q30: If your current primary care physician could not provide you with access to your Electronic Medical Records how likely would you be to switch to a new primary care doctor that could provide you access to your Electronic Medical Records? Especially 21-44 Women and 45-64 Increases with age Women Seniors South and West, 21-44, <$45k

33. research for your brand’s health COMMUNICATON METHODS Page 32

34. research for your brand’s health Page 33 Q31a: Which of the following communication methods have you used to communicate with your primary care physician? Look at what is popping up this year! Other Klein & Partners brand research is indicating that EMR is a key component of being a successful ‘system’ in the future… patients really get the value-add it provides in their care: 1) better access to their health and caregivers; and 2) better coordinated care for them across caregivers and care settings.

35. research for your brand’s health Page 34 Q31b: Which of the following communication methods have you used to communicate with your hospital?

36. research for your brand’s health Page 35 Q31c: Which of the following communication methods have you used to communicate with your health insurance company?

37. research for your brand’s health WEBSITES VISITED Page 36

38. research for your brand’s health Page 37 Q32/33: Have you been to a hospital/health plan website in the past year? Q32a/33a: What got you to go to that hospital’s/health plan’s website? 201020112012 Hospital website33%27%37% Health plan website54% 53% Women and younger visit hospital websites while non gender differences for health plan websites just age (45-64 higher) and income (>$45k higher).

39. research for your brand’s health INTEREST IN NEW INFORMATION SOURCES Page 38

40. research for your brand’s health Page 39 Q34: Besides your physician, which of the following have you sought health-related information from in the past year? Green = old school Blue = new school 2011 58% 48% 31% 23% 19% 14% 11% 8% 7% 6% 5% 3% 2% 3% 1% 2011 58% 48% 31% 23% 19% 14% 11% 8% 7% 6% 5% 3% 2% 3% 1%

41. research for your brand’s health Page 40 Q35: Which of the following information, if any, have you sought on the Internet? Increases with age Increases with income Seniors

42. research for your brand’s health Page 41 Q36: Next, which of the following online health-related activities have you participated in over the past few years? 45-64, college, higher income Men, Seniors Higher income

43. research for your brand’s health Page 42 Q37: If you could receive a general health and wellness newsletter from your hospital, health plan, or employer in any of the following formats, which one format would be your most preferred way to receive this newsletter? Q38: Now, if you had a specific medical condition that you were being treated for and could receive patient education (i.e., information related to your diagnosis, treatment, or procedure) from your hospital, health plan, or employer in any of the following formats, which one format would be your most preferred way to receive this newsletter? Down with age Up with age

44. research for your brand’s health Page 43 Q39: Which of the following healthcare topics have you recently read something about?

45. research for your brand’s health PRICE SHOPPING Transparency Page 44 Interest in price shopping?

46. research for your brand’s health Price check in aisle five! Page 45 Q42: Within the past year, did you or did a member of your immediate household contact any healthcare organization, hospitals, or physician offices to ask about the price for a specific visit, test, treatment, or surgery? IF YES… Q43: How did you check on pricing? Q44: What type of health service did you ask about pricing for? Q45: Did you end up choosing the least expensive provider? 4 th Qtr 2008 4 th Qtr 2009 4 th Qtr 2010 4 th Qtr 2011 4 th Qtr 2012 Households that have contacted a healthcare organization to ask the price for a specific visit, test, treatment, or surgery 33%32% 22%28% Chose the least expensive provider for one of these healthcare cases 36%41%31% 33% % of the total patient market  12%13%10%7%9% 2010 & 2011 Called = 71% 2010 & 2011 Called = 71% West

47. research for your brand’s health QUALITY PERCEPTIONS Page 46

48. research for your brand’s health Page 47 Q46: As you think of hospital quality and how you define it, which of the following would you include in your definition of hospital quality? While any and all of these things could be important, which ones truly define quality to you? MRSA is the poster child for poor quality in hospitals. Patient in a recent focus group: ‘MRSA is an infection the hospital gives you.’ Cleanliness is no longer a given. MRSA is the poster child for poor quality in hospitals. Patient in a recent focus group: ‘MRSA is an infection the hospital gives you.’ Cleanliness is no longer a given. 2011 31% 29% 28% 24% 23% 22% 19% 15% 14% 13% 12% 11% 10% 9% 8% 6% 5% 4% 3% 2% 1% Quality has as much to do with the ‘experience’ as it does clinical quality and safety. Red= Patient safety Purple=Quality (clinical) Green=The experience

49. research for your brand’s health Page 48 Q47: If you wanted to learn more about a hospital’s quality, which one of the following methods would you most prefer to receive quality information from? Yet few find these sources credible and even fewer have ever used them to choose a hospital.

50. research for your brand’s health CHOOSING A HOSPITAL Page 49

51. research for your brand’s health Average credibility = 14% Information source credibility – for choosing a hospital Page 50 Q40: Next, if you had to be hospitalized and you wanted to gather information about which hospital you should choose, which of the following sources of information are most credible to you (whether you have used them or not) and which ones have you actually used? Average used = 6% What will happen if employers stop offering benefits?

52. research for your brand’s health Information source credibility – for choosing a hospital Page 51 Q40: Next, if you had to be hospitalized and you wanted to gather information about which hospital you should choose, which of the following sources of information are most credible to you (whether you have used them or not) and which ones have you actually used? Credibility, especially for online independent sources, is not growing… (but right now it is more of a lack of familiarity challenge not a lack of credibility challenge)

53. research for your brand’s health Information source actually used – for choosing a hospital Page 52 Q40: Next, if you had to be hospitalized and you wanted to gather information about which hospital you should choose, which of the following sources of information are most credible to you (whether you have used them or not) and which ones have you actually used? …and neither is use

54. research for your brand’s health Average credibility = 16% Information source credibility – for choosing a health plan Page 53 Q41: And, if you were choosing a new health plan and you wanted to gather information about which health plan you should choose, which of the following sources of information are most credible to you (whether you have used one or not) and which ones have you actually used? Average used = 9% Even with all the new sources of information out there most folks still rely on traditional W-O-M.

55. research for your brand’s health ADVERTISING Page 54

56. research for your brand’s health Page 55 Q48: How much do you trust advertising from the following organizations? [Top-2 box score  completely+mostly trust advertising from that source] Trust tends to be higher among those without a college education.

57. research for your brand’s health Page 56 Q49: When you think of area hospital advertising that you may have seen or read over the past year, how useful to you are the following forms of hospital advertising in terms of you learning what a hospital has to offer? And which, if any, do you prefer most? Very useful: 2011 30% 23% NA 19% 13% 9% 8% 5% Very useful: 2011 30% 23% NA 19% 13% 9% 8% 5% Women are significantly more likely to find all of these advertising mediums very useful than are men.

58. research for your brand’s health HEALTH INSURANCE Page 57

59. research for your brand’s health Page 58 Q50: What type of health insurance, if any, do you have?

60. research for your brand’s health Page 59 Q51: Have you experienced a significant financial hardship in the past year due to medical bills? More likely: lower income, younger, and in Midwest and South regions

61. research for your brand’s health Page 60 Q52: In the past year have you had to delay or avoid seeking any healthcare services because you couldn’t afford the cost due to a change in your employment and/or health benefits? Q53: What healthcare services have you delayed? Nearly a third (30%) of Americans have delayed or avoided care due to inability to pay. (2011: 26%) Nearly a third (30%) of Americans have delayed or avoided care due to inability to pay. (2011: 26%) * * Significantly more likely: women, lower income, younger, and in Midwest and South regions

62. research for your brand’s health APPENDIX Page 61

63. research for your brand’s health Demographic profile Female79% Ethnicity Caucasian African American Hispanic Asian 60% 10 13 7 Age 21-34 35-54 55+ Median age 26% 39% 35% 50 Median household income$53,300 Education Level Up to high school Some college College grad (undergrad) Graduate degree 14% 57 17 12 Page 62

64. research for your brand’s health Additional information If you would like additional information regarding this study, please contact: Rob Klein President Klein & Partners, Inc. 14613 Morningside Rd. Orland Park, IL 60462 [630] 455-1773 rob@kleinandpartners.com Page 63