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Research Report, White Paper

A Provider Like Me: Research on Preferences, Care Selection, and Bias in Healthcare

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Introduction

In this paper, we explore data from recent consumer research to understand how people’s personal experiences and backgrounds shape their interactions with healthcare. We see that people are more likely to choose providers with whom they share traits, and that certain historically underrepresented communities both experience more and are more concerned about discrimination in healthcare. We contend that robust provider profiles on health plan websites are an important tool to help people make confident care choices and build trust between patients and providers. Healthcare is personal and everyone deserves to have a provider they trust.

Our health is one of the most personal aspects of our lives, but when it comes to the experience of actually getting healthcare, everyone wants the same thing: quality care from a provider they trust. But trust in the healthcare system isn’t widespread in this country- and especially not among historically underrepresented* groups of people. And that’s not surprising, as too often, the conditions in which people are born, grow, live, and work have a significant impact on their experience, healthcare options, and overall well-being.

The pandemic has shone a spotlight on disparities due to the disproportionate impact of COVID-19 on historically underrepresented communities- and it has fueled something of a reckoning in the healthcare industry. Amid large- scale, ongoing protests for racial justice, healthcare organizations large and small redoubled their efforts to address systematic inequalities in health outcomes.

At Kyruus Health, we want to be part of the solution. We want to help health plans understand the diverse needs, experiences, and points of view that members bring when they are searching for care. We want to offer ways for plans to ensure that they are providing information and resources that can help all people find providers that best meet their needs. To that end, we conducted research on preferences, care selection, and bias in healthcare. While selecting a provider is a personal and nuanced decision for all people, we wanted to look specifically at how race, ethnicity, gender, and sexual orientation impact people’s choices and preferences around providers as well as their experience with the healthcare system. The research looks at the breadth of factors people use to decide on a new healthcare provider with a lens toward helping the healthcare system improve access for all.

The study reveals some interesting data. We saw that people want to understand more detailed information about their providers, and are looking to health plan websites to find this information. We learned that people tend to gravitate toward providers whom they share traits with, and that more robust provider profiles in health plan provider directories can help facilitate those connections. A trusted provider relationship is a big step toward building trust and bridging gaps in healthcare- and improving health outcomes. By understanding -and acting on- the findings in this report, we can take the first steps toward improving not only the health and healthcare experience of underserved communities but also that of the population as a whole.

At the end of the day, despite differing experiences with healthcare, having the details needed to make an informed care choice is something that everyone wants- and health plans play a pivotal role in enabling it. Our society is certainly better when everyone gets good healthcare, feels comfortable seeking it, and faces no conscious or unconscious bias in the process. We want healthier communities and a healthcare system that works for everyone.

We see that people are more likely to choose providers with whom they share traits, and that certain historically underrepresented communities experience more discrimination in healthcare.

*This paper uses the term “historically underrepresented” to define groups of people most vulnerable to bias in healthcare: people of color, women, and those who identify as LGBTQ. We acknowledge this is not a perfect term and does not capture the complex experience of any one group.

About the research

We partnered with Ribnik Research to survey 1,000 people to generate insights we hope will help create a fairer, more equitable healthcare experience for all.

We partnered with Ribnik Research to survey 1,000 people1 to generate insights we hope will help create a fairer, more equitable healthcare experience for all.

What We Learned

People select healthcare providers with whom they share traits.

People are more likely to choose a healthcare provider of the same gender, age, and ethnicity. People who gravitate toward providers with similarities likely do so because they believe they will experience less discrimination, will be given better care, and can trust the provider more.

People select healthcare providers with whom they share traits.

For each of these ethnic groups, the percentage of people who had a doctor of their own ethnicity was significantly higher than the percentage who had a doctor of another particular ethnic group. Given the higher percentage of physicians who identify as white/Caucasian (56%, compared to 17.1% who identify as Asian, 5.8% as Hispanic, and 5% as Black or African American), these numbers reflect an overwhelming preference of people to select a doctor of the same ethnicity.

Experiences of bias and discrimination in healthcare go beyond direct discrimination.

Imagine being hesitant to visit a provider you were referred to because you fear they will treat you differently based simply on who you are. Our research found that this concern is impacting a large portion of individuals.

People report being very or extremely concerned about discrimination based on:

People report being very or extremely concerned about discrimination based on:

People of some groups are significantly more likely to have experienced discrimination in healthcare:

People of some groups are significantly more likely to have experienced discrimination in healthcare:

Fifteen percent of respondents say they have encountered discrimination while looking for or receiving healthcare.

Of the 15% of respondents who have experienced discrimination in healthcare, they feel the discrimination was due to:What do people do when faced with discrimination

When people feel discriminated against, trust plummets.

This matters because studies have shown that a higher degree of patient trust in a physician leads to higher adherence and better outcomes, including improved health- related quality of life and shared decision-making. A patient who feels their provider represents them is more empowered to ask questions and be assertive—and more likely to follow the provider’s advice down the road.

Understanding bias

Bias isn’t always conscious. Unconscious or implicit bias can have a detrimental effect as well—research has shown that implicit bias can lead to differential treatment of patients by race, gender, weight, age, language, income, and insurance status. Medical literature demonstrates that racial and ethnic minorities and women receive less accurate diagnoses, fewer treatment options, and less pain management, resulting in worse clinical outcomes. Strategies to address the impact of bias on clinical care decisions include establishing monitoring systems that compare processes or outcomes by race, educating healthcare professionals about implicit bias, and practicing evidence-based medicine.

Health plan websites are important tools to help people find the providers they want.

Health plans have a key role to play in facilitating trusting relationships between patients and providers that improve the system for everyone and increase access to care. Helping people find a provider who matches their criteria is an important way to do this. Half of our respondents looked for a new provider in the last year, and more than half (54%) said they use health plan websites to find new providers (more than any other source). Nearly two-thirds (63%) have used their health plan’s website to research a provider.

Most frequently searched provider details via health plan websites:

Members are also looking to other people for advice:

Members are also looking to other people for advice:

Members want more robust information from provider directories.

Beyond the big factors highlighted in this report (ethnicity, gender, and languages spoken), people say they would find several non-traditional pieces of information helpful in a provider directory, including:

Members want more robust information from provider directories.

Why are shared traits so important?

While a variety of factors go into selecting a healthcare provider, it’s clear that some members want to be able to find a provider who has traits in common with them. One powerful reason why shared traits matter: About half of consumers feel that having shared traits with their healthcare providers assures better care and more open discussion, mostly due to the provider being more understanding (37%) and more relatable (26%). Better care and more open discussion equals happier members.

Provider quality and experience are important.

When it comes to finding a new healthcare provider, whether it be via a health plan website or the internet (the two most common ways people search for provider information), people consider the following characteristics to be most important:

Provider quality and experience are important.

Regardless of gender, ethnic background, or sexual orientation, we all want the same thing- access to quality care for ourselves and our loved ones.

Our survey found that education/training, ratings, and treatment philosophy are much more important to people who identify as Hispanic. People who identify as African American are more likely than those of other ethnicities to consider ethnicity/race a helpful characteristic for a provider directory; given the history of discrimination in the U.S., this could be because they believe that an African American doctor is more likely to give them the quality care they’re searching for.

Again, trust is a critically important underpinning of the patient-provider relationship. Helping people from all communities feel confident in the care they receive -and the provider who administers it- goes a long way toward improving access, decision-making, and outcomes.

 

Preferences vary between specialists and primary care providers.

While several factors play an important role in finding a new provider, looking specifically at what is important when it comes to a relationship with a primary care provider (PCP) versus a specialist offers interesting insights. PCPs are the most frequently visited healthcare providers (78% of respondents visited a PCP in the last year), and people consider different factors when selecting a PCP than when choosing a specialist.

Location and gender are more important when it comes to choosing a primary care physician (PCP), while specialization, experience, affiliation, and education/ training are more important when choosing a specialist.

Preferences vary between specialists and primary care providers.

Especially interesting is the fact that people are likely selecting PCPs that are more like them (based on the traits that are more important). Specialists, on the other hand, are typically chosen for a specific task or procedure rather than for an ongoing relationship, so looking for someone with similar traits may be less important.

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