Reputation Matters: Google Reviews Driving More Healthcare Decisions, Especially for Millennials

A new study finds that online reviews are increasingly important in healthcare decision-making, but 50% of health systems lacked online reviews in 2020.

Consumers are increasingly using reviews found with Google search to make healthcare decisions, making patient sentiments and a health system’s overall reputation more important than ever, according to an analysis of 348,000 customer reviews released today.

The 2021 Healthcare Reputation Report, released by the reputation management company Reputation, found that millennials are much more likely than older generations to use online reviews to select a healthcare provider. The top factor that drives healthcare decisions is whether a health system or doctor accepts the person’s insurance, followed by location, but online reputation and patient reviews are rising as important factors.

Millennials are the generation most likely to use online reviews in making a healthcare decision, the report found. Yet 50% of health systems and 65% of physicians had no online reviews, the report found.

The 2021 report ranked the top 25 systems by Reputation Score and found a strong relationship between a high score and having more online reviews. Health systems at the top have an average of 232% more online, third-party reviews than those at the bottom, showing the importance of gaining patient engagement.

On a scale of 0 to 1,000 the top-rated health system, Universal Health Services rated 729, followed by HCA at 714 and Community Health Systems at 663. The highly regarded health system Cleveland Clinic was further down the list at 15th, with a 3% patient engagement rate.

According to a statement from Reputation, the score measures nine elements that range from how many “stars” patients award a health system to how many reviews it receives. Using artificial intelligence, the score incorporates both solicited an unsolicited feedback, from patient ratings to Facebook posts.

Chief Healthcare Executive™ spoke with Reputation’s Annie Haarmann, head of strategy and consulting, Healthcare and Life Sciences, about the survey findings and the shift in how consumers make healthcare decisions. (Edited slightly for clarity).

CHE: Can you tell us what the report found and why the chief executive of a health system would be interested in these results?

Haarmann: One thing we do on a regular basis is check is with consumers, to see what they are looking for in making a decision about a healthcare provider. This is important as we shift to a more consumer focused model in health care. Paired with that, we also do an analysis of the visibility of healthcare systems and their reputation online.

Based on our surveys of over 1,000 healthcare consumers, as well as looking at more than 300,000 online comments, ratings, and reviews from over 100,000 health care facilities, we had a very strong and robust, reliable data set, and it gave us some really interesting information.

For example, the third most important factor for patients when making a decision about a physician is ratings and reviews, which was higher than what we were expecting. The comes right after insurance being accepted and location. So, reviews are really important to consumers, [but] unfortunately, more than half of physicians do not have any ratings and reviews for 2020.

CHE: Ever since the coining of the term, the Triple Aim, we've heard more about the importance of the patient's experience in healthcare. What’s the relationship between the term patient experience and the reputation management that you examine in your survey?

Haarmann: We look not just at the reputation and not just the consumer experience, but the complete journey, reputation, and experience management. For us, it’s important to understand that your online presence is very important to consumers, as much as anything else that [health systems] are measured on in terms of quality measurements.

A millennial is twice as likely to search online for a health care provider than a baby boomer. What this tells us is with the Triple Aim, the consumer experience piece is driven more by the information that is available online. Consumers are armed with more data than they've ever had before. And that allows them to make more educated decisions. They’re not really relying just on word of mouth or who their insurance provider tells them to go to. Even in the case of referrals, if they're referred to another physician, they are Googling that physician to see what else is out there about them before they set that appointment. It’s really important for healthcare executives to realize that, that that piece of the Triple Aim, that consumer experience piece is really in the hands of the consumer.

CHE: Every patient who touches the health system has some type of experience, but not all groups give feedback in the same way. What's the difference between the way millennials give feedback and the way baby boomers give feedback?

Haarmann: We’ve seen that for millennials, it's very important to be able to look at prices and pricing information available online. They also have told us that, that online scheduling is really important to them. They’re providing feedback around the experience itself—the interaction outside of the clinical experience. Whereas [with] baby boomers the feedback they’re providing is more focused on the physician. They’re looking at, ‘What are the factors that make that physician the right person for me—whether it’s the educational background, or the connection to a specific brand.

It’s very interesting to see the differences in the two generations. But one thing that was interesting to us is the consistency across the two generations, that no matter how old you are, the three most important things were: Number one, Is my insurance accepted? Number two, location, they want it to be convenient, and, three, ratings and reviews.

CHE: How has COVID changed the importance of paying attention to the reputation of the health system or the individual healthcare facility?

Haarmann: There were a couple of things in our survey that were no surprise to us whatsoever. We wanted to understand, how were consumers making decisions differently after COVID than they were before COVID? The one thing that was no surprise, and I'm sure it's no surprise to you, or any of your readers is that nearly a third of respondents across all ages said that they now factor in the availability of virtual care options as a decision making factor in their in their selection. If you were to think about two years ago, consumers didn't know much about hospital acquired infections, or these things that had to do with safety.

With COVID and the attention given to PPE and the risk factors for airborne diseases, consumers now are looking for this information as they're making a decision. One of the highest rated areas that they said that they look for is, ‘What are the safety protocols related to COVID?’ They want to see what is the what is the expectation of me as a patient when I come into your building? And also, what are you doing to protect your staff, and to protect them from giving it to me? There's a lot more understanding around things like the waiting room, disinfection, and, you know, wearing protective equipment. And I think that will continue in the future, now that people understand that they can get these viruses anywhere.

CHE: That’s perfect transition to my next question—one of the first big rating things we heard about for many years is the Leapfrog Score, which grew out of the shocking findings of the Institute of Medicine report, which now more than 20 years old (To Err Is Human), which found how unsafe many healthcare facilities were. Safety became a big concern after that. What’s the difference between, say, the safety score—the letter grades that we became familiar with and the reputation score? What's the relationship between the two, and how can consumers use both?

Haarmann: I think that it's very important for, for healthcare systems to be aware of all of the various factors. You never want to just focus on one thing. The safety score is very important, because it tells you about a specific category that is very, very important. Reputation score is a different metric. But it also tells you important information. [Often] we think about safety as a very concrete, black and white thing—if they didn't have an adverse event, it was safe. If they didn't acquire an infection, it was safe. If we did all the right things, it was safe. But there's a difference in safety versus perception, and the perception of the safety to the consumer.

One of the things that we're seeing that reputation score can help with is not only how visible are you online, but what is the feeling? What is the sentiment from consumers who have had an experience with you when they talk about COVID? Are they speaking in negative terms? Are they speaking in positive terms? Are they commenting that it was very reassuring to see that everyone was wearing a mask? Or that they were kept socially distanced by waiting in their cars? Or was it a negative experience where they didn't feel good about being seated next to someone who was coughing, even though that person had already been screened, and was found not to have COVID, but the patient doesn't know that—and so there's a feeling of unease and not having safety. You’ve got to look at all of the factors, because consumer experience is often about the way I interpret a situation as a consumer.

Using AI, we can analyze sentiment at scale, and really understand what is the feeling out there. Other data sources cannot provide that.

CHE: What steps are taken to make sure that a reputation score is fair?

Haarmann: We took the methodology for this report very, very seriously, because we know that this is an audience of healthcare leaders, and they're very accustomed to making decisions based on scientific data. We took a number of steps to control all of the variables so we could feel confident in the analysis. First of all, some brands that we analyzed have a larger presence in states that had more lockdowns for ancillary services during 2020. When they were shutting off elective [procedures] that resulted in a much smaller number of online comments and ratings and reviews. To make it fair, we decided to take all of the acute care locations, which for the most part through 2020, remained open because they had to, regardless of where they were located. That gave us a really good apples to apples data set to do our rankings. Then we looked at how much data we could pull in, and we pulled in over 300,000 comments. I think we'd have to get you the exact number for more than 113,000 individual locations. That’s a massive data set to be able to analyze. The great thing about our tool is it's been more than a decade since we since we started building it. Our natural language processing has the benefit of many years of robust data analysis. So, our AI is very strong—we have 31 technology patents. When you think about AI, and some of the new developments in recent years, they haven't gotten to that ripe age to have the amount of data they need to make really good analysis possible, but ours does. We were able to use that to analyze those comments, and make it a very fair analysis.