1. ▪ research for your brand’s health klein & partners Another Kitchen Sink Survey from Klein & Partners: What consumers think about a plethora of healthcare topics… Presented by: Rob Klein, Founder & CEO Klein & Partners 4th Quarter, 2014 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 klein & partners INTRODUCTION Page 1

3. ▪ research for your brand’s health klein & partners 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 407 heads of household, 18 or older who are most responsible for healthcare decisions for themselves and/or the household. Interviewing was conducted from September 9 – 13, 2014. The sample frame used was Research Now’s online consumer panel. The final data set was weighted by geography, age, education, income, and ethnicity.  The total sample size of 407 yields a sample error of +/-4.1% 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 approximately 46% and 54%.  Significant differences are called out in the charts using letters or arrows. Colors and bolding are used to highlight interesting patterns and/or findings. Introduction Reactions to health reform Perceptions of health providers Tax exempt perceptions Perceptions of healthcare costs and profits Primary care physician Electronic medical record Medical home awareness and perceptions Concierge medicine Smart phone use Interest in new information sources Communication methods used Choosing a hospital Websites visited Retail clinics used Online healthcare shopping behavior Transparency/price shopping Health insurance and getting care Rural healthcare perceptions Page 2

4. ▪ research for your brand’s health klein & partners SO WHAT DID WE LEARN? Page 3

5. ▪ research for your brand’s health klein & partners This year’s theme? Page 4

6. ▪ research for your brand’s health klein & partners 1)Patients are becoming customers in their expectations. Health reform is a major cause of this shift in attitude because most folks feel they are paying more now under reform. 2)Catch-22 regarding tax-exempt status  most Americans don’t support you but they know they will pay the price if you lose your tax-exempt status. 3)Americans think hospitals make very large profits like health insurers. You are losing your ‘good guy’ status. 4)Fewer Americans are price shopping for healthcare services (hypothesis: they are not getting good answers so they are giving up). 5)Concierge medicine could create access problems and may create a moral challenge. 6)Why can’t I schedule a doctor’s appointment online when I can make a restaurant reservation with Open Table? 7)Trying to pick the best doctor remains a daunting task with little useful information available. 8)Medical Homes… What? 9)EMR  gaining traction 10)Like us on Facebook? Not likely 11)What people say – I will seek out lots of sources of information before deciding which hospital to choose. What people actually do – What ever you say doctor. 12)Very few people actually look to HealthGrades or US News & World Report or any other online quality ranking sites when choosing a hospital. 13)Most hospital website visitors find the experience ‘adequate’ but not ‘exceptional.’ We need to think of our website as a ‘digital brand dialogue’ that impacts our overall brand relationship. 14)The new competitors  Walgreens, CVS, Walmart, Target, etc. and they want primary care! Page 5 Top-10 (ok 14) key disruptive takeaways

7. ▪ research for your brand’s health klein & partners TOP CONCERNS Page 6

8. ▪ research for your brand’s health klein & partners Page 7 Significantly higher among women, seniors, and those with HHI <$45K Q1: Which one of the following issues is MOST important to you?

9. ▪ research for your brand’s health klein & partners REACTIONS TO HEALTH REFORM Page 8

10. ▪ research for your brand’s health klein & partners Q2: What do you feel is getting better or worse for you personally under healthcare reform? Page 9 And this is giving rise to the healthcare ‘customer.’

11. ▪ research for your brand’s health klein & partners Page 10 Significantly higher among college educated Q3: Next we have a question about how health care eventually will be delivered under reform called an Accountable Care Organization or ‘ACO’. Currently healthcare providers get paid when you, as a patient, receive care. Under reform, providers will be paid to manage the entire health of a population of people so they don’t get specifically paid when you need care, but they are paid a fixed sum to manage your health whether you ever get sick or injured or not. So their incentive is to keep you healthy and be cost effective in how they deliver care. And providers could include your local health care system of hospitals and doctors, a single hospital, even a large physician group, and they would be responsible for managing a large population of people in the community. Based on this basic description of healthcare under reform, how comfortable are you in having this ACO manage all aspects of your health and wellness? 2012 4% 15% 37% 17% 19% 8% 2012 4% 15% 37% 17% 19% 8%

12. ▪ research for your brand’s health klein & partners PERCEPTIONS OF HEALTH PROVIDERS Page 11

13. ▪ research for your brand’s health klein & partners Page 12 Q4: Next is a list of people or organizations that have been in the news lately. Please tell us how favorable you are towards each using a scale of 1 to 10 where 1 means very unfavorable and 10 means very favorable. Of course, you may use any number from 1 to 10. Don’t know enough to rate it 17%14%7%23%12%9%

14. ▪ research for your brand’s health klein & partners TAX EXEMPT STATUS Page 13

15. ▪ research for your brand’s health klein & partners Support hospitals being tax-exempt Page 14 Q5: Do you support or oppose hospitals being exempt from paying state and local taxes? 42%41% Support for tax-exempt status is not very strong among Americans.

16. ▪ research for your brand’s health klein & partners Q6: As you may or may not know, many local communities and states are looking for ways to increase revenue to meet rising demands for services. One way that has been proposed is to treat local hospitals just like any other business in the community and charge them property tax and sales tax. Do you think this is a good idea or a bad idea? Charging hospitals property and sales tax Page 15 Bad idea Not sure Good idea But taxing hospitals isn’t necessarily a good idea either.

17. ▪ research for your brand’s health klein & partners Page 16 Hospitals earning tax-exempt status Q7: Would you say that hospitals in your area do or do not provide enough free medical care and health education services in your community to justify their tax-exempt status? Would you say they…? 42% 35% Most Americans don’t think so. How much money do you spend each year trying to convince your communities?

18. ▪ research for your brand’s health klein & partners Views on hospitals Q8: Do you agree or disagree with the following statements? Strongly disagree Somewhat disagree Not sure Somewhat agree Strongly agree Page 17 7% 20% 9% 40% 24% 4% 10% 6% 33% 47% 12% 21% 11% 35% 22% 2013 Classic Catch-22

19. ▪ research for your brand’s health klein & partners PERCEPTIONS OF HEALTHCARE COSTS AND PROFITS Page 18

20. ▪ research for your brand’s health klein & partners Page 19 Q9: Which one of the following do you think has the largest impact on health insurance costs?

21. ▪ research for your brand’s health klein & partners Page 20 Q10: In the current healthcare environment, do you believe your local hospitals are…?

22. ▪ research for your brand’s health klein & partners Paid too much Paid appropriate amount Paid too little Not sure Amount paid for services Q11: For each of the following organizations, please check if you think they are paid too much, too little, or an appropriate amount for the services they provide in today’s healthcare environment? Page 21 Klein & Partners is seeing a shift in attitude towards hospitals. What were once viewed as altruistic organizations in line with the virtues of doctors, hospitals are now more in line with the ‘profit-driven’ health insurers.

23. ▪ research for your brand’s health klein & partners PRIMARY CARE PHYSICIAN Page 22

24. ▪ research for your brand’s health klein & partners Q12: Do you have a primary care or personal physician? Q15: Have you ever gone online to a social networking site and shared your experiences about a doctor or a hospital you recently visited? Page 23 Primary care physician Primary Care Doctor 82% Just 60% among Millennials. Going online to rate a doctor or hospital has doubled in the past few years: 6% in 2009 9% in 2011 14% in 2012 12% in 2013 12% in 2014 Going online to rate a doctor or hospital has doubled in the past few years: 6% in 2009 9% in 2011 14% in 2012 12% in 2013 12% in 2014

25. ▪ research for your brand’s health klein & partners Page 24 Q13: Why do you currently NOT have a primary care physician? Q14: If you needed to see a primary care doctor where would you most likely go (or where have you gone) for care? Purple = No need Green = Financial Red = Access Purple = No need Green = Financial Red = Access  Impacts access  Impacts costs

26. ▪ research for your brand’s health klein & partners Page 25 Q16: Are you aware of an online physician office scheduling App called ZocDoc? Recent focus group participant: “Why can I use Open Table to make a restaurant reservation but I have to call and argue with my physician’s office to schedule an appointment when I’m sick?”

27. ▪ research for your brand’s health klein & partners Page 26 Q17: Thinking back to when you were first looking for a new primary care physician, which of the following sources of information, if any, did you seek out to help you choose that physician? Q17a: Now, which one of these sources of information, if any, was most useful to you in choosing this physician? *Word-of-mouth! * * *Significantly higher among Millennials * *

28. ▪ research for your brand’s health klein & partners Page 27 Q18: Think back to when you chose your current primary care doctor which of the following factors did you take into consideration when you were deciding on which doctor you chose? Q18a: And which one of these factors would you say had the biggest influence on which primary care physician you chose?

29. ▪ research for your brand’s health klein & partners Page 28 Q19: Now, which of the following factors influence whether or not you want to stay with this physician? Q19a: And which one of these factors would you say has the biggest influence on whether or not you want to stay with this physician?

30. ▪ research for your brand’s health klein & partners Page 29 Q18a: And which one of these factors would you say had the biggest influence on which primary care physician you chose? Q19a: And which one of these factors would you say has the biggest influence on whether or not you want to stay with this physician?

31. ▪ research for your brand’s health klein & partners Views on physicians Q20: Next, for each of the following statements please check if you… Note: * = Asked of all; ** = Asked only of those with a PCP Page 30 * * * * * ** Views on physicians Strongly disagree Somewhat disagree Neutral Somewhat agree Strongly agree

32. ▪ research for your brand’s health klein & partners ELECTRONIC MEDICAL RECORDS Page 31

33. ▪ research for your brand’s health klein & partners Page 32 Especially 21-44 Q21: How interested would you be in having online access to your own personal health record – called an Electronic Medical Record (or Patient Portal) – to track your own health through a secure website that only you and your doctor and hospital can access? Q22: Which of the following features, if any, would you definitely be very interested in accessing or have accessed through your electronic medical record? [Among those very interested or already have access] Use EMR – 12% Haven’t used yet – 3% Use EMR – 12% Haven’t used yet – 3% Men  Women 

34. ▪ research for your brand’s health klein & partners MEDICAL HOME AWARENESS AND PERCEPTIONS Page 33

35. ▪ research for your brand’s health klein & partners Page 34 5% believe they are part of a Medical Home with their physician (3% in 2012) which equals <1% of the adult population. Consistent with other Klein & Partners research, half (55%) learned about a ‘Medical Home’ after they chose that physician. (53% in 2012). And when asked if they see any difference in their relationship with their physician because of the Medical Home program, 60% said yes. (new Q in 2014) Consistent with other Klein & Partners research, half (55%) learned about a ‘Medical Home’ after they chose that physician. (53% in 2012). And when asked if they see any difference in their relationship with their physician because of the Medical Home program, 60% said yes. (new Q in 2014) Q23: 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? Q24: Are you part of a Medical Home through your primary care doctor? Q25: 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? Q26: Do you notice any difference in your relationship with your physician because of the Medical Home program?

36. ▪ research for your brand’s health klein & partners Page 35 Q27: As part of a Medical Home with your primary care physician, there may be times when you come in for an appointment and you will see one of the doctor’s team members who could be a Nurse Practitioner, Physician’s Assistant, or some other care giver. How comfortable are you or would you be in being seen by one of the care givers instead of your primary care physician? [Among those with a PCP]

37. ▪ research for your brand’s health klein & partners CONCIERGE MEDICINE Page 36

38. ▪ research for your brand’s health klein & partners Page 37 Q28: Next, have you heard of a ‘concierge medical practice?’ Q29: If your primary care doctor told you that he/she was converting their practice to a concierge practice and offered you to stay for an additional annual fee like what was outlined above, what additional amount above and beyond what your insurance covers now would you be willing to pay annually to stay with your current doctor in this new concierge practice format? Additional amount willing to pay to stay with doctor in new concierge format: Less than $100: 2% $100-$199: 3% $200-$499: 3% $500-$999: 1% $1000+: 3% Would not pay extra: 58% Not sure: 29% Additional amount willing to pay to stay with doctor in new concierge format: Less than $100: 2% $100-$199: 3% $200-$499: 3% $500-$999: 1% $1000+: 3% Would not pay extra: 58% Not sure: 29% 2013 Yes, but not in one: 32% Yes, and in one: 2% No: 62% Not sure: 4% 2013 Yes, but not in one: 32% Yes, and in one: 2% No: 62% Not sure: 4% Mean = $495

39. ▪ research for your brand’s health klein & partners Page 38 Q30: Whether or not you have heard of concierge medicine prior to this survey, which statement best describes your reaction to it? Women more likely to feel this way Seniors more likely to feel this way Millennials more likely to feel this way Those with no PCP more likely to feel this way

40. ▪ research for your brand’s health klein & partners SMART PHONES ‘Can you hear me now?’ Page 39

41. ▪ research for your brand’s health klein & partners Q31: Next, have you used a smart phone (e.g., Droid, iPhone, Blackberry, or any phone that can access the Internet) to go online and do any of the following…? Page 40 Any of these uses is significantly higher among Millennials. Americans are using their smart phones to search for lots of information… just not healthcare… yet

42. ▪ research for your brand’s health klein & partners From a market segmentation standpoint, potential use for most of these Apps is higher among Millennials. Q32: If a hospital you used offered a mobile app for your smart phone, which of the following features would you MOST LIKELY USE? Page 41

43. ▪ research for your brand’s health klein & partners INTEREST IN INFORMATION SOURCES Page 42

44. ▪ research for your brand’s health klein & partners Page 43 Green = Offline Blue = Digital Q33: Besides your physician, which of the following have you sought health-related information from in the past year?

45. ▪ research for your brand’s health klein & partners Page 44 Q34: And which of the following information, if any, have you done online?

46. ▪ research for your brand’s health klein & partners Page 45 Q35: Which of the following online health-related activities have you participated in over the past few years?

47. ▪ research for your brand’s health klein & partners COMMUNICATON METHODS Page 46

48. ▪ research for your brand’s health klein & partners Q36a: Which of the following communication methods have you used to communicate with your primary care physician? Note: Not sure/no PCP scores re-percentaged out Page 47

49. ▪ research for your brand’s health klein & partners Q36b: Which of the following communication methods have you used to communicate with your hospital? Page 48 Significantly higher level of ‘none of these/don’t have a hospital this year compared to last year (33% vs. 21%).

50. ▪ research for your brand’s health klein & partners Page 49 Q37: In the past year, have you visited and/or ‘Liked’ a health plan or hospital Facebook page? 2013 4% 3% 2% 3% 91% 3% 2013 4% 3% 2% 3% 91% 3% Facebook visitors are almost entirely Millennials.

51. ▪ research for your brand’s health klein & partners Page 50 Q38: Have you ever had a ‘virtual doctor visit’ where you talk with a physician face-to-face using a PC, tablet, or smart phone? Opportunity or threat?

52. ▪ research for your brand’s health klein & partners CHOOSING A HOSPITAL Page 51

53. ▪ research for your brand’s health klein & partners Page 52 Q39: Have you personally been to a hospital for inpatient, outpatient, or ER care in the past 2 years? Q40: (Q39 Yes) Next, think back to when you were hospitalized and had to decide which hospital you should choose. Which of the following sources of information, if any, did you seek out to help you make that choice? (Q39 No) 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 would you definitely use to help you make that choice? Those who have not been to a hospital ‘think’ they would investigate their hospital choice a great deal more than what actually happens in a hospital choice scenario. The only real constant is ‘physician recommendation.’

54. ▪ research for your brand’s health klein & partners Q41: Now, if you were looking for information on hospital quality to compare different hospitals before you made a decision on which hospital to choose, which of the following sources of quality information, if either, would you more likely find useful in your decision-making? Page 53 Other Klein & Partners research has shown that consumers aren’t finding these sources useful yet because there are so few reviews for a particular doctor or hospital. We are conducting further research to find out how many reviews are needed for source credibility.

55. ▪ research for your brand’s health klein & partners WEBSITES VISITED Page 54

56. ▪ research for your brand’s health klein & partners Page 55 Q42: Have you been to a hospital website in the past 3 months? Q43: Think about the most recent hospital website that you visited. What were your main reasons for visiting this website? Q44: Overall, how well did this website meet your needs? Was this website visit…? Visited a hospital website in the past 3 months: 11%

57. ▪ research for your brand’s health klein & partners RETAIL CLINICS Page 56

58. ▪ research for your brand’s health klein & partners Page 57 Q45: Next, we have a couple questions about getting healthcare services or products at a retail store. Have you been to a {RESTORE RETAILER} for any of the following?

59. ▪ research for your brand’s health klein & partners Page 58 Q46: If your doctor wasn’t available and you had a minor illness (e.g., cold, flu, stomach or ear ache, etc.) and you decided to find an urgent care center because you didn’t want to wait to see your doctor for care – how comfortable would you be in going to {RESTORE Q45 RETAILER} for this type of care compared to another type of urgent care facility?

60. ▪ research for your brand’s health klein & partners ONLINE HEALTHCARE SHOPPING Page 59

61. ▪ research for your brand’s health klein & partners Page 60 Q47: In the past year have you purchased any healthcare-related products online? Q48: Why did you purchase these healthcare-related products online? Q49: What online site(s) did you purchase these healthcare-related products from? Purchased healthcare-related products online in past year: 23% Purchased healthcare-related products online in past year: 23%

62. ▪ research for your brand’s health klein & partners PRICE SHOPPING Page 61

63. ▪ research for your brand’s health klein & partners 2008200920102011201220132014 Households that have contacted a healthcare organization to ask the price for a specific visit, test, treatment, or surgery 33%32% 22%28%24%16% Chose the least expensive provider for one of these healthcare cases 36%41%31% 33%24%44% % of the total patient market  12%13%10%7%9%6%7% Price check in aisle five! Q50: 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… Q51: How did you check on pricing? Q52: What type of health service did you ask about pricing for? Q53: Did you end up choosing the least expensive provider? Called: 2010/2011 71% 2012 72% 2013 73% Called: 2010/2011 71% 2012 72% 2013 73% Page 62

64. ▪ research for your brand’s health klein & partners HEALTH INSURANCE AND GETTING CARE Page 63

65. ▪ research for your brand’s health klein & partners Page 64 Q54: What type of health insurance, if any, do you have currently?

66. ▪ research for your brand’s health klein & partners Q55: Have you experienced a significant financial hardship in the past year due to medical bills? Page 65 Especially among those <$45K HHI (25%).

67. ▪ research for your brand’s health klein & partners RURAL HEALTHCARE Page 66

68. ▪ research for your brand’s health klein & partners Yes No Not sure Adequate healthcare access in rural areas Q56: Would you describe where you live as…? Q57:You checked that you live in a rural area. Do you feel there is adequate access to each of the following types of healthcare services close by where you live or not (i.e., without having to drive a far distance to another town or city)? 17% consider themselves to live in a rural community Page 67

69. ▪ research for your brand’s health klein & partners Excellent Very good Good Fair Poor Adequate healthcare access in rural areas Q56: Would you describe where you live as…? Q58: And how would you rate the quality of medical care provided by each of these healthcare services? 17% consider themselves to live in a rural community Page 68

70. ▪ research for your brand’s health klein & partners APPENDIX Page 69

71. ▪ research for your brand’s health klein & partners Demographic profile Total Female54% Children in HH23% Ethnicity Caucasian Hispanic African American Asian Other/refused 62% 17 12 7 2 Age 18-44 45-64 65+ Median age 46% 36 18 47 Median household income$54,600 Education Level Up to high school Some college College grad (undergrad) Graduate degree 15% 56 18 11 Generally think of yourself as… Strongly Republican Moderately Republican Independent, lean Republican Independent Independent, lean Democrat Moderately Democrat Strongly Democrat Other Not sure 9% 13 10 18 14 13 0 10 Page 70 32% 40%

72. ▪ research for your brand’s health klein & partners Additional information If you would like additional information regarding this study, please contact: Rob Klein President Klein & Partners [630] 455-1773 rob@kleinandpartners.com Page 71