Connected Patient Report

INDUSTRY RESEARCH: HEALTHCARE 2016 Connected Patient Report Insights into patient preferences on telemedicine, wearables and post-discharge care

Introduction To understand how Americans today communicate with their healthcare providers, their opinions on telemedicine and wearable devices, and their experiences with post-discharge care, Salesforce conducted its 2016 Connected Patient Report. The survey was completed online within the United States by Harris Poll on behalf of Salesforce from June 8-10, 2016, with 2,025 U.S. adults, ages 18 and older, among whom 1,736 have health insurance and a primary care doctor. The report found that people primarily interact with their physicians through in-person visits, phone calls and emails, but are open to virtual care treatment options enabled through technology. The report also explored how wearable devices may one day impact the patient-doctor experience, with younger generations more likely to own wearables and more willing to share their health data with doctors and insurance companies. Finally, the report found that following discharge from a hospital or clinic, insured adults with a primary care provider strongly believe improvements can be made to their experiences through better communication with their primary care doctor and throughout their care network. Table of Contents 03 Doctor-Patient Communication Today 11 Telemedicine and Home Health 14 Wearables in Health 19 Post-Discharge Care 21 Methodology Salesforce Research 2016 Connected Patient Report / 2

I. Doctor-Patient Communication Today 8 of patients surveyed currently have health insurance Communication today between doctors and patients activities such as setting up appointments, getting test results or filling prescriptions is still traditional in nature (in-person meeting or over the phone). This trend extends to keeping track of health records, as 6 of insured adults with a primary care provider rely on their doctors to manage them, and nearly a third of respondents (2) keep them in a home-based physical storage location like a folder or shoebox. Base: respondents Do you currently have health insurance? Answer: Yes 8 7 8 9 Salesforce Research 2016 Connected Patient Report / 3

I. Doctor-Patient Communication Today Phone calls are still the primary way to set up doctor appointments Interestingly, nearly half of adults (4) have had the same doctor over the past 10 years, yet 3 feel their doctors would not recognize them walking down the street. That said, respondents overall are very satisfied (9) with their primary care doctor, and if they changed doctors in the last 10 years nearly half did so it was due to either one of them moving. Base: Have health insurance and a primary care doctor Which of the following, if any, do you use to communicate with your primary care doctor for each of the following? Phone Set up an appointment 7 7 7 7 Text/SMS In-person 2 2 2 2 Chat/IM Portal 1 Email 1 NA Mail Salesforce Research 2016 Connected Patient Report / 4

I. Doctor-Patient Communication Today Reviewing health data still happens primarily in-person Which of the following, if any, do you use to communicate with your primary care doctor for each of the following? Look at my current health data (e.g. medical records, lab results) In-person 3 3 3 3 Text/SMS Portal 2 2 2 2 Chat/IM Email 1 1 1 Phone 1 NA 2 1 2 2 Mail Salesforce Research 2016 Connected Patient Report / 5

I. Doctor-Patient Communication Today Doctors share test results in-person or over the phone Which of the following, if any, do you use to communicate with your primary care doctor for each of the following? Get test results In-person 4 4 3 4 Text/SMS Phone 3 4 3 3 Chat/IM Portal 2 2 2 2 Mail 1 1 1 1 NA 1 Email 1 1 1 Salesforce Research 2016 Connected Patient Report / 6

I. Doctor-Patient Communication Today Patients primarily get prescriptions in-person Which of the following, if any, do you use to communicate with your primary care doctor for each of the following? Get prescriptions and/or refills In-person 4 4 4 5 Text/SMS Phone 3 3 3 4 Chat/IM Portal 1 1 1 Email NA 1 1 1 Mail Salesforce Research 2016 Connected Patient Report / 7

I. Doctor-Patient Communication Today Patients check their insurance coverage over the phone Which of the following, if any, do you use to communicate with your primary care doctor for each of the following? Check insurance coverage Phone 2 3 2 2 Text/SMS In-person 20% 2 1 20% Chat/IM Portal 1 1 1 Email 1 NA 2 3 3 3 Mail 1 Salesforce Research 2016 Connected Patient Report / 8

I. Doctor-Patient Communication Today Nearly a third keep their records in a home-based physical storage location How do you currently keep track of your health records? Select all that apply. Rely on doctor 6 6 5 6 I keep my records in a folder, shoebox, lockbox, drawer or other home-based physical storage option 20% 2 3 3 I have access to a single self-service portal provided by my healthcare and/or insurance provider 1 2 2 2 I use multiple portals or websites provided by my healthcare providers 1 1 1 1 No one currently keeps track of my health records I have my own electronic method (e.g. scanning, saving to desktop or online file storage like Dropbox) If I walked past my primary care doctor while walking down the street, they would recognize me. Strongly/ Somewhat agree 6 6 6 7 Strongly/ Somewhat disagree 2 3 3 3 Salesforce Research 2016 Connected Patient Report / 9

I. Doctor-Patient Communication Today Even with high satisfaction, a majority of patients have changed doctors in the last 10 years Overall, how satisfied are you with your primary care doctor Very satisfied/ satisfied 9 90% 8 9 Not at all/ not very satisfied 1 Have you changed doctors in the past 10 years? Yes 5 4 60% 40% No 50% 50% 4 5 Which of the following, if any, are reasons why you changed doctors within the last 10 years? I/they moved 4 5 4 50% Misdiagnosis Inconvenient location 1 1 1 Costs Poor bedside manner Outdated technology Salesforce Research 2016 Connected Patient Report / 10

II. Telemedicine and Home Health 6 of respondents report their providers offer virtual care services Sixty-three percent of insured adults say their primary care physician provides virtual care services enabled by technology, but these are mainly delivered through legacy technologies such as phone (5) or email (2). Despite this, mobile engagement is important among respondents, with 5 saying they would choose a primary care doctor who offers a patient mobile app (allowing patients to make appointments, see bills, view health data, etc.) over one that does not. What types of virtual care services does your primary care doctor provide? Select all that apply. Provides any virtual care services Phone call with doctor or nurse Email with doctor or nurse Communication through a healthcare provider app on a mobile device 1 2 3 2 2 4 5 6 5 60% 5 6 7 Text with doctor or nurse 1 Instant message with doctor or nurse 1 Webcam call with doctor or nurse My primary care doctor 2 does not provide any virtual care services 3 3 4 Salesforce Research 2016 Connected Patient Report / 11

II. Telemedicine and Home Health 5 would choose a primary care doctor who offers a patient app over one who does not Interestingly, 6 say they strongly or somewhat agree that they would be open to virtual care treatments such as a video conference call, as an alternative to an inoffice doctor s visit for non-urgent matters. And 5 of would actually choose a primary care doctor who offers virtual care treatment options over one that does not. I strongly/somewhat agree with the following statements: I would be open to virtual care treatment options as an alternative to in-office doctor s visits for non-urgent matters I would choose a primary care physician who offers home care treatment over one that does not I would choose a primary care doctor who offers a patient app (which allows patients to make appointments, see bills, view health data, etc.) over one that does not 5 6 6 6 5 60% 6 6 60% 5 60% 70% I would choose a primary care doctor who offers virtual care treatment options over one that does not (e.g. video conference call) 3 4 5 5 I would choose a primary care doctor who uses data from patient s wearable devices to manage health outcomes over one that does not 2 3 40% 50% Salesforce Research 2016 Connected Patient Report / 12

II. Telemedicine and Home Health Convenience is the primary driver to why people would be open to virtual care Among those open to virtual care, they report clear reasons for their preferences around telehealth, with 7 stating it is more convenient, 5 it is easier for their schedules and 3 it lessens the risk of getting sick from other patients. Base: Would be open to virtual care. Why would you be open to a virtual care treatment option as an alternative to an in-office visit? 7 7 It s more convenient 7 7 It s easier for my schedule 40% 5 6 5 It lessens the risk of getting sick from other patients 3 3 2 40% It s more private 2 3 30% 2 I don t like going to the doctor s office 2 3 2 20% It s more beneficial to my medical condition It s too far a distance to the doctors office 1 1 1 Salesforce Research 2016 Connected Patient Report / 13

III. Wearables in Health 3 of own a wearable device, highest among generations surveyed Despite lack of broad deployment of wearables in the healthcare space, 6 of respondents claim they would choose a primary care physician who uses data from their wearable devices to manage their health outcomes, over one that does not. Of those insured adults who own a wearable, 7 would want their doctors to have access to health data from their wearable devices, so providers can have a more up-to-date view of their health (4), be able to see trends in health data in order to diagnose a condition before it comes serious or terminal (3) and to receive more personalized care (3). What types of wearable health tracking device to you currently own? Own a wearable tracking device Fitness related Consumer related Clinical related (mobile blood pressure monitor, oximeter) 2 2 20% 1 2 20% 1 1 3 I do not own a wearable device 6 7 7 80% Salesforce Research 2016 Connected Patient Report / 14

III. Wearables in Health 7 of wearable owners want their providers to have access to their wearable data are willing to go a step further, with 6 stating they use a wearable health tracking device given by a healthcare provider in order to support managing their health in exchange for access to the data provided by the device and 6 would be very or somewhat likely to use a wearable tracking device given to them by their insurance company in exchange for better health insurance rates. Base: Own a wearable health tracking device. Why would you want your doctor to have access to data from your wearable device? Select all that apply. I would want my doctor to have access to data from my wearable device (total) So they can have a more up-to-date view of my health 4 4 4 4 7 8 7 7 To allow my doctor to see any trends in my health data that could allow them to diagnose a condition before it becomes serious/terminal To receive more personalized care 3 3 4 4 3 40% 2 2 To have all of my health information in one place 2 2 3 4 To have the ability to get a remote diagnosis from my doctor 2 2 I would not want my 30% 1 doctor to have access 1 2 1 to this data. 2 Salesforce Research 2016 Connected Patient Report / 15

III. Wearables in Health 5 of wearable owners wear their devices every day In the last 12 months, how often did you wear your wearable health tracking device? Wear it once per month or more (total) 8 8 9 8 Daily 4 5 60% 6 A few times a week 2 2 20% 1 Once a week A few times per month Less than once per month Once per month I stopped wearing it 1 Salesforce Research 2016 Connected Patient Report / 16

III. Wearables in Health 90% of fitness app users want their apps to integrate together How many apps do you currently use to track your health, nutrition or fitness data? None 3 5 5 7 3 1 2 2 1 3 4 1 2 20% 5 or more Base: Use more than one fitness app. How much do you agree or disagree with the following statement: I would like my healthcare/nutrition/fitness apps to be able to integrate and share data together. Strongly/ somewhat agree 8 90% 9 9 Strongly/ somewhat disagree 1 Salesforce Research 2016 Connected Patient Report / 17

III. Wearables in Health 6 of would give their insurance company their wearable data for better rates How likely would you be to use each of the following. A wearable health tracking device given to me by my healthcare provider to support managing my health in exchange for access to all my health data provided by the device Very/somewhat likely 50% 4 4 6 Not at all/ not very likely 3 50% 5 5 A wearable health tracking device given to me by my insurance company in exchange for potentially better health insurance rates based on data provided by the device Very/somewhat likely 4 4 5 6 Not at all/ not very likely 3 4 5 5 Salesforce Research 2016 Connected Patient Report / 18

IV. Post-Discharge Care After leaving the hospital, more than half of patients had to visit more than one doctor More than a quarter (2) of insured adults with a primary care doctor report being hospitalized, or having a family member hospitalized within the last two years. According to this report, the complexity around the U.S. healthcare system emerges after being discharged from the hospital, with 5 of patients visiting two or more, and visiting five or more, healthcare professionals. Have you or a family member been hospitalized for any length of time within the last two years? 2 7 Yes No Base: Have been or had a family member hospitalized in last two years. Post-discharge, how many healthcare professionals did you or your family member visit? None 4 1 1 5 or more 2 2 Not sure 2 3 1 Salesforce Research 2016 Connected Patient Report / 19

IV. Post-Discharge Care 6 of patients say the post-discharge process can improve This potentially disconnected set of caregivers may be the reason why 6 of those who themselves or family member had been hospitalized in past two years say that improvements can be made in the post-discharge process, including better communication between their primary doctor and other members of the care team; better communication with their primary care doctor in general (3); and more modern technology to manage their health data across various providers (2). Base: Have seen any healthcare professionals post-discharge from the hospital or provider. Post-discharge, did the healthcare professionals have access to your/their current health data all in one place? 5 1 2 Yes No Don t know Base: Have been or had a family member hospitalized in last two years. Which of the following improvements, if any, could be made to the post-discharge process? Improvements can be made to the process (sub-total) 6 Easier scheduling processes for follow-up visits 2 Better communication between my/their primary care doctor and other members of the care team 3 Better educational materials (e.g. care instructions, side effects, etc.) 2 Better communication with my/their primary care doctor 3 More modern technology to manage data across healthcare providers 2 Nothing 2 Salesforce Research 2016 Connected Patient Report / 20

V. Methodology This survey was conducted online within the United States by Harris Poll on behalf of Salesforce from June 8-10, 2016, among 2,025 U.S. adults ages 18 and older, among whom 1,736 have health insurance and a primary care doctor. This online survey is not based on a probability sample, and therefore no estimate of theoretical sampling error can be calculated. For complete survey methodology, including weighting variables, please contact Joel Steinfeld at jsteinfeld@salesforce.com. Salesforce Research 2016 Connected Patient Report / 21