More than a decade and a half ago, patient experience researchers, the Beryl Institute, developed what is now a widely used definition of patient experience:
Patient experience is “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.”1
Around the same time, Deloitte Center for Health Solutions took a similarly holistic approach to defining the patient experience:
“The patient experience refers to the quality and value of all of the interactions—direct and indirect, clinical and non-clinical—spanning the entire duration of the patient/provider relationship.”1
With these definitions in mind, we can understand patient experience as more expansive than just the transactional diagnosis and treatment of a patient’s medical concerns. It encompasses every interaction the patient has with a healthcare provider and system and every subjective perception of those interactions.
In 2025, the Beryl Institute published their 16th patient experience study titled, Consumer Perspectives on Patient Experience in the U.S. It showed that patients continued to express strong sentiment for having a good patient experience. However, the studies also reveal a great disparity between this high importance patients place on a good healthcare experience generally, their assessments of their actual healthcare visits, and their perceived quality of healthcare generally. In each poll since 2022, more than 90% of patients indicated that having a good patient experience was “extremely important” or “very important” generally. However, less than 70% rated their experiences at actual healthcare visits as “good” or “very good” while less than half rated their perception of the healthcare system overall as “good” or “very good.”2
This disparity between the ideal of patient experience, its reality, and perceptions of the healthcare system itself is striking.
The Three Pillars of Patient Experience
Researchers in one study of hospitals found that patient experience was impacted by many factors that could be grouped into three interconnected themes or pillars:3
Pillar 1 - Treatment: Safe, timely, and effective treatment
- Feeling safe in the hospital
- Ease of hospital transitions
- Effective treatment that meets patient expectations
- Effective management of pain
Pillar 2 - Staff: Caring and attentive staff
- Being informed
- Being listened to and valued
- Responsiveness to patient needs
- Providing a consistent quality of care
Pillar 3 - Environment: Comfortable and healing environment
- In hospitals:
- Having a clean and functional room
- Promoting sleep and rest
- Providing nutritious food and dietary options
- Features that connected them to nature, such as large windows, natural light, and a clean and well-maintained environment
Interestingly, Beryl Institute research of the top three reasons why people feel that having a good patient experience is important2 seem to align well with these pillars:
#1 “My health and well-being are important to me” [Pillar 1 - Treatment]
#2 “I want to know my physical needs are being taken seriously” [Pillar 3 - Environment]
#3 “I want to be treated with respect” [Pillar 2 - Staff]
Through this three pillars lens, we see that consolidation brings mixed results when weighed against the oft-given goals of consolidation: “increased efficiency, lower administrative costs, and improved quality of health care”4 and the actual results.
Healthcare Consolidation’s Impact on Patient Experience
In 2024, the Federal Trade Commission, the Department ofJustice’s Antitrust Division, and the Department of Health and Human Services launched an inquiry into the impacts of consolidation (aka, integration)*transactions in healthcare. These agencies published a request for information(RFI) “to seek public comment regarding the effects of these transactions involving health care providers”5 with particular interest in comments related to “the goals or objectives of these transactions, as well as their effects on participants in the health care market including patients, communities, payers, employers, providers, and other health care workers and businesses.”5
This scrutiny is justifiable. Research suggests that consolidation “has led to less competition, which in turn comes with higher prices and significant economic impacts [and] declines in affordability and access.”6 Despite the increasing costs, though, quality for patients has stagnated or even decreased.6
A systematic review of literature of articles published from2000 to 2024 studied the impacts of integration on price to the consumer, costs of delivery, and quality of care found similar results. The reviewed articles included both horizontal integration (e.g., a merger of two or more hospitals or medical groups) and vertical integration (e.g., hospitals acquiring physician practices).7 The results showed no significant improvements in price, cost, or quality. Instead, many of the results were negative. Reviewed articles focusing on cost showed no change or even increases, while articles focusing on price mostly reported increases. More directly related to patient experience, of the articles focusing on quality,77% showed reductions or no change in quality.7 According to the lead author of the study, Bhagwan Satiani:
“Proponents of healthcare integration have claimed it controls costs and enhances care quality . . . but we found that evidence is lacking that integration alone is an effective strategy for improving the value of health care delivery. . . . Quality improvement in healthcare cannot be achieved by mergers and acquisitions alone.”8
The reality, though, is not that clear. Another study found that hospitals integrating vertically saw higher patient experience scores than those in horizontally integrated systems and independent hospitals,9while a RAND researcher in her testimony to the U.S. House of Representatives Committee on Ways and Means, Subcommittee on Health in 2023 testified that“vertical integration of hospitals or health systems with physician practices does not lower spending and does not improve quality of care.”4
The decades-long trend of healthcare consolidation continues and—as reported by Kaelin O’Reilly in her "Private Equity inHealthcare Today” article elsewhere in this issue—may be accelerating. However, there do not seem to be many clear prescriptions for balancing the economic and financial goals of hospital systems, insurers, private equity firms, and corporations like CVS, Walmart, and Amazon against the generally declining patient experience.
* The terms consolidation and integration are used interchangeably in the literature and in the studies mentioned in this article. To maintain the integrity of the research references, the term used in the reference is used here.
References
1. Jason A. Wolf, et al. “Defining Patient Experience.”Patient Experience Journal. 2014; 1(1):7-19. [https://pxjournal.org/journal/vol1/iss1/3/]
2. The Beryl Institute - Ipsos PX. ConsumerPerspectives on Patient Experience in the U.S. PX Pulse. February 2025. [https://theberylinstitute.org/wp-content/uploads/2025/02/TBI_PXPulse_Q2_Feb2025_v2.pdf]
3. Corey Adams, et al. “The Three Pillars of Patient Experience: Identifying Key Drivers of Patient Experience to Improve Quality in Healthcare.” Journal of Public Health (Berl.), 33, 2105–2113 (2025).DOI: 10.1007/s10389-023-02158-y [https://doi.org/10.1007/s10389-023-02158-y]
4. Cheryl L. Damberg. “Health Care Consolidation: The Changing Landscape of the U.S. Health Care System.” Testimony submitted to the U.S. House of Representatives Committee on Ways and Means, Subcommittee onHealth. May 17, 2023. DOI: 10.7249/CTA2770-1[https://doi.org/10.7249/CTA2770-1]
5. U.S. Department of Justice, U.S. Department of Health andHuman Services, and U.S. Federal Trade Commission. “Request for Information on Consolidation in Health Care Markets.” Docket No. ATR102. February 29, 2024. [https://www.ftc.gov/system/files/ftc_gov/pdf/FTC-2024-0022-0001-Request-for-Information-on-Consolidation-in-health-care-markets.pdf]
6. Erin C. Fuse Brown, et al. “The Rise Of Health Care Consolidation And What To Do About It.” HealthAffairs. September 9, 2024. DOI: 10.1377/forefront.20240906.397095 [https://www.healthaffairs.org/content/forefront/rise-health-care-consolidation-and-do]
7. Bhagwan Satiani, et al. “Systematic Review of Integration Strategies Across the US Healthcare System: Assessment of Price, Cost, and Quality of Care.” Journal of the American College of Surgeons.240(5):p 758-773, May 2025. DOI: 10.1097/XCS.0000000000001229
8. Richard Payerchin. “HealthCare Consolidation Pushes Up Costs, But Not Quality.” Medical Economics. January 2, 2025. [https://www.medicaleconomics.com/view/health-care-consolidation-pushes-up-costs-but-not-quality
9.Jillian S. Torres, Mark L. Diana. “Associations BetweenIntegration and Patient Experience in Hospital-Based Health Systems: AnExploration of Horizontal and Vertical Forms of Integration.” Journal ofHealthcare Management. 69(5):p 321-334, September/October 2024. DOI:10.1097/JHM-D-23-00266