Hospitals and health systems see Amazon.com and other technology, retail and insurance companies as their biggest competitive threat in digital and consumer-driven healthcare.

But health system executives still are more talk than action when it comes to spending the time and money needed to make their organizations more competitive, according to a new survey of 200 executives at community hospitals, academic medical centers, children’s hospitals and regional and national health systems from consulting, data services and research firm Kaufman Hall.

Nearly 46% of survey respondents view Amazon.com as the biggest competitive threat to hospitals and health systems over the next five years followed by CVS Heath/Aetna (45%), UnitedHealthcare (41%), Apple Inc. (34%) and Google at 31%.

Just over one-quarter of health system—26%—view UnitedHealth as an “extreme” threat between now and 2024, compared with 21% for CVS Heath/Aetna and 10% for Amazon.

Overall 88% of U.S. hospital and health system executives agree that their organizations are vulnerable “to consumer-friendly offerings” from non-hospital competitors, says Kaufman Hall.

“Many hospitals and health systems remain focused on a brick-and-mortar model of offering consumers access to their providers,” says Kaufman Hall senior vice president strategic and financial planning Dan Clarin. “Consumers are accustomed to the convenience of being able to access the goods and services they need on their smartphones, tablets, and computers—healthcare organizations that want to connect with new or potential consumers should adapt their delivery models to remain relevant in an increasingly digital environment.”

Despite the new competitive threat to their organization, many hospitals will continue to invest the time and money into technology and services that support their existing in-system infrastructure and competition against other healthcare systems, says Kaufman Hall.

For example, while 81% of health system executives say “improving the customer experience” is a high priority for their organizations, only 11% have what they call “best-in-class customer experience capabilities” in place.

Few organizations offer real-time scheduling and communications necessary to keep pace with today’s digitally connected consumers, says Kaufman Hall. 66% of health systems offer limited or don’t offer real-time patient feedback, while 50% of organizations offer no real-time updates on in-office wait times and 38% offer such updates only on a limited basis, says Kaufman Hall.

“As consumers continue to gain greater digital access to information and services in other areas of their lives, they expect the same of their healthcare experience,” Clarin says. “Providers must introduce digital best practices as part of their overall customer experience strategies and begin to think in terms of ‘delighting’ rather than merely ‘satisfying’ consumers going forward.”