Customer Centricity in Healthcare

Laying the Foundation for a Customer-Centric Organization
Customer Centricity in Healthcare

May 17, 2012
make an impact!
COPYRIGHT 2012 ALL RIGHTS PROTECTED AND RESERVED.
Todays Speakers
Partner, Peppers & Rogers Group
Marc Ruggiano
Executive Editor, Strategy Peppers & Rogers Group
Elizabeth Glagowski
COPYRIGHT 2011. ALL RIGHTS PROTECTED AND RESERVED.
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Agenda
The Case for Trusted Relationships
Peppers & Rogers Group Client Examples
Q&A Discussion
The Case for Trusted Relationships
US Healthcare Spending Leads OECD
Total Health Expenditure, Per Capita (PPP adjusted dollars)
Source: OECD Health Data (database) from Kaiser Family Foundation via http://facts.kff.org/ accessed on February 25, 2012.
COPYRIGHT 2011. ALL RIGHTS PROTECTED AND RESERVED. COPYRIGHT 2012 ALL RIGHTS PROTECTED AND RESERVED
While Life Expectancy Lags Considerably
Life Expectancy at Birth, Total (Number of Years)

90
80
70
60
50
40
Source: OECD FactBook 2010; via www.oecd-ilibrary.org/ accessed on February 25, 2012.
and Consumers Rate the Experience Poorly
Customer Experience Index (CxI) by Industry
Source: Forrester Research, The Customer Experience 2012
Health Visual Definition
the general condition of body and mind
a healthy state of wellbeing free from disease
Source: ThinkMap Visual Thesaurus, 2011

Care Visual Definition

the work of providing treatment for or attending to someone or something
Source: ThinkMap Visual Thesaurus, 2011

10
Consumers Define Health in Many Ways
Source: Peppers & Rogers Group research

11
Consumer Perception of Todays Health Insurers

12
Consumers Describe the Ideal Health Insurer

13

14

15
Customers Trust in the Health Insurance Sector
38%
Trust
19%
43%
Distrusters
Neutral
Trusters

16
Characteristics of a Trustable Health Insurer

Transparent/Secretive Organized/Disorganized Accessible/Inaccessible Clear/Confusing Easy/Difficult 3 2 1 0 -1 Superior/Inferior -2 -3 Kind/Unkind Flexible/Inflexible Compassionate/Uncompassionate Caring/Uncaring Generous/Stingy
Up-to-date/Outdated
Fair/Unfair
Reliable/Unreliable
Helpful/Unhelpful
Informative/Uninformative Friendly/Unfriendly Cooperative/Combative Fast/Slow Distrusters

Believable/Unbelieveable Effective/Ineffective Warm-hearted/Cold-hearted Trusters
17
Customers Trust for Individual Health Insurers

Variations in Trust Among Large Insurers
100%
80%
Respondents
60%
40%
20%
0% Anthem BCBS United Healthcare Aetna Humana Kaiser Permanente
Distrusters
Neutral
Trusters
18
Customers Value Trustworthiness

Consumer Willingness to Pay for Trustability
$30.0 $24.7
$20.0
$Billions
$12.1 $10.0 $6.4 $3.9 $Anthem BCBS United Healthcare Aetna Humana Kaiser Permanente $3.1
Annual Premium
19
Peppers & Rogers Group Client Examples
20
Making the Case for Transformation
Expectation
Customer expectations from their experiences in other industries has begun to permeate the healthcare industry.
Competition
Consumer choice is only increasing, as they take a more active role in the healthcare decisionmaking process.
Regulation
The Affordable Care Act and other healthcare reform is ongoing at both the state and federal level.
21
We started by taking the pulse of our clients organization with a current state assessment
Internal External
Document
Reviews (70+)
Industry
Working Sessions Interviews across

the organization
Dynamics and Trends Stakeholders Landscape
Key
Competitive
PRG analyzed both internal and external factors over a five week period, in order to gain a snapshot of which areas needed more support and which areas are already further along in their customer centricity journey.
22
which yielded a clear picture of where the organization stood and which areas required additional attention going forward Illustrative
Integrated 1to1 Enterprise Consumer/ OutcomeDriven
Consumer Centricity Maturity Spectrum
Consumer/ OutcomeSensitive
Product/ Process-Driven
Operati ons Health Care Services
Sales
Commun ications
Risk
Finance
IT
HR
Group/Division
23
Market Research yielded key insights about attitudes and motivations regarding Health Insurance and Health and Wellness
24
as well as insights into which new products and services would consumers be most interested in if offered by their health insurer Illustrative
A new product concept survey was conducted with members of the clients internal online community, evaluating 6 new product concepts
Research revealed that if any one of the product concepts that were part of the survey were offered, members were more likely to consider the insurer as a partner in their health and wellness, with results of increased partnership ranging from 22-39%, depending on the product
25
Branding, while not historically a huge focus area for health insurers, has now come to the forefront in todays environment
By answering these three questions, we were able to help our client undertake a serious look at their branding strategy
26
Our branding approach consists of 3 key steps that inform the branding recommendation that we ultimately make for our clients
Competitive
3rd party research was used to understand what terms customers associated with the company Research provided guidance about where work was needed in order to improve brand perception
Analysis
Competitive Analysis provided insight into which brand positions were cluttered and which were untapped, providing insights into potential areas of opportunity from a branding perspective
Underlying needs emerged via market research Understanding which needs are common, shared and differentiating helps determine channels and messaging used for branding
Brand Perception
Needs Research
With the keys to branding firmly in their grasp, our clients are well positioned to better organize the firms operations to help deliver on these brand promises
27
Our 3D Segmentation methodology serves as the tool to gain a more robust, holistic understanding of who the customer is
28
Integrated Customer Segments are depicted with personas to help make the segment more tangible for the organization Illustrative
Young and Mobile
Needs and Behavior This segment is defined by their active, on-the-go lifestyle and attitude towards their health and wellness. Their busy lifestyle and overall high levels of health means that this segment utilizes their health insurance benefits only minimally. When this segment does have the need to interact with their insurer, they prefer to do so via an app or a mobile website. And would prefer to avoid having to speak on the phone with a CSR Young and Mobiles secure coverage from a health insurer most often to provide coverage in the event of a life-changing event
29 years old on average 61% female High level of employment (83% fully employed) High income level (52% have higher than $95 K household income) 76% have earned a Bachelors degree or greater She spends less time on average relative to her peers in other segments reading about health and wellness Value As this segment pays a relatively high monthly premium and only utilizes their benefits on a few occasions per year, this segment is considered to be a high value segment, which on average contribute $922 annually towards gross margin
29
Mapping existing processes from a members perspective highlights experience improvement opportunities
Mail (Out) Mail (Out) Mail (Out) Mail (Out) Phone (In) Phone (In) Mail (In) Web (In) Mail (Out) [7 days after application] An application receipt acknowledgement letter is sent within 7 days Verification contacts are made with all Medicare Advantage applicants (One verification call followed by one letter and two more calls) Welcome to Medicare (6 mons before age 65) BRC to get consent to call Med. Adv. info (3 mons before age 65) BRC to get consent to call Med. Sup. info(1 month before age 65) BRC to get consent to call Reminder (1 month after age 65) BRC to get consent to call During peak periods (Q4 and Q1) call center agents ( Dial America) At othe times sales agents take the inbound calls They first try to schedule home visit If individuals dont take the home visits they intive them to information meetings People can call to enroll by phone People can download, print, complete and mail application forms People can apply online at www.client-medicare.com or www.medicare.gov Acknowledgement letter
A Eligible ? Ye s
Ye s
In Person (Out) BRC (In) Community events SCHIP meetings
Did prospect take a faceto-face meeting?
N o
Did prospect give consent to receive enrollment kit?
N o
Prospective member gives consent to receive a call or preenrollment kit Consent expires after 14 days Filter out sensitive groups (Tenn rural health, fed gov. or sensitive broker accounts)
client contacts prospects who provided consent for calling Phone (Out)
Ye s
Mail (Out)
Mail (Out)
Broker or Captive Staff (Out) Sales agent try to call within 24 hours They first try schedule home visit If individuals dont take the home visits they intive them to information meetings
Direct Mail Marketing Campaigns: They target ail individuals older than 65 Use both internal and external data
Denial Letter: An application rejection notice is gets sent to applicant Prospect applies
D2
Face-to-face sales call
Pre-Sales Call D1 BRC is manually keyed in to the CRM tool
Mail (In)
D3
Print (Out)
Drivers License Data
Newspaper ads
Applic ation Data
Enrollment Kit: Summary of benefits Automatic bank draft form Application form Rx drug coverage Education material on PFFS plans
Dep. of Motor Vehicles DB
Medicare CRM Tool
SalesLogix
Mail (Out)
Web(In/Out)
Call (Out)
Call (Out)
Mail (Out)
Mail (Out) [???]
Mail (In)
Mail (Out) [Before the effective date]
Mail (Out) [Within 10 days of effective date]
Phone (Out) [Approx. 30 days after effective date]
In Person (Out)
Quarterly Newsletter Originally a compliance tool Moving away from product newsletter towards a Medicare newsletter May need separate versions for Med Adv. vs. Med Sup.
client-medicare.com: BlueAccess Personal Health Manager (PHM)
Automated preventive calls: Annual exam and flu shot reminders Gaps in care reminders based on analytics Scripts are tailored for different seasonal initiatives
Nurses reach out to members to enroll them in DM or CM programs
Medical EOB Sent after every claim is made
Health Risk Assesment (HRA): Mail includes directions about how to do the HRA online or using customer service
Healthcare Handbook: When the member completes the HRA, she receives a Healthcare Handbook The handbook is positioned as an incentive
New Member Socials: They kick off on 1st of Feb ID Card Welcome Pack: Confirmation letter EOC Summary of benefits PHI opt-out info Provider directory Pharmacy directory Formulary Advanced directives Mail-order pharmacy info Welcome Call: Make sure member received everything thats been sent Answer questions Great retention tool to keep member from switching in the January change period Let member know that she can give permission to speak on her behalf by sending a letter Verbal permission is good only for 14 days Tell about: client-medicare.com Customer service # Billing information
Mail (In) Mail (Out) Member completes HRA EOB for Medicare Part D Sent monthly to members who subscribed to the MAPD program
D4
Phone (In)
Welco me Call
Member completes HRA
Phone (Out) Web (In)
Member completes HRA
Member doesnt complete the HRA.
Health Risk Assesment (HRA): If member doesnt respond then call them to complete the HRA CMS requires HRA to be compeleted within 90 days of coverage
D5
Claims, current conditions, data from HRA, demographic data and other 3rd party data about the member are used to identify gaps in care and members may be referred to DM or CM.
HRA Data
Care Advance Facets MEDai Care Advance
Facets/SalesLogix
30
Redesigning the critical onboarding phase yielded member experience improvements, insurer cost savings, and greater employer satisfaction
Pre Enrollment
1 Contact Us 3 Online Demo 5
Enrollment
Enrollment Data Capture
(web)
Post Enrollment
7 Welcome Kit
(paper)
ID Card Mailer
11
Welcome Call
Posters, postcards, that ask member/prospect to call a consumer advisor with any question or experience BCBSX Blue Access with online demo
Provides an overview of insurance 101 topics, demonstration of online tools and resources. For existing members it provides an opportunity to configure your relationship
Modify online enrollment to ask a small number of additional questions to enable BCBSX to communicate with them in relevant ways.
Redesigned kit focused on welcoming members, informing them about their plan, referencing EOC and other materials online, educating about blue perks, and reminds them to register online
Personalized mailer with welcoming tone, personalized by name, lists family members, contains location based health suggestions (gyms, hospitals, clinics,), and reminds them to register online
Personalized welcome call based on info from online registration process and disease mgmt. / wellness segmentation. Purpose is to educate, welcome, and help with health issue
Value Statement
Call a Consumer Advisor
Enrollment Data Capture

(paper)
Welcome Kit
(email)
10
Configure Your Relationship
12
Email Newsletter
(quarterly)
Existing Members Only: Personalized mailer to thank the member for their membership, summarize health activity, point out gaps in care
Call a consumer advisor with questions about plan, general insurance questions, etc. For existing members we use as a chance to path them into wellness or disease mgmt.
For paper enrollment, modify forms, or provide an additional form, to enable BCBSX to collect data to communicate with the member in relevant ways
Redesigned kit focused on welcoming members, informing them about their plan, referencing EOC and other materials online, educating about blue perks, and reminds them to register online
Improved Blue Access Registration Process. This is a key interaction where members can tell us how they want to be communicated with by BCBSX
Personalized quarterly email newsletter with the standard and personalized content to inform member and provide key messages based on health status
31
A Value Map drives decision making on current and existing services and offerings by putting customer-based initiatives into financial terms
Value Map Description
Analytical Tool/ Framework
The Value Map utilizes the concept of consumer value to determine the financial feasibility of a consumer initiative
"Get-Keep-Grow framework
Using Peppers & Rogers Groups Get-Keep-Grow framework, the map outlines how specific initiatives, such as decreasing the number of claims, connect to consumer value, and what the appropriate metrics are to measure progress for each initiative It is helpful when deciding which initiatives to prioritize while giving a rough estimate on possible ROI for taking initiatives through to implementation
Prioritization
32
Although based on a fixed framework, the Value Map expands and flexes continually to ensure that all potential initiatives can leverage it Illustrative
33
Why a Roadmap?
Customer Centricity is a journey, not a project In fact, most clients journey will take approximately 24-36 months until they complete the full roll-out and implementation of the Roadmap recommendations
PRG created a Roadmap to help serve as a compass as our client continues onto the next stages in their journey
34
The Roadmap serves as a project plan to guide clients on the implementation phase of their journey
Duration: The Roadmap covers a 3-4 year time period
Individual Recommendations: Each item is sequenced based on the difficulty, priority and dependency on other items that must be completed prior to focusing on a recommendation
Legend: Recommendation items have been color-coded to help easily distinguish between pilot programs and full recommendations
35
Lessons Learned
Support from executive leadership Managing the organizational appetite Handling the resistance that will crop up Involving the support functions Communicating with all levels Evaluating the business impact Separating opinion from expertise
36
Q & A Session
Marc Ruggiano
Elizabeth Glagowski
37
PRG Healthcare Practice Activity

1. Download our white paper on a consumer-centric transformation
Click on the bottom right button in the presentation screen
2. Peppers & Rogers Group Healthcare Webinar Series

If youve missed any installments in our Healthcare Webinar Series, view the archives at http://www.peppersandrogersgroup.com/healthcare
3. Continue the conversation with Peppers & Rogers Groups Healthcare experts with our new LinkedIn Group CustomerCentric Healthcare
Join today at http://linkd.in/KPXUv5
4. Follow us on Twitter @PeppersRogers
5. Visit us on Facebook.com/PeppersandRogersGroup
38
Q & A Session
Marc Ruggiano
Elizabeth Glagowski
39
Marc Ruggiano Partner mruggiano@peppersandrogersgroup.com +1.203.989.2189 (office)
Tom Schmalzl Director, Business Development tschmlalzl@peppersandrogersgroup.com +1.203.989.2208(office)
40

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Laying the Foundation for a Customer-Centric Organization

Customer Centricity in Healthcare

COPYRIGHT 2012 ALL RIGHTS PROTECTED AND RESERVED.

Partner, Peppers & Rogers Group

Executive Editor, Strategy Peppers & Rogers Group

COPYRIGHT 2011. ALL RIGHTS PROTECTED AND RESERVED.

Download a PDF of todays slides

Have a question for the presenters?

COPYRIGHT 2011. ALL RIGHTS PROTECTED AND RESERVED.

The Case for Trusted Relationships

Peppers & Rogers Group Client Examples

COPYRIGHT 2012. ALL RIGHTS PROTECTED AND RESERVED.

The Case for Trusted Relationships

COPYRIGHT 2012. ALL RIGHTS PROTECTED AND RESERVED.

US Healthcare Spending Leads OECD

Total Health Expenditure, Per Capita (PPP adjusted dollars)

While Life Expectancy Lags Considerably

Life Expectancy at Birth, Total (Number of Years)

and Consumers Rate the Experience Poorly

Customer Experience Index (CxI) by Industry

Source: Forrester Research, The Customer Experience 2012

Health Visual Definition

the general condition of body and mind

a healthy state of wellbeing free from disease

Source: ThinkMap Visual Thesaurus, 2011

Care Visual Definition

Source: ThinkMap Visual Thesaurus, 2011

Consumers Define Health in Many Ways

Source: Peppers & Rogers Group research

Consumer Perception of Todays Health Insurers

Source: Peppers & Rogers Group research

Consumers Describe the Ideal Health Insurer

Source: Peppers & Rogers Group research

Source: Peppers & Rogers Group research

Source: Peppers & Rogers Group research

Customers Trust in the Health Insurance Sector

Source: Peppers & Rogers Group research

Characteristics of a Trustable Health Insurer

Informative/Uninformative Friendly/Unfriendly Cooperative/Combative Fast/Slow Distrusters

Believable/Unbelieveable Effective/Ineffective Warm-hearted/Cold-hearted Trusters

Customers Trust for Individual Health Insurers

0% Anthem BCBS United Healthcare Aetna Humana Kaiser Permanente

Customers Value Trustworthiness

Peppers & Rogers Group Client Examples

COPYRIGHT 2012. ALL RIGHTS PROTECTED AND RESERVED.

Making the Case for Transformation

COPYRIGHT 2011. ALL RIGHTS PROTECTED AND RESERVED.

Working Sessions Interviews across

Dynamics and Trends Stakeholders Landscape

Consumer Centricity Maturity Spectrum

COPYRIGHT 2012. ALL RIGHTS PROTECTED AND RESERVED.

COPYRIGHT 2012. ALL RIGHTS PROTECTED AND RESERVED.

COPYRIGHT 2012. ALL RIGHTS PROTECTED AND RESERVED.

COPYRIGHT 2012. ALL RIGHTS PROTECTED AND RESERVED.

Young and Mobile

COPYRIGHT 2012. ALL RIGHTS PROTECTED AND RESERVED.

In Person (Out) BRC (In) Community events SCHIP meetings

Did prospect take a faceto-face meeting?

Did prospect give consent to receive enrollment kit?

Face-to-face sales call

Pre-Sales Call D1 BRC is manually keyed in to the CRM tool

Drivers License Data

Applic ation Data

Dep. of Motor Vehicles DB