Placing Customer Centricity at the Heart of Healthcare

A look at how healthcare providers, pharmaceuticals, and health insurers are adapting to the changing customer landscape and evolving their patient experiences

Exerpted Articles From:

©2014 www.1to1media.com 2

As millions of consumers flood the market, the lines between traditional insurance and consumer-

driven insurance plans will begin to blur.

Over time, the number of consumers purchasing healthcare insurance directly from health insur-

ers, or “payers” will continue to grow, including people who currently receive insurance through their

employers but are interested in exploring other options. This transition into the B2C environment will

require payers to adopt a customer-centric business model, reorganizing internally around the cus-

tomer and deploying the necessary solutions to enable the new engagement strategies.

The transition to customer centricity will require three immediate imperatives:

1. Create an omnichannel patient experienceConsumers interact with brands across a variety of touchpoints, starting their journeys on their desk-

tops, moving to their mobile devices, and making their purchases in stores. Healthcare isn’t immune

to this omnichannel trend.

For many organizations, creating a multichannel engagement strategy to reach the omnichannel

customer is an aspiration that few have actually successfully implemented. It requires tearing down

silos and integrating digital channels with physical ones. For industries with traditional business models

and complex systems like healthcare, this is no easy task and requires a new mindset and corporate

culture.

2. Prepare the contact centerAs millions of Americans enroll on Healthcare.gov, they’ll likely encounter a lack of resources such

as informational websites and robust knowledgebases. There will be a significant need for informed

contact center associates who have ready access to information. As a result, contact centers must be

prepared and staffed to respond to these inquiries through regular training, process improvements,

and technology updates like moving to a more agile Cloud model that will allow insurers to easily inte-

grate customer data and enable agents to access information from a central location.

3. Become a trusted advisorIn recent years, rising costs, member engagement, and the complexity of healthcare have earned the

health insurance industry a negative reputation. With millions of new customers flooding the market-

place, insurers must work to shed their unfavorable image.

Perhaps the most important step in becoming a trusted advisor is making oneself completely available

to clients at any time. Prospective customers will be much more at ease if they know without a doubt

that their health insurer is available to help them with any issue that may arise. In insurance, like many

other industries, customers will look for another provider if they feel they’re being ignored or their

questions are going unanswered. Therefore, transparency and trust are critical during this transition.

As a number of industry reports suggest, many insurers are not yet prepared to handle the pro-

jected number of consumers who will reach out about health insurance options. In the pages that

follow, my hope is that the best practices and thought leadership around the customer experience in

healthcare will help accelerate your investments in the customer experience and serve as your guide

on the path to customer centricity.

—Pat McCaffrey, Senior Vice President, Healthcare Services, TeleTech

Forging Healthcare’s Path to Customer Centricity

Executive Overview:

Table of Contents

Executive Overview ............. 2

Healthcare Providers ... 3

Pharmaceutical ............ 5

Health Insurers ........... 11

Conclusion ......................... 18

©2014 www.1to1media.com 3

Can healthcare move past industry restrictions and age-old practices to engage with customers in the new

omnichannel environment?

Cutthroat competition and increased choice have inflated customers’ expectations of good service.

Today’s customers won’t think twice about stopping doing business with an organization that doesn’t

provide them the level of service they expect.

This empowerment means that customers also presume the best from their health providers and health

insurance companies. While changing a health insurer or switching to another doctor isn’t as easy as mov-

ing to a new mobile phone operator, providing a positive experience is especially important at a potentially

stressful time.

Of high importance to patients is the ability to easily and efficiently interact with healthcare organizations

over their chosen channels. According to research by the NCR Corporation, 70 percent of Americans are

likely to choose a healthcare provider that reduces frustration by providing them the flexibility to interact

easily online, over a mobile phone, or through kiosks. Further, 54 percent of respondents welcome the

flexibility to book appointments online, and obtain test results or follow-ups securely on the Internet. The

NCR research found that 43 percent of patients want to manage their personal health information online.

Similarly, in a longitudinal study of healthcare consumers, The 2012 Survey of U.S. Health Care

Consumers: Five-Year Look Back, conducted by Deloitte, stresses that as healthcare consumerism grows,

consumers want greater and better choices and are showing interest in online tools that provide informa-

tion on potential cost of care and insurance, quality, and performance information on both physicians and

hospitals. “Many use online resources for information about treatments and medical conditions and grow-

ing numbers (younger generations in particular) look for technology based solutions such as

monitoring devices, apps, and information from social media,” Deliotte notes.

These numbers shouldn’t come as a surprise. As we highlighted earlier this year,

customers are increasingly looking for ways to self-serve. “As consumers, we have

become comfortable with self-service, and, in fact, now expect to choose when,

where, and how we make transactions,” notes Putting the Patient in Control:

Employing Technology Solutions to Empower Patients, a study by NCR and

the now defunct Center for Health Transformation. “Healthcare must now

respond to the major shift taking place to what is known as e-health or wire-

less healthcare, which involves electronic health information and mobile

channels,” notes Steve Francis, GMC Software Technology’s president and

general manager for North America.

But according to Lou Carbone, founder and CEO at Experience Engineering,

much of the healthcare industry is still stuck in the past and not delivering the

Taking the Pulse of Customer ServiceCan healthcare move past industry restrictions and age-old practices to engage with customers in the new omnichannel environment?

Adapted from 1to1 Media

Healthcare Providers: Articles

Taking the Pulse of Customer Service ................. 3

A Prescription for Patient-Centric Healthcare ...... 6

Demonstrating Competence in Healthcare Through Technological Sophistication ................ 9

The High Touch Culture of the Hospital of the Future......................................... 11

Putting Customer Centricity at the Heart of Healthcare ............................................ 13

Healthcare Providers

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Healthcare Providers

“ People have different means of communication and part of the challenge is making sure that the signal comes across through the noise.”

—Mark Pitts, Director for Data Science, Solutions and Strategy, UnitedHealth Group

experience and service that customers expect and need. “They don’t stitch the experience together, which

is a handover from the industrial age when everything was still siloed,” he notes. Carbone explains that most

of the frameworks in healthcare are built around old-world thinking and business leaders are losing sight of

patients’ needs. “Many organizations are focused on managing the processes rather than the experience.”

Multichannel health serviceWhile patients’ expectations are on the increase, the healthcare industry is being plagued by a shortage

of doctors, apart from the shortage of nursing staff that has been a problem for several years. According

to the Association of American Medical Colleges, nationwide doctor shortages are expected to continue

growing, reaching a 90,000 deficit by 2020. Further, advances in medicine mean that people are living

longer and expecting a better level of care. Therefore, the fewer doctors have to deal with an increasing

number of patients.

To further complicate matters, as with other industries, customers want to access healthcare across

multiple channels. As Mark Pitts, director for data science, solutions and strategy at UnitedHealth Group,

notes, the explosion of different modes of communication is one of the challenges faced by the healthcare

industry. “People have different means of communication and part of the challenge is making sure that the

signal comes across through the noise,” he says. In fact, with so many interactions across different chan-

nels, it is at times difficult for organizations to understand exactly the message that customers are trying to

deliver. “It can be a challenge to find the needle in the haystack,” Pitts says.

As Deloitte points out, “multichannel information strategies will be necessary to reach consumers in a

marketplace that is fragmented with multiple opportunities, resources, and information streams for con-

sumers to use to access information and facilitate decision-making about the healthcare they consume.”

Further, different age groups have different media preferences and utilization behavior, making it neces-

sary for healthcare organizations to take these differences into account. “Emerging media formats, tools,

and apps offer consumers—particularly younger generational groups—considerable opportunities to use

online resources and social media for motivation and health goal tracking, wellness, information gather-

ing, support, and encouragement,” Deloitte argues. And, as Ken Epstein, vice president of global sales

and marketing at C3/CustomerContactChannels, points out, older generations are becoming more accus-

tomed to new service channels like email and mobile and are expecting organizations to facilitate such

interactions. “The adoption of technology based services will increase because baby boomers are more

comfortable with them,” Epstein says.

John Sung Kim, CEO of DoctorBase, notes that patients are expecting to connect with their physicians

in the same way they communicate with other organizations, with mobile communications leading the way

and patients wanting to interact with physicians even via text messages. Dr. Adrienne Lara, who heads the

Celebrating Women Center, has experienced this move first hand. “Most of my patients are now buried

in their phones,” she says, adding that they’ve also become less tolerant about getting answers to their

health questions. “They expect immediacy,” she notes. Lara was receiving multiple calls, emails, and even

faxes from patients who needed their questions answered. Two years ago Lara implemented DoctorBase’s

mobile messaging, which allows patients to communicate with Lara over their mobile phones through short

messages and allowing them to attach photos. By allowing patients to communicate with her over their

preferred channels, Lara is able to respond to their questions in the way patients want.

The Mayo Clinic has also recognized the importance of leveraging mobile technology and last year

launched a comprehensive health app to provide patients and consumers access to health information and

management tips from Mayo’s website and online publications as well as clinical trials and even links to

request an appointment at several locations.

However, experts argue that much of the healthcare sector is still lagging behind when it comes to

investing in new customer service channels. “It’s difficult not to realize that customers are using multiple

channels,” notes Jeanne Bliss, founder of Customer Bliss. While healthcare business leaders understand

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Healthcare Providers

this need for multichannel service because they encounter it in their lives, they are still finding it difficult to

provide a seamless multichannel service. One challenge, Bliss explains, is that data wasn’t originally built

to be connected across different channels, giving a disconnected view of customers.

Another challenge affecting, healthcare are the restrictions on operating amidst tight regulations and

many organizations are apprehensive to be completely transparent with customers because of them. But

Bliss notes that it’s still possible to abide by regulations while at the same time focusing on improving

patients’ lives. She refers to the Mayo Clinic’s app as a shining example. “The companies that are trying

to make simple interactions are being heralded,” she notes. GMC’s Francis highlights the importance of

providing patients with the opportunity to interact with healthcare organizations over the channel of their

choice “assuming it meets compliance.”

Preempting patient needsForward-thinking healthcare providers and insurers don’t just react. Instead, these companies are taking a

pivotal role in understanding patients’ needs and trying to preempt problems and stop them from happen-

ing. UnitedHealth Group’s Pitts notes that data is integral to understand members’ needs and deliver the

service and experience that they need over the channel of their choice. Blue Cross Blue Shield of North

Carolina is one such organization that’s leveraging data to gain a 360-degree view of patients, allowing

the insurer to help healthcare institutions provide the best care for its members. Daryl Wansink, Ph.D., the

insurer’s director for health economics, notes that the organization is using a number of predictive models

to determine the risk of adverse events, helping hospitals reduce the number of readmissions and helping

patients lead a more healthy life.

One challenge that healthcare providers face is lack of data about their patients. If, for example, a patient

has been admitted to another hospital recently or has seen a primary care physician shortly before admis-

sion, hospitals don’t always have access to this information. Because Blue Cross Blue Shield of North

Carolina has a more holistic view of patients, the insurer is able to give additional information to treating

hospitals. “We are trying to determine the likelihood of people needing hospitalization in order to better

coordinate with their doctors,” Wansink says. The near real-time readmission models alert the insurer

when a high-risk patient is receiving treatment, allowing the insurer to contact a nurse or case manager

who will work with hospital staff to make sure the patient receives the care she needs. This is not only a vic-

tory for patients who receive the treatment they need, but also for hospitals that can avoid readmissions.

These advanced companies are the ones that are really understanding their patients and then building all

their systems surrounding their patients’ needs. “Start with understanding the customers’ lives and then

translate that into the different channels,” Bliss says. g

“ The companies that are trying to make simple interactions are being heralded.”

—Jeanne Bliss, Founder of Customer Bliss

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Healthcare Providers

Stephen Bonner, president and CEO, of Cancer Treatment Centers of America, shares some of his organi-

zation’s strategies for fostering innovation throughout CTCA’s network of hospitals.

Great healthcare doesn’t happen by accident; it must be designed around the concept of providing the

best care possible for patients. Rising costs and constricting regulations often stymie progress. Today,

successfully implementing a patient-centric approach requires leadership who not only have innovative

visions for their organizations, but who also have the tools, processes, and the environment in which to

implement them.

When centered on innovation, healthcare providers anywhere in the world can operate successfully,

exceed financial goals, and deliver patient expectations. Cancer Treatment Centers of America is one

healthcare organization that has implemented several enterprisewide innovative practices for listening to

its customers, empowering employees, and rewarding them for meeting customers’ needs.

Here, Stephen Bonner, president and CEO, shares some of the strategies his organizations uses for

fostering innovation throughout CTCA’s network of hospitals.

1to1 Media: Cancer Treatment Centers of America has an innovative patient-centric approach to cus-tomer experience design based on listening to customers’ needs. How did this strategy come about and why is this unique in the healthcare industry?

Stephen Bonner: CTCA was founded by Richard J. Stephenson after his own mother died following an

unhappy, disempowering experience in healthcare. No one in healthcare was listening to her needs. And if

they were, they certainly weren’t responding. To fill the void, Richard created CTCA and he wired our DNA

to think, “only and always about the patient.”

CTCA stands apart from the crowd because of the extensive, fundamental structures and processes that

focus onpatient and caregiver needs, compared to the conventional approach that pushes the patient out

of the decision-making process. If patients are not free to choose, all of the normal forces that drive quality

up and prices down are unable to discipline the healthcare market. No wonder those forces are absent in

most of healthcare today.

1to1 Media: Your company’s network of six hospitals has established a doctrine at the core of its opera-tions called Patient Empowered Medicine. The philosophy encourages physicians, clinicians, and all CTCA stakeholders (i.e. employees) to empower patients to take an active role in their treatment. How do you continuously refine your processes and services to meet patients’ needs, expectations, and preferences?

SB: We listen to our patients and constantly recalibrate ourselves to what they want from their healthcare

experience. Our overarching guidance for CTCA is to pursue the “Mother Standard of Care,” a simple

objective to provide what you would want your own mother to have in every patient experience. We know

that cancer is a dynamic disease and the needs of our patients are constantly changing. We are voracious

in our desire to hear from the people we serve. We never start a board meeting without having a patient

tell us how we are doing; we conduct focus groups weekly with patients and caregivers in every CTCA

hospital; and we conduct surveys on the patient experience in every hospital every day as well. All patient

feedback is reported at the board level, including the action that was taken by our team to respond. It is

amazing how much we learn by remembering that we are not the customer, and only they can really shape

A Prescription for Patient-Centric HealthcareStephen Bonner, president and CEO, of Cancer Treatment Centers of America, shares some of his organization’s strategies for fostering innovation throughout CTCA’s network of hospitals.

Adapted from 1to1 Media

“ We listen to our patients and constantly recalibrate ourselves to what they want fron their healthcare experience.”

—Stephen Bonner, President & CEO, Cancer Treatment Centers of America

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Healthcare Providers

our business and our future. Those processes allow us then to clarify what each patient needs and wants

and to give them the information they need to shape their care and to empower them to make the key

decisions about their care.

1to1 Media: In your organization, all stakeholders—even housekeeping—are empowered to spend time with patients to build relationships with them and to listen to them during the course of their visit to ensure that CTCA is meeting their needs. Why is listening such a critical element to ensuring the delivery of optimal customer experiences and in what ways do your employees act on that information?

SB: One of our favorite concepts is “Wisdom Medicine,” a holistic and embracing model that acknowl-

edges that cancer is so much more than a tumor. Cancer affects the entire life of the patient and also of

their families and friends. Wisdom Medicine begins with listening. Listen to what the patient is telling you,

as no one knows better than the patient about what they desire. Then act. There are so many amazing

examples of CTCA stakeholders (what we call our employees) going above and beyond for our patients.

This can be as simple as always remembering the extra blanket a patient prefers when getting their che-

motherapy, or as extravagant as one of our stakeholders taking a blind patient who loved baseball but

had never been to a game before, to a Philadelphia Phillies game and giving him the verbal play-by-play.

We call each interaction with a patient a “moment of truth.” A moment to show them we don’t just talk

the talk, but truly care about them and offer them hope.

1to1 Media: Listening may be one of the keys for Patient Empowered Care to work effectively, but lis-tening is nothing without the ability to act on the knowledge. All stakeholders at CTCA are empowered to do so through training and through a culture that rewards innovation and encourages development. What’s your advice to companies who fail to deliver performance reviews, reward positive behavior, or foster innovation?

SB: Do it! Or you’ll be forced out of the game. We believe our success is completely driven by the talent

of the individuals we employ. In fact, great talent is probably the single most limiting factor to continued

growth, particularly in a field like healthcare. You must recognize good talent wants to be a part of a culture

where they are free to innovate, grow, make an impact, and encourage and recognize their contributions.

They want to make a difference; they are closest to the patient at each Moment of Truth, and they will

work with each patient to make the best decision and to implement it. That adds to speed, quality, patient

loyalty, and to better outcomes.[

1to1 Media: Does your culture of innovation come from the top down and if so, why is that important to the success of building a patient-centric environment?

SB: At CTCA innovation comes from everywhere—bottom up, top down, inside out, and outside in. We

recently launched an “Ideas Marketplace,” which is an online tool where any CTCA stakeholder can sub-

mit an idea they think will improve the patient experience directly or indirectly help those who help our

patients. Submitted ideas are vetted by an innovation committee and resources are allocated to support

stakeholders to act on their proposals.

We also have an annual strategy review meeting with our executives where we identify three to five key

strategic objectives to pursue. These objectives are then communicated to the enterprise, equipped with cross-

functional teams, timelines, and resources. One key to success in innovation is having the ability to know that

innovation can come from anywhere, and we empower individuals to make it happen with a lot of authority and

accountability. This will move the culture forward most effectively. It will also create a great place to work, and

it will put cancer on the run, since the culture and the talent will be more dynamic than the disease.

1to1 Media: In addition to training, it’s also important to ensure that the employees are following up on the information collected and they’re aligned with corporate in delivering on the brand promise. In keeping with that, each of your hospitals hosts a 15-minute daily alignment meeting that reiterates through various themes the mission and values of the organization. How does this help all stakeholders

“ You must recognize good talent wants to be a part of a culture where they are free to innovate, grow, make an impact, and encourage and recognize their contributions.”

—Stephen Bonner, President & CEO, Cancer Treatment Centers of America

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Healthcare Providers

in CTCA gain inspiration and to provide continuous value for patients?

SB: This daily interaction promotes a transparent culture and builds relationships as we share success

stories, updates, and take a few moments to focus ourselves on our mission to serve cancer patients. It lets

us review Mission, Vision, and Values each day with every Stakeholder. Our team does amazing work every

day, and it’s important to take the time to recognize our wins and celebrate them…quickly.

In addition to cultural alignment to the mission, CTCA also believes that efficiency measures should be

tied to every process. Stakeholders from every department are offered the opportunity to attend Six Sigma

classes and earn a green belt or black belt. They’re then encouraged to adopt or launch a project or pro-

cess in CTCA that supports CTCA’s mission.

1to1 Media: This is very innovative. Can you explain the genesis of that idea and how the program has helped spawn innovations within CTCA?

SB: We know there is enormous waste in healthcare, and at CTCA we recognized that very early on. There

were huge opportunities to increase efficiencies in our own system, but to try and implement that in a top-

down strategy would never work. We knew that our stakeholders could better identify the opportunities to

decrease waste, and we wanted to empower them to take on these initiatives themselves. So we imple-

mented a Center for Learning, the only of its kind we know in healthcare, and encourage all stakeholders

to attend Lean Six Sigma courses. These facilitated classes teach how to identify, measure, and eliminate

waste from our system.

Since implementation, more than 1,900 CTCA stakeholders have been trained.That’s nearly one of every

two stakeholders. In the last year alone, 282 Lean projects were completed, 152,948 hours of patient wait

time was eliminated, and more than $76 million of total revenue impact was realized. That is $76 million we

can reinvest in patient care and innovation, and an infinitely wiser use of our scarce resources.

1to1 Media: CTCA’s Net Promoter Scores of 95 or above are proof that the innovation model works; a score of 80 is considered to be world class. What do you attribute to your world-class score?

SB: It’s our people and our continuous tuning of the culture to support them, all in the spirit of the Mother

Standard of Care. CTCA has a very particular talent acquisition process for all levels of the organization. In

fact, when we opened our most recent facility in Georgia we screened more than 20,000 applications for

only 180 positions. Further, when we open a new center at least one-third of the team has to come from

existing CTCA facilities to infuse our patient-centric culture. Talent will always be a key to success in a

customer service organization.

1to1 Media: How do you plan to evolve the customer-focused strategies that are in place and to con-tinue to foster innovations at CTCA?

SB: The patients will guide us and tell us what they value in their healthcare experience, and we will evolve

to their demands. In fact, we are currently sponsoring a project through the National Patient Advocate

Foundation to conduct seminal consumer research to create an index of what patients truly value in their

oncology experiences. The ultimate goal is for all oncology providers to populate this index with their data,

and once they do, consumers will have the JD Power of oncology care where they can go to compare

providers when selecting where to treat. Actually, we are looking for partners who are interested in this

research to join us and encourage anyone interested to reach out to us or the NPAF for more information. g

“ The patients will guide us and tell us what they value intheir health-care experience, and we will evolve to their demands.”

—Stephen Bonner, President & CEO, Cancer Treatment Centers of America

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Healthcare Providers

Trust is a critical element for establishing and maintaining strong, lasting customer relationships. It’s also

something that most payers seem to be lacking with consumers.

When examining the healthcare industry, it’s important to separate payers (healthcare insurers) from

practitioners (doctors, nurses, technicians, etc.). In contrast to payers, practitioners are on fairly solid

ground with respect to the two building blocks for trust: intent and competence. Most people do trust a

doctor or nurse to have patients’ best interests in mind when they’re being treated, and the majority of

practitioners are ethical and trustworthy.

In addition, most practitioners appear to go out of their way to take care of their patients. Sure, it may

be a good living, but you don’t become a doctor these days to become wealthy, at least not the way the

current healthcare system is organized. Unless they’re part of a larger medical group, most physicians

have to book a certain number of appointments each day simply to cover their costs. And getting a medi-

cal practice up and running is an extremely expensive undertaking when you factor in the costs of medical

school, malpractice insurance premiums, etc.

Consumers’ opinion of payers, however, is less charitable. Health insurance carriers and other financial

participants in America’s convoluted healthcare industry are viewed as far less trustworthy than provid-

ers. For instance, few consumers would say that a payer has their best interests at heart when it comes

to treating them for medical conditions. Rightly or wrongly, many consumers would be of the opinion that

payers are more concerned with keeping costs down and profits high for their organizations, rather than

providing the highest quality healthcare.

Technological CompetencyOn the other hand, when it comes to competence, payers have definitely made some inroads through their

use of technologies and automated processes, and the convenience and efficiency of these new technolo-

gies cannot help but improve the image and trustability of payers in consumers’ minds.

For instance, most health insurers now offer friendly and easily accessible service via online access or

contact centers. In addition, payers have helped usher in the movement to electronic prescription fulfill-

ment, a practice that has led to greater efficiency and fewer errors, both of which benefit consumers.

Still, there are additional automation practices that, if implemented, would improve customers’ experi-

ences with practitioners, and payers could enhance their own image with consumers by spearheading

efforts to make these improvements.

Calling for carePhone service is a perfect example. When was the last time you received any medical advice from your

doctor by phone? In every other service industry, consumers can obtain at least a modicum of advice

by phone. And while we all recognize the necessity for a physician to see and touch a patient in order to

provide the best possible care, the simple fact is that many problems could easily be resolved by phone,

including routine medical problems.

But you can’t get phone advice from a doctor today, largely because phone advice isn’t reimbursed by

payers to physicians. If doctors aren’t reimbursed for phone time with patients, you can’t expect them to

Demonstrating Competence in Healthcare Through Technological SophisticationAs the healthcare industry continues to evolve and shift towards a more open and competitive model, this presents terrific opportunities for practitioners and payers to strengthen their relationships with customers.

Adapted from 1to1 Media, By Don Peppers and Martha Rogers, Ph.D.

“ When it comes to competence, payers have definitely made some inroads through their use of technologies and automated processes, and the convenience and efficiency of these new technologies cannot help but improve the image and trustability of payers in consumers’ minds.”

— Don Peppers & Martha Rogers, Ph.D., Founders, Peppers & Rogers Group

©2014 www.1to1media.com 10

Healthcare Providers

make the time. Good physicians will often get on the phone anyway, of course. That’s what good doc-

tors do -- they go out of their way to help their patients. But there’s no organized system for making this

channel available to consumers. A truly competent healthcare company, interested in providing the best,

most efficient healthcare to consumers might want to launch a pilot project to provide medical advice to

customers either via telephone or even online -- without cutting the consumer’s own doctor out of the

equation, of course.

21st Century medicineAlso, when was the last time you used a fax machine? Even if you’ve used one in the past several months,

you probably didn’t use it more than once or twice. But doctors and their offices use fax machines all the

time. It’s a terribly antiquated and inefficient way to communicate with people. It’s one of the reasons the

federal government is offering physician groups, clinics, and hospitals millions of dollars in financial incen-

tives to adopt electronic health records (EHR). Not only are EHR systems more efficient and cost-effective,

they also are safer and less prone to error, and they are vital for helping physicians communicate with

hospital administrators about a patient’s medical history if they’ve been brought into an emergency room

for treatment.

The use of electronic medical records also syncs with consumer preferences. According to a Gartner

study, the use of mobile phones, sensor technologies, portable medical devices, and wireless health appli-

cations are expected to play a greater role in connecting patients with providers over the next five years.

It makes sense for both practitioners and payers to consider the different communication channels and

techniques that customers prefer to use to connect with them.

In the future, automation may also enable healthcare providers to reach out to customers in a more

proactive manner. Imagine a sensor or chip in your body that monitors your respiration, heart rate, liver

output, blood sugar, etc. And when you have a problem, healthcare practitioners contact you, the same

way GE contacts an airline when a sensor on one of their jet engines indicates wirelessly that it needs to be

serviced. That type of proactive service is an invaluable way to build customer trust and solidify relation-

ships in the moment, and over the long term. g

“ In the future, automation may also enable health-care providers to reach out to customers in a more proactive manner.”

— Don Peppers & Martha Rogers, Ph.D., Founders, Peppers & Rogers Group

©2014 www.1to1media.com 11

Healthcare Providers

When pressured by competition, a slumping economy or consumer demand, companies in far-flung indus-

tries - from retail, to manufacturing, to finance - have learned to rebuild their cultures around the customer

experience, focusing on service as a differentiator and the goodwill, brand loyalty and positive halo effect

that often follows.

Now, it’s healthcare’s turn.

Engaging in a dialogueIn the face of the Affordable Care Act, the hospital of the future will learn how to speak the language of

marketing and sales and create a high-touch customer experience. Customer-centric exemplar organiza-

tions such as Zappos, Starbucks and Ritz-Carlton can provide useful lessons. How did these popular,

category leader brands create their consumer-focused cultures? How do they generate word of mouth,

customer loyalty and repeat business?

For starters, they ‘ve created an outside-in culture that actively engages con-

sumers in meaningful dialogues that embed a highly memorable and talk-worthy

experience associated with the brand. For payers and providers, it’s not just a

matter of having patients fill out satisfaction surveys. It’s about creating a sense

of urgency around engaging and pleasing patients throughout every step in the

care process.

Successful brands don’t ever rest on their laurels, but continuously engage con-

sumers at every possible touch point in a personal, customer-centric way.

Cleveland Clinic famously built a brand around the patient-centric culture they

created. The resulting world class experience touches on patient access (intake

request processing, patient information capture, payer communications); care

planning (practitioner input coordination, treatment plan coordination, cost and

revenue estimates); and revenue cycle management services (patient access

including scheduling, pre-registration, admitting; service documentations includ-

ing charge capture and health information management; revenue management

including claims, reimbursement, collections, denials). Marketing professionals at the Cleveland Clinic look

at each and every aspect of the patient experience so that the clinic’s leaders can manage daily operations

and personnel to assure the best possible customer experience. No surprise, it gets people talking - and

returning when they need care in the future.

Cleveland Clinic puts patients first. Every employee - from surgeons to cafeteria workers - have the word

“caregiver” on their name tags. Cleveland Clinic was always respected for its clinical outcomes, but today

it is also respected for its service outcomes thanks to its patient-centered culture change. The key is a

highly engaged workforce. Engaged employees know what’s expected of them, they have the resources

they need, they’re recognized for their performance, supervisors encourage them, they feel that their work

counts, they have opportunities to develop and they believe that the organization’s mission is important.

Following the Cleveland Clinic’s example, the hospital of the future will do a better job than today’s

institutions at keeping patients informed so that they are more familiar with the processes and caregivers.

The hospital of the future will understand that patients are now consumers and will increasingly make con-

sumer choices regarding their healthcare. The hospital of the future won’t only provide excellent care, but

it will know how to communicate about that care, how to capture patient input and needs and use these to

The High Touch Culture of the Hospital of the Future

Adapted from Strategy Speaks, the Peppers & Rogers Group Blog

©2014 www.1to1media.com 12

Healthcare Providers

retain current patients and attract new ones. It will provide real-time customer service, enabling patients to

provide feedback regarding doctor/nurse response time, care and hospital accommodations. It will likely

offer enhanced personalization such as walk-in clinics (as an alternative to ER visits), coaching and patient

advocacy, in-room Netflix streaming and other amenities. After all, competition will be steep.

Generating word-of-mouth buzzThe going won’t be easy. There will be increased complexity around recruiting and hiring, performance

management, Medicare and Medicaid, and virtually every patient touch-point along the way. It will require

new training, new methods of patient education (such as e-Learning modules) and perhaps a few personnel

changes because not every employee will be suited to work in a service-focused culture. These complexi-

ties will lead to cost and quality challenges. There will be casualties, just as there are in other industries.

On the other hand, new efficiency models are being applied at leading healthcare organizations - with

dramatic results. Most experts agree there’s no panacea, but a combination of preventive care, cost cut-

ting via provider payments, more patient participation, more young people on insurance rolls and improved

efficiency models.

Some solutions will be low-tech, such as basic waiting room and ER redesign, and capturing patient and

family opinions for use as word-of-mouth advertising. Beyond that, hospitals must begin to think about

themselves as marketers. Some marketers at hospitals think they are doing it right. But are they collecting

data, getting patient experience feedback, doing surveys, developing case studies and measuring results?

The efforts should be methodological, scientific and constant.

Face-to-face communication still works. It drives decision-making. The hospital of the future will figure

out how to capture and analyze patient satisfaction, how to create meaningful content and how to generate

word-of-mouth marketing based on a customer-centric culture.

Ultimately, the hospital of the future will thrive because of relationships, not advertising. Customer-

centric organizations engage their customers in deep and meaningful dialogue, the fruits of which provide

the direction needed to build a culture around great service outcomes. So it is with the consumer-centric

retailers of today, and so it will be with the patient-centered hospital of the future. g

“ The hospital of the future will figure out how to capture and analyze patient satisfaction, how to create meaningful content and how to generate word-of-mouth marketing based on a customer-centric culture.”

— Don Peppers & Martha Rogers, Ph.D., Founders, Peppers & Rogers Group

Healthcare Providers

Healthcare is a necessity for most people at some point in their lives. This is, perhaps, the reason why

health organizations, ranging from insurers to pharmaceutical companies, historically haven’t put customer

centricity among their highest priorities.

But, a changing landscape is putting pressure on healthcare organizations to introduce customer-centric

strategies. This paradigm shift is partly due to the fact that in the not-so-distant future, consumers will be

forced to play a much greater role in their healthcare decisions. Not only is healthcare reform in the United

States promising to change the way we think about health services—from doctor’s visits to prescription

medicines—but we’re seeing changes in the way such services are being financed.

Together with increased choices, customers are now responsible for managing and paying a bigger part of

the medical bill. These trends lead to a more discriminating customer who is looking for organizations that pro-

vide the best value, the best support for achieving their health-related goals, and the best overall experience.

As customers feel more in control of their healthcare choices—whether it be their health insurer or policy,

their physician, or the medications they take—they are looking for partners in the businesses they interact

with. They are looking for healthcare companies they can trust to help them get or remain healthy, and

understand and manage their healthcare-related spending. These organizations have to battle longstanding

perceptions that might not always be correct. Health insurers, for example, have traditionally been seen as

penny-pinching businesses more interested in saving money than promoting health. Pharmaceutical manu-

facturers may be perceived as very rich companies charging too much for their products and more interested

in their bottom line rather than helping patients get better. Even though these perceptions aren’t entirely

true, healthcare organizations are working hard to change their customers’ minds and be considered trusted

partners in consumers’ endeavors to remain healthy or treat and manage long-term illnesses and conditions.

For healthcare companies to become truly customer-focused, they have to focus on customer data,

make sure their operations and processes have a customer connection, and ensure that their people are

customer-focused. These three elements will help them build a customer-centric DNA. Health insurers in

particular will benefit from adopting this view of customer centricity.

Maximizing data for patients’ best interestsThe health insurance industry is bombarded with tremendous amounts of data, especially since every

interaction with a health-related service is documented. This gargantuan amount of information is both

a blessing and a curse for health insurers. Mountains of data can help organizations understand how a

product impacts a person’s health and a doctor’s effectiveness, for example. It can also track the impact

of insurance programs on a member’s health.

However, in many cases, data exists in different silos that are, because of regulatory reasons, nearly

impossible to connect. Different physicians, for example, will have a small slice of data about the health of

their patients rather than a holistic picture. Or pharmacies, even those that are part of the same chain, only

have access to medications bought from a particular location by that patient. This makes it extremely hard

for the healthcare industry to get a full view of consumers.

We believe that it’s imperative for each of these organizations to make the most of the data assets they

already have and aggregate the information available, organizing it per individual consumer across multiple

©2014 www.1to1media.com 13

Putting Customer Centricity at the Heart of HealthcareAs customers become more involved in choosing and paying for health insurance and other health-related products and services, the healthcare industry is under increased pressure to become customer-focused.

Adapted from Customer Strategist Journal

“ For healthcare companies to become truly customer-focused, they have to focus on customer data, make sure their operations and processes have a customer connection, and ensure that their people are customer-focused.”

©2014 www.1to1media.com 14

Healthcare Providers

departments, and analyze it to mine insights. United Healthcare, for example, is crunching the numbers

and turning data into tangible information that can help its members better manage their health, creating

blueprints for personalized solutions for its members based on their individual health. It’s been so success-

ful that it has broadcasted its results in recent television ads, showing how the organization is using health

data to help patients manage their asthma or diabetes, for example.

This, however, is only a first step. Industry leaders need to examine the way current healthcare regula-

tions restrict them in making the most of their data assets, and should define solutions that will allow them

to better integrate data to be able to offer a better service to their consumers. Then, they need to take a

stand with regulators and lawmakers by presenting hard facts on how a 360-degree view of their consum-

ers will help health insurers and other healthcare organizations do what’s best for the population.

Putting the customer at the centerOrganizations that prioritize their customers easily differentiate themselves from their competition.

Unfortunately, most healthcare companies are not organized in this way. Most have a product-centric

focus. Many health insurers, for example, are made up of product or service divisions with very little vision

into how the various departments holistically interact with and impact patients.

The goal should be for the healthcare industry to completely shift from its current product-centric focus

and instead organize itself around customer groups. The first step out is for companies to morph into ones

that look at customer segments and examine the impact that their products or services have on these

groups. For example, a pharmaceutical manufacturer might recognize that patients who have been pre-

scribed a particular drug are highly likely to be taking another medicine.

Connecting products around customer groups or even individual customers will reveal insight that will

allow healthcare companies to interact in a more timely, relevant, and efficient way with customers.

Everything starts with the right peopleHealthcare is essential, but there’s growing customer choice when it comes to health insurers and other

care providers. Companies can learn a lot from leading retailers that focus on consumers on a daily basis,

making sure that the brand is top-of-mind with customers. Zappos, for example, is renowned for its excep-

tional service and customer focus of its frontline employees who do their utmost to answer customers’

questions and solve their problems. Health insurers and healthcare providers need to take a page out of

the retail book and train their employees to take a customer-first attitude, striving to help their members

and patients to better manage their health.

A move toward customer centricity starts with hiring and keeping the right individuals. As organizations

move from being product-centered to more customer-focused, they have to ensure that their employees

put patients at the center of everything they do. The healthcare industry is unique in how personal and

intimate it is with customers. This means that employees need to be friendly, courteous, and empathetic.

Companies must adapt their hiring profile to look for these character traits. Policies, procedures, and

scripts must be flexible to empower employees to be human first, and company representatives second. In

many cases, this is the main driver of internal and external attitudes about the organization.

‘The road to customer centricityAt Peppers & Rogers Group, we have made it our mission to help organizations become more customer-

focused. The fact is that it has been proven that client-centered organizations that put the customer at

the core of whatever they do achieve customer relationship and bottom-line benefit. But it’s not easy,

especially in a complex industry such as healthcare. At times, it requires transforming their organizational

design, performance management, scorecard design, trust-building strategy, voice of the customer strat-

egy, and process design for key customer touchpoints, including through their call center, online, mobile,

and social. And, it requires both strategic and tactical commitment at all levels of the organization.

“ Healthcare is essential, but there’s growing customer choice when it comes to health insurers and other care providers.”

©2014 www.1to1media.com 15

As the healthcare industry transforms toward patient-centric services and delivery, pharmaceutical com-

panies realize that a change in their paradigm is crucial—from a disease-centric view to a patient-centric

perspective. Traditionally, pharmaceutical companies have been “pill” suppliers with little role in the health-

care delivery and marginal interaction with the patient. But today’s reality presents the industry with a

remarkable opportunity.

The prescription drugs manufactured by a pharmaceutical company are more than merely products that

treat a disease or improve a symptom: they represent the foundation of a potential relationship which, if

nurtured, holds the possibility of not only enhancing the wellbeing of the patient but also of organically

growing the business of the company. Central to the success of that relationship is trust, the absence of

which hinders the opportunities to expand beyond a provider of pills to a partner in wellbeing.

To understand the current state of patients’ trust in prescription drugs and in pharmaceutical companies,

Peppers & Rogers Group recently gathered online survey data from more than 2,400 adults in the U.S.,

each of whom had taken a prescription drug in the last 12 months. We queried their opinions about that

drug and its manufacturer.

Overall, the research shows that trust influences tangible business outcomes such as compliance,

patient engagement, and sales of new products and services.

Interpreting trust with the Trustability IndexIn their recent book Extreme Trust: Honesty as a Competitive Advantage, Don Peppers and Martha Rogers,

Ph.D., founding partners of Peppers & Rogers Group, coined the term “trustability” to refer to a heightened

level of trust. By trustability, Peppers and Rogers refer to “proactive trustworthiness,” where trustworthi-

ness in turn is composed of competence (doing things right) and good intentions (doing

the right thing). This framework was used to create a three-pronged “Trustability

Index” upon which to measure trust in relation to pharmaceuticals via prod-

uct competence, customer competence, and good intention.

Peppers and Rogers describe product competence as delivering a good

quality product that meets the need or solves the problem it is designed

to handle, and customer competence as providing a superior customer

experience by understanding the customer’s individual needs and inter-

acting with the customer smoothly and efficiently. Good intention is

defined as “ensuring that the way your organization makes money aligns

with the needs and best interests of your customers,” which is accom-

plished by focusing on both the short- and long-term customer relationships.

Our analysis indicates that pharmaceutical companies have tremendous

Great Drugs Are Not Good EnoughNew research defines the role and impact of trust and patient engagement within the pharmaceutical industry, and examines trust’s influence on business outcomes.

Adapted from Customer Strategist Journal

PharmaceuticalPharmaceuticals: Articles

Great Drugs Are Not Good Enough ................... 15

Pharma’s Brave New World: Customer Engagement ...................................... 20

Pharmaceuticals

opportunity to establish patients’ trust and redefine patient engagement (see Figure 1).

Overall, patients have a very positive view of the products in terms of product compe-

tence, reflected through the efficacy and safety of the drug. Patients expect a better

customer experience from pharmaceutical companies, representing the customer com-

petence aspect of trustability. Finally, patients have an undecided view of pharmaceutical

companies on whether they “do the right thing” or have good intentions.

• Product Competence: 59 percent of patients rate the product competence of theirprimary drug highly. Our analysis indicates that patients equate “trust” in prescriptiondrugs to “efficacy and safety.”

• Customer Competence: 58 percent of patients are not satisfied with the customerexperience provided by pharmaceutical companies, and 27 percent of patients areneither satisfied nor dissatisfied.

• Good Intention: Two out of three patients (67 percent) believe that pharmaceuticalcompanies do not focus on doing the right thing.

• Trustability: The three elements of trust combine for a comprehensive analysis oftrustability. Overall, the research shows that 24 percent of surveyed patients do notbelieve that pharmaceutical companies are trustable and 42 percent feel neutraltoward the pharmaceutical companies’ trustability.

With measures of product and customer competence as well as good intentions in hand, an intrigu-

ing question arises: what is the relative importance of each of these three components of trustability in

delivering a variety of business outcomes that are central to the current success and future growth of

pharmaceutical companies?

The impact of trust on your businessOverall, most patients have a positive view of products in terms of efficacy and safety. But the relationship

stops there. Pharmaceutical companies would be well advised to think beyond product competence to

more inclusively consider the significant impact of customer competence and good intention on enhancing

compliance, improving patient engagement, increasing advocacy and dedication, and potentially expand-

ing share-of-patient through the sale of new products and services.

As part of the research, data were

gathered on six diverse business out-

comes: attitudinal loyalty, customer

advocacy and dedication, health insurer

selection, new products and services,

social interactions, and compliance.

Respondents rated 29 statements that

were grouped into categories to facilitate

the understanding of the likelihood of

engaging in a variety of profitable behav-

iors, the likelihood of purchasing new

products and services, and the degree of

agreement to attitudinal dispositions. For

each of these business outcomes, there

is a differential impact of product compe-

tence, customer competence and good

intentions, with each outcome primarily

influenced by one of these three trust-

ability components (see Figure 2).

©2014 www.1to1media.com 16

Figure 1: Trust Indicators

While a majority of consumers trust the competance of the products they use, a large gap exists between consumer expectation and organizational reality regarding customer competance and good intention

Figure 2: Trustability Drivers of Businss Outcomes

Our research shows that various business outcomes are influenced by specific trust drivers.

Source: KBM Group

Source: KBM Group

Pharmaceuticals

Good Intention: Attitudinal loyalty, and advocacy and dedication. Attitudinal loyalty and advocacy and

dedication are essential to establishing a productive and authentic relationship, and both business out-

comes are primarily influenced by respondents’ perception of the good intentions of the pharmaceutical

company. For example, current attitudes are predictors of future behavior. Respondents’ level of agree-

ment to statements such as “you are proud to be a customer of your primary drug” and “you feel a strong

sense of attachment to your primary drug” reflect the degree to which an affective bond exists between the

patient and the drug. That bond, like advocacy and dedication, is primarily influenced by the good intention

component of trustability.

In today’s socially connected world, advocacy is an outcome of interest to all businesses, measured

by respondents’ rating of the likelihood to “recommend your primary drug to a friend or colleague,” for

example. While drugs are unique in that the patient may have an influence on (but not control over) the

selection, enhancing awareness and preference through positive word-of-mouth recommendations may

influence the purchase decision, especially in cases where a generic equivalent exists.

Customer Competence: Social interactions, new products and services, and health insurer selection.

Each of these three business outcomes is primarily influenced by customer competence. Social interac-

tions refer to respondents’ likelihood to “participate in an online community of individuals with similar health

concerns” or to “proactively use social networks to comment favorably on your drug,” for example. These

outcomes should be of interest to pharmaceutical companies because involvement in an online community

is one way to develop patient engagement, and, in that way, indirectly influence compliance. Additionally,

proactive commentary on social networks enhances the brand image of the drug.

The opportunity to grow share-of-patient and to establish new revenue streams may be achieved by

the introduction of new products and services. Respondents were asked to rate the likelihood of purchas-

ing a product or service from the manufacturer of their prescription drug, assuming it was offered at a

competitive price that was paid personally out-of-pocket. Overall, the influence of customer competence

dominates, indicating that receptivity to purchasing such products and services and to thereby expanding

share-of-patient is influenced by the quality of patients’ experiences.

Finally, the outcome “selecting a health insurer based on their coverage of your prescription drug” is

primarily driven by the customer competence component of trustability. While health insurers have a tre-

mendous influence on prescription drug utilization through drug formularies, patients have shown certain

loyalty to their “preferred” prescription drugs.

Product Competence: Compliance. In this research, compliance was measured through respon-

dents’ ratings of the likelihood to “take your primary drug as often as your doctor instructed” and “refill

your prescription for your primary drug promptly to ensure that it is available to take,” for example.

As shown in Figure 2, the primary trustability driver for this outcome is product competence, the extent

to which the prescription drug is perceived as effective and safe, accounting for 42 percent of the relative

importance among the three components of trustability. The strategic implication is that for a pharmaceuti-

cal company to enhance compliance, it needs to not only deliver an effective and safe product, but also to

help develop positive patient experiences and establish patients’ beliefs that the company is committed to

“doing the right thing.”

From pills to patients: Engagement built on the bedrock of trustAcross the set of business outcomes examined, the relative importance of good intentions (49%) dominates,

followed by customer competence (37%) and product competence (13%). With product competence—the

effectiveness and safety of the drug—shown to be the least salient factor, the case is clear: pharmaceutical

companies would be well served to develop strategies and to make investments to deliver improved patient

experiences and to improve patients’ perceptions of the good intentions of the company.

The business case is compelling, built on the potential to improve patients’ lifetime value through enhanced

patient engagement.

©2014 www.1to1media.com 17

Pharmaceuticals

The magic behind patient engagement Most pharmaceutical companies understand and value the importance of patient engagement and many

develop patient programs aimed at increasing patient engagement. However, many of these programs

don’t address the underlying issues.

Peppers & Rogers Group’s Life Sciences practice has developed a Patient Engagement Model (PEM),

founded on deep understanding of the patient based on research results and industry expertise. Patients

differ across three dimensions—needs, behavior, and value. Understanding those differences and using

that insight to build strong, lasting, and beneficial relationships is the primary objective of patient-centric

initiatives. We built PEM based on the idea that pharmaceutical companies should improve their patient

initiatives across the PEM continuum: Inform, Participate, Empower, and Collaborate (see Figure 3).

Pharmaceutical companies have traditionally focused on the Inform and Participate areas, providing

information to patients and caregivers through few channels (e.g. websites, portals, contact centers, social

media). In some instances they have engaged patients in a more meaningful manner through Empowerment

and Collaboration, but that is not yet the norm. There is a tremendous opportunity for pharmaceutical

industry to transform its involvement in healthcare delivery and improve patient engagement.

An understanding of a patient’s behavior, needs, and value allows companies to create segmentation

strategies based on the engagement level of patients. Segmenting patients by engagement levels while

understanding their motivations and behaviors, pharmaceutical companies can customize interaction

plans that optimize their experience throughout the patient journey.

Using Peppers & Rogers Group’s PEM can provide pharmaceutical companies the framework to assess

their current engagement approach and successfully implement new ones. Peppers & Rogers Group’s

enhanced PEM can unlock patient value and enable pharmaceutical companies to focus on health out-

comes, which have been the focus in the healthcare industry.

By unlocking patient engagement through trust-based activities, pharmaceutical companies can fight

competitive pressure, maximize internal resources, and strengthen relationships with constituents across

the healthcare ecosystem. g

©2014 www.1to1media.com 18

Figure 3: Patient Engagement Model

The goal of the Patient Engagement Model is tomove consumers across the interaction continuum to build patient engagement

Source: KBM Group

©2014 www.1to1media.com 19

Pharmaceuticals

Compliance: With patient compliance averaging below 65 percent, according to CapGemini, the U.S.

pharmaceutical industry is losing $188 billion annually in revenue as a consequence of patients not taking

prescription drugs for chronic conditions. The research shows that building trust with patients has a direct

impact on compliance. Trusters tend to be 10 percent more compliant than Neutrals, and Neutrals are 11

percent more likely to be compliant than Distrusters. The spread between Trusters and Distrusters is 21

percent. Enhancing compliance, therefore, has the potential to improve the wellness of the patients and to

be a substantial driver of organic business growth.

New products and services: Many pharmaceutical companies have started exploring products and services adjacent to their core pills

business. A key success factor of anything new will be patient receptiveness. The research explored exam-

ples of services that pharmaceutical companies may offer, such as health and wellness programs, and

tools to track medical conditions. The analysis indicates that attitude toward the pharmaceutical compa-

nies and their drug trustability can be a factor in patients’ acceptance of new products or services from the

same pharmaceutical company. Neutral patients are 37 percent more likely than Distrusters and Trusters

are 25 percent more likely than Neutrals to use new products or services from the manufacturer of their

primary prescription drug.

Selecting a health insurer: Traditionally, patients have had limited options around health insurance selection. But the old model is

changing. For example, Medicare Part D allows seniors to choose from several plans based on different

factors. And only 6 to 9 percent of seniors chose their prescription plans based on lowest cost. Healthcare

reform will likely extend this option beyond Medicare. The research indicates that attitude toward the

pharmaceutical companies and their drug trustability can be a factor in choosing the health insurer. Neutral

patients are 46 percent more likely than Distrusters, and Trusters are 33 percent more likely than Neutrals

to make this choice. g

Great Drugs Are Not Good EnoughTrust’s Impact On...

TRUSTERS:

Patients who rank their level of TRUST between 8.5 and 10 on a 10-point scale

NEUTRALS:

Patients who rank their level of TRUST between 6.5 and 8.5 on a 10-point scale

DISTRUSTERS:

Patients who rank their level of TRUST between 0 and 6.5 on a 10-point scale

©2014 www.1to1media.com 20

Pharmaceuticals

Pharma’s Brave New World: Customer EngagementThe new pharma era breeds customer centricity, innovation, and engagement with patients, physicians, and all partners in the healthcare ecosystem.

Adapted from Customer Strategist Journal

The good old days of the blockbusters are gone. The pharmaceutical industry has to adapt to a new reality

and the changes that come along with it. The patent cliff is no longer years away, it is here now. Healthcare

reform, changing customer expectations, technology advancements, and cost containment signal that

pharma companies must rethink the traditional industry paradigm

The emerging healthcare ecosystem is one where the patient is a focal point for a myriad of healthcare

services. In order for pharma to participate in the new ecosystem, the industry must not only focus on

the patient, but also partner with its stakeholders to improve health outcomes, costs, and experiences.

Organizations will thrive if they transition by recognizing and engaging their respective constituencies.

Those that don’t will experience the full force of changing market dynamics.

Pharma companies must step back and think strategically, starting with the definition of “customer.” The

definition of customer has evolved from “someone who buys good or services” to “an individual with whom

one must deal,” which implies emphasis on the relationship. In pharma, a customer can be a patient, physi-

cian, payer, or provider. Companies that proactively engage the customer, whoever that may be, will be

able to navigate the rapidly changing environment. The emerging business model is one that accentuates

consumer choice, explicit value versus price considerations, engagement and dialog, and lifestyle care.

Pharma companies will have to overcome current challenges when engaging different stakeholders. It’s

up to them to recognize these components and craft customer-centric strategies that identify, and inter-

nally adapt to, change.

Why customer centricity matters in pharmaPharma must take a new approach to business as the industry transforms. Decision-making was once the

domain of the physician, but increased patient activity blurs the line as to who owns the relationship with

pharma companies. Balancing cost with effectiveness is a top strategic priority, as is getting the right mes-

sage to the right constituencies through multiple owned and indepen¬dent channels. And, while engagement

is a critical consideration, communication and dialogue with stakeholders is happening outside of traditional

venues. Pharma must contend with new audi¬ences looking for new products and new information in new

channels, all while managing costs and delivering safety and efficacy. In addition, pharma must focus on

delivering value as part of engaging healthcare stakeholders (e.g. payers and providers).

Patients are changing their attitudes and behavior toward healthcare. They have an increased awareness

and role in decision-making, due in large part to shifting financial responsibility. They are hungry for infor-

mation from numerous sources—from their doctor and health insurer to their pharmacist, drug companies,

independent experts, and peers. They are looking for guidance as they navigate the increasingly complex

world of healthcare. And, they want to break down traditional communication barriers to enable interactive

dialogue, not just a one-way flow of information.

The days of controlling the message are over. Transparency is expected, and complete control is a thing

of the past. Customer-focused pharma companies seek out opportunities to transparently engage consum-

ers, physicians, payers, and other customer groups wherever discussion is taking place. And, as channels

expand, opportunities arise to interact efficiently, effectively, and relevantly with different stakeholder groups

in preferred and appropriate channels, depending on the needs, values, and behaviors of each group.

Customer centricity provides pharma companies with a blueprint for engaging all parties by focusing

on their needs and priorities, highlighting product value, and delivering quality products and services. As

“ Decision-making was once the domain of the physician, but increased patient activity blurs the line as to who owns the relationship with pharma companies.”

©2014 www.1to1media.com 21

Pharmaceuticals

healthcare delivery shifts from consumer awareness to decision management, pharma must analyze and

act on data about patients, physicians, payers, and other stakeholders to engage decision-makers at every

level. In addition, “total value of treatment” should be driven by the value delivered to the patients and their

experience during the treatment process.

Four pillars of pharma customer engagementPolitical, economic, social, cultural, technological, legal, and business trends have evolved to create a new

paradigm. The industry mindset has changed from ignoring customers to informing and engaging them,

with consumer opportunities and impact growing along the way.

The new reality in healthcare means that companies must either take a customer-centric perspec¬tive

or succumb to those that do. There are four fronts of customer-centric business strategy where pharma

companies can achieve real business results:

1. Enhanced Patient Experience: Patients are looking for better information and experiences related totheir overall healthcare journey. They are leveraging new tools and channels to create a dialogue about health, disease areas, and drugs. And with economic issues at the forefront, patients are seeking value while being cost-conscious.

2. Effective Commercial Model: New marketing tactics are available to transform the commercial modelto resonate with Healthcare Professionals (HCPs). There are also new opportunities to engage physi-cians and healthcare providers in more interactive and efficient ways.

3. Improved Payer Engagement: Targeting and messaging to payers can be improved by addressingtheir pain points while still remaining profitable. Information-sharing and dialogue is critical with thisconstituency, with emphasis on patient adoption and access to drugs.

Figure 4: From Ignoring Customers to Engaging Them

Over the last 20 years, the

Source: KBM Group

©2014 www.1to1media.com 22

Pharmaceuticals

4. Informed Medical Relationship: It’s important to engage the medical community to ask for feedback

and gain insight based on their expertise and experience. There are new tools and channels that can

be leveraged to share information and research more effectively with the medical community.

Moving to a customer-centric approach can be a competitive advantage and strategic lever as pharma

rethinks how to engage different customer constituencies: patients, physicians, payers and providers. In

order to successfully transform, pharma must focus on improving the customer experience, which requires

a change in paradigm in both customer-facing and internal operations.

Pharma must proactively redefine and, in most cases, establish a relationship with patients to meet

the demand for patient-centric service. Patients now expect the same level of service and engagement in

healthcare as other services they receive from other industries (e.g. telecom, financial services, or retail).

Therefore, pharma should find ways (within the regulatory constraints) to engage patients, leveraging a

patient-centric view based on patients’ needs and behavior, as well as consumer insights best practices

from other industries. For instance, many CPG and retail companies have effectively leveraged customer

journey maps and established appropriate interaction channels. Pharma would also need to advance its

understanding of the patient journey not only during the treatment, but also prior to and after their diagnosis.

As pharma moves away from the traditional sales force model, it must find innovative, but less intrusive

ways to communicate and interact with physicians. There should be more emphasis on the HCP’s pri-

orities, needs, and available communication channels. Additionally, pharma must develop trust with Key

Opinion Leaders (KOLs) and physicians in order to change the perception of the industry from being sales-

focused to a provider of valuable infor¬mation.

Finally, the pharma industry must transform the historically combative relationship it has had with pay-

ers and providers. In the past, those relationships have been focused on formulary and cost. Pharma

must forge new relationships that are value-focused, such as reimbursement, formulary decision-making,

clinical development guidelines, and patient-oriented services. For example, pharma needs to effectively

partner with payers to successfully implement “outcome-based” agreements, which have been slow to be

adopted. It’s key to understand payers’ and providers’ pain points and priorities to develop innovative ways

to partner with them. Only then will pharma thrive in this engaged new healthcare world. g

“ Moving to a customer-centric approach can be a competitive advan-tage and strategic lever as pharma rethinks how to engage different cus-tomer constituencies: patients, physicians, payers and providers.”

©2014 www.1to1media.com 23

Between politicians at the podium and talking heads on television, most of what the public knows about

the Affordable Care Act (ACA) hails from the headlines. But, in less than one year, millions of Americans age

18-64 will be seeking healthcare coverage independently for the first time with little information to guide

their decisions. And, as the “2013 Consumer Health Care Market Report” by The Agency Inside Harte-

Hanks highlights, many insurers are not yet prepared to handle the projected number of inquiries, either.

In 2014, new mandates will require the uninsured to purchase private healthcare coverage, opening up

the opportunity for insurers to target those who make too much money to qualify for Medicaid and those

who could not afford or would not buy health insurance on the private market before. These non-elderly

uninsureds represent the primary focal point for insurance companies, as they look to market to an audi-

ence segment with which they’ve never interacted on a one-to-one basis.

Scott Overholt, vice president, healthcare markets at The Agency Inside Harte-Hanks, reemphasizes

that the things most people know about the law are politically motivated arguments found in the media,

most of which have little to do with consumers or health. If insurers don’t act now, they risk relinquishing an

opportunity to build relationships with desirable uninsureds early and often in this growing environment of

fear, doubt, and uncertainty. These health insurance companies know they must identify and engage with

healthy targets, thereby bringing predictive analytics into play.

“Analytics will become even more important to understand the new customer base, map its health risk

profile, and adjust strategies for the next round of product pricing and marketing,” says Overholt. The sec-

ond piece of the puzzle is understanding consumer motivations around the ACA and the channels in which

they want to communicate about open enrollment.”

The Agency’s research, which polled more than 600 presently uninsured Americans age 18-64, explores

how those with and without children are responding to the impending mandate, including motivations,

channel preference, and likelihood to purchase. By shedding light on this

untapped marketplace, this study offers insurers insight that can help them

begin to focus their efforts more appropriately and deploy their budget

accordingly. Key findings are as follows:

For uninsured adults who rate their health at that of their family members

as good:

• Most have carried health insurance coverage in the past, yet more thantwo-thirds currently don’t have coverage for their children.

• People and families in this group have 25 percent fewer prescriptionmedicines than average.

• These uninsureds are more likely to say that the ACA is bad and thinkthat health insurance will remain unaffordable.

Health Insurers Prepare for the Affordable Care Act

Adapted from 1to1 Media

Health InsurersHealth Insurers: Articles

Health Insurers Prepare for the Affordable Care Act ............................................ 23

Cigna Personalizes Its Approach to Healthcare Customer Service ............................. 25

Keeping Promises Helps Aflac Build Lasting Customer Trust ...................................... 26

Creating a 5-Star Health Insurer ........................ 29

©2014 www.1to1media.com 24

Health Insurers

For young adults age 18-39 in good health:

• One in six has never had health insurance. For those with children, nearly two-thirds don’t have insur-ance for them.

• Most would trust their parents for advice and are generally open to what the ACA has to offer.

• Two-fifths of those polled are “extremely” or “very likely” to sign up, while an additional two-fifths are“somewhat likely”.

• This younger demographic is more likely to rent than their older counterparts.

By understanding the significant factors driving these uninsureds’ decisions, companies can use this

opportunity to connect with and educate individuals on the benefits of owning health insurance. “Insurers

are [currently] using simple channels that communicate quickly and easily, like video,” Overholt adds.

“Healthcare marketers are up against an environment of negative healthcare messages. By driving con-

sumers to digital destinations, they are using video to explain the ‘what’s in it for you, the consumer’ to

[provide] a better understanding of the individual mandate and the value proposition of the insurer.”

Ultimately, by observing and understanding consumer behaviors, insurers will develop methods for

attracting the younger, healthier members of this demographic who will keep their risk portfolio in balance,

for those uninsureds with the low-quality health will be eager to sign up. Attracting those at peak health will

mitigate the risk to the company’s bottom line and build the foundation for trustworthy, reliable relation-

ships moving forward. g

©2014 www.1to1media.com 25

Health Insurers

Cigna aims to make healthcare a fun, relevant part of each person’s everyday life by helping every cus-

tomer reach their full potential.

Doctors may no longer make house calls, but for Cigna, reviving the personalized approach for today’s

consumer has boosted engagement and instilled the sort of trust that has been absent from the industry

in recent years.

In its move to connect consumers with customer service, Cigna instituted a social media strategy that

has enabled it to engage with customers in a way that reaches them on their terms and through their

channel of choice. By providing customers with an array of contact channels, Cigna also reinforces trans-

parency in its customer interactions, as customer service professionals actively engage across platforms,

including Facebook, Twitter, LinkedIn, Pinterest, Foursquare, Tumblr, podcasts, and YouTube. This online

customer service optimization strategy, managed by Cigna’s Internet Customer Service (iCSA) team, sup-

ports questions about the MyCigna.com site, monitors and responds to postings on social media sites

24/7/365, addresses all service related postings, and engages in other areas of the organization when

additional support is needed.

“Cigna is committed to helping our customers improve their health, well-being, and sense of security,” Eric

Galvin, senior director of service operations at Cigna. “We recognize that to be a truly customer-centric com-

pany, we need to be where our customers are. By engaging with our customers through social media, we have

the opportunity to show them we are listening and demonstrate we want to build a relationship of trust. We want

to understand each customer’s unique needs so we can deliver solutions relevant to their personal health.”

By upholding its mission to care for the individual, Cigna has been able to tap into the opinions, concerns,

likes, and dislikes customers frequently share on the Internet to earn their trust in an effort to cultivate brand

ambassadors that will embrace and recommend the service to others. Social media also offers Cigna the

unique opportunity to reach people who may not be current customers by presenting prospective and cur-

rent consumers with health-related information, facts, and tips through Cigna’s GO YOU! Facebook page,

Twitter feed, and YouTube account.

While making health a fun and relevant part of each person’s everyday life represents Cigna’s primary

goal, the GO YOU! brand also honors the individual, recognizing that each customer has their own needs.

Cigna strives to help customers be true to themselves and reach their full potential, going beyond benefits

coverage and insurance claims by offering health coaches who work with customers to set up personal

plans that support their individual health goals. For Cigna, the GO YOU! brand represents the company’s

overarching mission to earn trust and build long-term, fulfilling customer relationships that inspire, encour-

age, and celebrate each unique individual.

Since implementing this personalized social strategy, Cigna has seen a 20 percent increase in its trans-

actional NPS, while its GO YOU! Facebook page added 4,396 new “likes” in November 2012 alone. Cigna

also set and surpassed its goal to respond to 90 percent of customer-related issues within 30 minutes of

posting, often redirecting customers to more personalized service settings, such as phone or direct email

when appropriate, to protect confidentiality. Public relations handles inquiries relating to industry criticism,

healthcare reforms, and questions about products, with an overall goal to respond to all posts within two

hours. However, in November 2012, Cigna exceeded its business goal by responding to more than 99 per-

cent of customer posts within 30 minutes, exhibiting the company’s core mission through action.

Cigna Personalizes Its Approach to Healthcare Customer ServiceCigna aims to make healthcare a fun, relevant part of each person’s everyday life by helping every customer reach their full potential.

Adapted from 1to1 Media

“ Cigna is committed to helping our customers improve their health, well-being, and sense of security,” Eric Galvin, senior director of service operations at Cigna.”

—Eric Galvin, Senior Director of Service Operations, Cigna

©2014 www.1to1media.com 26

Health Insurers

Companies make several promises to encourage customers to do business with them. The differentiator

among trustworthy companies is that they strive to live up to their promises and ensure that they deliver

what their customers expect from them. This is even more important in today’s highly competitive and very

social world, where customers are not only able to see the difference between organizations, but are very

willing to tell the world about their experiences.

Aflac has been sending the message that it will take care of its members during their time of need, help-

ing them pay their bills when they’re not well enough to go to work. This message, delivered by the lovable

Aflac duck, is the credo that the company has to live up to.

Executive Vice President Michael W. Zuna, also the company’s chief marketing and sales officer, notes

that for almost six decades Aflac has kept its promise to protect its members when they need it most, gain-

ing their trust in return. Here Zuna speaks about the importance of gaining and maintaining customer trust,

the role of social media, and the future of the Aflac duck in driving solid business results.

Customer Strategist: Organizations are striving to be seen as customer-focused. What makes Aflac a customer-centric organization?

Michael Zuna: Our customers have always been, and will always be, our first priority. Despite uncertainty in

the economy and on the health insurance front, we have continued to grow over the past 20 years by never

straying from our core values and always putting customers first. This is our mantra—it’s the “Aflac Way.”

Since our company was founded in 1955, we’ve kept our promise to those we insure that we will protect

them when they need it most. This is how we’ve gained the trust of more than 50 million people worldwide.

At Aflac, we realize that unpredictable medical situations can affect every part of our customers’ lives.

Aflac’s success comes from offering voluntary insurance policies that help provide additional financial pro-

tection to employees and individuals faced with expenses resulting from an accident or illness. Instead of

checks being sent directly to the doctor or hospital, Aflac sends cash benefits directly to policyholders so

they can use those funds as they see fit. We also work hard to pay claims fairly and promptly. In fact, our

claims are processed usually within four days, according to company statistics. As Aflac continues to evolve,

our commitment remains steadfast to providing customers with the products and services they need most.

CS: A good reputation and trust are essential ingredients for organizations, especially in today’s com-petitive market. What are you doing to make sure that Aflac has a good reputation and also enjoys its customers’ trust?

MZ: Aflac has provided a strong and lasting safety net for families dealing with medical needs for nearly 60

years. Today, more than 50 million people worldwide are insured by Aflac, and we pride ourselves on the

continuous development of innovative, cross-generational solutions for our policyholders. We listen to our

customers and have added products to address their needs, like our enhanced individual Vision Now and

group accident plans, as well as our New York group accident and critical illness plans. At the same time,

our customers can always trust we will stay true to our core values and the “Aflac Way.” We will always make

it top priority to deliver the products and the financial peace of mind they’re looking for in times of need.

Keeping Promises Helps Aflac Build Lasting Customer TrustMichael Zuna, executive vice president and chief marketing & sales officer, Aflac, has helped the company grow by nearly 7 percent during an economic downturn. He explains how Aflac prides itself on maintaining the promises made by its marketing icon to enable healthy business outcomes.

Adapted from 1to1 Media

“ Our customers have always been, and will always be, our first priority.”

—Michael Zuna, Executive Vice President and Chief Marketing & Sales Officer, Aflac

©2014 www.1to1media.com 27

Health Insurers

CS: What are your priorities and challenges in leading the company’s marketing and sales?

MZ: Right now is an exciting time to be part of marketing and sales at Aflac. The healthcare insurance

industry is undergoing unparalleled transformations in the face of legislative reform. One of our biggest

priorities is to thrive in the changing insurance landscape, and we have put the pieces in place to do that.

We believe healthcare reform has created an opportunity for us, especially since our business in Japan is

already thriving under national healthcare. We plan to focus our business, broker, agent, and policyholder

marketing efforts on educating both consumers and business decision-makers about the need for, and

value of, voluntary insurance.

CS: What are some changes in Aflac’s sales and marketing strategies since you became the company’s Chief Marketing and Sales Officer? Can you discuss your work to continue building the Aflac brand?

MZ: A few years ago, Paul S. Amos II, the COO of Aflac, decided to separate marketing and sales into two

entities to enable the marketing function to grow and develop into a more sophisticated operation. We’ve

since seen our marketing function develop into a world-class marketing department, and like many compa-

nies, decided it was the right time to bring the two back together to benefit the entire company. Combining

our marketing and sales capabilities allows us to better link marketing efforts to securing, serving, and

retaining customers through our primary distribution channel: our field force of 70,000+ Aflac agents. We

believe the two functions are inherently linked and with both teams collaborating and working together as

a united front, we’ll drive even greater success and provide greater value to our policyholders, accounts

and shareholders.

This move has already resulted in positive changes by enabling our product development and strategy

teams to work more closely together. As we move forward, we remain laser focused on what will maximize

the sales and profitability of our company. To make these two entities work under one roof, I spend a tre-

mendous amount of time with our sales people to understand their perspectives and to align our sales and

marketing efforts in a way that sets us up for short- and long-term success.

CS: In 2011, your first full year as the company’s CMO, Aflac U.S. saw a 6.8 percent increase in new annu-alized premium sales. To what do you attribute this success?

MZ: I give much credit to our sales force—our agents and brokers—who are taking the initiative to get

out there and personally educate consumers about our products. I also give credit to our marketing team,

which provides support to our sales force every step of the way through brand messaging, our famous

duck commercials, and more. One of the great things about Aflac is that our team is made up of dedicated

people who are passionate about our brand and about helping those in financial need due to medical emer-

gencies. This passion is a major contributor to our success. We continuously seek ways to enhance and

improve our offerings to meet customer demand, and we make sure to listen to what our customers have

to say so that we can always keep our finger on the pulse of their needs.

CS: Most often customers contact their insurance company when they’re already encountering a problem. What is Aflac’s strategy to ensure the best experience possible at a time when customers need the com-pany’s help?

MZ: We are committed to providing the best customer service to ensure a consistent and positive expe-

rience during any and all interactions at Aflac. We aim to educate our customers to be prepared for the

unexpected; we know that they often contact us when they’re facing a health crisis. Medical bills can add

up quickly, so we make sure to pay claims fairly, promptly, and directly to our customers so they can use

those funds as they see fit. We made a promise to our customers to be there when they need us most.

We take their concerns to heart during times of need. We realize that stress is heightened during medical

emergencies, and we strive to make sure their experience with us puts them at ease. Our mission is to

“ We continuously seek ways to enhance and improve our offerings to meet customer demand, and we make sure to listen to what our customers have to say so that we can always keep our finger on the pulse of their needs.”

—Michael Zuna, Executive Vice President and Chief Marketing & Sales Officer, Aflac

©2014 www.1to1media.com 28

Health Insurers

provide a safety net of cash benefits to help with out-of-pocket expenses not covered by major medical so

that policyholders can focus on their recovery, not financial stress. We will continue to focus our efforts on

achieving unmatched customer service experiences for our policyholders.

CS: It is at times difficult for customers to fully understand insurance policies and what they’re entitled to. How does Aflac make sure that it delivers the right message to customers?

MZ: Delivering the right message to our customers starts internally. We make sure our sales force under-

stands our insurance policies and is able to simplify the information and clearly relay it to consumers and

business decision-makers so that they fully understand their options. It will help customers make informed

benefits decisions that best suit them and their families’ needs.

Aflac is committed to providing customers with precisely what they need. This mission led to the devel-

opment of the Aflac WorkForces Report, an annual employee benefits study of both American workers

and business decision-makers that examines the forces impacting the trends, attitudes, and utilization

of employee benefits. We share the study’s top findings with our agents, brokers, and customers to help

business decision-makers reconcile the perceptions and realities of benefits in the workplace. By doing so,

we help businesses make better informed decisions and offer enhanced benefits solutions that protect one

of our greatest assets—a healthy, engaged, and productive workforce, while also protecting businesses’

bottom line.

But we don’t stop there. We actively educate the public on all aspects of health insurance: making the

right decisions during open enrollment, taking full advantage of flexible spending accounts (FSAs), and

taking advantage of employee wellness programs through all channels, including personal interactions.

Our goal is to arm not only our customers, but everyone, with the knowledge they need to make the best

possible benefits decisions.

CS: The Aflac duck is synonymous with the organization. What does it represent and how are you using it to market Aflac

MZ: The Aflac duck is a marketing icon and has definitely done great things for us as a face for this com-

pany. Thanks to the duck, nine out of 10 people in the United States know the Aflac name. Now we are

beginning to see the shift of the duck to representing more than just the Aflac name and helping people

understand what we do. Just know that the duck is here to stay and will forever be the top dog—or should

we say top duck—at Aflac. g

“ Aflac is committed to providing customers with precisely what they need.”

—Michael Zuna, Executive Vice President and Chief Marketing & Sales Officer, Aflac

©2014 www.1to1media.com 29

Health Insurers

Innovation in the healthcare industry typically refers to new treatment strategies or breakthrough drugs.

But for some health insurance companies, innovation can mean something different. Improving operations,

efficiencies, and the overall customer experience can have an immediate impact on consumers as well as

the balance sheet.

Each year, the Centers for Medicare and Medicaid Services (CMS)-the federal agency that oversees

Medicare-rates Medicare Advantage and Part D prescription drug programs on a five-star scale, based on how

well they performed in the prior year, with five stars representing the best performance. Plans with high ratings

receive bonus payouts of up to hundreds of millions of dollars. In 2012, the total bonus payment is projected

to be nearly $3.1 billion, with a few companies taking the lion’s share-UnitedHealthcare is projected to receive

$547 million and Kaiser Permanente is projected to receive $380 million, according to the Kaiser Foundation.

The idea behind this bonus payment system is twofold. First, it rewards plans that do well by awarding

them a higher bonus payment. Second, it brings down overall Medicare program costs by cutting down on

payments made to plans in excess of projected spending. For consumers, the system offers an easy way to

shop for and compare plans during enrollment periods. This new program began in 2011 and is scheduled

to continue until at least 2014. The first payouts were delivered in 2012.

What does a five-star health plan look like?Medicare plans are measured by how well they deliver across five customer-related dimensions: staying

healthy, managing chronic care, member experience, complaints and performance, and customer service.

For example, the complaints and performance dimension measures the number of complaints submitted

for every thousand members and the problems that Medicare found in members’ access to service and

in the plan’s performance. Similarly, Part D programs are rated on drug plan customer service, member

complaints and performance, member experience, and patient safety and pricing accuracy. For example,

measures under the drug plan customer service dimension cover the time spent on hold when a pharmacist

calls the health plan and the availability of foreign language options in the contact center (see Figure 1). A

Creating a 5-Star Health InsurerA healthy customer experience can lead to hundreds of millions of dollars in bonus payouts for some Medicare plans

Adapted from Customer Strategist Journal

Figure 5: How Health Plans Are Rated

The CMS rating system is based on how well a health insurance plan delivers on a numner of customer-related attributes

Source: KBM Group

©2014 www.1to1media.com 30

Health Insurers

number of stakeholders provide feedback and data to inform the CMS rating, including consumers, doctors

and hospitals, pharmacists, and regulators.

However, some measures are weighted more heavily than others. CMS broadly groups measures into

five categories, including process-, experience-, access- and outcome-based measurements. Outcome-

based measures that tie to the improvement of health and care are weighted heaviest while process-based

measures are weighted the lightest.

Reach for the starsThe goal of the rating system and bonus structure is to ultimately create better health outcomes for plan

members. Customer satisfaction with the health insurance industry overall is low. Consumers are used to

a higher quality of service each day from vendors in other industries and seek that same experience from

their health plan. Payers looking at only the dollar bonus amounts will miss out on the bigger opportunity

to create a better health plan, which will create satisfied members

and retain them over the long term. This leaves much opportunity

for improvement among health plans.

Figure 2 illustrates the ratings breakdown based on the most

recent figures from CMS. Less than 1 percent of plans achieve

5-star ratings, and about 44 percent receive less than 3 stars.

However, some health plans have begun to take notice and have

made changes in order to obtain a higher star rating. Of the 419

plans Medicare Advantage plans rated in both 2012 and 2013, 28

percent showed improvement over the previous year. Similarly, of

59 Part D plans rated in 2012 and 2013, 49 percent improved their

ratings in 2013.

Insurers looking to improve must place the member at the top

of their organizational priority list; in other words, they must create

a customer-centric organization. Many of the measures that CMS

rankings deal with how well elements of the healthcare system

work together. This requires a transformation in the way payers

treat their members by rethinking organizational design, customer experience strategy, and customer trust,

among many other actions, to create a richer member experience. And CMS will periodically update its list

of measures, making this customer-centric transformation a journey, not a one-time process.

Customers today have increasing choice when it comes to their health plans and they will exercise those

choices, especially when there is a rating attached to a plan. For health insurers, this means that paying

attention to star ratings and creating the right conditions for a higher star performance will become even

more important going forward.

The way ahead requires a holistic approachFor insurers who want to stay on top of the star ratings program, a clear focus on higher overall plan quality

is the right approach. Any improvements need to be holistic and considered from the point of view of the

entire member lifecycle, not just focused on improving the individual measures that comprise the inputs

to the star ratings. Ratings can drop for many reasons. While some of these are relatively easy to fix, such

as getting members to have an annual flu vaccine, others might prove to be more of a challenge, such as

patient adherence to prescription medication guidelines.

Consider the evaluation of a member’s overall rating of a health plan. An overall rating is the sum of

many factors, largely driven by that member’s experience with the health plan across multiple interactions.

At each of these interactions, a member’s expectations on the desired experience can vary widely from

member to member.

Figure 1: Distribution of Medicare Advantage Star Ratings, 2012-2013

When it comes to enhancements in efficiencies and the member experience, there is much opportunity for improvement among health plans. Very few receive high rankings.

Source: Medicare and Medicaid Services

©2014 www.1to1media.com 31

Health Insurers

A member who has just turned 65, is still working, and lives at home has a different set of needs and expec-

tations than an older member who is 80 and lives in a retirement home. A member with a chronic illness will

require more attention and handholding than a member who comes in for screenings and basic checkups.

In order to create a satisfied member who will give a high overall rating for the health plan, the payer

must create customized interactions that will meet each member’s needs at multiple points in the member

experience. To do this, each member’s needs, behaviors, and value to the health plan must be carefully

analyzed from the point of view of the member lifecycle. A holistic approach to improving ratings can thus

ensure that the member’s needs are met during each interaction and will leave the member satisfied and

less likely to switch plans the next time enrollment period comes around.

Another benefit of a holistic approach is that CMS updates the inputs to its star ratings annually. The

agency has structured the star ratings strategy to be consistent with its three-part aim: better care, healthier

people and communities, and lower-cost care through improvement. Any future updates to the measures

will incorporate this strategy. Therefore, an approach to create the ideal experience must look at all aspects

of the member lifecycle; otherwise the result will be a piecemeal approach that will result in lopsided or

short-term gains to the ratings.

ConclusionConsumers rely on ratings and reviews to inform their decisions in nearly every other industry. So why not

healthcare? The ratings bonus program from CMS presents an immediate opportunity for health insur-

ers who operate in the Medicare space to get ahead of the competition and stay there as the healthcare

industry evolves. Monetary, relationship, and reputational benefits are all at stake. It is the perfect time to

innovate around customers.

About 1to1 Media1to1® Media is an online resource dedicated to helping organizations across the globe realize the greatest value from their customer base. We provide content and resources that help senior executives to drive change and make customer-based initiatives the center-piece of their growth strategy. 1to1 Media’s Weekly Digest explores the best practices, trends, and developments from companies that are using customer initiatives to drive bottom-line impact. 1to1 Media combines thought leader-ship, field experience, and editorial expertise to deliver the content needed by our audience of more than 130,000 decision-makers.

For more information, visit www.1to1media.com

About Peppers & Rogers Group

Peppers & Rogers Group is dedicated to helping its clients improve business performance by acquiring, retaining, and growing profit-able customers. As products become commodities and globalization picks up speed, customers have become the scarcest resource in business. They hold the keys to higher profit today and stronger enterprise value tomorrow. We help clients achieve these goals by building the right relationships with the right customers over the right channels. We remove the operational and organizational barriers that stand in the way of profitable customer relationships. We show clients where to focus customer-facing resources to improve the performance of their marketing, sales, and service initiatives.

For more information, visit www.peppersandrogersgroup.com