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make an
impact!
Customer Centricity in Healthcare
May 17, 2012
Laying the Foundation
for a Customer-Centric Organization
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Today’s Speakers
Elizabeth Glagowski Executive Editor, Strategy
Peppers & Rogers Group
Marc Ruggiano Partner,
Peppers & Rogers Group
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The Case for Trusted Relationships
Peppers & Rogers Group Client Examples
Q&A Discussion
Agenda
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The Case for
Trusted Relationships
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US Healthcare Spending Leads OECD
Total Health Expenditure, Per Capita (PPP adjusted dollars)
Source: OECD Health Data (database) from Kaiser Family Foundation via http://facts.kff.org/ accessed on February 25, 2012.
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While Life Expectancy Lags Considerably
40
50
60
70
80
90
Source: OECD FactBook 2010; via www.oecd-ilibrary.org/ accessed on February 25, 2012.
Life Expectancy at Birth, Total (Number of Years)
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and Consumers Rate the Experience Poorly
Customer Experience Index (CxI) by Industry
Source: Forrester Research, The Customer Experience 2012
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Health Visual Definition
a healthy
state of
wellbeing free
from disease
the general
condition of
body and
mind
Source: ThinkMap Visual Thesaurus, 2011
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Care Visual Definition
the work of
providing
treatment for
or attending
to someone
or something
Source: ThinkMap Visual Thesaurus, 2011
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Consumers Define Health in Many Ways
Source: Peppers & Rogers Group research
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Source: Peppers & Rogers Group research
Consumer Perception of Today’s Health Insurers
Source: Peppers & Rogers Group research
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Consumers Describe the Ideal Health Insurer
Source: Peppers & Rogers Group research
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Source: Peppers & Rogers Group research
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Source: Peppers & Rogers Group research
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Customers’ Trust in the Health Insurance Sector
43%
19%
38%
Distrusters Neutral Trusters
Trust
Source: Peppers & Rogers Group research
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Characteristics of a Trustable Health Insurer
-3
-2
-1
0
1
2
3
Clear/Confusing
Easy/Difficult
Caring/Uncaring
Generous/Stingy
Fair/Unfair
Compassionate/Uncompassionate
Flexible/Inflexible
Helpful/Unhelpful
Believable/Unbelieveable
Effective/Ineffective
Warm-hearted/Cold-hearted
Fast/Slow
Cooperative/Combative
Friendly/Unfriendly
Informative/Uninformative
Reliable/Unreliable
Kind/Unkind
Superior/Inferior
Up-to-date/Outdated
Accessible/Inaccessible
Organized/Disorganized
Transparent/Secretive
Distrusters Trusters
Source: Peppers & Rogers Group research
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Customers’ Trust for Individual Health Insurers
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Variations in Trust Among Large Insurers
Customers’ Trust for Individual Health Insurers
0%
20%
40%
60%
80%
100%
Anthem BCBS United
Healthcare
Aetna Humana Kaiser
Permanente
Re
spo
nd
en
ts
Distrusters Neutral Trusters
Source: Peppers & Rogers Group research
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Customers Value Trustworthiness
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Consumer Willingness to Pay for Trustability
Customers Value Trustworthiness
Source: Peppers & Rogers Group research
$12.1
$24.7
$6.4
$3.9 $3.1
$-
$10.0
$20.0
$30.0
Anthem BCBS United
Healthcare
Aetna Humana Kaiser
Permanente
Annual Premium
$B
illio
ns
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Peppers &
Rogers Group
Client Examples
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Making the Case for Transformation
Expectation Competition Regulation
Consumer choice is only increasing, as they take a more active role in the healthcare decision-making process.
The Affordable Care Act and other healthcare reform is ongoing at both the state and federal level.
Customer expectations from their experiences in other industries has begun to permeate the healthcare industry.
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We started by taking the pulse of our client’s organization with a
current state assessment…
• Document
Reviews (70+)
• Working Sessions
• Interviews across
the organization
• Industry
Dynamics and
Trends
• Key
Stakeholders
• Competitive
Landscape
Internal External
PRG analyzed both internal and external factors over a five week period, in order to gain a
snapshot of which areas needed more support and which areas are already further along in their customer centricity journey.
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…which yielded a clear picture of where the organization stood and
which areas required additional attention going forward
Consumer/ Outcome-Driven
Integrated 1to1 Enterprise
Consumer/ Outcome-Sensitive
Sales Operations
Health Care Services
Communications
Product/ Process-Driven
Co
nsu
me
r C
en
tric
ity M
atu
rity
Sp
ec
tru
m
Risk Finance IT HR
Group/Division
Illustrative
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Market Research yielded key insights about attitudes and motivations
regarding Health Insurance and Health and Wellness…
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…as well as insights into which new products and services would
consumers be most interested in if offered by their health insurer
Illustrative A new product concept
survey was conducted
with members of the
client’s internal online
community, evaluating 6
new product concepts
Research revealed that if
any one of the product
concepts that were part
of the survey were
offered, members were
more likely to consider
the insurer as a partner in
their health and wellness,
with results of increased
partnership ranging from
22-39%, depending on
the product
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Branding, while not historically a huge focus area for health insurers,
has now come to the forefront in today’s environment
By answering
these three
questions, we
were able to
help our client
undertake a serious look at
their branding
strategy
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Our branding approach consists of 3 key steps that inform the
branding recommendation that we ultimately make for our clients
•3rd party research was used to understand what terms customers associated with the company
•Research provided guidance about where work was needed in order to improve brand perception
Brand Perception
•Competitive Analysis provided insight into which brand positions were cluttered and which were “untapped”, providing insights into potential areas of opportunity from a branding perspective
Competitive
Analysis •Underlying needs emerged via market research
•Understanding which needs are common, shared and differentiating helps determine channels and messaging used for branding
Needs Research
With the keys to branding firmly in their grasp, our clients are well positioned to better organize the
firm’s operations to help deliver on these brand promises
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Our 3D Segmentation methodology serves as the tool to gain a more
robust, holistic understanding of who the customer is
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Integrated Customer Segments are depicted with personas to help
make the segment more tangible for the organization
• 29 years old on average
• 61% female
• High level of employment (83% fully
employed)
• High income level (52% have higher
than $95 K household income)
• 76% have earned a Bachelor’s degree
or greater
• She spends less time on average
relative to her peers in other segments
reading about health and wellness
Needs and Behavior
• This segment is defined by their active, on-the-go lifestyle and
attitude towards their health and wellness.
• Their busy lifestyle and overall high levels of health means that
this segment utilizes their health insurance benefits only
minimally.
• When this segment does have the need to interact with their
insurer, they prefer to do so via an app or a mobile website. And
would prefer to avoid having to speak on the phone with a CSR
• Young and Mobiles secure coverage from a health insurer most
often to provide coverage in the event of a life-changing event
Value
• As this segment pays a relatively high monthly premium and only
utilizes their benefits on a few occasions per year, this segment is
considered to be a high value segment, which on average
contribute $922 annually towards gross margin
Young and Mobile
Illustrative
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Mapping existing processes from a member’s perspective highlights
experience improvement opportunities
No
Yes
A
Denial Letter: An application rejection notice is gets sent to applicant
Mail (Out)
•Acknowledgement letter
Mail (Out) [7 days after application]
An application receipt acknowledgement letter is sent within 7
days
Verification contacts are made with all Medicare Advantage applicants (One verification
call followed by one letter and two more calls)
Eligible?
Welcome Pack: •Confirmation letter •EOC •Summary of benefits •PHI opt-out info •Provider directory •Pharmacy directory •Formulary •Advanced directives •Mail-order pharmacy info
Mail (Out) [Within 10 days of
effective date]
New Member Socials: •They kick off on 1st of Feb
In Person (Out)
Welcome Call: •Make sure member received everything that’s been sent •Answer questions •Great retention tool to keep member from switching in the January change period •Let member know that she can give permission to speak on her behalf by sending a letter •Verbal permission is good only for 14 days •Tell about:
•client-medicare.com •Customer service #
•Billing information
Phone (Out) [Approx. 30 days after effective date]
Facets/SalesLogix
D4
Welcome Call
•ID Card
Mail (Out) [Before the effective
date]
Health Risk Assesment (HRA): •Mail includes directions about how to do the HRA online or using customer service
Mail (Out) [???]
Health Risk Assesment (HRA): •If member doesn’t respond then call them to complete the HRA •CMS requires HRA to be compeleted within 90 days of coverage
Phone (Out)
Member doesn’t complete the HRA.
•Member completes HRA
Mail (In)
•Member completes HRA
Phone (In)
•Member completes HRA
Web (In)
Healthcare Handbook: •When the member completes the HRA, she receives a Healthcare Handbook •The handbook is positioned as an incentive
Mail (In)
D5
HRA Data
Care Advance
Quarterly Newsletter •Originally a compliance tool •Moving away from product newsletter towards a “Medicare” newsletter •May need separate versions for Med Adv. vs. Med Sup.
Mail (Out)
client-medicare.com: •BlueAccess •Personal Health Manager (PHM)
Web(In/Out)
Medical EOB •Sent after every claim is made
Mail (Out)
MEDai Facets
Automated preventive calls: •Annual exam and flu shot reminders •Gaps in care reminders based on analytics •Scripts are tailored for different seasonal initiatives
Call (Out)
Nurses reach out to members to enroll them in DM or CM programs
Call (Out)
Care Advance
Claims, current conditions, data from HRA, demographic data and other
3rd party data about the member are used to identify gaps in care and members may be referred to DM or
CM.
EOB for Medicare Part D •Sent monthly to members who subscribed to the MAPD program
Mail (Out)
•Sales agent try to call within 24 hours •They first try schedule home visit •If individuals don’t take the home visits they intive them to information meetings
Phone (Out)
•During peak periods (Q4 and Q1) call center agents ( Dial America) •At othe times sales agents take the inbound calls •They first try to schedule home visit •If individuals don’t take the home visits they intive them to information meetings
Phone (In)
Did prospect
take a face-to-face
meeting?
Did prospect
give consent to
receive enrollment
kit?
Enrollment Kit: •Summary of benefits •Automatic bank draft form •Application form •Rx drug coverage •Education material on PFFS plans
Mail (In)
Face-to-face sales call
Broker or Captive Staff (Out)
Yes
No
A
Yes
Prospect applies
D3
Application Data
D2
Pre-Sales Call
client contacts prospects who
provided consent for calling
•People can apply online at www.client-medicare.com or www.medicare.gov
Web (In)
•People can download, print, complete and mail application forms
Mail (In)
•People can call to enroll by phone
Phone (In)
SalesLogix
•Med. Adv. info (3 mons before age 65) •BRC to get consent to call
Mail (Out)
Dep. of Motor Vehicles DB
Filter out sensitive groups (Tenn rural health, fed gov. or sensitive
broker accounts)
•Prospective member gives consent to receive a call or pre-enrollment kit • Consent expires after 14 days
BRC (In)
BRC is manually keyed in to the
CRM tool
D1
Driver’s License Data
•Med. Sup. info(1 month before age 65) •BRC to get consent to call
Mail (Out)
•Reminder (1 month after age 65) •BRC to get consent to call
Mail (Out)
•Community events •SCHIP meetings
In Person (Out)
Direct Mail Marketing Campaigns: •They target ail individuals older than 65 •Use both internal and external data
Mail (Out)
Newspaper ads
Print (Out)
Medicare CRM Tool
•Welcome to Medicare (6 mons before age 65) •BRC to get consent to call
Mail (Out)
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Redesigning the critical onboarding phase yielded member experience
improvements, insurer cost savings, and greater employer satisfaction
Pre Enrollment Enrollment Post Enrollment
Contact Us 1
Posters, postcards, that ask member/prospect to call a consumer advisor
with any question or experience BCBSX Blue
Access with online demo
Call a
Consumer
Advisor
4
Call a consumer advisor with questions about
plan, general insurance questions, etc. For
existing members we use as a chance to path them into wellness or
disease mgmt.
Online
Demo
3
Provides an overview of insurance 101 topics,
demonstration of online tools and resources. For
existing members it provides an
opportunity to “configure your
relationship”
Value
Statement
Existing Members Only: Personalized mailer to thank the member for
their membership, summarize health
activity, point out gaps in care
2 Enrollment
Data Capture (paper)
6
For paper enrollment, modify forms, or provide
an additional form, to enable BCBSX to collect data to communicate
with the member in relevant ways
Enrollment
Data Capture (web)
5
Modify online enrollment to ask a
small number of additional questions to
enable BCBSX to communicate with
them in relevant ways.
Welcome Kit (paper)
7
Redesigned kit focused on welcoming
members, informing them about their plan, referencing EOC and other materials online,
educating about blue perks, and reminds
them to register online
Welcome Kit (email)
Redesigned kit focused on welcoming members,
informing them about their plan, referencing
EOC and other materials online, educating about blue perks, and reminds them to register online
8
ID Card
Mailer
9
Personalized mailer with welcoming tone,
personalized by name, lists family members,
contains location based health suggestions (gyms, hospitals,
clinics,), and reminds them to register online
Configure
Your
Relationship
10
Improved Blue Access Registration Process. This is a key interaction where members can tell us how they want to be communicated with by BCBSX
Welcome
Call
11
Personalized welcome call based on info from online registration process and disease mgmt. / wellness segmentation. Purpose
is to educate, welcome, and help with health issue
Newsletter (quarterly)
Personalized quarterly email newsletter with the standard and personalized content to inform member and provide key messages based on health status
12
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A Value Map drives decision making on current and existing services
and offerings by putting customer-based initiatives into financial terms
Using Peppers & Rogers Group’s “Get-Keep-Grow” framework, the map outlines how specific initiatives, such
as decreasing the number of claims, connect to consumer value, and what the appropriate metrics are to measure progress for each initiative
The Value Map utilizes the concept of consumer value to determine the financial feasibility of a consumer initiative Analytical Tool/
Framework
"Get-Keep-Grow” framework
It is helpful when deciding which initiatives to prioritize while giving a rough estimate on possible ROI for taking initiatives through to implementation
Prioritization
Value Map Description
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Although based on a fixed framework, the Value Map expands and
flexes continually to ensure that all potential initiatives can leverage it
Illustrative
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Why a Roadmap?
Customer Centricity is a journey, not a project… In fact, most client’s journey will take
approximately 24-36 months until they complete the full roll-out and implementation
of the Roadmap recommendations
PRG created a Roadmap to help serve as a compass as our client continues onto the next stages in
their journey
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The Roadmap serves as a project plan to guide clients on the
implementation phase of their journey
Duration: The
Roadmap covers a
3-4 year time period
Individual
Recommendations:
Each item is
sequenced based on
the difficulty, priority
and dependency on
other items that must
be completed prior to
focusing on a
recommendation
Legend:
Recommendation
items have been
color-coded to help
easily distinguish
between pilot
programs and full
recommendations
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• Support from executive
leadership
• Managing the organizational
appetite
• Handling the resistance that
will crop up
• Involving the support functions
• Communicating with all levels
• Evaluating the business impact
• Separating opinion from expertise
Lessons Learned
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Q & A Session
Elizabeth Glagowski Executive Editor, Strategy
Peppers & Rogers Group
Marc Ruggiano Partner,
Peppers & Rogers Group
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PRG Healthcare Practice Activity
1. Download our white paper on a consumer-centric transformation
• Click on the bottom right button in the presentation screen
2. Peppers & Rogers Group Healthcare Webinar Series
• If you’ve missed any installments in our Healthcare Webinar Series, view the archives at http://www.peppersandrogersgroup.com/healthcare
3. Continue the conversation with Peppers & Rogers Group’s Healthcare experts with our new LinkedIn Group “Customer-Centric Healthcare”
• Join today at http://linkd.in/KPXUv5
4. Follow us on Twitter @PeppersRogers
5. Visit us on Facebook.com/PeppersandRogersGroup
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Q & A Session
Elizabeth Glagowski Executive Editor, Strategy
Peppers & Rogers Group
Marc Ruggiano Partner,
Peppers & Rogers Group
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Marc Ruggiano Partner
[email protected] +1.203.989.2189 (office)
Tom Schmalzl
Director, Business Development
+1.203.989.2208(office)