4 STEPSTO OPTIMIZING CUSTOMER VALUE IN HEALTHCARE LEVERAGING PREDICTIVE ANALYTICS FOR CUSTOMER CENTRICITY

Despite the lure of customer centricity, many healthcare organizations still rely on product-centric customer interactions. But in the new world of retail healthcare, organizations must deliver a customer-focused experience that will differentiate their business and help them successfully acquire, engage and retain customers, including members, patients and providers.

In this ebook, Pegasystems’ Elizabeth Hart discusses a new approach to optimizing customer value by leveraging predictive and adaptive analytics. Called Next-Best-Action (N-B-A), this approach revolutionizes the relationship with your customer, delivering targeted and personalized interactions that can significantly increase customer satisfaction, sales, retention and revenues.

Elizabeth HartHealthcare PrincipalPegasystems

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Next-Best-Action provides a corporate “decision hub” that guides each inbound and outbound customer communication across every communication channel and line of business in your healthcare enterprise—all in real time.

Next-Best-Action presents your service, marketing and sales representatives (both direct and indirect) with up-to-the minute insight into each customer or prospect so they can execute on that understanding and manage relationships to optimize the value of your company to the customer, and the customer to your company.

What is Next-Best-Action?

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Sophisticated predictive and adaptive analytics are at the heart of the N-B-A decision hub.

� Predictive analytics use relevant data, such as age, income, gender and claims history to predict a customer’s expected behavior, such as how likely the individual is to buy a specific health plan.

� Adaptive analytics learn from each customer interaction to refine predictions and continuously improve the success of retention strategies, cross-sell and up-sell propositions.

Using these models, healthcare organizations can market to consumers based on anticipated behavior. N-B-A uses these models in real time, turning once-static predictive models into actionable models that guide every customer interaction and optimize the outcome, increasing customer engagement and satisfaction.

Analytics —The Heart of Next-Best-Action

Each customer can become a “segment of one” with the action or offer targeted directly to the individual.

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N-B-A facilitates holistic, continuous communications that select the optimal treatment, one step—or decision—at a time based on analytic predictions. The decision can be made in real time, or it can be made when an output file is generated by marketing or sales for outbound communication.

The just-in-time decision process develops, ranks and presents multiple options, accounting for factors such as the customer’s propensity to enroll, eligibility, margin and market-share goals. The customer gets the recommendation which is most likely to yield a positive result and maximizes value to your organization. There is no channel conflict because N-B-A is channel agnostic and can deliver an offer via multiple inbound and outbound channels, while ensuring offers do not collide.

How Does N-B-A Work?

BestOffer

Medical PlanPropensity

Medical PlanEligibility

Medical PlanStrategy

Travel Coverage

Propensity

TravelCoverageEligibility

TravelCoverageStrategy

WellnessProgram

Propensity

WellnessProgramEligibility

WellnessProgramStrategy

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Now that we’ve outlined a general understanding of how Next-Best-Action works, let’s examine the four steps to optimizing customer value.

The first step is to answer one simple—but critical—question:

Ask the Critical Question1STEP

The answer requires collaboration between all the groups and departments involved in crafting customer interaction strategies, including marketing, sales, underwriting, care management, compliance and customer service.

The goal is to make sure all stakeholders agree on the priorities for the business: What is our risk appetite? What customers are we targeting? Is selling more important than retention? Priorities should be based on considerations such as corporate strategy, expected underwriting profitability, operational constraints, regulations, company policies and business goals.

WHAT IS THE APPROACH WE WILL TAKE TO MAXIMIZE THE RELATIONSHIP WITH EACH CUSTOMER WHEN CONTACT OCCURS?

OPTIMIZING CUSTOMER VALUE

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Once agreement is reached, each stakeholder works on their specific Next-Best-Action questions. For example, if the answer to the critical question is that selling is the priority, then which offer should be made first? What level of risk is acceptable? Each relevant question needs to be asked and answered until the sub-strategy and all its components are developed.

Define Sub-Strategies 2STEPOPTIMIZING

CUSTOMER VALUE

What is the purposeof the interaction?

What is the level of risk?How to respond?

Is there a retention risk?If so, should we invest in retention?If so, how to retain?

If risk is acceptable, what sales proposition should be made and in what way?

CallReason

ValuePrediction

ValuePredictionExposure Value

PredictionLong Term

ValueValue

PredictionMitigationStrategy

ValuePrediction

ServiceStrategy

ChampionChallenger

ValuePrediction

Best Offer

ValuePredictionRetention

Matrix

CallReasonProduct

Propensity

CallReasonProduct

Propensity

CallReasonProduct

Propensity

CallReasonProduct

Eligibility

CallReasonProduct

Eligibility

CallReasonProduct

Eligibility

CallReasonProduct

Proposition

CallReasonProduct

Proposition

CallReasonProduct

Proposition

Next-Best-Action

RetentionProposition

1

RetentionProposition

2

ValuePrediction

RetentionPenetration

AccountPenetration

RiskPrediction

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When invoked, the decision hub applies the sub-strategies repetitively and determines the optimal recommendation for each case. Since the customer’s interests may be affected by the offer or other factors, such as a change in life circumstances, the N-B-A recommendation is likely different each time the decision hub is invoked.

Unlike product-specific marketing, N-B-A starts with a holistic view of the customer. The logic of the process does not vary much from one customer to another, so that a single campaign can be fitted to the customer, rather than making the customer fit the campaign. By answering the critical question first, customer segmentation naturally follows from the level of customer differentiation that is actually operationally supported, reducing costs and enhancing transparency.

Why Answering the Critical Question is Important

You can develop best-practice blueprints to fast track the implementation of campaigns driven by N-B-A

Implementation time for early adopters, which usually takes eight months to recuperate costs and 18 months for a full multi-channel rollout, can shrink by 50% with blueprints.

OPTIMIZING CUSTOMER VALUE

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With N-B-A, outbound campaigns are just one element of the total customer experience. This changes the role of outbound marketing.

� The rise of consumerism in healthcare creates greater interest in outbound campaigns that can encourage customers to engage via inbound channels, which can be a more effective selling channel as your customer chooses the time to interact and is likely to be receptive to offers.

� Outbound marketing becomes part of the continuous customer interaction across channels. For instance, an inbound interaction concludes with the customer agreeing to engage contact, and an outbound communication is the way to ensure that promise is kept. Or, lifecycle events like a birthday can trigger an outbound action suggesting a relevant new health plan or wellness promotion.

Rethink Outbound Marketing3STEPOPTIMIZING

CUSTOMER VALUE

Campaigns can be consolidated in a holistic outbound customer contact strategy in which all campaigns compete for the “right” to be the one sent to the customer, doing away with the random (and probably irrelevant) product-centric campaign.

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N-B-A can have a profound effect on your contact center. Customer service representatives (CSRs) who were dedicated to just service can now engage across the customer lifecycle. By continuously providing the CSR with recommendations for the Next-Best-Action, each interaction becomes a meaningful conversation that leverages opportunities appropriately across sales, servicing and retention activities.

A good N-B-A strategy mirrors the contact center’s best practices and ensures that CSRs are making recommendations that best meet the customer’s needs. For example, it can alert CSRs of a caller’s upcoming life event and suggest pertinent offers, or caution them that a caller is at risk of terminating coverage and guide them through appropriate retention activities. As a result, customers and CSRs experience much higher levels of satisfaction and value.

Drive Your Contact Center with N-B-A

4STEPOPTIMIZING CUSTOMER VALUE

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There are many functions within the customer lifecycle where a healthcare organization can leverage Next-Best-Action including:

Using N-B-A in Healthcare

MARKETING

CUSTOMER SERVICE

DIRECT & INDIRECT

SALES

� Increase campaign response rates via personalized, multi-channel campaigns

� Intelligently segment markets and continuously hone campaigns with built-in modeling, forecasting and testing capabilities

� Automate real-time event push and pull marketing

� Deliver dynamic, targeted retention, service and sales recommendations

� Personalize interactions with adaptive analytics that continuously incorporate new information, including real-time customer behavior

� Increase offer conversion rates with tailored sales recommendations

� Improve offer presentation rates with automated, cross-channel programs

� Engage customers in dialog about specific needs with “what if” and comparison scenarios

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� Channel consistency — The decision hub in N-B-A executes a holistic strategy that recommends the best action across every channel for consistent communications that avoid channel collisions.

� Natural conversations — Dynamic Next-Best-Actions support natural, interactive communication. Customers easily participate in the conversation, focusing their attention on what is being offered rather than being distracted, confused or annoyed by the process itself.

� Cost alignment — Predictive models help you to optimize resource use and align the cost of the effort with key business factors, such as the likely response to a proposition or customer lifetime value.

� Effective monitoring — Every decision and its basis is captured so that you can accurately judge the performance of the N-B-A strategies, in real time or later.

� Total control — Because information fed to the decision hub is developed and maintained by line-of-business management rather than IT, strategies can be adjusted on demand. With the hub as the central location for making all customer-facing decisions, changing the instructions changes the way your company does business.

The Benefits of N-B-A for Optimizing Customer Value

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Next-Best-Action represents a real solution to achieving true customer centricity. It can add value to each customer decision and interaction, with the bottom line contribution increasing as both the number of interactions and their complexity grows.

Next-Best-Action coincides nicely with the move to retail healthcare, which will require organizations to treat customers as individuals. It also supports the customer’s desire to choose the moment and channel to contact your company, then select, negotiate and configure a product or service of their choice. Next-Best-Action ideally fits this model, allowing your organization to effectively manage customer interactions to deliver outstanding experiences across every channel, fulfill brand promise, increase revenues and optimize the use of resources.

N-B-A: Delivering Real Customer Centricity for Optimal Results

© Copyright 2013 Pegasystems Inc. All rights reserved. All trademarks are the property of their respective owners.

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About Pegasystems

Pegasystems, the leader in business process management and software for customer centricity, helps organizations enhance customer loyalty, generate new business, and improve productivity. Our patented Build for Change® technology speeds the delivery of critical business solutions by directly capturing business objectives and eliminating manual programming. Pegasystems enables clients to quickly adapt to changing business conditions in order to outperform the competition.

For more information, please visit us at www.pega.com.