customer centricity in healthcare

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COPYRIGHT 2012 ALL RIGHTS PROTECTED AND RESERVED.

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Customer Centricity in Healthcare

May 17, 2012

Laying the Foundationfor a Customer-Centric Organization


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COPYRIGHT 2011. ALL RIGHTS PROTECTED AND RESERVED. 2

Todays Speakers

Elizabeth GlagowskiExecutive Editor, Strategy

Peppers & Rogers Group

Marc RuggianoPartner,



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Twitter Hash tag: #prghealthcare


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The Case for Trusted Relationships

Peppers & Rogers Group Client Examples

Q&A Discussion

Agenda


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The Case forTrusted 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.

COPYRIGHT 2012 ALL RIGHTS PROTECTED AND RESERVED
http://facts.kff.org/http://facts.kff.org/


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While Life Expectancy Lags Considerably

40

50

60

70

80

90

Source: OECD FactBook 2010; viawww.oecd-ilibrary.org/accessed on February 25, 2012.

Life Expectancy at Birth, Total (Number of Years)

http://www.oecd-ilibrary.org/http://www.oecd-ilibrary.org/http://www.oecd-ilibrary.org/http://www.oecd-ilibrary.org/



and Consumers Rate the Experience Poorly

Customer Experience Index (CxI) by Industry

Source: Forrester Research, The Customer Experience 2012




Health Visual Definition

a healthystate ofwellbeing freefrom disease

the generalcondition ofbody and

mind

Source: ThinkMap Visual Thesaurus, 2011



Care Visual Definition

the work ofprovidingtreatment foror attendingto someone

or something

Source: ThinkMap Visual Thesaurus, 2011



Consumers Define Health in Many Ways

Source: Peppers & Rogers Group research




Consumer Perception of Todays Health Insurers





Consumers Describe the Ideal Health Insurer





Customers Trust in the Health Insurance Sector

43%

19%

38%

Distrusters Neutral Trusters

Trust





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





Customers Trust for Individual Health Insurers


Variations in Trust Among Large Insurers

Customers Trust for Individual Health Insurers

0%

20%

40%

60%

80%

100%

Anthem BCBS UnitedHealthcare

Aetna Humana KaiserPermanente

Responde

nts

Distrusters Neutral Trusters




Customers Value Trustworthiness


Consumer Willingness to Pay for Trustability

Customers Value Trustworthiness


$12.1

$24.7

$6.4

$3.9$3.1

$-

$10.0

$20.0

$30.0

Anthem BCBS UnitedHealthcare Aetna Humana KaiserPermanente

Annual Premium

$Billions



Peppers &Rogers GroupClient Examples



Making the Case for Transformation

Expectation Competition RegulationConsumer choice is onlyincreasing, as they take amore active role in thehealthcare decision-making process.

The Affordable Care Actand other healthcarereform is ongoing at boththe state and federallevel.

Customer expectationsfrom their experiences inother industries hasbegun to permeate thehealthcare industry.


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We started by taking the pulse of our clients organization with acurrent state assessment

DocumentReviews (70+)

Working Sessions

Interviews acrossthe organization

IndustryDynamics andTrends

Key

Stakeholders

CompetitiveLandscape

Internal External

PRG analyzed both internal and external factors over a five week period, in order to gain asnapshot 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 andwhich areas required additional attention going forward

Consumer/Outcome-Driven

Integrated1to1 Enterprise

Consumer/Outcome-Sensitive

SalesOperations

HealthCareServices

Communications

Product/Process-Driven

Consume

rCentricityMaturitySpectrum

Risk Finance IT HR

Group/Division

Illustrative


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Market Research yielded key insights about attitudes and motivationsregarding Health Insurance and Health and Wellness


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as well as insights into which new products and services wouldconsumers be most interested in if offered by their health insurer

Illustrative A new product concept

survey was conductedwith members of theclients internal online

community, evaluating 6new product concepts

Research revealed that ifany one of the productconcepts that were partof the survey wereoffered, members weremore likely to considerthe insurer as a partner in

their health and wellness,with results of increasedpartnership ranging from22-39%, depending onthe product


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Branding, while not historically a huge focus area for health insurers,has now come to the forefront in todays environment

By answeringthese threequestions, wewere able tohelp our clientundertake aserious look attheir brandingstrategy


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Our branding approach consists of 3 key steps that inform thebranding recommendation that we ultimately make for our clients

3rd party research was usedto understand what termscustomers associated withthe company

Research provided

guidance about where workwas needed in order toimprove brand perception

BrandPerception

Competitive Analysisprovided insight into which

brand positions werecluttered and which wereuntapped, providinginsights into potential areasof opportunity from abranding perspective

Competitive

Analysis Underlying needs emergedvia market research

Understanding which needsare common, shared anddifferentiating helps

determine channels andmessaging used forbranding

NeedsResearch

With the keys to branding firmly in their grasp, our clients are well positioned to better organize thefirms operations to help deliver on these brand promises


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Our 3D Segmentation methodology serves as the tool to gain a morerobust, holistic understanding of who the customer is


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Integrated Customer Segments are depicted with personas to helpmake the segment more tangible for the organization

29 years old on average

61% female

High level of employment (83% fullyemployed)

High income level (52% have higherthan $95 K household income)

76% have earned a Bachelors degreeor greater

She spends less time on averagerelative to her peers in other segmentsreading about health and wellness

Needs and Behavior

This segment is defined by their active, on-the-go lifestyle andattitude towards their health and wellness.

Their busy lifestyle and overall high levels of health means thatthis segment utilizes their health insurance benefits onlyminimally.

When this segment does have the need to interact with theirinsurer, 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 onlyutilizes their benefits on a few occasions per year, this segment isconsidered to be a high value segment, which on averagecontribute $922 annually towards gross margin

Young and Mobile

Illustrative


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Mapping existing processes from a members perspective highlightsexperience improvement opportunities

No

Yes

A

DenialLetter:Anapplicationrejectionnotice is getssent toapplicant

Mail(Out)

Acknowledgement letter

Mail(Out)[7 days afterapplication]

Anapplicationreceiptacknowledgementletteris sent within7

days

Verificationcontacts are madewithallMedicareAdvantageapplicants(Oneverification

callfollowed byoneletterandtwomorecalls)

Eligible?

Welcome Pack:

ConfirmationletterEOC

Summaryofbenefits

PHI opt-out info

Providerdirectory

Pharmacydirectory

Formulary

Advanceddirectives

Mail-orderpharmacyinfo

Mail(Out)[Within10 days of

effective date]

New MemberSocials:

Theykick offon1st ofFeb

InPerson(Out)

Welcome Call:

Make sure memberreceivedeverything thatsbeensent

Answerquestions

Great retentiontooltokeepmemberfromswitchingintheJanuarychangeperiod

Let memberknowthat shecangivepermissiontospeakonherbehalfbysendingaletter

Verbalpermissionis goodonlyfor14days

Tellabout:

client-medicare.com

Customerservice#

Billinginformation

Phone (Out)[Approx. 30 days aftereffective date]

Facets/SalesLogix

D4

WelcomeCall

ID Card

Mail(Out)[Before the effective

date]

HealthRisk Assesment(HRA):

Mailincludes directionsabouthowtodotheHRA online orusingcustomerservice

Mail(Out)[???]

HealthRisk Assesment(HRA):

Ifmemberdoesnt respondthencallthemtocompletetheHRA

CMSrequires HRA tobecompeleted within90days ofcoverage

Phone (Out)

Member doesnt complete theHRA.

MembercompletesHRA

Mail(In)

MembercompletesHRA

Phone (In)

MembercompletesHRA

Web(In)

Healthcare Handbook:

WhenthemembercompletestheHRA,shereceives a HealthcareHandbook

Thehandbook is positionedas anincentive

Mail(In)

D5

HRAData

Care Advance

Quarterly Newsletter

Originallyacompliance tool

Movingawayfromproduct newslettertowardsa MedicarenewsletterMayneed separateversionsforMed Adv.vs. MedSup.

Mail(Out)

client-medicare.com:

BlueAccess

PersonalHealthManager(PHM)

Web(In/Out)

MedicalEOB

Sent aftereveryclaimis made

Mail(Out)

MEDaiFacets

Automatedpreventive calls:

Annualexamand flushot reminders

Gaps incarereminders based onanalyticsScripts aretailored fordifferent seasonalinitiatives

Call(Out)

Nurses reachout tomembers toenrolltheminDM orCMprograms

Call(Out)

CareAdvance

Claims, current conditions,datafromHRA,demographic dataand other

3rd partydata about the member areused toidentifygaps incareand members maybe referred toDM or

CM.

EOB forMedicare PartD

Sent monthlytomembers whosubscribedtotheMAPD program

Mail(Out)

Sales agent trytocallwithin24hours

Theyfirst tryschedulehomevisit

Ifindividuals donttakethehomevisitstheyintive themtoinformationmeetings

Phone (Out)

Duringpeak periods (Q4and Q1) callcenteragents (DialAmerica)

At othetimessalesagentstaketheinbound calls

Theyfirst trytoschedulehomevisit

Ifindividuals dont takethehomevisitstheyintive themtoinformationmeetings

Phone (In)

Didprospect

takea face-to-face

meeting?

Didprospect

giveconsent to

receiveenrollment

kit?

EnrollmentKit:

Summaryofbenefits

Automaticbank draft form

Applicationform

Rxdrugcoverage

EducationmaterialonPFFSplans

Mail(In)

Face-to-facesalescall

Brokero rCaptiveStaff (Out)

Yes

No

A

Yes

Prospect applies

D3

ApplicationData

D2

Pre-SalesCall

client contactsprospectswho

provided consent forcalling

People canapplyonline atwww.client -medicare.com orwww.medicare.gov

Web(In)

Peoplecandownload,print,completeand mailapplicationforms

Mail(In)

Peoplecancalltoenrollbyphone

Phone (In)

SalesLogix

Med. Adv.info(3monsbeforeage65)

BRC toget consent tocall

Mail(Out)

Dep. of MotorVehicles DB

Filterout sensitivegroups (Tennruralhealth, fed gov. ors ensitive

brokeraccounts)

Prospective membergives consent toreceivea callorpre-enrollment kit

Consent expiresafter14days

BRC(In)

BRC is manuallykeyed intothe

CRM tool

D1

DriversLicenseData

Med. Sup. info(1monthbefore age 65)


Mail(Out)

Reminder(1monthafterage65)


Mail(Out)

Community events

SCHIP meetings

InPerson(Out)

DirectMailMarketingCampaigns:

Theytarget ailindividualsolderthan65Usebothinternalandexternaldata

Mail(Out)

Newspaperads

Print(Out)

Medicare CRMTool

WelcometoMedicare(6mons beforeage65)


Mail(Out)
http://www.medicare.gov/http://www.bcbst-medicare.com/http://www.medicare.gov/http://www.medicare.gov/http://www.medicare.gov/http://www.bcbst-medicare.com/http://www.bcbst-medicare.com/http://www.bcbst-medicare.com/


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Redesigning the critical onboarding phase yielded member experienceimprovements, insurer cost savings, and greater employer satisfaction

Pre Enrollment Enrollment Post Enrollment

Contact Us1

Posters, postcards, that

ask member/prospect tocall a consumer advisor

with any question orexperience BCBSX Blue

Access with online demo

Call aConsumer

Advisor

4

Call a consumer advisorwith questions about

plan, general insurancequestions, etc. For

existing members we useas a chance to paththem into wellness or

disease mgmt.

OnlineDemo

3

Provides an overview ofinsurance 101 topics,

demonstration of online

tools and resources. Forexisting members itprovides an

opportunity toconfigure yourrelationship

ValueStatement

Existing Members Only:Personalized mailer tothank the member for

their membership,summarize health

activity, point out gaps incare

2Enrollment

Data Capture(paper)

6

For paper enrollment,modify forms, or provide

an additional form, toenable BCBSX to collectdata to communicate

with the member inrelevant ways

EnrollmentData Capture

(web)

5

Modify online

enrollment to ask asmall number of

additional questions toenable BCBSX to

communicate withthem in relevant ways.

Welcome Kit(paper)

7

Redesigned kit focusedon welcoming

members, informing

them about their plan,referencing EOC andother materials online,educating about blue

perks, and remindsthem to register online

Welcome Kit(email)

Redesigned kit focusedon welcoming members,

informing them abouttheir plan, referencing

EOC and other materialsonline, educating aboutblue perks, and remindsthem to register online

8

ID CardMailer

9

Personalized mailer withwelcoming tone,

personalized by name,

lists family members,contains location based

health suggestions(gyms, hospitals,

clinics,), and remindsthem to register online

ConfigureYour

Relationship

10

Improved Blue AccessRegistration Process.This is a key interactionwhere members cantell us how they wantto be communicatedwith by BCBSX

WelcomeCall

11

Personalized welcomecall based on info fromonline registration

process and diseasemgmt. / wellnesssegmentation. Purposeis to educate,welcome, and helpwith health issue

EmailNewsletter(quarterly)

Personalized quarterlyemail newsletter withthe standard andpersonalized contentto inform memberand provide keymessages based onhealth status

12


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A Value Map drives decision making on current and existing servicesand offerings by putting customer-based initiatives into financial terms

Using Peppers & Rogers Groups Get-Keep-Grow

framework, the map outlines how specific initiatives, suchas decreasing the number of claims, connect toconsumer value, and what the appropriate metrics are tomeasure progress for each initiative

The Value Map utilizes the concept of consumer value todetermine the financial feasibility of a consumer initiativeAnalytical Tool/

Framework

"Get-Keep-Grow

framework

It is helpful when deciding which initiatives to prioritizewhile 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 andflexes 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 clients journey will take

approximately 24-36 months until they complete the full roll-out and implementationof the Roadmap recommendations

PRG created a Roadmap to help serve as a compass as our client continues onto the next stages intheir journey


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The Roadmap serves as a project plan to guide clients on theimplementation phase of their journey

Duration: TheRoadmap covers a3-4 year time period

IndividualRecommendations:Each item is

sequenced based onthe difficulty, priorityand dependency onother items that mustbe completed prior tofocusing on arecommendation

Legend:Recommendationitems have beencolor-coded to helpeasily distinguishbetween pilotprograms and full

recommendations

L L d


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Support from executive

leadership Managing the organizational

appetite

Handling the resistance thatwill 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 GlagowskiExecutive Editor, StrategyPeppers & Rogers Group



PRG H lth P ti A ti it


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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 youve missed any installments in our Healthcare Webinar Series,view the archives athttp://www.peppersandrogersgroup.com/healthcare

3. Continue the conversation with Peppers & Rogers GroupsHealthcare 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
http://www.peppersandrogersgroup.com/healthcarehttp://linkd.in/KPXUv5http://linkd.in/KPXUv5http://www.peppersandrogersgroup.com/healthcare


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Q & A Session

Elizabeth GlagowskiExecutive Editor, StrategyPeppers & Rogers Group




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Marc RuggianoPartner

[email protected]+1.203.989.2189 (office)

Tom SchmalzlDirector, Business Development

[email protected]+1.203.989.2208(office)
mailto:[email protected]:[email protected]:[email protected]:[email protected]

customer centricity in healthcare

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