Case Study: Making the Consumer-centric Transformation
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Case Study: Making the Consumer-centric Transformation

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One health insurer chose not to sit idly by and watch the industry change around it. The organization's leadership wanted to stay ahead of the curve. Working with Peppers & Rogers Group, the company ...

One health insurer chose not to sit idly by and watch the industry change around it. The organization's leadership wanted to stay ahead of the curve. Working with Peppers & Rogers Group, the company created a multi-pronged approach to transform its business to be healthier over the long term, with customer centricity at its core.

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Case Study: Making the Consumer-centric Transformation Case Study: Making the Consumer-centric Transformation Presentation Transcript

  • make an Laying the Foundation impact! for a Customer-Centric Organization Customer Centricity in Healthcare May 17, 2012COPYRIGHT © 2012 ALL RIGHTS PROTECTED AND RESERVED.
  • Today’s Speakers Marc Ruggiano Elizabeth Glagowski Partner, Executive Editor, Strategy Peppers & Rogers Group Peppers & Rogers GroupCOPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 2
  • Event logistics Please turn off your pop-up blocker • You will not be able to participate in today’s survey Download a PDF of today’s slides • Click the green PDF icon Have a question for the presenters? • Click the red Q&A icon Helpful tools • Click the gold question mark for help with technical issues • Enlarge slides when needed • Twitter Hash tag: #prghealthcareCOPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 3
  • Agenda The Case for Trusted Relationships Peppers & Rogers Group Client Examples Q&A DiscussionCOPYRIGHT © 2012. ALL RIGHTS PROTECTED AND RESERVED. 4
  • The Case for Trusted RelationshipsCOPYRIGHT © 2012. ALL RIGHTS PROTECTED AND RESERVED. 5
  • 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 COPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 6
  • While Life Expectancy Lags Considerably Life Expectancy at Birth, Total (Number of Years) 90 80 70 60 50 40 Source: OECD FactBook 2010; via www.oecd-ilibrary.org/ accessed on February 25, 2012.COPYRIGHT ©2012 ALL RIGHTS PROTECTED AND RESERVED COPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 7
  • and Consumers Rate the Experience Poorly Customer Experience Index (CxI) by Industry Source: Forrester Research, The Customer Experience 2012COPYRIGHT ©2012 ALL RIGHTS PROTECTED AND RESERVED COPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 8
  • Health Visual Definition a healthy the general state of condition of wellbeing free body and from disease mind Source: ThinkMap Visual Thesaurus, 2011COPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 9
  • Care Visual Definition the work of providing treatment for or attending to someone or something Source: ThinkMap Visual Thesaurus, 2011COPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 10
  • Consumers Define Health in Many Ways Source: Peppers & Rogers Group researchCOPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 11
  • Consumer Perception of Today’s Health Insurers Source: Peppers & Rogers Group researchCOPYRIGHT ©2012 ALL RIGHTS PROTECTED AND RESERVED COPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 12
  • Consumers Describe the Ideal Health Insurer Source: Peppers & Rogers Group researchCOPYRIGHT ©2012 ALL RIGHTS PROTECTED AND RESERVED COPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 13
  • Source: Peppers & Rogers Group researchCOPYRIGHT ©2012 ALL RIGHTS PROTECTED AND RESERVED COPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 14
  • Source: Peppers & Rogers Group researchCOPYRIGHT ©2012 ALL RIGHTS PROTECTED AND RESERVED COPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 15
  • Customers’ Trust in the Health Insurance Sector 38% 43% Trust 19% Distrusters Neutral Trusters Source: Peppers & Rogers Group researchCOPYRIGHT ©2012 ALL RIGHTS PROTECTED AND RESERVED COPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 16
  • Characteristics of a Trustable Health Insurer Clear/Confusing Transparent/Secretive 3 Easy/Difficult Organized/Disorganized Caring/Uncaring 2 Accessible/Inaccessible 1 Generous/Stingy 0 Up-to-date/Outdated Fair/Unfair -1 Superior/Inferior -2 Compassionate/Uncompassionate -3 Kind/Unkind Flexible/Inflexible Reliable/Unreliable Helpful/Unhelpful Informative/Uninformative Believable/Unbelieveable Friendly/Unfriendly Effective/Ineffective Cooperative/Combative Warm-hearted/Cold-hearted Fast/Slow Distrusters Trusters Source: Peppers & Rogers Group researchCOPYRIGHT ©2012 ALL RIGHTS PROTECTED AND RESERVED COPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 17
  • Customers’ Trust for Individual Health Insurers Variations in Trust Among Large Insurers 100% 80% Respondents 60% 40% 20% 0% Anthem BCBS United Aetna Humana Kaiser Healthcare Permanente Distrusters Neutral Trusters Source: Peppers & Rogers Group researchCOPYRIGHT ©2012 ALL RIGHTS PROTECTED AND RESERVED COPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 18
  • Customers Value Trustworthiness Consumer Willingness to Pay for Trustability $30.0 $24.7 $20.0 $Billions $12.1 $10.0 $6.4 $3.9 $3.1 $- Anthem BCBS United Aetna Humana Kaiser Healthcare Permanente Annual Premium Source: Peppers & Rogers Group researchCOPYRIGHT ©2012 ALL RIGHTS PROTECTED AND RESERVED COPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 19
  • Peppers & Rogers Group Client ExamplesCOPYRIGHT © 2012. ALL RIGHTS PROTECTED AND RESERVED. 20
  • Making the Case for Transformation Expectation Competition Regulation Customer expectations Consumer choice is only The Affordable Care Act from their experiences in increasing, as they take a and other healthcare other industries has more active role in the reform is ongoing at both begun to permeate the healthcare decision- the state and federal healthcare industry. making process. level.COPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 21
  • We started by taking the pulse of our client’s organization with acurrent state assessment… Internal External • Document • Industry Reviews (70+) Dynamics and Trends • Working Sessions • Key • Interviews across Stakeholders the organization • Competitive Landscape 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.COPYRIGHT © 2012. ALL RIGHTS PROTECTED AND RESERVED. 22
  • …which yielded a clear picture of where the organization stood and which areas required additional attention going forward Illustrative Integrated 1to1 EnterpriseConsumer Centricity Maturity Spectrum Consumer/ Outcome- Driven Consumer/ Outcome- Sensitive Product/ Process-Driven Health Operati Commun Sales Care Risk Finance IT HR ons ications Services Group/Division COPYRIGHT © 2012. ALL RIGHTS PROTECTED AND RESERVED. 23
  • Market Research yielded key insights about attitudes and motivationsregarding Health Insurance and Health and Wellness…COPYRIGHT © 2012. ALL RIGHTS PROTECTED AND RESERVED. 24
  • …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 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 productCOPYRIGHT © 2012. ALL RIGHTS PROTECTED AND RESERVED. 25
  • 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 strategyCOPYRIGHT © 2012. ALL RIGHTS PROTECTED AND RESERVED. 26
  • Our branding approach consists of 3 key steps that inform thebranding recommendation that we ultimately make for our clients Competitive •3rd party research was used Analysis •Underlying needs emerged to understand what terms via market research customers associated with •Understanding which needs the company •Competitive Analysis are common, shared and provided insight into which •Research provided differentiating helps brand positions were guidance about where work determine channels and was needed in order to cluttered and which were messaging used for improve brand perception “untapped”, providing branding insights into potential areas of opportunity from a Brand branding perspective Needs Perception 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 promisesCOPYRIGHT © 2012. ALL RIGHTS PROTECTED AND RESERVED. 27
  • Our 3D Segmentation methodology serves as the tool to gain a morerobust, holistic understanding of who the customer isCOPYRIGHT © 2012. ALL RIGHTS PROTECTED AND RESERVED. 28
  • Integrated Customer Segments are depicted with personas to helpmake the segment more tangible for the organization Illustrative Young and Mobile Needs and Behavior • This segment is defined by their active, on-the-go lifestyle and attitude towards their health and wellness. • Their busy lifestyle and overall high levels of health means that this segment utilizes their health insurance benefits only minimally. • When this segment does have the need to interact with their insurer, they prefer to do so via an app or a mobile website. And would prefer to avoid having to speak on the phone with a CSR • Young and Mobiles secure coverage from a health insurer most often to provide coverage in the event of a life-changing event • 29 years old on average • 61% female Value • High level of employment (83% fully • As this segment pays a relatively high monthly premium and only employed) utilizes their benefits on a few occasions per year, this segment is • High income level (52% have higher considered to be a high value segment, which on average than $95 K household income) contribute $922 annually towards gross margin • 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 wellnessCOPYRIGHT © 2012. ALL RIGHTS PROTECTED AND RESERVED. 29
  • Mapping existing processes from a member’s perspective highlightsexperience improvement opportunities Mail (Out) Mail (Out) Mail (Out) Mail (Out) Phone (In) Phone (In) Mail (In) Web (In) Mail (Out) [7 days after application] •Welcome to Medicare (6 •Med. Adv. info (3 mons •Med. Sup. info(1 month •Reminder (1 month after •During peak periods (Q4 •People can call to enroll by •People can download, print, •People can apply online at Verification contacts are made An application receipt mons before age 65) before age 65) before age 65) age 65) and Q1) call center agents ( phone complete and mail www.client-medicare.com or with all Medicare Advantage acknowledgement •BRC to get consent to call •BRC to get consent to call •BRC to get consent to call •BRC to get consent to call Dial America) application forms www.medicare.gov applicants (One verification •Acknowledgement letter letter is sent within 7 •At othe times sales agents call followed by one letter and days take the inbound calls two more calls) •They first try to schedule home visit •If individuals don’t take the home visits they intive them to information meetings A Ye Eligible s ? Did Did prospect Ye prospect N give s take a face- o consent to In Person (Out) to-face receive meeting? enrollment N BRC (In) kit? o •Community events •SCHIP meetings client contacts •Prospective member prospects who gives consent to provided consent for receive a call or pre- calling Ye Mail (Out) enrollment kit • Consent expires s after 14 days Phone (Out) Mail (Out) Broker or Captive Denial Letter: Filter out sensitive groups (Tenn Staff (Out) An application rejection rural health, fed gov. or sensitive notice is gets sent to broker accounts) •Sales agent try to call within applicant Direct Mail Marketing 24 hours Campaigns: D2 •They first try schedule home Face-to-face sales call Prospect applies •They target ail individuals visit older than 65 •If individuals don’t take the •Use both internal and home visits they intive them external data to information meetings Pre-Sales Mail (In) Call D1 BRC is manually Enrollment Kit: A D3 •Summary of benefits keyed in to the CRM tool •Automatic bank draft form Driver’s •Application form Print (Out) •Rx drug coverage License Data •Education material on PFFS Applic plans ation Newspaper ads Data Dep. of Motor Vehicles DB Medicare CRM Tool SalesLogix Mail (Out) Mail (In) Mail (Out) Mail (Out) In Person (Out) [???] Phone (Out) Mail (Out) Web(In/Out) Call (Out) Call (Out) Mail (Out) [Before the effective [Within 10 days of [Approx. 30 days after effective date] date] effective date] Health Risk Assesment (HRA): Healthcare Handbook: New Member Socials: Quarterly Newsletter client-medicare.com: Automated Nurses reach out to Medical EOB •Mail includes directions about •When the member •They kick off on 1st of Feb •Originally a •BlueAccess preventive calls: members to enroll •Sent after every claim how to do the HRA online or completes the HRA, she Welcome Pack: Welcome Call: •ID Card compliance tool •Personal Health •Annual exam and flu them in DM or CM is made using customer service receives a Healthcare •Confirmation letter •Make sure member received •Moving away from Manager (PHM) shot reminders programs Handbook •EOC everything that’s been sent product newsletter •Gaps in care •The handbook is positioned •Summary of benefits •Answer questions towards a “Medicare” reminders based on as an incentive •PHI opt-out info •Great retention tool to keep newsletter analytics •Provider directory member from switching in the •May need separate •Scripts are tailored for •Pharmacy directory January change period versions for Med Adv. different seasonal •Formulary •Let member know that she vs. Med Sup. initiatives •Advanced directives can give permission to speak •Mail-order pharmacy info on her behalf by sending a letter •Verbal permission is good only for 14 days Mail (In) •Tell about: Mail (Out) •client-medicare.com D4 •Customer service # •Billing information •Member completes HRA EOB for Medicare Part Welco D me •Sent monthly to Call members who Phone (In) subscribed to the MAPD program •Member completes HRA Phone (Out) Web (In) Health Risk Assesment (HRA): •Member completes HRA •If member doesn’t respond then call them to complete the HRA •CMS requires HRA to be Member doesn’t complete the compeleted within 90 days of HRA. coverage D5 Claims, current conditions, data from HRA, HRA demographic data and other Data 3rd party data about the member are used to identify gaps in care and members may be referred to DM or CM. Care Advance Facets/SalesLogix Care Facets MEDai AdvanceCOPYRIGHT © 2012. ALL RIGHTS PROTECTED AND RESERVED. 30
  • Redesigning the critical onboarding phase yielded member experience improvements, insurer cost savings, and greater employer satisfaction Pre Enrollment Enrollment Post Enrollment1 3 5 7 9 11 Contact Us Online Enrollment Welcome Kit ID Card Welcome Demo Data Capture (paper) Mailer Call (web) Provides an overview of Redesigned kit focused Personalized mailer with Personalized welcome insurance 101 topics, on welcoming welcoming tone, call based on info from Posters, postcards, that demonstration of online Modify online members, informing personalized by name, online registrationask member/prospect to tools and resources. For enrollment to ask a them about their plan, lists family members, process and diseasecall a consumer advisor existing members it small number of referencing EOC and contains location based mgmt. / wellness with any question or provides an additional questions to other materials online, health suggestions segmentation. Purpose experience BCBSX Blue opportunity to enable BCBSX to educating about blue (gyms, hospitals, is to educate,Access with online demo “configure your communicate with perks, and reminds clinics,), and reminds welcome, and help relationship” them in relevant ways. them to register online them to register online with health issue2 4 6 8 10 12 Value Call a Enrollment Welcome Kit Configure Email Statement Consumer Data Capture (email) Your Newsletter Advisor (paper) Relationship (quarterly) Redesigned kit focused Personalized quarterly Call a consumer advisor For paper enrollment, on welcoming members, Improved Blue Access email newsletter with Existing Members Only: with questions about modify forms, or provide informing them about Registration Process. the standard and Personalized mailer to plan, general insurance an additional form, to their plan, referencing This is a key interaction personalized content thank the member for questions, etc. For enable BCBSX to collect EOC and other materials where members can to inform member their membership, existing members we use data to communicate online, educating about tell us how they want and provide key summarize health as a chance to path with the member in blue perks, and reminds to be communicated messages based onactivity, point out gaps in them into wellness or relevant ways them to register online with by BCBSX health status care disease mgmt. COPYRIGHT © 2012. ALL RIGHTS PROTECTED AND RESERVED. 31
  • A Value Map drives decision making on current and existing servicesand offerings by putting customer-based initiatives into financial terms Value Map Description  The Value Map utilizes the concept of consumer value to Analytical Tool/ determine the financial feasibility of a consumer initiative Framework  Using Peppers & Rogers Group’s “Get-Keep-Grow” "Get-Keep-Grow” framework, the map outlines how specific initiatives, such framework as decreasing the number of claims, connect to consumer value, and what the appropriate metrics are to measure progress for each initiative  It is helpful when deciding which initiatives to prioritize Prioritization while giving a rough estimate on possible ROI for taking initiatives through to implementationCOPYRIGHT © 2012. ALL RIGHTS PROTECTED AND RESERVED. 32
  • Although based on a fixed framework, the Value Map expands andflexes continually to ensure that all potential initiatives can leverage it IllustrativeCOPYRIGHT © 2012. ALL RIGHTS PROTECTED AND RESERVED. 33
  • Why a Roadmap?Customer Centricity is a journey, not a project… In fact, most client’s journey will takeapproximately 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 in their journeyCOPYRIGHT © 2012. ALL RIGHTS PROTECTED AND RESERVED. 34
  • The Roadmap serves as a project plan to guide clients on theimplementation 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 recommendationsCOPYRIGHT © 2012. ALL RIGHTS PROTECTED AND RESERVED. 35
  • Lessons Learned• Support from executive leadership• Managing the organizational appetite• Handling the resistance that will crop up• Involving the support functions• Communicating with all levels• Evaluating the business impact• Separating opinion from expertiseCOPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 36
  • Q & A Session Marc Ruggiano Elizabeth Glagowski Partner, Executive Editor, Strategy Peppers & Rogers Group Peppers & Rogers GroupCOPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 37
  • PRG Healthcare Practice Activity 1. Download our white paper on a consumer-centric transformation • Click on the bottom right button in the presentation screen 2. Peppers & Rogers Group Healthcare Webinar Series • If 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/PeppersandRogersGroupCOPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 38
  • Q & A Session Marc Ruggiano Elizabeth Glagowski Partner, Executive Editor, Strategy Peppers & Rogers Group Peppers & Rogers GroupCOPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 39
  • Marc Ruggiano Tom Schmalzl Partner Director, Business Development mruggiano@peppersandrogersgroup.com tschmlalzl@peppersandrogersgroup.com +1.203.989.2189 (office) +1.203.989.2208(office)COPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 40