Case Study: Making the Consumer-centric Transformation

make
an
Laying the Foundation impact!
for a Customer-Centric Organization

Customer Centricity in Healthcare
May 17, 2012

COPYRIGHT © 2012 ALL RIGHTS PROTECTED AND RESERVED.

Today’s Speakers

Marc Ruggiano Elizabeth Glagowski
Partner, Executive Editor, Strategy
Peppers & Rogers Group Peppers & Rogers Group

COPYRIGHT © 2011. ALL RIGHTS PROTECTED AND RESERVED. 2

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Agenda

The Case for Trusted Relationships

Peppers & Rogers Group Client Examples

Q&A Discussion


The Case for
Trusted Relationships


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

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.


and Consumers Rate the Experience Poorly

Customer Experience Index (CxI) by Industry

Source: Forrester Research, The Customer Experience 2012


Health Visual Definition

a healthy
the general
state of
condition of
wellbeing free
body and
from disease
mind

Source: ThinkMap Visual Thesaurus, 2011


Care Visual Definition

the work of
providing
treatment for
or attending
to someone
or something

Source: ThinkMap Visual Thesaurus, 2011


Consumers Define Health in Many Ways

Source: Peppers & Rogers Group research


Consumer Perception of Today’s Health Insurers



Consumers Describe the Ideal Health Insurer



Customers’ Trust in the Health Insurance Sector

38%
43%
Trust

19%

Distrusters Neutral Trusters



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Up-to-date/Outdated Fair/Unfair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



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


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


Peppers &
Rogers Group
Client Examples


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.


We started by taking the pulse of our client’s organization with a
current 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.


…which yielded a clear picture of where the organization stood and
which areas required additional attention going forward

Illustrative

Integrated
1to1 Enterprise
Consumer 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

Market Research yielded key insights about attitudes and motivations
regarding Health Insurance and Health and Wellness…


…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


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


Our branding approach consists of 3 key steps that inform the
branding 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 promises


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


Integrated Customer Segments are depicted with personas to help
make 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 wellness


Mapping existing processes from a member’s perspective highlights
experience 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
Advance


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

Pre Enrollment Enrollment Post Enrollment

1 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 registration
ask member/prospect to tools and resources. For enrollment to ask a them about their plan, lists family members, process and disease
call 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 issue

2 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 on
activity, point out gaps in them into wellness or relevant ways them to register online with by BCBSX health status
care disease mgmt.


A Value Map drives decision making on current and existing services
and 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 implementation


Although based on a fixed framework, the Value Map expands and
flexes continually to ensure that all potential initiatives can leverage it

Illustrative


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


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

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 expertise


Q & A Session



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
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Centric Healthcare”
• Join today at http://linkd.in/KPXUv5

4. Follow us on Twitter @PeppersRogers

5. Visit us on Facebook.com/PeppersandRogersGroup


Q & A Session



Marc Ruggiano Tom Schmalzl
Partner Director, Business Development
mruggiano@peppersandrogersgroup.com tschmlalzl@peppersandrogersgroup.com
+1.203.989.2189 (office) +1.203.989.2208(office)


Case Study: Making the Consumer-centric Transformation

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