Retaining health plan members in the digital era requires a strategic, organization-wide approach that addresses the key drivers of attrition across all customer touchpoints. Analytics can help identify at-risk members, but health plans must convert insights into actions that enhance the customer experience. A focus on customer service, personalized benefits, and digital convenience can help provide a "WOW experience" and reduce churn rates, which currently average 40% annually for many plans. Success requires benchmarking competitors, prioritizing retention, investing in analytics to refine processes, and transforming all touchpoints based on customer feedback.
All product and company names mentioned herein are for identification and educational purposes only and are the property of, and may be trademarks of, their respective owners.
Making the Shift: Healthcare's Transformation to Consumer-CentricityProphet
In our latest report, “Making the Shift: Healthcare’s Transformation to Consumer-Centricity” Prophet interviewed more than 50 executives across the U.S., Europe and Asia, from healthcare organizations including hospital systems, payers, pharmaceutical companies and digital health companies to identify the five keys shifts that healthcare organizations need to make to become more consumer-centric.
Learn key findings from each of the five shifts including the challenges and solutions organizations face to become more consumer-centric.
2013 10 utilizing member engagement to improve cahps scoresimagine.GO
The Accountable Care Act means more access to healthcare for more people. But to pay for that access it also means margins for healthcare companies are going to be squeezed. But this does not necessarily imply doom for healthcare companies. The law actually encourages healthcare businesses to build better business models – and is willing to pay for it. By retooling your market approach, and the operations that run your business, you can actually improve your margins and your customer’s happiness at the same time you are helping to create a better and more efficient healthcare ecosystem.
Placing Customer Centricity at the Heart of Healthcare1to1 Media
A look at how healthcare providers, pharmaceuticals, and health insurers are adapting to the changing customer landscape and evolving their patient experiences. www.1to1media.com
All product and company names mentioned herein are for identification and educational purposes only and are the property of, and may be trademarks of, their respective owners.
Making the Shift: Healthcare's Transformation to Consumer-CentricityProphet
In our latest report, “Making the Shift: Healthcare’s Transformation to Consumer-Centricity” Prophet interviewed more than 50 executives across the U.S., Europe and Asia, from healthcare organizations including hospital systems, payers, pharmaceutical companies and digital health companies to identify the five keys shifts that healthcare organizations need to make to become more consumer-centric.
Learn key findings from each of the five shifts including the challenges and solutions organizations face to become more consumer-centric.
2013 10 utilizing member engagement to improve cahps scoresimagine.GO
The Accountable Care Act means more access to healthcare for more people. But to pay for that access it also means margins for healthcare companies are going to be squeezed. But this does not necessarily imply doom for healthcare companies. The law actually encourages healthcare businesses to build better business models – and is willing to pay for it. By retooling your market approach, and the operations that run your business, you can actually improve your margins and your customer’s happiness at the same time you are helping to create a better and more efficient healthcare ecosystem.
Placing Customer Centricity at the Heart of Healthcare1to1 Media
A look at how healthcare providers, pharmaceuticals, and health insurers are adapting to the changing customer landscape and evolving their patient experiences. www.1to1media.com
Presentation: Understanding Customer Centricity
Have you ever wondered why some organizations fail while some achieve stunning success? What is the secret behind successful organizations? To survive and thrive in this competitive world organizations are moving from product first approach to something else.
Presented to: Women in Agile Houston Group
Presented on: 7/15/2020
Catasys, Inc. harnesses proprietary big data predictive analytics, artificial intelligence and telehealth, and human intervention to deliver improved member health and cost savings to health plans through integrated technology enabled treatment solutions. It is our mission to provide access to affordable and effective care, thereby improving health and reducing cost of care for people who suffer from the medical consequences of behavioral health conditions. Catasys helps these people and their families achieve and maintain better lives.
Patient Engagement: The Next Wave of Change in Healthcare ITCascadia Capital
Patient Engagement is one of the fastest growing sub verticals in Healthcare. Is it really going to solve some of the big issues plaguing the Healthcare system? We think so.
Innovative Solutions for Building Healthy Communities PresentationSalesforce.org
At their best, communities are places where we make connections and share knowledge, stories, and support. They are places where we learn and become something greater than we were. They are places where problems big and small are tackled by groups of people working towards a common goal. Join this webinar to learn more about how Salesforce Communities can help you better engage with your supporters and how Health Leads is using Communities to connect patients with the basic resources they need to be healthy. We will also discuss best practices for building a thriving healthy community.
Hospital / Technology / Revenue / Business
This is the approach for success in terms of workflow, revenue, and technology effeciency in HIT (Healthcare Information Technology).
The economic, regulatory and competitive environment has created consumers that are more conservative and considerably “choosier” in their selection of financial products. Products that address consumer and credit union member needs in innovative ways, and that are delivered to them in ways that are convenient to them will be the success stories in the future. In this presentation from the 2011 NAFCU Strategic Growth Conference, you will learn about strategies that issuers have been using post-CARD Act and potential strategies that could help credit unions compete and win against their bank competitors, especially the mega banks! To be successful in the future, credit unions will need to have an integrated strategy leveraging credit, debit, on-line banking, mobile, and other alternative payment options together, to acquire new member relationships, and generate the most return and create long term member loyalty.
DocEngage is a Healthcare CRM, focused on making each patient interaction more personal and meaningful.
We are empowering Clinics/Hospitals to measure care life cycle, build strong relationship with patients, improve patient satisfaction, increase revenue & outcome through a comprehensive set of powerful and usable tools.
Chi Sigma Consulting (CSC) is a student-run pro-bono consulting group. CSC is comprised of students from Northeastern University with the common goal of giving back to the community by consulting non-profit organizations.
The 10 Leading Patient Engagement Solution Providers in 2018insightscare
There are a few contributors in the industry aiding to take this concept further and to help the care givers to adopt and apply it. To acknowledge the good work of these business giants, we bring to you our special edition of “The 10 Leading Patient Engagement Solution Providers in 2018”.
Follow the money healthcare business models - seattle startup weekGeof Baker
Healthcare business models are particularly challenging to distinguish between customers, buyers, and the users. Many claim we are moving away from our business as usual “fee for service” to value based reimbursement. What does this mean for digital health, biotech and device entrepreneurs and what is the timing for this change? Who pays for any solutions in healthcare? Where can you be successful?
This session will start with a discussion of healthcare customers: insurance companies, hospitals, doctors, patients, and consumers. We will focus on the unique challenges that each present. What defines winning for each player? And what does each player need to do to win.
We will propose various approaches to help your business models succeed by drawing on our own healthcare startup and corporate experiences
As healthcare becomes more of a commodity over time, healthcare consumers will engage in shopping behavior based on price and quality. They will be demanding a better experience.
Patient Loyalty: What it Takes to Earn Their Loyalty Sallie Burnett
Patient Loyalty Is Up for Grabs
Recent research showed consumers are just as likely to switch healthcare providers as hotels if they don’t get responsiveness and convenience. In fact, 61% would switch providers to get an appointment quickly. 52% would switch to get an appointment at a convenient location.
Those healthcare providers that develop strategies, capabilities and analytics to enable the key elements of a superior patient experience—speed to access, convenience, information transparency and personalized service— will be best positioned to outperform their peers.
This presentation gives you insight into the current healthcare marketplace and seven best practices for building patient loyalty.
Presentation: Understanding Customer Centricity
Have you ever wondered why some organizations fail while some achieve stunning success? What is the secret behind successful organizations? To survive and thrive in this competitive world organizations are moving from product first approach to something else.
Presented to: Women in Agile Houston Group
Presented on: 7/15/2020
Catasys, Inc. harnesses proprietary big data predictive analytics, artificial intelligence and telehealth, and human intervention to deliver improved member health and cost savings to health plans through integrated technology enabled treatment solutions. It is our mission to provide access to affordable and effective care, thereby improving health and reducing cost of care for people who suffer from the medical consequences of behavioral health conditions. Catasys helps these people and their families achieve and maintain better lives.
Patient Engagement: The Next Wave of Change in Healthcare ITCascadia Capital
Patient Engagement is one of the fastest growing sub verticals in Healthcare. Is it really going to solve some of the big issues plaguing the Healthcare system? We think so.
Innovative Solutions for Building Healthy Communities PresentationSalesforce.org
At their best, communities are places where we make connections and share knowledge, stories, and support. They are places where we learn and become something greater than we were. They are places where problems big and small are tackled by groups of people working towards a common goal. Join this webinar to learn more about how Salesforce Communities can help you better engage with your supporters and how Health Leads is using Communities to connect patients with the basic resources they need to be healthy. We will also discuss best practices for building a thriving healthy community.
Hospital / Technology / Revenue / Business
This is the approach for success in terms of workflow, revenue, and technology effeciency in HIT (Healthcare Information Technology).
The economic, regulatory and competitive environment has created consumers that are more conservative and considerably “choosier” in their selection of financial products. Products that address consumer and credit union member needs in innovative ways, and that are delivered to them in ways that are convenient to them will be the success stories in the future. In this presentation from the 2011 NAFCU Strategic Growth Conference, you will learn about strategies that issuers have been using post-CARD Act and potential strategies that could help credit unions compete and win against their bank competitors, especially the mega banks! To be successful in the future, credit unions will need to have an integrated strategy leveraging credit, debit, on-line banking, mobile, and other alternative payment options together, to acquire new member relationships, and generate the most return and create long term member loyalty.
DocEngage is a Healthcare CRM, focused on making each patient interaction more personal and meaningful.
We are empowering Clinics/Hospitals to measure care life cycle, build strong relationship with patients, improve patient satisfaction, increase revenue & outcome through a comprehensive set of powerful and usable tools.
Chi Sigma Consulting (CSC) is a student-run pro-bono consulting group. CSC is comprised of students from Northeastern University with the common goal of giving back to the community by consulting non-profit organizations.
The 10 Leading Patient Engagement Solution Providers in 2018insightscare
There are a few contributors in the industry aiding to take this concept further and to help the care givers to adopt and apply it. To acknowledge the good work of these business giants, we bring to you our special edition of “The 10 Leading Patient Engagement Solution Providers in 2018”.
Follow the money healthcare business models - seattle startup weekGeof Baker
Healthcare business models are particularly challenging to distinguish between customers, buyers, and the users. Many claim we are moving away from our business as usual “fee for service” to value based reimbursement. What does this mean for digital health, biotech and device entrepreneurs and what is the timing for this change? Who pays for any solutions in healthcare? Where can you be successful?
This session will start with a discussion of healthcare customers: insurance companies, hospitals, doctors, patients, and consumers. We will focus on the unique challenges that each present. What defines winning for each player? And what does each player need to do to win.
We will propose various approaches to help your business models succeed by drawing on our own healthcare startup and corporate experiences
As healthcare becomes more of a commodity over time, healthcare consumers will engage in shopping behavior based on price and quality. They will be demanding a better experience.
Patient Loyalty: What it Takes to Earn Their Loyalty Sallie Burnett
Patient Loyalty Is Up for Grabs
Recent research showed consumers are just as likely to switch healthcare providers as hotels if they don’t get responsiveness and convenience. In fact, 61% would switch providers to get an appointment quickly. 52% would switch to get an appointment at a convenient location.
Those healthcare providers that develop strategies, capabilities and analytics to enable the key elements of a superior patient experience—speed to access, convenience, information transparency and personalized service— will be best positioned to outperform their peers.
This presentation gives you insight into the current healthcare marketplace and seven best practices for building patient loyalty.
Hospital administrator should
ensure that clear, early,
complete and simple financial
communication is provided
both at the admission and
at the discharge occasion to
create patient-friendly financial
services for customer delight.
This effort shall enhance
both the brand value and
bottom line of the healthcare
organisation
Patient Satisfaction : The Indispensable OutcomeCare Analytics
As we move into the future, the measurement of patient satisfaction is becoming less of a luxury and more of a necessity for medical groups and facilities. It is increasingly important that a patient-satisfaction program be done well, using sound protocol and methods.
Survey findings can also be used for accreditation and marketing. In this era of increasing competition and high patient demand for health care excellence, medical groups and skilled nursing facilities cannot afford to forgo the insights they can derive from patient-satisfaction surveys.
Streamlining Your Medical Practice for Profitability and SuccessConventus
Conventus webinar video providing key success strategies and tactics for improving productivity, profitability, and patient care. The one-hour video features host Susan Lieberman of Conventus and Stevie Davidson of Health Informatics Consulting.
Outsourced Customer Care for Healthcare InnovatorsSuranjanShome
How do you build your own world-class CX infrastructure? You don't.
How outsourced customer support enables healthcare and healthtech businesses to thrive.
Reduce costs, enhance customer experience and drive towards self-service utilization.
The role of benefit brokers and financial advisors is shifting quickly and dramatically. Benefit brokers are competing regularly with companies like Zenefits and Gusto for business, providing more consultations as a result of the Affordable Care Act (ACA), and facing the demands of a well-educated, tech-savvy clientele¹. Similarly, financial advisors are enduring the side effects of a sluggish U.S. economy, preparing for the inevitable change in workforce demographics, and contending with digital advisory services². It is imperative both benefit brokers and financial advisors reject complacency and embrace innovation in these evolving times.
In addition to external factors, client needs are also shifting. Clients don’t just want a provider; they expect a partner to help them stay compliant, informed, and effective. What’s more, clients exhibit heightened loyalty to someone they consider a partner versus a provider. However, people and service are not enough to differentiate one broker or advisor from the next. Benefit brokers and financial advisors must be aware of emerging trends, as well as new approaches, tools, and technologies in order to create business connections and drive growth.
Paylocity’s 2016 Benefit Broker and Financial Advisor Insight Report offers a detailed look into the changing demands of HR and payroll professionals. With insight from nearly 900 respondents nationwide, this report uncovers opportunities, addresses clients’ concerns, and explores upcoming trends.
Overview of an Open-Platform Health Plan that Lowers Costs and Improves Perfo...Mark Gall
It's hard to gauge how well a health plan is performing. Do our employees understand and get the most out of their benefits? How effective is our wellness program? Are we paying too much for services? These are typical questions. An Open-Platform Health Plan is a self-funded health plan with unique features that allow an employer to establish, track and review performance benchmarks and reduce their exposure to risk.
HLU Consultants, Inc. is a privately held, independent consulting firm based out of Cincinnati, OH since 1961. The consultants at HLU successfully bring together a tremendous amount of industry expertise, valued partners and innovative technologies to design a better, cost-efficient health plan around a customer’s workforce. They help employers establish meaningful benchmarks so they can gauge the success of their plan with a focus on reducing costs, improving outcomes and helping employees successfully navigate the complex healthcare system.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
1. Retaining Members in the
Digital Era
A strategic approach to solving the retention puzzle
for Health Plans!!
2. 2
Executive Summary
How do we address this?
We propose an end to end approach
and evaluate the People, Process and
Technology dimensions across the
Organization. The health plan should
focus on every customer touch point
across the lifecycle, to understand
what motivates the customer to leave
and how we can address these
drivers.
Overview
Two thirds covered under ACA (around
4.5 million) are expected to change
plans in 2015 based on a survey1.
While most customers are satisfied
with their coverage, they would still
shop around for better plans.
A 200,000-member plan with a $120
monthly premium and 8 percent
annual disenrollment loses $24 million
in revenue each year. With such an
impact on the top line, health plans
are shifting focus to customer
retention by implementing retention
programs.
Why retention programs fail?
Payers have started investing heavily in
analytics solutions and other
technologies, but they still face
challenges in addressing the key
drivers of attrition.
The focus has been on processing large
data sets and deriving insights, but not
on how these insights can be put into
action.
Most of the existing solutions use
analytics to identify customers
propensity to churn, when they should
be identifying the root of the problem
and how these customer can be
retained.
4. 4
Overview
The healthcare reforms have fundamentally changed the insurance
market. With changing healthcare landscape and maturing
customer demand, the non-agile will be weeded out of the system
with alacrity. Price is slowly becoming less important and the
customer today needs a reason to stay. Lack of access, long waiting
time, claims management and bad customer experiences will no
longer be tolerated and customers are more than willing to change
plans (see sidebar for example).
With the emergence of exchanges, porting plans have never been
easier and even the members who are completely satisfied with
their health plans, would shop around for better products and
alternatives. In fact 2 in 3 members covered under the ACA are
expected to change plans in 2015 based on a survey1.
Highmark recently lost
150,000 members to
competitors who were
concerned about keeping
discounted access to the
UPMC's huge network2
5. 5
What are payer challenges?
Health plans are struggling and
slowly moving towards an inflection
point due to numerous
unprecedented market challenges:
Falling Profitability
With an annual turnover rate of
40%3, healthcare payers are
experiencing unprecedented
decrease in profitability. A 200,000-
member plan with a $120 monthly
premium and 8 percent annual
disenrollment loses $24 million in
revenue each year, according to The
Bayer Corporation Guide
With newer market
challenges, Customer
Retention is paramount if
Payers want to emerge as
winners
Competition
Emerging disruptors like Oscar and
HealthLoop are disrupting the
conventional market and are
competing on customer experience
rather than price. With the emergence
of exchanges, porting plans have
become easier and simpler.
Maturing Customer Expectations
With pricing taking a back seat,
exceeding customer expectations is
the order of the day. With industries
like retail and banking way ahead in
providing a WOW experience,
customers have similar expectations
from health plans. Most customers
today expect the smooth, fast, secure
and individualized services of a bank.
Healthcare has no option but to follow.
6. 6
How are Health Plans reacting?
Customer retention has always been a
concern in every service industry and
healthcare is no different. Many health
plans have attempted to improve their
retention rates but, have met with
limited success. Customer retention
rates are less than 30% in many
instances4.
Customer retention rates
are less than 30% in many
instances even after health
plans have implemented
retention programs
Why are Health Plans failing?
Our analysis of payers of different sizes
has enabled us to identify the key
reasons for the failures of customer
retention programs :
Payers don’t understand the root
cause of churn
Payers have limited understanding
of market flows and customer
segmentation to perform effective
retention management
Payers are performing marketing
and risks functions in silos and
there is limited cohesion between
the various departments within
the organization
Health plans lack analytical
capabilities and sometime even
the data for effective analysis
Plans use complex analytics
programs to process data but
are not converting the insights
into actions
7. 7
Key Drivers of Attrition
We performed a detailed analysis of
the healthcare payers across various
customer touch points and found that
myriad of factors leads to attrition. As
discussed earlier, some of the
customers leave because of multiple
reasons rather than a single reason.
Each of the reasons may be
insignificant, but multiple small ones
often cumulatively frustrate the
customer and cause the customer to
port to a better plan. Thus, the success
of a payer will depend on how
effectively the payer can identify the
key drivers of attrition.
We have identified the following key
drivers of member churn:
Organization Value
Proposition
The organization value propositions do not meet the customer’s
changing needs
Product Design and
Premiums
The factors for increasing the premiums over the years are
opaque
Products are generic and not developed with the consumer in
mind
Ineffective Incentives
Incentives are focused on the ‘bottom line’ when it should be
ideally targeted to the customer preferences
Limited Focus on End
Customers
Focus is on the intermediaries and employer groups rather than
the individuals who are the end customers
Customer
Services
Customer’s bad experiences in customer call centers, bill
payments can lead to attrition
Organization Culture
Cost cutting on member satisfaction and bulking up sales does
not help in the long run
No ownership for retention activities
Economic
Outlook
An economic downturn can reduce the affordability of the
products leading to consumers moving to inexpensive plans
8. 8
Customer churn is not the result of
a onetime event; It is a “snow ball”
effect of multiple bad experiences
across various touch points
A detailed understanding of the customer journey
along with the experience of the customer at each
touch point in the journey is key to understand the
drivers of attrition. Though the frustrations of the
customer may look benign, multiple instances like
these lead to an inflection point and the customer
ends up porting to a different plan (see Figure 1).
Solving the Retention puzzle – Our Mantra
9. 9
Figure 1: John’s journey with a Payer
Enroll
Manage
Benefits
• Why are products so complex?
• How do I find the products that
suit my needs?
• The products do not cover my
needs?
• There are others health plans
offering better products at
cheaper price
• Why is it so difficult to find the
information that I need?
• How can I update outdated
information?
• Why can’t my plan provide
better mobile facilities?
• Many time I don’t even get my
explanation of benefits. Why
can’t I get it online?
• Why is the explanation of
benefits so complex?
• Why does not my plan offer
me personalized wellness
programs and provide me with
a coach?
• Why can’t I see my progress
towards my wellness goals
• The plan only offers rewards
which I’m least interested in
• The doctors recommended by
my friends and family are not
in the network?
• Why can’t I set up an
appointment through my
phone?
• None of the specialist
providers have any
appointment in the near future
• Why do I have to wait so much
and press so many buttons to
reach an agent?
• Why are the agents so rude
and unhelpful?
• Why do I have to repeat my
info so many times to different
agents to fix one issue?
Visit Doctor
Claims
Status
Customer
Service
Loyalty/
Wellness
Never
Again!!
10. 10
Customer retention cannot be
achieved by working in silos; It
takes the focus of the entire
organization
In order to implement a successful customer
retention program, there should be an organization
wide initiative. All the departments interacting with
customers at various points of the journey should
work together. The initiative should be driven by
the executive leadership with a well defined
governance structure with representation from
across business functions.
Solving the Retention puzzle – Our Mantra
11. 11
A WOW Experience
“To WOW, you must
differentiate yourself, which
means do something a little
unconventional and
innovative. You must do
something that’s above and
beyond what’s expected. And
whatever you do must have
an emotional impact on the
receiver.”
Tony Hsieh, CEO Zappos 5
Healthcare has always been Business
to Business and the focus was on large
employer market. The health plans
never built a lasting relationships with
the end consumers and never really
understood what they really wanted.
With the rise of consumerism, the
focus has shifted to individuals and the
healthcare payer market is being
disrupted by players like Oscar who
rely on digital technologies to embrace
the mantra of consumer centricity and
focus on user experience, customer
service and innovative care options
delivering a WOW experience to
customer.
Health plans who fail to innovate and
focus on customer experience are
expected to lose their relevance in the
changing healthcare landscape and will
become obsolete.
As discussed earlier, to provide a WOW
experience, selective focus on the
touch points will not suffice. But a
focused end to end transformation of
all the touch points in the customer
journey is the need of the hour (see
Figure 3). The change process is
complex but will ensure that the plans
are fit for future.
12. 12
Figure 3: Illustrative WOW Experience
Enroll
Manage
Benefits
• Products designed based on
the voice of the customer and
customer segments
• Cost effective products for
customers and on par with
market needs and competitor
offerings
• Seamless multi channel
enrollment /signup in minutes
• Easy to use portals and call
centers, price estimators, free
generic drugs, free x visits to
doctors
• Multiple options to access
benefits – websites, phones,
sms
• Multiple channels to check
claims status and submit out of
network claims through mobile
• Low turnaround time on
appeals or claim payments,
personalized health timeline
• Easy to understand
explanation of benefits
• Personalized and proactive
engagements with the
members, fitness rewards
• Personalized health coaches
• Identify trends in digital and
provide members with smart
devices like fitbit
• Networks preferred by the
customer
• Low waiting times, quick
appointments
• Low out of pocket costs
• Support for tele-health and
tele-visits
• Easy to reach customer service
and automatic routing to
representatives, Low waiting
time
• Access through multiple
channels and based on
customer preference
Visit Doctor
Claims
Status
Customer
Service
Loyalty/
Wellness
WOW !!
13. 13
Moving Forward
Managing customer attrition is not a
one time silver bullet but is a
continuous process requiring focused
effort across the organization. There
should be ongoing focused efforts
across the various touch points in the
customer journey to identify what are
the customer pain points. The
feedback acquired after the customer
exits has immense scope for providing
insights but is retrospective!! Thus,
these processes should be well
developed and the feedback loop fully
designed and integrated into the
organization to rectify issues before
hand.
Benchmark your organization to identify areas
of improvement
If you can’t identify it, you can’t improve it… We believe that assessing
your organization will be the first step in building a strong customer
retention program. Benchmarking your existing capabilities with best in
class capabilities will help you in understanding how your competitors
fare and gain an understanding of what your strengths and weaknesses
are.
1
We recommend the payers to adopt a three pronged strategy to reduce
its customer attrition and to build a strong customer retention program:
14. 14
Make customer retention one of the top priorities in the organization
Imbibe a culture of customer retention across the organization. A top down approach using a well defined
governance structure would be ideal. To ensure that this vision is sustained, include customer retention metrics in
your SLAs and also in the performance evaluation of your employees. And finally ensure that all your employees are
empowered to serve the customer in the most effective manner and are not penalized for providing the best
customer experience.
2
3Invest in analytics and adopt agile processes to refine the model
Invest in the right technology and the right partner to do more than identifying customers who are expected to
churn. With analytics moving from predictive to prescriptive models, payers are now more empowered to analyze
the data and come up with insights to identify the best action to retain the right customers. It is not enough to
focus on data and insights, the highlight should always be on converting these insights into effective actions. From
all the insights gained from analytics, perform an end to end transformation on the customer touch points to
enhance the customer experience.
15. 15
End Notes
1 Two-thirds Of Insured Via Obamacare Will Change Plans In 2015 (http://www.radius-global.com/about/news-
releases/two-thirds-change-healthcare-plan)
2 Highmark loses subscribers in possible fallout from UPMC fight (http://triblive.com/business/headlines/7707881-
74/highmark-company-percent)
3 PWC Experience Radar 2012 - Consumer insights for the US healthcare payer industry
(https://www.pwc.com/us/en/advisory/customer-impact/assets/pwc-experience-radar-healthcare-payer.pdf)
4 Curing Customer Churn (http://www.pwc.com/us/en/increasing-it-effectiveness/assets/curing-customer-
churn.pdf)
5 Delivering Happiness: A Path to Profits, Passion and Purpose by Tony Hsieh
16. 16
About the Authors
Kevin Mathew John
Kevin has completed his post graduate program in management from the Indian School of Business. He has a total experience of 7 years
with experience in PMO, business analysis, digital strategy and operational improvement.
https://www.linkedin.com/in/kevinmathewjohn
Bhargava GH
Bhargava is a Healthcare IT Professional with a rich experience of 16 years in the Payer & PBM domains with a total industry experience
of over 18 years. He has extensive experience in supporting large IT applications for Fortune 50 clients in the Payer & PBM space.
https://www.linkedin.com/in/bhargavahukunda