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Customer Centricity in Healthcare
May 17, 2012
Laying the Foundationfor a Customer-Centric Organization
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Todays Speakers
Elizabeth GlagowskiExecutive Editor, Strategy
Peppers & Rogers Group
Marc RuggianoPartner,
Peppers & Rogers Group
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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.
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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)
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and Consumers Rate the Experience Poorly
Customer Experience Index (CxI) by Industry
Source: Forrester Research, The Customer Experience 2012
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Health Visual Definition
a healthystate ofwellbeing freefrom disease
the generalcondition ofbody and
mind
Source: ThinkMap Visual Thesaurus, 2011
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Care Visual Definition
the work ofprovidingtreatment foror attendingto someone
or something
Source: ThinkMap Visual Thesaurus, 2011
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Consumers Define Health in Many Ways
Source: Peppers & Rogers Group research
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Source: Peppers & Rogers Group research
Consumer Perception of Todays Health Insurers
Source: Peppers & Rogers Group research
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Consumers Describe the Ideal Health Insurer
Source: Peppers & Rogers Group research
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Source: Peppers & Rogers Group research
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Source: Peppers & Rogers Group research
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Customers Trust in the Health Insurance Sector
43%
19%
38%
Distrusters Neutral Trusters
Trust
Source: Peppers & Rogers Group research
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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
Source: Peppers & Rogers Group research
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Customers Trust for Individual Health Insurers
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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
Source: Peppers & Rogers Group research
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Customers Value Trustworthiness
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Consumer Willingness to Pay for Trustability
Customers Value Trustworthiness
Source: Peppers & Rogers Group research
$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
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Peppers &Rogers GroupClient Examples
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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)
BRC toget consent tocall
Mail(Out)
Reminder(1monthafterage65)
BRC toget consent tocall
Mail(Out)
Community events
SCHIP meetings
InPerson(Out)
DirectMailMarketingCampaigns:
Theytarget ailindividualsolderthan65Usebothinternalandexternaldata
Mail(Out)
Newspaperads
Print(Out)
Medicare CRMTool
WelcometoMedicare(6mons beforeage65)
BRC toget consent tocall
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
Marc RuggianoPartner,
Peppers & 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
Marc RuggianoPartner,
Peppers & 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]