HCL Member Experience Management

Transcription

1 HCL Member Experience Management Author: Ajit Sahai Saxena ADDITIONAL INPUTS: RAM ANANTHASUBRAMONY, HEALTHCARE (PAYER) PRACTICE whitepaper dec 2013 MEMBER EXPERIENCE MANAGEMENT STRATEGIZE AND IMPLEMENT The Payer Industry is gearing up for a fundamental change in the way business is being conducted with the implementation of key provisions of the Patient Protection and Affordable Care Act (PPACA). It is expected that up to 50 million new customers will be shopping for insurance with the introduction of exchanges in The focus of the exchanges are individual buyers and small group of up to 50 employees. Health plans must formulate and execute a business strategy(s) that is focused towards acquiring members from this group of new entrants while they redouble their efforts to retain their existing member base. This dynamic situation with the Accountable Care Act (ACA regulations would also result in an altered risk profile within plans as customers with prior health conditions, who previously could not obtain/ afford coverage would now be able to obtain health coverage and in the future would require more visits to the physician s office. These customers, considering that they are new members of the plan, would also not have spent time with the plan to develop a sense of customer loyalty and hence would be more likely to shift plans if they get coverage at a lower cost. Compounding all of the above is the fact that traditionally health plans have had abysmal consumer experience scores. The low scores arise due to a multiple reasons including confusing plan documentation and poorly explained Explanation of Benefits (E0Bs) which results in increased customer confusion and frustration. The ACA regulations have addressed it to an extent by mandating health plans to release information about the coverage options using a standard format. The low scores and an increasingly well-informed customer base will mean that plans need to alter their strategy of approaching the market. It is expected that up to 50 million new customers will be shopping for insurance with the introduction of exchanges in 2014:

2 When the Supreme Court upheld the PPACA with changes that didn t impact the base Act, all healthcare entities continued moving forward full steam ahead with their plans to deal with the changed market scenario To complicate matters, the shift to a B2C model will also mean that companies with a rich customer service background (retailers) could enter into the market2. These companies have already in place sophisticated systems that analyze buyer behavior and it would not be long before they leverage their experience and methods successfully against the health insurance industry. ADAPTING TO A NEW MARKETING PARADIGM Let us examine what a health plan can do in light of the consumer decision journey model proposed by McKinsey in June The consumer decision journey model highlights the shift in consumer behavior with the increase in information available through multiple channels - both traditional (e.g., print, TV, radio) and digital (internet, mobile). This information overload leads to a consumer purchase cycle as shown below The health plan marketing effort should be focused on identifying specific characteristics of their coverage schemes such that it appeals to a consumer and brings the plan to the top of the consumer s mind when they are shopping around for plans. Today s customers want personalized suggestions to enrich their shopping experience. Companies invest a lot in segmenting their consumer base and generating personas that help them analyze and identify the right product combination to be pushed to the right customer at the right time. Retail and financial services industries have been taking this approach for a long period of time. Health plans need to learn from such strategies and evolve their own customer acquisition strategies to ensure that when 2014 comes around their plan is in the top of the mind of the consumer and hence ends up in the initial consideration set. 2 Consumers add or subtract brands as they evaluate what they want. 1 The consumer considers an initial set of brands, based on brand perceptions and exposure to recent touch points. Activate Evaluation Information Gathering, Shopping Loyalty Loop 3 Ultimately, the consumer selects a brand at the moment of purchase. Initialconsid eration set Trigger Moment of purchase Postpurchase Experience Ongoing Exposure 4 After purchasing a product or service, the consumer builds expectations based on experience to inform the next decision journey. 1. Temkin Ratings

3 More importantly, the plans need to focus on the customer service to ensure the loyalty of their customer base. The McKinsey study theorized that there are two kinds of loyalists - Active loyalists who stay with the brand and advocate the same Passive loyalists who stay with the brand but don t bother to shop around This changing member dynamics require health plans to carefully monitor their member base to see for signs of dissatisfaction which could lead to attrition. By adopting analytical measures health plans can devise retention strategies that convert more of the passive loyalists into active loyalists while ensuring that the active loyalists have more positives to communicate about the plan. The analytics can also be used to derive acquisition trigger to enable the plans marketing strategy. The US media space is saturated with stories on how insurers have denied claims and withheld benefits. A majority of these reports deal with the fact that the consumers need to be better educated about the working of a health plan as it applied to them. The Health plans have a large amount on data ranging from claims to member demographics to clinical data of the member. By incorporating analytics, these data can be used to derive a single view of the consumer and presented to the front line personnel along with a mechanism that measures the consumer s experience with the plan. This would provide the front line personnel with the information to make independent decisions thus ensuring that the customer receives the best possible service from the plan. Also, it is thus important to provide customers with information to validate over time that they have made the correct choice in choosing a particular plan. The customers can evaluate the suitability of their plans as against their expenses through the Need Analyzer. This Need Analyzer will allow the customer to see the comparison output in the form of a True Insurance Value of various plans against their needs and choose the most suitable plan. Confirmation that one has currently chosen the best plan reinforces the positive image of payer and ensures positive word of mouth. Additionally, technological advances have made today s consumer more comfortable in managing his health. Plans will need to push information to the patient on his or her most preferred channel (eg: mobile, ipad, , paper mail). When this information push is combined with analytics (claims, information gathered during renewals etc.) the health plan can ensure that the most appropriate health information is passed to the consumer based on his or her medical history, both as a member of the plan and prior to being a member of the plan. The Health Plan can combine the historical data with the current transactions to discover insights into member behavior identify triggers to retention and respond with suitable offering over appropriate channel through effective campaign management. With segmentation and persona definition, the health plan can proactively anticipate member needs while formulating customized products to meet the same. Over a period of time the member s behavior can be analyzed by looking into pertinent data to identify the levers that will help in bringing down the cost of care for the individual and then incentivizing the individual to adopt the necessary measures to realize the savings. MANAGING THE CUSTOMER EXPERIENCE Ensuring a positive customer experience is one of the foremost tenets towards achieving higher satisfaction levels and gaining customer loyalty. By disseminating information real-time and maintaining consistency across all the customer touch points, health plans are slowly but steadily travelling down the tough path of managing customer experience and creating the `WoW factor. The steps in this process are: 1. Define Member Segments 2. Persona Identification 3. Creating customer journey 4. Mapping customer persona to identify key touch points 5. Inject new actions into customer journey

4 ENTERPRISE APPROACH TO CUSTOMER EXPERIENCE The healthcare industry is going through a shift in the way the business has been conducted. In this context, a superior customer experience management strategy would allow the health plan to provide a differentiated experience to their existing and prospective customer base. Health plans need to focus on optimizing care delivery across multiple healthcare delivery channels and ensuring that the best practices are shared across the channels. The members also need to be educated to manage their health outcomes by actively engaging with the health plan to understand the latest trends in healthcare and the outlets through which the member can utilize these healthcare best practices. HCL along with its partner vendors offers an integrated and enterprise approach for Payers to provide a differentiated and superior customer experience across multiple channels through it Member Experience Management Solution. For more information, pis contact HCL, at contact.lsh@hcl.com

5 About HCL Technologies: HCL Technologies is a leading global IT services company, working with clients in the areas that impact and redefine the core of their businesses. Since its inception into the global landscape after its IPO in 1999, HCL focuses on transformational outsourcing, underlined by innovation and value creation, and offers integrated portfolio of services including software-led IT solutions, remote infrastructure management, engineering and R&D services and BPO. HCL leverages its extensive global offshore infrastructure and network of offices in 31 countries to provide holistic, multiservice delivery in key industry verticals including Financial Services, Manufacturing, Consumer Services, Public Services and Healthcare. HCL takes pride in its philosophy of Employees First, Customers Second which empowers our 95,000 transformers to create a real value for the customers. HCL Technologies, along with its subsidiaries, had consolidated revenues of US$ 6.5billion as on 31st March, 2014 (on LTM basis). HCL Life Sciences & Healthcare: HCL is one of the market leaders in life sciences & healthcare IT service providers. HCL s clientele includes nine of the top ten global pharmaceutical companies, six of the top ten health insurers, one of the largest payer conglomerates in US and top five service providers in UK. With experienced and certified technology and domain specialists, HCL offers services in the critical areas of drug discovery, clinical development, drug safety, Pharmacovigilance, regulatory compliance, manufacturing and plant automation, sales and marketing, member experience management, fraud, waste and abuse management, ICD-10 transformation and others. For more information write to us at: contact.lsh@hcl.com