The Lack of a CRM Strategy Will Hinder Health Insurer Growth

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1 Industry Research Publication Date: 15 October 2008 ID Number: G The Lack of a CRM Strategy Will Hinder Health Insurer Growth Joanne Galimi The Gartner 2008 healthcare payer application survey reveals slow adoption of an enterprisewide CRM strategy. Having no CRM strategy in place will cause roadblocks to business growth as health insurers struggle to increase membership. Key Findings A customer relationship management (CRM) strategy is an inescapable necessity for effective CRM investment. However, health insurers are not thinking strategically and are budgeting and investing in CRM without having a CRM strategy in place. The 2008 Gartner healthcare payer application survey revealed that 47% of health insurer respondents do not have a CRM strategy and have no plans to create one. Effective CRM is not just about deploying sales, marketing and customer service technologies. Business strategies for member acquisition and retention are critical components that many health insurers have failed to create. Recommendations To develop and manage a CRM strategy, health insurers should: Set goals and objectives by customer segment, align the goals with corporate objectives, and establish a governance structure. Establish metrics for selection, acquisition, retention and cross-selling, based on these goals. Determine the appropriate products, channels and pricing, based on customer segments. Develop tactical plans, and define and document processes for customer communications across marketing campaigns, sales, and service channels for execution. Specify the technologies required to support each area, and ensure alignment across marketing, sales and service. Reproduction and distribution of this publication in any form without prior written permission is forbidden. The information contained herein has been obtained from sources believed to be reliable. Gartner disclaims all warranties as to the accuracy, completeness or adequacy of such information. Although Gartner's research may discuss legal issues related to the information technology business, Gartner does not provide legal advice or services and its research should not be construed or used as such. Gartner shall have no liability for errors, omissions or inadequacies in the information contained herein or for interpretations thereof. The opinions expressed herein are subject to change without notice.

2 TABLE OF CONTENTS Analysis CRM Strategy Planning Marketing, Sales, and Customer Service Adoption and Investment Priorities CRM Budgets for Recommendations... 6 Recommended Reading... 7 LIST OF TABLES Table 1. Health Insurers' CRM Strategy Planning... 3 Table 2. Health Insurers' Investment Priorities... 4 Table 3. Health Insurers' 2009 Budget Allocations... 5 Publication Date: 15 October 2008/ID Number: G Page 2 of 7

3 ANALYSIS Customer relationship management is a business strategy that is enabled and supported by many technologies and applications. CRM is designed to integrate these technologies and applications with optimal business processes across sales, marketing, and service, while balancing and optimizing the number of channels that customers use to conduct business. The underlying premise of CRM is the capability to provide value to both parties for the enterprise, the aim is to optimize profitability, revenue and customer satisfaction; for the customers, the aim is to satisfy requirements and exceed customer expectations. In August 2008, Gartner conducted its healthcare payer application study that explored CRM strategies for health insurers. Sixty health insurers participated in the study. There was an even mix of small, midsize and large organizations. Among the respondents, 22% reported having less than $100 million in gross revenue; 25% reported having between $100 million and $600 million; 17% reported having between $600 million to less than $1 billion; and 36% reported having $1 billion or more in gross revenue. Adoption rates and investment priorities were captured for each of the three CRM business processes: sales, marketing and customer service. 1.0 CRM Strategy Planning Most insurers understand the basic tenets of CRM. They understand the need to automate sales, marketing and customer service processes. They understand that this is a business strategy that is supported by technology, rather than simply a technology. They understand also that a multichannel approach is needed to make customer interactions more efficient and relationships more effective. However, most insurers' approach to CRM has been to make tactical investments in sales, marketing and customer service without having a CRM strategy in place. This is shown by the fact that only 35% of health insurers responding to the 2008 survey indicated that they had a CRM strategy (see Table 1). Although the past few years show that there is an increasing trend of insurers having a CRM strategy, the overall percentage of health insurers that have a CRM strategy remains low. Table 1. Health Insurers' CRM Strategy Planning We have a CRM strategy. 3% 10% 10% 31% 35% We have no CRM strategy and no plans to develop one. 85% 45% 53% 48% 47% Note: The survey was not performed in 2001 and from 2005 to Source: Gartner (October 2008) The most surprising piece of data within the survey was the percentage of health insurers that do not have a CRM strategy and have no plans to craft one. A whopping 47% of health insurer respondents indicated that they had no plans to implement a CRM strategy. This figure has remained high during the past eight years and reveals the lack of priority health insurers are placing on managing customer relationships. Many health insurers may not realize how CRM creates value, and therefore, have failed to develop CRM strategies. CRM is often implemented in a piecemeal fashion without a clear strategy in place. However, a CRM strategy is required to give a coherent and structured approach to delivering more value to the business from its customers. Gartner research shows Publication Date: 15 October 2008/ID Number: G Page 3 of 7

4 that one of the biggest gaps between CRM success and failure is having a proper strategy that directs CRM investment in the customer asset base. The CRM strategy should outline a plan as to how the health insurer can build valuable customer relationships and customer loyalty. A CRM strategy aims to effectively manage the customer life cycle from selection and acquisition through retention and cross-selling. A CRM strategy takes the direction and financial goals that are provided by the business strategy and revisits the marketing strategy to align it with organizational goals. The marketing strategy focuses on determining what products and services are sold, in which markets, to which customer segments, at what price, and through what channels. Technology enables health insurers to understand customers and improve interactions to create a favorable customer experience and build customer loyalty. However, without a strategy based on an understanding of a customer's wants and needs, these technologies will fail to help health insurers meet their customer and growth objectives. In another Gartner survey, health insurers identified business growth as the No. 1 business priority for 2008 and To grow their business, health insurers will need to tap into the growing number of uninsured people within the U.S. (which was most recently estimated at 47 million people). To attract, acquire and retain this new individual market, a comprehensive CRM strategy becomes more critical for health insurers. 2.0 Marketing, Sales, and Customer Service Adoption and Investment Priorities CRM strategies are not part of many health insurers' strategic road maps; however, insurers do continue to implement fragmented CRM initiatives for marketing, sales and customer service. Applications for marketing, sales and customer service are being deployed in a tactical fashion. In addition, health insurers are now starting to embrace member acquisition and retention initiatives as core elements of managing relationships. The focus has been on the applications and technologies, not on a business strategy for how to attract and retain members. Health insurer respondents were asked to prioritize their lists of system investments for 2008 and In 2008, CRM did not make the top 10 list of investment priorities for health insurers. However, in 2009, CRM was ranked as the seventh investment priority (see Table 2). Investments for marketing, sales and customer service were dispersed throughout the list in both 2008 and Table 2. Health Insurers' Investment Priorities 2008 Investment Priorities 2009 Investment Priorities 1 Health and wellness 1 Core administrative systems 2 Business intelligence 2 Health and wellness 3 Core administrative system 3 Business intelligence 4 Care management 4 Customer service 5 Customer service 5 Care management 6 Predictive analytics 6 Business process management 7 Electronic billing 7 CRM 8 Business process management 8 Electronic billing 9 Sales 9 Predictive analytics 10 Gaps in care 10 Gaps in care Publication Date: 15 October 2008/ID Number: G Page 4 of 7

5 2008 Investment Priorities 2009 Investment Priorities 11 Personal health management tools 11 Personal health management tools 12 CRM 12 Personal health record 13 Marketing 13 Sales 14 Personal health record 14 Marketing Source: Gartner (October 2008) CRM is rising in priority; however, sales and marketing investments have dropped from Clearly, investments for scaled-down, incremental niche solutions for sales and marketing have taken over the large-suite approach to implementing CRM. This lack of strategic investment raises long-term issues when the enterprise needs to expand beyond the original niche market. In addition, implementing CRM in a piecemeal fashion without a CRM strategy will lead to wasted investments and missed opportunities. Anecdotal information from health insurer clients reveals that the tactical investments have been taken because their approach to a specific "pain point" is to go to the market for a best-of-breed solution that meets their immediate needs. In addition, budget funds are typically allocated for tactical purchases and not for large CRM suite solutions. Health insurers continue to lack the preparedness and resources to implement the full suite of CRM-related products, and more importantly, there are no proven CRM suite solutions in the healthcare market. Health insurers continue to build their CRM competencies in specific lines of business and departments, such as sales, service and marketing. With this approach, insurers must be cognizant of implementing niche solutions that may not fit their long-term enterprisewide architecture. Health insurers should consider point solutions from vendors offering comprehensive CRM solutions so that integration or replacement with another solution is economically feasible. 3.0 CRM Budgets for 2009 Health insurers were asked how much they will be budgeting for each of the systems in Surprisingly, marketing ranked No. 1 in terms of budget funds allocated for 2009 (see Table 3). CRM ranked third, customer service ranked fourth and sales ranked behind them all. Table 3. Health Insurers' 2009 Budget Allocations Ranking in Terms of Budget Funds for Marketing 2 Health and wellness 3 CRM 4 Customer service 5 Electronic billing 6 Core administrative system 7 Business intelligence 8 Gaps in care 9 Business process management 10 Care management System Publication Date: 15 October 2008/ID Number: G Page 5 of 7

6 Ranking in System Terms of Budget Funds for Personal health management tools 12 Predictive analytics 13 Sales 14 Personal health record Source: Gartner (October 2008) Although marketing ranked fourteenth in terms of investment priorities for 2009, it had the largest amount of budget funds allocated. Marketing is one of the most immature departments in terms of IT automation for health insurers. Health insurers realize that they must refocus on improving market segmentation, enhancing targeted marketing and creating a direct-to-consumer marketing strategy to drive growth. Health insurers have traditionally sold to employer groups and lack the analytic capabilities to understand individual buyers and the marketing tools to acquire these buyers. 4.0 Recommendations Developing a CRM strategy is a creative science that relies on hard data and an intuition of client needs. CRM benefits come from using customer insight to deliver relevant, value-added products and services that benefit the organization making the investment as well as the customers affected. Making the strategy's objectives measurable with CRM metrics is vital to its success and evolution. Health insurers must realize that a CRM strategy is required to give a coherent and structured approach to delivering more value to the business from its customers. Health insurers must move from a subdepartmental view of CRM to a more robust, enterprisewide view of customer centricity. This requires having an enterprisewide CRM strategy. However, a CRM strategy will not succeed if it is developed in isolation from the corporate strategy. Although organizations may not have a documented corporate strategy, all organizations should have strategic goals and plans for reaching the corporate strategy. Tactical purchases can be made; however, insurers must consider the possibility that it will be necessary to add another vendor's product (with the attendant cost and risks for application integration) or replace the niche product (with the attendant disruption for its users). These considerations do not preclude installing a niche product or a piece of a suite, particularly if the product being installed will bring a dramatic return on investment. Health insurers should analyze the trade-offs with this approach and make sound business decisions on whether it is worth taking the long-term risk to achieve immediate benefits. To develop and manage a CRM strategy, health insurers should: Set goals and objectives by customer segment, align the goals with corporate objectives, and establish a governance structure. Establish metrics for selection, acquisition, retention and cross-selling, based on these goals. Determine the appropriate products, channels and pricing, based on customer segments. Publication Date: 15 October 2008/ID Number: G Page 6 of 7

7 Develop tactical plans, and define and document processes for customer communications across marketing campaigns, sales, and service channels for execution. Specify the technologies required to support each area, and ensure alignment across marketing, sales and service. RECOMMENDED READING "Health Insurers Must Create Member Acquisition and Retention Strategies" REGIONAL HEADQUARTERS Corporate Headquarters 56 Top Gallant Road Stamford, CT U.S.A European Headquarters Tamesis The Glanty Egham Surrey, TW20 9AW UNITED KINGDOM Asia/Pacific Headquarters Gartner Australasia Pty. Ltd. Level 9, 141 Walker Street North Sydney New South Wales 2060 AUSTRALIA Japan Headquarters Gartner Japan Ltd. Aobadai Hills, 6F 7-7, Aobadai, 4-chome Meguro-ku, Tokyo JAPAN Latin America Headquarters Gartner do Brazil Av. das Nações Unidas, andar World Trade Center São Paulo SP BRAZIL Publication Date: 15 October 2008/ID Number: G Page 7 of 7