Cognizant 20-20 Insights

Operationalizing Customer Centricity: A Prescription for Building Brand Loyalty and Healthy Competitive Advantage
Payers must rene processes across multiple channels to create a highly competitive brand based on consistently high-quality, member-centric experiences.
Executive Summary
There is no question that the healthcare system is ailing. Costs are rising as customer satisfaction falters. New technologies, regulations and an increasingly competitive marketplace are forcing healthcare providers and payers to rethink how they operate. Customers are at the center of the tempest, and the industry must nd new ways to engage with them. According to a report by J. D. Power & Associates, many consumers are not satised with their health insurance provider interactions, whether paying a bill or inquiring about in-network physicians (see Figure 1). Common reasons for dissatisfaction include unhelpful call center agents and cumbersome interactive voice response (IVR) systems. And when payers deny members claims, the result is anger and distrust. Most consumers today hold payers to the same standards they experience with other businessto-consumer businesses, such as retailers, in terms of their ability to deliver highly personalized, high-value services. Their experience with online retail giants such as Amazon have taught consumers to expect high-touch interactions and a choice of channels, along with speedy service and quality products. They want clear communications about benets and coverage in plain language; caring and informed customer service; and efciency and consistency at every touchpoint, from enrollment through billing, across every access platform. Most healthcare payers fall far short of this ideal, leading to a general perception of poor service in the market. Even with the millions of new healthcare consumers entering the market under the Affordable Care Act, some payers may have a hard time attracting and retaining members. Consumers today also have more freedom and nancial incentive to switch payers if theyre not happy. The time has come for health insurers to change their approach to building customer relationships. They need to reevaluate each element of the interaction cycle, including awareness, consideration, enrollment, onboarding, service, billing and ongoing communication. Payers should also consider how new technologies are changing the determination of diagnoses, treatments and ongoing care, and redesign their processes to compete in this new context.

cognizant 20-20 insights | april 2014

Reasons for Member Dissatisfaction

Message outcome IVR too difficult Inconsistent communications Agent knowledge gap Unhelpful agent Agent voice/volume/tone Plan design/provider network Content level Transfer call disconnected Request can't be performed Call hold/wait time too long Communicated timeline not met Too many transfers Provider DB inaccuracy Routed incorrectly System outage Could not reach live person Office closed

Top Reasons for Dissatisfaction

Process knowledge Communication Call routing Health plan operations Staffing 59% 27% 22% 8% 4%

10

15

20

Source: J.D. Power & Associates, 2012 Figure 1

To turn the situation around, healthcare payers need to shift their focus from internal objectives to customers. Missing the chance to understand customer needs and failing to provide the consistent, quality experiences they seek will lead to irrelevance and insolvency. This white paper probes how payers can meet these expectations and build a strong brand synonymous with service, quality and trustworthiness. The key to competitive branding will be operationalizing a member-centric vision. Payers must use multichannel capabilities and the data generated by members and providers to inform and realign business processes so they can deliver a consistent, rich experience for prospects and members across multiple channels. This approach will also improve business performance and cost issues by creating a more virtual, efcient organization. Payers following this course will be positioned to build lifetime relationships with existing members and attract new ones for sustainable competitive advantage.

tations; consumers give the health insurance industry low marks on its ability to communicate through multiple channels.2 Consumer expectations for health insurance services are high (see Figure 2, next page), particularly for consistent experiences at all touchpoints and channels. Providing a consistent experience requires continuity of services, data access and look and feel across channels, whether by telephone, on the Web or via chat. Consistently high performance is a hallmark of strong brands, as is routine delivery of experiences that meet or exceed consumer expectations. Healthcare consumers say brand strength is a strong inuence on their healthcare purchase decisions. 3

Operationalizing Member Centricity across Multiple Channels

For payers, meeting the demands of healthcare consumers will require infusing member-centricity into business processes to deliver seamless service and rich experiences across multiple channels (see Figure 3, page 4). Proactively designing the customer experience will enable payers to make better business decisions; drive segmentation to individual member levels; and create customized, rich interactions with members that epitomize their branding.

Engaging Healthcare Consumers

Todays consumers want more engagement with healthcare players through their preferred channels of interaction, especially when shopping for insurance, comparing benets and assessing provider quality.1 Payers arent meeting expec-

cognizant 20-20 insights

Service Expectations

What consumers want from customer service centers in order to give them an excellent rating.
The customer service representative is friendly/polite Has a range of ways to contact the customer service center

I am able to interact with a customer service representative quickly

Base: 259
I am able to access the information I need to resolve my query myself

Base: 156

Base: 65
The method to interact with customer service is easy to use

The customer service representative is easy to understand

Base: 218

Base: 89

Base: 132

The customer service representative understands my needs

Base: 210

The customer service representative has access to all my information

Base: 100

100
29% 28% 29% 29% 33% 29% 32%

30%

34%

42%

31%

32%

38%

37%

40%

37%

32%

34% 53% 42%

25%

31%

30%

33%

31%

25%

38%

38%

33%

35%

33%

36%

42%

22% 25%

43%

42%

41%

40%

38%

36%

35%

34%

31%

30%

29%

28%

27%

27%

26%

24%

0
I am able to interact with a person

Base: 247

The customer service representative had good communication skills

Base: 129
My query is resolved quickly

The customer service representative is helpful/enthusiastic

All my details are recognized

Base: 148

Base: 51

The customer service representative is based in this country

Im treated with respect

Base: 150

Base: 438

Base: 213

Base: 106

My information on record is accurate

The customer service representative is knowledgeable

Base: 289

Base: Consumers who had contacted a customer service center in the U.S. or Canada in the last three months (percentages may not total 100 because of rounding). Source: A commissioned study conducted by Callcentres.net and analyzed by Forrester Consulting on behalf of Avaya, February 2011. Figure 2

Using multiple channels and analytics, payers can begin to retool business processes by learning more about their members and prospects. Frequent exchanges and alerts regarding care management within a member segment could trigger phone calls to members to ensure they are satised with the care they are receiving from their primary care physicians. Monitoring social network chatter could uncover trends in sentiment toward a particular plan or service. Mobile apps and monitoring tools could enable payers to communicate with members and update member data more frequently. These activities drive organizational-level accountability for delivering the dened service experience.

Although healthcare regulations such as the Health Insurance Portability and Accountability Act (HIPPA) restrict the personally identiable data that can be shared and by whom, payers should not consider privacy and security concerns as barriers to customer experience. They can still use data to personalize service and build multichannel capabilities that address specic member segments. Aggregated, depersonalized data can offer a wealth of insight into various demographic groups, such as how their use of specic health resources changes over time, and enable payers to customize offerings and interactions with these segments.

cognizant 20-20 insights

Member Centricity

Internal processes need to be aligned with member needs and expectations across multiple channels and access platforms.

Data and Analytics Member Insights

Mob i & l

ts Tex e, pps

Plan Offerings

Web &

il ma Eter

Consistent Member Experience

Member Data Personalized Communications

lC C al

Figure 3

Before embarking on process reconguration, payers must take the following three steps to ensure their process improvements support a strong, member-centric brand. Step 1: Dene the member experience.

Align performance with experience objectives from top to bottom.

Proactively

design the customer experience: Know your customers, their intents and how customers from each segment will satisfy those intents.

Actions: >> Capture and evaluate every interaction. >> Hold vendors and agents accountable. >> Monitor customer engagement and satisfaction.

>> Prioritize factors that drive customer satis>> Deliver

more effective training to improve the customer experience.

Actions: >> Prioritize customer intentions. >> Dene a customer experience blueprint. >> Implement a customer-oriented process design.

>> Assess

customer communications and expectations. rience objectives.

>> Align training programs with customer expePayers can analyze their existing member base from various perspectives to identify member segments or even individual member behavior. Segment data may include demographics, health conditions, utilization rates, lifetime value, preferred channels, etc. Step 2: Deliver the service promise.

Payers must map member experiences to existing processes to understand the member perspective, with special attention to where gaps exist between customer expectations and the payers ability to deliver. This will help identify pain points and highlight ways to improve the member experience. Predictive analytics can offer insights into how the benet needs and economic power of various segments will evolve over time and inuence the service promise (see sidebar, next page). Step 3: Create programs and offerings to expand customer relationships.

Drive organizational (vendors, agents, operations management) accountability for delivering the dened service experience.

Deepen customer relationships by increasing

share of wallet and upselling the bundle.

>> Monitor every customer against a common

cognizant 20-20 insights

en

So

ia l

faction and net promoter scores (CSAT/NPS).

customer engagement index and actively work to extend each relationship.

 Actions: >> Collaborate on marketing campaigns. >> Leverage an average revenue per
(ARPU) increase framework.

user

>> Implement

an upsell and cross-sell engine and provide training.

>> Develop contact center sales offerings. >> Develop more effective sales agents through

improved training and faster time to prociency.

Payers should consider extending their offerings to complementary services, such as health club discounts, personal trainers following orthopedic rehabilitation, nutrition coaches, discounted monitoring devices and rewards programs that provide incentives for managing chronic health issues. With some of the newer sensor-based health monitoring devices, organizations can also track adherence to wellness programs and provide virtual coaching to ensure that members follow treatments that lead to better health.

With a granular understanding of member segments and individuals, payers can present new benet options to members as their lifestyles and economic conditions change, whether the member is starting a family or nearing retirement. These options can be generated on-the-y by smart algorithms and workows, making them cost-effective to offer.

Focus on Member Centricity Improves Business Results

When payer organizations put members at the center of their business processes, they stand to realize powerful business benets, including:

Additional

value creation and business process improvement opportunities created

Quick Take
Gaining a Deeper Understanding of Members Needs Through Predictive Analytics
Retailers, especially those with online roots, are training consumers to expect their needs to be anticipated and for appropriate solutions and products to be offered before they ask for them. In healthcare, insight into members future needs may lead to wellness and lower costs, as well as greater member retention rates. Predictive analytics can help payers achieve such foresight. Predictive analytics enables payers to anticipate issues that will arise within segments of the health populations they serve. The data feeding the analytics tools can come from multiple channels, from customer complaint logs to health resource use to demographic data. Algorithms parse these variables and more to predict which segments and members are likely to be:

Misusing

provider resources due to lack of primary care access.

Predictive insights can also reveal factors contributing to member dissatisfaction, as well as missed opportunities for member-centric offerings. Disconnected processes, fragmented systems and data silos can prevent contact center representatives from seeing complete member interaction histories or failing to connect at-risk members with care management specialists. Analytics can also help determine where to focus on process optimization and new service development for the greatest return. Optimizing the design and delivery of the member experience through predictive analytics also helps payers unlock value. Offering segment-driven, personalized benets options to members at risk for disenrollment could lead to retained business; for example, providing coaching to help manage chronic conditions can reduce costs by slowing or preventing more expensive medical intervention. The success factor will hinge on using predictive analytics insights to design and provide these offerings before members ask for them.

At risk for disenrollment. Considering transitioning between plans. Perceiving poor payer experiences. Lacking early disease detection. Struggling to manage chronic conditions. Overusing diagnostic procedures or drugs.
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through improved customer insight utilization across the organization. The same insights that assist a customer service representative or prompt a Web server to offer help tools can be used by internal quality improvement, clinical, nancial and marketing functions for better decision-making.

Enable Create

member insights to ow through the organization to support business, nancial and clinical functions. consistent experiences for members receiving services spanning several business units, such as Medicare, Medicaid and Tricare, ensure smooth coordination of benets among the relevant plans and provide a single point of contact to these members. self-service options across different access platforms. member preferences for using a variety of access platforms and communications tools, from mobile texts to written communications. members (e.g., distribute health and wellness messages or appointment alerts) and listen for aggregate health concerns.

Cost

reduction achieved through improved integration of channels. A single view of the member that is visible across lines of business and multiple channels reduces contact center costs and overhead through shortened resolution times, resulting in a reduced cost structure. Similar cost cuts are possible through reduced duplication of effort, error elimination, etc. tunities achieved through targeted communications and personalized relationships with customers. As payer organizations consolidate data to develop rich customer segments and use predictive analytics tools to anticipate future behavior, they can create detailed and granular member personas that reect their many types of customers. These personas, created from segment transaction history, demographics and predictive models, make the potential life changes and resulting product needs of each segment more tangible. Creating nely detailed, insightful proles can help payers further personalize their customer-centric offerings, such as knowing which communication channels each member type prefers and offering more personalized, targeted offerings to member segments.

Offer

Support

Greater member retention and sales oppor-

Use social network tools to communicate with

This list is ambitious but reects todays competitive realities. Payers that execute on these capabilities will build stronger brands and retain and grow their member bases more effectively than those struggling with data silos and non-integrated channels.

Looking Ahead
Creating value maps is one way that payers can identify the best opportunities for immediate cost savings and service improvements. Such maps put member-focused initiatives into nancial terms to help drive decision-making about current and existing services. These maps can also provide insight into whether payers should attempt to invest in member-centric processes internally or work with experienced third-parties that can deliver the required functions as services, eliminating the need for capital investment and making operating costs scalable and predictable. Were still in the early days of the transition of healthcare to a retail-focused industry. This time advantage gives forward-thinking payers a window of opportunity to make effective decisions and build brands based on membercentric services, powered by multichannel capabilities with indicative and predictive analytics. The payers that accomplish this will create sustainable differentiation in the marketplace, a solid foundation for continued process improvement and a loyal, strong and ultimately protable member base.

Delivering Rich Member-Centric Experiences: A Checklist

Providing members with personalized, streamlined services, whether for initial enrollment or managing chronic conditions, requires the following capabilities:

Collect and analyze digital data from a wide

variety of member and prospect touchpoints as regulations permit, including monitoring of data generated by existing members as they interact with payer processes and provider networks. prospects, based on demographics, utilization of services, etc., to understand member needs. member perceptions and experiences with key business processes, from enrollment through billing. cognizant 20-20 insights

Develop granular segments for customers and Understand

Footnotes
1

Sherry Coughlin and Paul Kecklin, 2012 Survey of U.S. Health Care Consumers: Five-Year Look Back, Deloitte University Press, Dec. 14, 2012, http://dupress.com/articles/2012-survey-of-u-s-health-care-consumers-ve-year-look-back/. ACSI Finance & Insurance Report 2013 Third Quarter Update On Overall U.S. Customer Satisfaction, American Customer Satisfaction Index, Dec. 10, 2013, http://www.theacsi.org/news-and-resources/customer-satisfaction-reports/customer-satisfaction-reports-2013/acsi-nance-and-insurance-report-2013/ acsi-nance-and-insurance-report-2013-download. More than Four in Five Americans Say Brand Is Important when Selecting a Health Insurance Plan, Harris Interactive, June 20, 2013, http://www.harrisinteractive.com/NewsRoom/HarrisPolls/tabid/447/ mid/1508/articleId/1217/ctl/ReadCustom%20Default/Default.aspx.

About the Author

Kamesh Somanchi is a Healthcare Market Leader for business process services and global growth markets within Cognizants Business Process Services Practice. His experience spans both U.S. and international healthcare, as well as life sciences. During his career, Kamesh has assisted those industries in areas that include product lings, sales and marketing launch strategies, product launches and postlaunch stabilization and performance improvement. He has helped clients set up shared service centers consolidating and optimizing operations to improve the customer experience. His expertise includes management consulting, end-to-end process consulting, systems integration and business process outsourcing. Kamesh can be reached at Kamesh.Somanchi@cognizant.com.

About Cognizant
Cognizant (NASDAQ: CTSH) is a leading provider of information technology, consulting, and business process outsourcing services, dedicated to helping the worlds leading companies build stronger businesses. Headquartered in Teaneck, New Jersey (U.S.), Cognizant combines a passion for client satisfaction, technology innovation, deep industry and business process expertise, and a global, collaborative workforce that embodies the future of work. With over 50 delivery centers worldwide and approximately 171,400 employees as of December 31, 2013, Cognizant is a member of the NASDAQ-100, the S&P 500, the Forbes Global 2000, and the Fortune 500 and is ranked among the top performing and fastest growing companies in the world. Visit us online at www.cognizant.com or follow us on Twitter: Cognizant.

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