Experience + Job = Relationship

Expanding on the concept of “Milkshake Marketing” and translating it to health care and consumer engagement, payers “do the job” of providing benefit plans and services to consumers. In their annual customer experience index, Forrester ranks health plans in the “poor-to-very poor” range mostly because the experience of purchasing and using health plans are less than desirable. On top of this, payers lack differentiation between themselves and there is a low barrier to change payers for consumers. This is largely in part because payers do not practice relationship building with consumers.

Contrary to popular belief, Payers want to engage consumers and help them live a healthy life, but consumers do not want to be engaged by payers at this early stage. Instead, consumers prefer to have an existing relationship in place with payers in order to build a relationship. Only when the consumer experience and the “job-to-be-done” are considered acceptable by the consumer, can a payer then begin to build and nurture the relationship.

If you ask them, payers may say there is a lack of consumer or member experience during the claims process because payers process the claims internally and the member does not participate directly. The payers, to a degree, can be considered right and wrong in this regard. They are right in that payers do not in fact generate a member experience during this process and it is possible that the member will start wondering what happened to their claim. Payers are wrong in that there is no managed experience; a missed opportunity in relationship building. After all, it is human nature to think the worst and in this case their claim is not going well or something has gone wrong.

After a period of time the member will enter the frustrated stage and call their payer to find out the status of their claim if things are not running smoothly. This call will end up costing the payer approximately $3 to $5. If payers could generate a better member experience around the claims process, the payer would not incur the cost of this call. Perhaps, payers could provide a message to members using SMS or email to advise them where their claim is in the process. A simple graphic with a four-stage process or a text message stating the claim is in “Stage 3” with no expected delays provide the necessary and relevant information to prevent the consumer from entering the “frustrated stage”. Does this sound familiar? Amazon accomplishes this feat by communicating order-tracking information to show consumers their order statuses. Seeing order activity or progress eases the concerns of consumers as they wait for their order to be processed and shipped.

In a consumer driven world, we usually do not like to wait. That being so, if payers were able to communicate the status of a consumer’s claim as it traveled through the process, the member experience would be much more enjoyable. Members would become satisfied since the payer took the action first and generated a dialog around the claim event. This may even sound like a reassuring voice such as, “Don’t worry, we are providing personalize attention to your claim.” With this capability, members would be able to choose how much information they want to receive, how often and even select their preferred channel of delivery. After all, it is all about “me” in the world of the consumer.

By providing a positive member experience coupled with products that do the required job, payers are now able to build relationships with members through useful communications and interactions. Overtime, as the relationship grows, the opportunity for engagement by the payer will be created.

In order to build relationships with members however, payers must focus on the following three guidelines:

  1. Offer a product that does the job for members in a way they want to do the job.
  2. Provide a grand experience in two areas; a well-designed member experience on all member touch points and a tuned member experience so that consumers are happy interacting with the payer.
  3. Extend their products to be more than benefit plans and provide members the tools to help them in their pursuit of healthy living and enjoyable lifestyles. The result is the, “doing the job” indicator goes up.

Building relationships aid in member engagement and increases retention. It is about the quality of the interaction and not quantity. The relationship is formed around common goals such as improving members’ health. If the interaction is pointless and without value, it becomes annoying to the member and the experience deteriorates.

Engagement is Good for Everyone

Engagement at a member level has many benefits not only for members, but also for payers and the health system. At the “Engaged Stage”, payers can:

  • Modify member behaviors to lower causes of chronic diseases
  • Promote healthy living for members
  • Offer information and tools to help members make intelligent health decisions

Although medical costs are increasing at an alarming rate each year, member health is a priority for payers and providers in order to manage costs. The CDC says chronic diseases account for $3 of every $4 spent on healthcare and that chronic diseases are preventable by modifying consumer behaviors. This is a perfect example of how consumer engagement solutions can help lower costs and decrease chronic diseases but member relationships are required for engagement programs. For payers to engage their members, they need to focus on two areas:

  1. The customer and user experience
  2. A product or service that performs what the member wants to do.

Bring these two items into the design of a mobile app that supports healthy behaviors with relevant content, healthy tips and encouragement, the payers open the door to engagement with members by helping them modify their behaviors that lead to the causes of chronic diseases. That is a lot to say but you can see how it is all connected and healthcare has many moving parts.

Consumer Centricity

A rise in priority of consumer centricity is just as important as cost management is for payers. Engaging members in healthy living and using self-service tools is important to lowering health costs and empowering members in an era of consumer driven health care. Therefore, in the end a sustainable solution to lowering health costs and having a healthy member base over the long term can be achieved through consumer centricity. This approach takes time and is an investment in the health system and in its members.

If looking for low hanging fruit and easy successes, focus on the user experience. The fastest road to a good experience is to remove pain points in services and products that touch customers. Usability testing can provide enlightening results and insight into any such pain points. An annoyed customer can be transformed into a satisfied customer by assessing online assets and updating the design based on the findings.

In order to offer a more consumer-centric experience one solution could be to offer consumer centered products and services that are aligned to the consumer’s personalized needs, tune customer experiences to build relationships, or engage members in healthy living and decision making with personalized programs. These are all examples that can contribute to lower costs by improving member health and consumer engagement. Payers now have a raison d’etre and they remain relevant. Payers can use their big data repositories filled with member information to provide members with targeted and relevant information and tools backed by a terrific experience. Why would it work? Payers took time to build relationships and trust with their members and shifted into a consumer mode of business. Moving to a consumer view is a graceful transition toward diversification since payers can provide solutions that accommodate members where they live the most; in their lifestyle.

How does this resonate with your experience at your payer? As a consumer, what are your expectations of your payer?

Point of View in Consumer Centricity