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As health care evolves, its entire ecosystem – from payers and providers to pharmaceutical companies and government agencies – seeks to find common ground. More data is available than ever. But transforming information into innovation is challenging. Organizations strive to create shared goals, internally and externally, trying to improve patient [...]
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One interesting outcome of regulatory reform in health care is seeing the use of the word "customer" filter into the dialogue in the industry.
The context for that development in the United States’ health care industry is upheaval not seen in any sector of the economy since the government-mandated breakup of the monopoly Bell Telephone System in the mid-1980s.
At the same time, technology is radically transforming health care, and the precedent in communications is how the Bell System breakup coincided with the commercialization of innovations such as voice mail, mobile telephones and the internet, to name a few. So will this upheaval in health care also usher in great innovations? I think it’s quite likely – and one big question is, “Who will do the innovating?”
In times of change, the organizations that thrive are the ones that adapt, often ending up operating alongside new players that might do things that were previously unimaginable. I imagine the same will hold true in health care as it evolves.
We’ve already seen adaptation taking place among health insurance plans in fundamentally strategic ways, and two standouts include Blue Cross Blue Shield of North Carolina and Florida’s GuideWell Connect (GWC) - an affiliate of FloridaBlue. The most striking changes have involved the ways they engage with their customers, essentially orienting their organizational direction more toward individual members’ needs and desires and not so much as a consequence of regulatory requirements.
As a health insurance customer, I could not be more excited. As a marketer, I could not be more intrigued.
I’ve written before about how complex the buying process is for health care, and operating an organization in the health care ecosystem is equally complex. One element of that complexity is that for almost as long as health insurance plans have been around, working-age adults and their families in the United States have predominantly received health insurance coverage through their employer. According to a report by the Economic Policy Institute, 69.2% of Americans under the age of 65 had access to employer-sponsored health insurance in the year 2000, and that rate fell to 58.4% in 2012. During that same period, the rate of non-elderly Americans without any health insurance rose from 14.7% to 17.7%.
The Affordable Care Act (ACA) is part of the upheaval that's changing the health care ecosystem in many ways, but the interesting outcome from a marketing perspective is the emergence of the individual as the customer. Most health plans’ largest customers are employers and the individual employees are typically referred to as “members.”
The ACA includes incentives for individuals, as well as disincentives for organizations to be active in the health insurance equation. One outcome of the ACA already has been to increase the number of individuals seeking and receiving health insurance, and that dynamic provides impetus for health plans to engage with their individual members as customers. And that’s where the North Carolina and Florida health plans provide some interesting lessons.
GuideWell Connect: Get insights and use them.
Florida’s GWC aggregates services for consumers, who can then create a free account and have access to a personalized wellness plan, motivation to reach their goals, an online community and product recommendations to help meet their wellness goals. The goal is to connect the people and the resources that are needed to manage their health. So why has it been so complicated, asks Raj Vavilala, Senior Director at GWC?
He explains with an analogy to Apple’s iPad – it’s not the device, per se, that people desire. It’s really the apps available on that device that consumers value. And health insurance is not too different – it's possible to offer consumers a nice, shiny plan but the real value is derived in understanding what they are using it for.
It’s an interesting analogy, and not surprising coming from an executive affiliated with an innovator like Florida Blue - one of the first health plans to roll out retail centers, swipe cards and other innovations. They provide an interesting example of how to become customer-oriented. Their organization is already an established user of analytics in their marketing, so Vavilala believes getting data is not the issue – it’s getting the insights that are needed for action that presents the most urgent challenge. For GWC, it starts with segmentation based on publicly available information, and builds from there.
Improving the onboarding process has been a priority, so customer-friendly changes were built around the steps mandated by regulation, which resulted in impressive gains. For instance:
- Providing a one-pager with 10 bullet points and then the required contractual language is provided on a flash drive. They’ve found a 2% increase in retention rate among customers who receive their welcome kit versus those who do not.
- Distributing member cards with an activation sticker (like for credit cards) and 70% of their welcome kit recipients activate that way. Knowing that enables them to focus on the other 30% of their customers. They’ve found a 10% increase in retention rate among people that actually call and engage with them.
- Giving people tools and services at the time of their need in the channels where they are engaged. They know mobile is not just a fad, so they put a lot of effort into making sure their mobile app is ready and easy to use.
That’s putting their insights to use!
Vavilala’s point is to get all of the players to work together and instead of solving for big, systemic problems, approach it by tackling the small problems. Simple things, such as getting people to a doctor. Almost 50% of their members did not have an attributable primary care physician, which means the first time they had a condition they would find the highest cost, most expensive form of treatment – not an ideal scenario for anyone involved, but relatively easy and impactful to address.
BCBSNC: Drive value with a data-driven strategy.
When the ACA became law, BCBSNC already provided health insurance options to individuals, so it provided a challenge to retain their existing base of customers, while pursuing the opportunity presented by the Act’s individual mandate. The retention challenge alone represented a multimillion-dollar risk for the health plan, so doing nothing was not an option. Like many health plans, BCBSNC found that absolutely none of their addressable market was neutral about the changes from the ACA – they were either happy or horrified.
And no health plan could specifically answer individuals’ questions about how much their health insurance cost was going to change, but that was the looming question That fear of the unknown was the first fear, and the second fear was wondering what the best choice might be. In order to be proactive, BCBSNC needed to go deeper than high level demographics.
Michael Parkerson, Vice President of Marketing at BCBSNC offers an interesting example of the pitfalls of relying too much on demographics for marketing. Consider the case of an individual profiled as follows:
Male, 64 years old, English,
Affluent, 2 adult children
That demographic either describes the Prince of Wales or Ozzy Osbourne – and there’s no way their needs will be the same. That’s why the power of the data is so important – you can turn it into information that’s then actionable and can be used to drive value.
From the impact of the ACA, BCBSNC needed to consider the rate impact of the government subsidy – as an individual, would it be the savior or not? Then, channel options – are they buying direct or through an agent? Then, consumer segment preferences. Lastly, it’s the pivotal question of what would the customer value – and how could they address that value for the customer. Their analysis showed their customers fell into five segments:
- Maintain the status quo (not deeply impacted positively or negatively)
- Happy recipients (pretty significant decrease based on subsidies),
- Frustrated seekers(the horrified few whose costs were going up no matter what),
- Subsidy required(they will be okay if we could get them to their subsidy),
- High utilizers,
Their strategy was to focus on the segments that would have the most to gain from meaningful interaction – numbers 3 and 4, representing about half of the population. They developed a three-step strategy to get them to enroll:
- Reconnect – They had to engage customers about reform and position their organization as a trusted expert on reform since so many of the customers didn’t always have an agent to help them through the process.
- Advise – Their goal was to make reform relevant and personalized, and promote a strong call to action by going beyond just educating, so the customers would be equipped and confident enough to take action.
- Enroll – Customers needed to conclude that signing with BCBSNC was an easy, smart and valuable decision.
To engage their market among those three steps, BCBSNC developed BlueMap – designed to be way more than an application, and more of an experience for the customer. And because of the wide degree of preferences of their customers, BlueMap was rolled out with a multi-faceted outreach:
- A multi-piece direct mail stream,
- Member services customization,
- Custom landing pages,
- Outbound phone calls,
- Channel integration with brokers, and
- Special events, such as sporting events and even the State Fair.
In the summer of 2013, they also did something quite innovative - they rented out movie theaters across North Carolina and gave out free tickets to a newly released movie in return for the opportunity to hear a 15 minute presentation about the ACA. At each theater, they had ipads lined up enabling people to surf through and figure out what they needed and even email their spouse with their findings. These events sold out across the state in hours.
The results from the roll-out of BlueMap is impressive, particularly in how they maintained about half of the market they expected to be at risk of attrition by increasing their persistency from a projected 70% to an actual 85%. By all measures, BlueMap has helped BCBSNC to deliver on their brand promise by getting their members/customers to rely on them for the confidence, understanding and stability that they’re looking for to “live fearless.”
Parkerson describes it as part of their mission and their vision for the kind of organization they can become as they redefine their business model from one that traditionally has been focused on products to one where they now consider their products, services and consumer touch-points from the perspective of the customer. The goal is to find ways for them to create unique, differentiated value for customers at each touch point so it builds loyalty. That’s not an easy task considering their products are intangible, and customers receive benefits outside their company walls, but it seems like they’re up to it.
For so many years, health insurance plans have referred to individual users as “members,” and what’s more impressive is how both of these leading health insurance plans have reoriented their focus on the individual customer that uses and benefits from their services. The examples of these two leading health plans are useful roadmaps for how to respond to the evolution of the health care ecosystem, and particularly to the emergence of the health care customer.
Raj Vavilala and Michael Parkerson participated on a panel discussion at the 11th annual SAS Health Analytics Executive Conference in Cary, NC, which was moderated by Sarah Rittman, Principal, SAS Health & Life Sciences Practice, and also available on-demand as a virtual conference.
The health and life sciences industries affect all other industries on two levels – our employers and governments are heavily involved as influencers in payment systems, and as individuals we all engage directly with health care organizations. Because of those two reasons, people in all industries have a stake in how the healthcare ecosystem evolves in the face of change.
And talk about change! Kecia Serwin, Vice President and General Manager, SAS Health and Life Sciences sums it up this way. The three greatest drivers of change in the healthcare ecosystem right now are:
- Technology and innovation
- Government mandates
- Empowered consumers
And each of those three change drivers have such a compelling mix of challenges and opportunities that how organizations respond to them will determine who will matter in the future – and who will not. So Kecia asks, what can really move the needle? What’s working? How can we transform our organizations the way we need to?
It’s no longer about payers – providers – pharma; it’s now about the whole health care ecosystem. New models involve greater collaboration and shared risks/rewards. And perhaps most signigicantly, new strategies are emerging to deal with the new empowered consumer.
How Health Analytics moves the needle
What does Health Analytics really mean? The broadest definition is that it’s the collection of enabling technologies and skills that can be used to generate insight to support strategic decision-making. Health Analytics makes extensive use of data – data collection for meaningful use, data sharing for collaboration and health information exchanges, and data analyses to inform and to allow predictions.
Traditionally, analyses have been retrospective, so the focus was primarily on explaining and describing. As in the case of caring for an individual health condition – the diagnosis is fundamental. But what really matters is the treatment plan that drives the best outcome. So to move the needle, it comes from the power of forward-looking predictive analytics. It’s the ability to conduct accurate what-if simulations and include qualitative data that enables the consideration of what could and should happen, and most importantly – knowing the best thing that can happen.
Health Analytics is key to the treatment plan
So of those three drivers of change that Kecia identifies, is there a common thread? Dr. Farzad Mostashari, visiting fellow at the Brookings Institution says that the biggest underlying reason is that health care “costs too damn much and we’re not getting enough value for it.” And he sees all the changes holistically coming in the shift from “volume” to “value” of care, were quality will be measured and rewarded, as will be total cost. And both safety and appropriateness will matter.
As the health care ecosystem evolves, health plans will be sharing risk with providers on the total cost of care. In the United States, we’ve seen a similar shift with the advent of managed care – which heralded a new era of cost-containment that never quite materialized. Dr. Mostashari believes that’s what’s different now is that we now have the ability to predict. Based on data, we can predict hospitalizations, Emergency Room visits and other events.
Envisioning individual patient benefits is a powerful way to understand the impact of health analytics’ ability to produce accurate predictions. Just imagine:
- Reaching quicker and more accurate diagnoses – knowing sooner what’s wrong and getting better earlier.
- Using data-driven treatment plans of drugs, therapies and behavior modification tailored to patient preferences and demonstrated past efficacies.
- Getting adherence to prescription regimens based on relevant rewards.
If each scenario results in fewer sick days, or reduced traffic accidents, and/or overall higher quality of life, then imagine the economic impact at a population level. To be sure, what’s different now is our ability to predict, but what’s also different is that we now have empowered consumers.
Caring for the patient as a consumer
Patients show up in waiting rooms and hospitals with specific conditions that need attention. The organizations engaged in the care of the health of that patient have traditionally focused on the condition at hand. Frequently, how they receive care is determined by the condition and the payment parameters set by the applicable health insurance plan. But the patient shows up as a whole person with needs, desires and expectations from living in a technology-driven online-all-the-time social savvy world.
And with the shift in the overall market toward more individual participation in health insurance coverage from the affordable health care act, the patient will become choosier – and will have the ability (and desire) to make choices more easily.
As electronic medical records have become more prevalent, so has the ability to use data to care for patients as consumers. And all these changes will translate into care improvements and the potential cost savings we all have a stake in achieving. Dr. Mostashari lays out a few ways to pursue that path:
- Find ways to get feedback loops to pursue continuous improvement. In doing that, look for ways to collect data in ways that are accurate but not individually-identifiable.
- Embrace testing and experimentation. Science and medicine invented the randomized trial, for goodness’ sake, so this should be a natural.
- Prepare for operating based on improved outcomes. Currently, the economics of health care are oriented toward numbers of patients and numbers of procedures. That is quickly changing.
- Engage the patient and his/her family as key players in the care of the individual. Most treatment regimens and outcomes happen at home and not in the clinical environment, and other factors matter, such as nutrition, hygiene and mobility.
- Make the easy thing to do the right thing to do. As Dr. Mostashari puts it, “there’s too much friction in the health care ecosystem.”
By friction, he means all the different obstacles that patients face in getting care – from bad waiting rooms, unnecessarily complex claims payment & processing, to having to deal with outsourced procedures that the physician needs to complete the diagnosis or the treatment.
As a non-medical “lay person,” what I am hearing from all that is the need to become more customer-centric. Along with that, of course, the role of customer analytics and health analytics is to enable the decision-making process so all players can make decisions on an informed basis, and to center their thinking – and operating – around the idea that it’s all about the patient/consumer. That’s like music to this marketer’s ears!
One additional piece of advice from Dr. Mostashari applies to any industry:
Don’t ever surprise your Board or your Customers.
And so the good Doctor has spoken.
Kecia Serwin and Dr. Farzad Mostashari presented the Welcome Address and Keynote Presentation at the 11th Annual SAS Health Analytics Executive Conference in Cary, NC on May 14, 2014.