Can You Change Your Member Experience During These Challenging Times?

With the spread of the COVID-19 virus, healthcare is right at the center of nearly every conversation. Many consumers are asking questions about their own healthcare coverage. Who do I turn to with questions about the virus? What should I do if I start to be symptomatic? What does my health care plan cover? What happens if I lose my job and can’t pay my insurance? How do I take care of pre-existing conditions and overall health concerns? 

With this heightened anxiety, it is absolutely critical for healthcare and insurance organizations to put a member experience lens on the situation—but this is easier said than done. Right out of the gates, health insurance companies are at a disadvantage when they seek to measure the experience provided to members because a member’s purchase decision is often not their own, but one made on their behalf by their employer. So whether you are measuring the member experience in “normal” times, or in the midst of a pandemic, healthcare providers and insurance companies will need to adapt to a new norm.  

With a better understanding of some fundamental aspects of the member relationship, companies can be in a position to turn a member’s apprehensive purchase decision into an exciting, positive experience. Before companies can do this however, we need to acknowledge some fundamental challenges when it comes to delivering a better member experience in the health insurance industry. Here are a few questions you should ask yourself:

Question #1: Do You Understand the Member Journey?

It’s an unfortunate truth, but few health insurance companies we partner with truly understand their members’ journey. Sure, a company might have a decent understanding of the experience at the call center, but what about the myriad of other touchpoints? Also keep in mind that a portion of the journey is external and therefore not directly influenceable by the insurance company but by the healthcare provider themselves e.g., doctor’s office visit, ease of getting prescriptions, clinic locations, etc.  

Whether the interaction is directly with the health insurance company or someone tangential to it, members are likely to view it as one and the same. It is important then that insurance organizations consider the member experience from three perspectives:

1) the member’s direct journey with the health insurance company

2) the journey health insurance companies create for their employees

3) the member’s journey with the experiences external to the health insurance company.  

Once a health insurance company has this perspective, they will be in a better position to understand the impact of the internal and external forces, and leverage that understanding to drive experiential changes. For instance, think of how much the member experience would improve if a health insurance company shared insights with their physician network about member visit expectations so that physicians can modify their experiences accordingly?

Question #2: Do You Know Who Your Members Are and What They Want?

Understanding the journey is one piece of the experience puzzle, but some companies fall short in taking the next step to know what the member expectations are across all journey points. Companies like Apple, Zappos, and USAA all differ in what they provide, but all are recognized for their excellent service because they have taken the time to segment their customers, understand their expectations, and build processes around those expectations.

Now think about a fairly typical experience with a health insurance company: a member contacts the company with a question about their bill, help on losing weight, finding a doctor, or perhaps they were just told they have cancer and don’t know where to turn next. These are the situations where health insurance companies need to create empathetic member experiences that stand out and touch members emotionally.

United Healthcare is one such company who listened to their members’ calls for more preventative measures and launched a program called Real Appeal to help members lose weight and improve their overall health. It was an interactive online program, using personal coaches and well-known celebrities such as Dr. Oz.  Participants received exercise DVDs and resistance bands, food scales, and other weight loss support items. Since the program was launched in late 2015, more than 100,000 members have collectively lost over 1 million pounds or an average of 7% of their body weight, according to United Healthcare. The program has saved employers up to 16% in annual medical costs, when program participants are compared to nonparticipants.

How great is that! Not only did United Healthcare listen to and put a plan in place to respond to member needs and expectations, but there was a positive financial outcome for doing so.  

But getting to this point requires that companies go beyond just understanding the journey and instead seek to understand member expectations and needs so they can build systems and processes around those expectations. Because like it or not, the expectations members have for their health insurance companies are being shaped by best-in-class experiences from leaders like Zappos, Apple, etc. This is the bar companies should be shooting for—instead of simply trying to be better than other health insurance organizations.  

Question #3: Do You Know Who Owns the Member Experience?

In her book Chief Customer Officer, Jeanne Bliss talks about how cross-functional teams will often build “three-hump camels.” What she means by this is that while everyone may agree that member retention is important and a simple solution is readily available, once people start to put on their “silo hat,” the simple solution now needs to satisfy all the silo priorities sitting in the room—and the original problem at hand may no longer be effectively addressed.

We are not saying that cross-functional involvement should be avoided, in fact, quite the opposite. But what an organization needs is a clear owner that drives a consistent member experience strategy throughout the organization. An individual to ensure that all decisions are being made with a “member first” lens and thus can bring together the various silos of the experience to create memorable interactions with members.

On paper, this seems like a pretty simple recommendation i.e., put someone in charge. However, you’d be surprised at how often ownership is unclear. While there are several approaches a health insurance company could leverage to identify owners, we often recommend using the RACI framework (Responsible, Accountable, Consulted and Informed). This framework is simply a matrix of all the activities or decision-making authorities undertaken in an organization set against all the people or roles. Just be sure you only have one accountable person assigned to each task or deliverable to ensure there is no confusion about ownership!

Question #4: Are You Measuring the Right Key Metric(s)?

Many organizations today are focused on a customer’s likelihood to recommend by calculating a Net Promoter Score or NPS. For industries like consumer goods where customers have several options to consider, or those where consumers are heavily involved in the decision-making process, NPS is probably a good metric to track. However, for industries like health insurance where the company is often dictated (versus proactively chosen), NPS may not be the right metric.  

In fact, Fred Reichheld, the pioneer of NPS, said this as it relates to the applicability of NPS: “we found that ‘would recommend’ also didn’t predict relative growth in industries dominated by monopolies or near monopolies, where customers have little choice.”

Unfortunately, there is no magic metric for health insurance companies to use because the right metric should be driven by the organizations’ goals and the strategies to meet those goals. In our experience, an index or combination of metrics is often the best predictor of member behaviors.  For some this might be NPS (satisfaction with the call center experience, and satisfaction with coverage), but for others it might be level of effort, likelihood to renew, understandability of coverage, and overall satisfaction.

Arriving at your key metrics will take time though. Yes, it would be easier to focus on NPS since others do and it’s simple, but the key question you should be asking yourself is ‘how good is that (or any) metric at predicting/influencing your strategic objectives?’ Having the answer to this and tracking your performance against it will help you meet your goals.  

Can You Change Your Member Experience? Heck Yes!

There is no question that the current pandemic will have a lingering impact on all of us, but it also provides an opportunity to better understand what your members need and to find creative solutions to connect with them. It is about building for and delivering upon member expectations, because creating a better member experience is not just about surveying members, it’s about understanding them and acting on their changing needs.

Looking for more information about improving the patient experience? Check out this eBook, “3 Reasons Health Systems Should Invest in Improving Patient Experience!

About Author

Brian O'Connor & Cammy Enck Customer Success Directors

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