Exploring the Key Loyalty Drivers in Healthcare

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Here's how payers are driving member engagement and retention in a consumer-centric landscape.
Customer Experience

This article was adapted from Customer Strategist Journal with permission.

Consumerism is a growing trendthat is transforming the healthcare space. The Congressional Budget Office estimates that 26 million more people will be insured by 2017 under the Affordable Care Act. As millions of new consumers shop for health insurance, the pressure is rising for health insurance companies to retain members and earn the loyalty of new customers.

Health insurance members, however, are not traditionally loyal customers. About one quarter (26 percent) of health insurance customers describe themselves as "not loyal at all" to their insurer, according to Accenture. It's no surprise, considering the industry's historical lack of focus on the consumer. Though the industry is improving, health insurance was still the lowest ranked category in the 2014 Forrester Customer Experience Index.

Loyalty is difficult to achieve in health insurance, but not insurmountable. Kaiser Permanente, for example, received the highest customer loyalty ranking in the health insurance category of the Satmetrix 2014 Net Promoter Industry Benchmarks. It scored an all-time high of 40 points, compared to a health insurance average of 17. Consumers felt that the company was on their side.

"Consumers cited positive aspects of the entire health care experience when sharing about their interactions with the Kaiser Permanente health plans, giving the company the highest scores in the industry on key measures, including 'acts in my best interest,' 'my policy gives me peace of mind' and 'treats customers fairly,' " saidSatmetrix data scientist Brendan Rocks in a statement.

Loyalty programs have long been seen as a way to foster greater customer engagement and many healthcare organizations already have loyalty programs in place, particularly around wellness activities. But they could go further.

As health insurance providers update their loyalty programs as part of increased consumer focus, "going beyond transactional rewards to bring a balanced loyalty design approach will maximize impact," notes KBM Group. "A focus on understanding and creatively engaging people in positive health outcomes will spark positive loyalty outcomes."

Even before the Affordable Care Act's coverage mandate pushed more consumers to examine their health insurance choices, they have been taking an increasingly active role in their care experience. Healthcare companies have noticed and are striving to provide more consumer-friendly experiences. And while price will continue to play a major role in healthcare decisions, individuals are more likely to remain with a company that provides them with accessible information and seamless user experiences across channels. As customer experiences play a larger role in healthcare, here are a few examples of what companies are doing to earn their members' loyalty.

CareSource personalizes the experience

Headquartered in Dayton, Ohio, CareSource is a health insurance plan provider that serves more than 1.4 million members across Ohio. Its services include assistance signing up for Medicaid, Children's Health Insurance Plan, and MyCare Ohio, which offers health and long-term care services to those who are eligible for both Medicaid and Medicare. The organization also offers a health plan for individuals and families called CareSource Just4Me, which is offered through the state health insurance marketplace.

CareSource's goal is to enhance its customer experience and drive loyalty with more personalized, multichannel experiences, explains Karen Posey, director of consumer experience. "We look at our customer experience strategy in four pillars: purposeful leadership, brand promise, consumer understanding, and employee engagement," she says. "We're always looking for ways to improve our services, especially when loyalty and retention are more important than ever."

And it uses loyalty initiatives to help achieve these goals. For example, its Babies First program lets mothers-to-be earn points for completing tasks such as regularly visiting a doctor. The points can be exchanged for a rewards card worth up to $150 for health-related merchandise.

CareSource's priority is to develop a 360-degree customer engagement experience. It records member information, though much of the information is siloed, Posey notes. "We track our members' activities with us, but it needs to be consolidated," she says. "That way if members sign up for various programs we can see how effective those programs are and optimize their experiences."

The company also wants to analyze customer behavior to deliver more accurate communications. For example, members might indicate that they prefer to be contacted via telephone, but their behavior may change, suggesting they're more likely to respond to a text message or email. By analyzing members' behavior, Posey says, CareSource can uncover patterns "that allow us to better meet our customers' preferences so that we can engage effectively with them without being abrasive."

Implementing an effective CRM system for recording and tracking member data is a key part of the company's goals. CareSource executives are aware that "a lot of information processing needs to be done" and are reviewing self-service CRM tools, Posey says.

CareSource's road map also includes expanding its gamification and digital strategies. The company is looking into building mobile apps that complement its offerings, including its rewards programs.

A mobile version of the program could potentially allow members to track their points on their phone and perform other tasks. But before moving forward with an app, the company is reviewing the functions that would be most useful to members. "There are a lot of mobile apps we'd love to build," Posey says. "But we have to understand our members first and their attitudes and behaviors to make sure we're delivering a valuable app."

Additionally, the company is looking for ways to further engage members and encourage them to use its health services more frequently. Allowing members to earn points for activities like annual checkups or getting the flu shot is only the beginning. "There are so many things that we'd love to educate our consumers on like weight loss, exercise, and smoking cessation," she says. "We're looking at gamification to help us do that and step two would be figuring out how to engage each member based on their progress and preferences."

Use technology to get closer to individuals

Indeed, many healthcare firms are still in the early stages of embracing customer-centric approaches to drive loyalty, says Munzoor Shaikh, senior manager in consulting firm West Monroe Partners' Healthcare practice. Most payers already track operational data in a single member record. However, those systems tend to be focused on group plans without including customer-centric data.

"Having singular member records is a necessary but insufficient pre-requisite to having a strong loyalty program," Shaikh explains. "To understand recent behaviors, frequency of interaction and lifetime cost or value of a customer/member/patient, firms need to tie key transactional data such as clinic visits, web visits, purchases, payments, etc. to the single record of the customer."

Additionally, providers and health and wellness companies face similar challenges in which patients have multiple records, making it difficult to get a comprehensive view of the patient's clinical data. And even when companies are able to obtain a single record of the patient, "what overall seems to be missing is the customers' preferences in how they want to be engaged," Shaikh adds. "As such member/patient engagement remains a challenge."

Individual records provide much insight and opportunity for engagement, but there are data concerns that come with personalization. Cybersecurity and protecting patient information is also a critical component of the member experience, notes ?Pat McCaffrey, senior vice president of health care at TeleTech. "If you're going to be in the healthcare business, you have to be HIPAA compliant, and we're also starting to get questions from customers about taking additional measures [to protect member data]," McCaffrey says. It's essential to be aware of how any enhanced customer program fits into the HIPAA world.

An ideal customer program understands all the "touchpoints" a customer may have with an insurer, accounts for all the possible paths that a customer can take, and captures their experience along those possible paths. From there, information can be fed back into voice-of-the-customer programs and analytics platforms to yield insights.

Healthcare companies should also look to other industries like retail for ideas on how to provide better customer experiences, says Robert Wollan, senior managing director of sales and customer services at Accenture Strategy. "Consumers often take an expectation from one industry and apply it to another," Wollan observes. "For instance, as on-demand services increase, it won't be long until consumers start saying, 'where's my healthcare claim? Why can't I see the status of my claim as it's being processed?"

Meeting changing customer expectations at Fallon Health

Peter Atkins, director of market research and planning at Fallon Health, agrees that healthcare companies are facing a lot of pressure to engage members as consumers. Based in Holyoke, Mass., Fallon Health provides about 225,000 members with health insurance solutions and a variety of Medicaid and Medicare products, as well as healthcare programs and services aimed at seniors and other individuals.

To improve its member experience, Fallon Health partnered with Forrester Research to identify customer expectations that cross industries. What Fallon Health learned through consumer surveys, according to Atkins, is that "people aren't necessarily comparing you to other health insurance companies; they're looking for that Amazon experience. How can Amazon ship something across the country in one day while it takes three weeks to get an ID card?" It's clear, Atkins continues, that "member expectations have changed and we're trying to apply best practices not only from healthcare, but also from other industries like banking and retail."

And given that there's a high cost to acquire a new members, "member loyalty is important to us and we try to engage our members in all life stages from infancy onwards," Atkins says. To better engage members and drive loyalty, the company is using solutions, such as VOC programs and journey mapping tools. Such tools helps Fallon Health "put ourselves in the shoes of our members and design processes from a member's perspective," Atkins says.

As an example, Atkins points to retail centers where members can take a yoga class, get a blood pressure reading, or speak with advisors about questions related to Medicare and Medicaid and other insurance plans. The company rolled out a handful of these centers in Massachusetts based on feedback it received through its VOC platform. Giving members the opportunity to get face-to-face assistance has been a great success, according to Atkins.

Additionally, the company expanded its discounts for health club memberships to include discounts for other healthy activities like horseback riding, swimming, and golf. "We realize there are many ways to stay healthy and we want to reward people for it, so we've been expanding our list of approved activities," Atkins says. "We got a lot of positive feedback about doing that and we believe it helped us retain members."

Fallon Health was also the first health plan in Massachusetts to let members access their ID card through a mobile apps, Atkins says. And as mobile usage grows, the company is looking for other capabilities that members would want in a mobile app, he adds.

Providing easy-to-use estimation tools via mobile can create more "member stickiness and loyalty," notes West Monroe's Shaikh. The app's features doesn't have to include "cutting edge abilitiesbut really provide what the customer needs," he adds. This includes features like provider search, FSA planning, point of care estimations, plan selection via statistics etc.

Also, providing meaningful rewards is another way to foster member loyalty. Meaningful rewards aren't just financial in nature, either. "Some social network ecosystems provide 'social status' rewards based on customer achievement of certain health activities," Shaikh says. "And such rewards can often be more meaningful than financial ones."

Looking ahead, engaging loyal members will grow more critical as competition increases. "It's becoming more important for us to understand our individual members' wants and needs," Atkins says. "We think a large percentage of our business will come from people who are presented with a number of choices and there'll be less variation on things like price and plan design features as regulations change."

Loyalty programs that offer points-based incentives and rewards are helpful for promoting customer loyalty, but their effectiveness is limited. Companies must look beyond the transactional relationship. Engaging members by understanding what motivates them to remain loyal and exceeding expectations will have an even greater impact as health insurance competition grows.

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