Bob Yurkovic

Business Growth, Customer Experience, Engagement, Digital Operations & Solutions

Point of View in Consumer Centricity

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Whitepaper

Abstract

Companies launch products and services to consumers with the thought that their product will offer so much value to the consumer without considering the bigger picture. It is a holistic view of the consumer experience that matters if consumer centricity is to be attained. The combination of a product’s functionality and the experience it offers sets a condition for potential consumer engagement and relationship development. Translating this to healthcare, it is important for payers to provide information and tools so members manage their health while offering a connected experience to simplify and navigate the complex maze of healthcare.

Executive Summary

The shift to consumer-driven health is evolving rapidly. Payers need to adapt to retain their members, stay relevant, and manage costs. With medical costs rising and consumers managing their health, payers want to engage them in healthy behaviors and cost-effective decision making. To engage members, payers need to develop trusted relationships and form useful interactions with their members. Relationships require a combination of a superior experience and products that help members manage their health.

A once antagonistic relationship can turn into a productive, lasting relationship by forming an experience high in usability around services and products that interact with consumers, as well as creating the whole experience or journey in dealing with a payer.

Traditionally, healthcare payers focused on providing support to their members through transactions. Transactions include such tasks as looking up benefits, submitting claims, and looking up providers. This is a “get the job done” mentality and lacks a good experience. Transactions support only a fraction of what members need in a consumer-driven world. Health reform and Consumer-Directed Health Plans (CDHPs) started the transformation to consumer-focused healthcare. CDHPs put the consumer or member in control of their health, which places demands on the payers to provide relevant information and useful tools that support decision making and healthy living.

Payers cannot develop meaningful relationships through transactions alone. They need to go where consumers engage with life every day: their lifestyles. Lifestyle is the day-to-day living where healthy behaviors are set and routines developed. Enablers in healthcare, such as biometric devices and mobility, offer a strong connection to consumers, providing immediate monitoring and feedback of their health indicators. The devices and their applications are tools that support members’ healthy lifestyles. A great experience with useful products that target a member’s lifestyle is a winning combination to improve personal health and manage costs.

Doing The Job

There is a need to combine experience and function into a consumer model, and I believe there is a strong use for it in healthcare to achieve member engagement. An idea came to me after I read about the work of Clayton Christensen and a fellow researcher. It was an article on “Milkshake Marketing” from Harvard Business School published in 2011. Clayton’s claim is that 95% of new products fail, and companies need to look at products in the way that customers do: how a product “gets the job done.” Jobs have functional, emotional, and social dimensions.

I was fascinated by this article, which followed the role of a milkshake in the eyes of a consumer. The goal was to increase the sales of milkshakes. The study found that consumers bought the most milkshakes in the morning and for a common reason. Consumers faced a long commute and needed something to make their commute more interesting. They were not hungry but would be by 10:00 a.m. The milkshake was thick, so sucking through a straw gave them something to do. They were in business clothes and the milkshake was less likely to get their clothes dirty than a donut or bagel would; it was contained enjoyment.

Traditional marketing says to segment the market by demographics and product. Clayton’s argument was to segment according to jobs-to-be-done. Focusing on the job, they found that by increasing the thickness and adding chunks of fruit, they enhanced the job-to-be-done and sales increased. They also had another version, a treat for children with a thinner consistency so parents would not have to wait for them to finish it. This shows two jobs that needed to be done. Now add experience.

Experience

I noticed a correlation between a product’s job and the overall experience the person has with it. It seems that more than just user experience (usability), this involves the journey or customer experience of the event before use, during use, and after use. I observed that products that were lean on features but robust on the experience were more likely to be adopted and succeed. The concept of consumers choosing packaging over content has been around for a while. We choose a laundry detergent because our family used it when growing up (brand) or the color of the package is striking (packaging). Not many people actually read and understand the chemistry of the ingredients (content). Maybe we are seeing a shift in consumer behavior and the new form of “packaging” is the experience. Personally, I sacrifice features to remove the hassles of product selection, purchase, and use. To me, experience became the product differentiator, if for no other reason than to avoid adding frustration to my busy lifestyle. If a vendor has a useful product with a great experience, then I do not mind waiting in lines to get it, either. Even the wait can turn into an interesting experience if we design the experience well.

The following figure shows a model for connecting the experience and functionality with consumer relationships

job-experience

Scenario 1 – High excitement and limited use

Product type                  Fad
Consumer feeling         Excited
Consumer mode          Courtship

If you have a useful product that offers a great experience in purchasing it and using it, you could see strong user adoption. The excitement may not be sustained over time, as users realize the “fun” is gone and the usability of the product has waned. Remember the fads of yesteryear. Clothing can fit into the category of a fad. Articles of clothing that have lost their excitement include bleached jeans, hoop earrings, penny loafers, and leggings. They are still functional, but a shift in the experience occurred. Experience can impact the functionality, as well. If a style no longer creates a good feeling while wearing it, the clothing no longer “performs its job” to make the person feel good, and it will be discarded for another piece of clothing. In this mode, you create a short-term relationship and the product seems more like a fad with a short lifecycle.

Scenario 2 – High use and limited experience

Product type                  Commodity
Consumer feeling         Bored
Consumer mode          Acceptance

A product such as phone service and cable TV from a cable provider, which does an OK job and provides a poor customer experience, may not have a foundation for a relationship to develop. Forrester reports the customer index for cable TV providers is in the poor range. From a consumer perspective, we put up with the cable TV provider and consumers accept what they are given but will jump to another provider at an opportunity if the product stops performing or they are fed up with the experience. This industry has retention issues, which could be more severe if there were more vendors offering services. The barrier to switching to another provider is low.

Scenario 3 – High use and high experience

Product type                  Valued
Consumer feeling         Satisfied
Consumer mode          Engagement

If you have a service with great products and a satisfying experience, such as Amazon. com, there is a foundation on which to build a relationship – even online. Amazon ripped business away from brick-and-mortar stores and offers excellent customer service throughout my shopping experience. I get reviews of products, updates on my order, and an evolving shipping status in real time. The experience supports two tenants of consumerism: It is convenient and fast. Facebook is another example of a product that does the job without getting overly complicated and offers a good experience. Users of Facebook are truly engaged and we see this in how much time is spent on it. It has integrated into the user’s lifestyle – a powerful combination.

To sustain the relationship and use, you must either tune the experience to keep it fresh or maintain the usefulness of the product. I believe I see this in Apple’s iPods. I own four iPods and wondered, “Why?” Apple generated a fun experience for me with their initial product launch. For me, it hit the fad stage first and moved into the valued area. Early iPods did the job of playing music, but over time I began to retire my iPod to a drawer. Why? I found that the excitement of having one diminished and the experience decreased. I then moved into the commodity area.

Soon, Apple released a newer model, which increased my excitement, and the bonus was the newer model had a new feature, making it seem more useful to me. So I bought it. I believe that I quickly moved back to the fad area. Usefulness and experience are high again, so I drift into the valued area. Repeat that cycle nine months later.

It seems like the experience was being pulsed to hook me into buying “upgrades” to keep the experience going. I call this “Pulsating Experience Marketing.” I was an experience junkie, and the behavior seemed a lot like the way I play with a cat. I would put a toy on a string and then tease the cat by moving the toy close and then pulling it away. Repeat for a sustainable experience. Without the introduction of a new experience, the first iPod would have gone to my daughter’s play box with no repeat of the cycle. I believe that experience and usefulness are closely linked to driving consumer behavior, and behaviors drive consumer engagement.

Experience + Job = Relationship

Expanding on the concept of “Milkshake Marketing” and translating it to healthcare 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 is 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 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 deeper 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, members imagine their claim is not going well or something has gone wrong.

delivery channels

After a period of time, the member will enter the frustrated stage and call their payer to find out the status of their claim. 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. They could use a simple graphic with a five-stage process or a text message stating the claim is in “Stage 3” with “We are processing your claim with no expected delays,” which provides 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 personalized 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. Over time, 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 the job to be done.
  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 that the “doing the job” indicator goes up.

Building relationships aids in member engagement and increases retention. It is about the quality of the interaction, and not the 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 likelihood of chronic diseases
  • Promote healthy living for members
  • Offer information and tools to help members make intelligent health decisions

Because 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

By bringing 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 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 healthcare. 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 you are 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, some solutions 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 would take time to build relationships and trust with their members and shift 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.

HealthScape

The traditional interaction with payers has been around transactions: find a doctor or pharmacy, look up my benefits, and look up my claim. This is the transaction layer in the consumer relationship. There is little opportunity for a payer to develop a relationship and generate consumer stickiness in this area. Members, in this case, only go to the transaction layer to perform a transaction, which for any large payer is about one to two times a year. The main reason that many members perform a transaction is because they are going through a health event, like a sickness or medical condition, and members are already in a stressed state of mind dealing with a personal or family health issue. This is not the best time to generate a relationship. The best way a payer can generate a positive experience in this layer is to provide superior support for the member when needed. This translates to a flawless experience by offering a caring connection, managing administrative tasks and processes, and performing event logistics so members can focus on their health. In order to build productive relationships, payers need to go where the people are when they are in a good state of mind.

The following figure shows a representation of the HealthScape from a consumer perspective. There are three distinct layers around health and consumer involvement, with the transaction layer being at the core. Each layer is different in how often members interact in each layer.

HealthScape

In the “Transaction Layer,” members may interact several times a year with a payer performing a health transaction. In the “Wellness Layer,” members interact far more often, such as one to two times a week, depending on their personal plans for nutrition and exercise. When in the “Lifestyle Layer,” there is a potential for members to be involved in health every day, as it becomes part of a routine in a person’s daily living. In the “Lifestyle Layer,” a payer has the potential to achieve relationship nirvana – stickiness.

While in the “Wellness Layer,” members are focusing on sustaining or achieving a state of wellness. In this layer, the main issues on members’ minds are nutrition, exercise, and healthy behaviors. Members are focusing on their health to minimize the risk of becoming sick and maximize the potential of leading a productive life. Members also begin to enter into a relationship with wellness providers and coaches to engage in healthy behaviors. Telephone coaching is an example of this. However, wellness is one of many personal priorities a member manages, so it may not be their top priority all the time. For wellness to be embraced, a member must absorb healthy thinking into their life on a daily basis and it must become part of their lifestyle.

In a “Lifestyle Layer,” members interact, work, play, and experience life every day. Examples of health in the “Lifestyle Layer” are the many new devices that monitor daily activity, such as sleeping habits and nutrition. The “Jawbone UP” and “Fitbit Flex” are wearable devices providing biometric data to consumers throughout the day. These devices provide feedback to members so they can adjust their actions and behaviors in order to reach their desired goals. These devices become part of the wearer’s lifestyle and that lifestyle changes based on the feedback they receive. If a member works in an office and sits at a desk too long, an alarm will go off, letting the wearer know they need to be more active and move around. If this happens often enough, their thinking will be changed and a new behavior formed, leading to healthy outcomes.

Solutions in the “Lifestyle Layer” focus on supporting consumers in their quest for sustained healthy living. It is important to help members approach health in a holistic manner and offer encouragement in the form of helpful tools that promote education in the areas of nutrition, exercise, stress, care, community, and healthy living habits. In this layer, relationship maturity can blossom. To assist payers in their vision to diversify, they can take advantage of this opportunity in the “Lifestyle Layer” by offering such tools to reinforce healthy behaviors for their members and provide more than just health plans. The definition of health to a payer is more about healthy living for members and not just paying a claim.

Years ago, the same transformation occurred in the banking industry. Banks interacted with consumers simply by performing transactions such as depositing a check. Now banks offer a full suite of services, such as financial planning for retirement, college savings, and family growth, supporting a person throughout their life.

An extension of a payer’s offer could be to aggregate data from multiple biometric devices to provide services to their members such as a health dashboard with relevant content to support decision making and behavior changes in pursuit of healthier living. As mentioned under the “Engagement Section,” healthy behavior lowers the likelihood of chronic diseases, which in turn lowers medical costs in health care.

Summary

It may appear that payers are losing some control to consumers, but in reality, they are increasing cost control through member enablement. It is important for payers to trust and empower members to do the right thing for their health. Payers must provide relevant information and decision tools to arm their members in their pursuit of a healthy lifestyle.

The benefits of consumer centricity align well with payer value:

  • Coordinated member experience
  • Personalized communications to channel preferences for engagement
  • Usable consumer tools and online assets to manage the experience
  • Align consumer programs with the business strategy to manage effectiveness
  • Drive member healthy behaviors to manage chronic diseases and manage costs
  • Support consumer health decisions with information and tools to manage costs
  • Unified platform for member communications for consistency
  • Generate 1:1 relationships with members for retention and engagement
  • Increase stickiness with members for retention
  • Compliance to CMS and federal disabilities organizations to minimize risks
  • Integrated mobile and social enablers to optimize consumer engagement
  • Payer remains relevant through useful solutions

Payer centricity and provider centricity is replaced over time with consumer centricity. Consumers begin to take control of their health, with payers and providers transforming to meet the consumer challenge of a long, productive life and quality care while managing costs.

The goal is to have an engaged, healthy community of people. With so many moving parts and interactions, a thorough assessment of the payer’s approach to a consumer-driven world is required before embarking on launching disparate tactical programs, or confusion replaces engagement.

Our State of Health – Health Nurturing Concept

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This post is a continuation of the previous post titled’ “Our State of Health – Why are We Here?”

As Humans, we are intelligent beings so perhaps if we were to get information about how to manage our health in a manner we like to receive it and in a way we can absorb it, we can begin to make better decisions and take actions toward better health. We want to do it so perhaps past methods were not the correct ones to motivate us.

Present forms of communicating desired changes to health habits involve spreading fear, shouting threats, punishing wrong doing, and pushing commands to this or that. To make it worse, Payers, Providers and others are doing this in an uncoordinated manner fueling chaos and despair. To a consumer, it is like being in a mad house during a full moon so they shut down all input. Instead of using negative approaches, why not take a positive approach through nurturing? The average person wants to make good decisions but they need information and tools to be able to do it.

No one likes to be told they are fat each morning and then get a threat from a consumer web site after they sign in saying, “You are fat and you need to lose weight” and you will be hounded each day on the site for being FAT. Sound ridiculous? This is what two senior people from a healthcare Payer proposed to be done on their consumer portal during a customer experience initiative. The intent was to force people to lose weight using an “in your face” approach but in reality, it demonstrated a terrible, degrading customer experience. In another example, digital nanny applications in early mobile health programs nagged you when your health parameters did not meet their expectations. So after a few days, consumers deleted the application after experiencing constant frustration. These approaches do not build relationships and it demotivates their customers. They are negative approaches in an attempt to help people. But as consumers, we are not wired to respond to this approach even though it may have worked 30 years ago.

Health Nurturing

I call the concept of interacting and communicating information with consumers along a series of gradual steps … “Health Nurturing.” These are baby steps and not leaps. Consumers are not pushed forward but instead lead to actions that generate forward progress from with inside them. Consumers accept and digest bits of information at their own pace leading to insights and actionable behavior changes.

If we use the Health Nurturing concept, we begin a path to adoption such as:

  • Collaborate with consumers giving them what they need to become aware of a health situation. Help them become aware of potential health issues and their risks.
  • Enable consumers to research pertinent information in their quest to understand health issues and how it may impact them or others they know. Offer information that is relevant so they may analyze and internalize it at their pace.
  • Allow consumers time to accept the impact and outcome of the situation once they have come to understand it. Let them gain insight to how it affects them and what can be done to assist them in moving forward.
  • Enable consumers with programs and useful information so they may adopt new behaviors and execute on steps toward a better outcome.

I use four natural stages of consumer based thinking to achieve behavioral change. They are (1) awareness, (2) research, (3) embrace, and (4) adoption and they guide the consumer down a path to self-realization and self-action.

This approach works because the process is internalized and tuned to the person so that they may accept it on their terms as opposed to it being forced upon them through negative reinforcement. This approach does not force feed and push but instead lets the consumer digest information at their personal pace to, hopefully, gain insights can change their way of thinking to correct a behavior for better health.

Excerpted from my book titled, “Commercializing Consumer Engagement.”

Our State of Health – Why Are We Here?

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We are what we eat, we are what we do, and we are what we accept … we are unhealthy.

If our health is so important to us and we, as Americans, spend $2.7 trillion dollars on healthcare annually, the question arises, “Why is our health worsening and the quality of care decreasing?” According to the CDC, obesity rises 6% annually and affects one third of the population. Diabetes rises 8% annually with about 26% of the population either undiagnosed or on the verge of diabetes. 75% of medical costs are due to Chronic Diseases and most of these can be managed through behavioral changes. Most people want better health care that is affordable and accessible but we do little to help ourselves stay healthy.

As people, we tend to focus on health when something has gone wrong and not only wrong, but very wrong. For most of us, health does not tend to be a priority in our lifestyles. Why is this? People tend to focus on social activities, material gain, family issues, jobs, or entertainment. Our daily living habits confirm this as we do not get enough sleep, do not get enough physical activity, and do not get the nutrition we need to remain healthy.

The trends of consumerism fueled new behaviors and we shifted our values over time. Convenience, cost, and speed now rule our behaviors since we are so used to getting fast food and products delivered in days as we rush trying to do too many things at once. We sacrificed quality for convenience since we are so used to taking the easy, convenient route. Most of us are strapped with debt and trying to manage a household on a tight budget so we are faced with a dilemma … should we pay $12 for GMO, food additive laden, processed food that is almost ready to eat once nuked to death or pay $32 for quality food products that you actually have to take the time to prepare and cook for yourself and the ones you love? It is usually the cheaper, easier option. The excuses are … “Don’t have the time”, “Can’t afford it”, “I can’t cook”, “I have more important things to do” and “That is too much effort”. We reprioritized how we perceive what is important to our lives and the sad news is health, as a priority, has been dropping steadily. We tricked ourselves into believing that good living is about quick, easy, convenient and cheap. We forgot how important we are and what it takes to keep us healthy to lead productive lives.

There simply are no short cuts to good health. Good health is not quick, easy, convenient and cheap. If your health deteriorates, you may find that repairing the damage is expensive, difficult, takes time, and is invasive to your lifestyle. Contrary to many TV commercials, there is no secret pill you can take to get the nutrients, sleep, and exercise required to maintain a healthy body and a healthy lifestyle. Partly to blame for this is the time lag of an action taken to the results exhibited. When we do something that is bad for our health, it usually takes a while to show up and since it takes a while, most of us do not see the gradual deterioration until a major event occurs … like a heart attack.

Most Americans actually take better care of their cars than they do their bodies … the oil gets changed and our cars fed with gasoline. I never heard of a person jamming a Twinkie down the gas tank. Why? Because we know it is bad for the car. BUT, why is it the same people do not see it may be bad for the body too? What can one Twinkie do? You do not really see the effects immediately but a daily habit will have an effect after time. 5,000 Twinkies later, you are 100 pounds overweight and combating diabetes. If you stop changing the oil in your car, eventually the engine stops running and it fails. So we know better. Admittedly, there are some of us humans that have not changed the oil in our cars, but not 1/3 of the population … but 1/3 of America is obese.

Summary

Health takes a back seat … until something goes horribly wrong. There must be a way to increase how we focus on health in our daily lives and adopt it as part of our lifestyle. Payers and Providers have been trying to figure out how to engage patients – members – consumers to manage their health better. One way is to understand them as consumers and the behaviors that drive them.

Excerpted from my book titled, “Commercializing Consumer Engagement.”

Health and Our Decline

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What is Health About?

Our health is a combination of several key things that need to stay in balance in order to remain healthy. We need to feed our bodies, we need to flex our bodies, we need to rest our bodies, and we need to manage the external forces that affect us. If we are out of balance, chronic diseases and other disorders may occur.

There are 7 components to health and to be healthy, all 7 must be in balance.

What is Health 8

How far out of balance are we?

Sometimes tough facts are difficult to swallow, but denial is no longer an option. Let’s take a look at two chronic diseases, obesity and diabetes. About 1 in three people are obese in America. The alarming statistic is the increase from 15% of the population in 1990 to 34% in 2013. The figure rises 6% year over year. A study in 2010 by the Organization for Economic Cooperation and Development (OECD) said 75% of Americans will be overweight by 2020. Obesity is responsible for 5-10% of total health expenditures in the United States. An obese person incurs 25% higher health expenditures than a person of normal weight in any given year. In the United States, obese people are 76% more likely to suffer short-term disability adding production losses to health care costs that account for over 1% of the GDP. The costs will rise as obesity related diseases develop. A Johns Hopkins University researcher claims, in the 2008 journal Obesity that about 65% of Americans will be overweight by 2030. Costs to treat obesity and health related costs could also rise at staggering amounts. Our economy may not be able to support those increased costs.

obesity facts 2

If we look at diabetes, about 7% of the population has been diagnosed with diabetes. The alarming facts is about 26% of Americans are on the verge of diabetes or undiagnosed. Complications due to diabetes lead to more serious diseases such that the related costs are $245 billion in 2012. According to the CDC, 1 in 3 adults could have diabetes by 2050 if current trends continue. The International Diabetes Federation predicts as many as 438 million people in the world will have diabetes by 2030.

diabetes facts 2

The trends in both diseases are similar and growing at high rates. How we address chronic diseases in people requires immediate attention if we are to manage medical costs and the population’s health.

Excerpted from my book titled, “Commercializing Consumer Engagement.”

Consumer Insights: Profiling Consumers to Target Personalized Communications and Sustainable Health Programs

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The healthcare climate has changed, and consumer centricity in healthcare is now more important than ever. In order to better serve consumers, enact more personalized healthcare communication programs and develop more sustainable health programs that influence the lives of consumers for the better in the future, it is necessary for health providers and payers to leverage big data in new and innovative ways. There are huge stores of data available for healthcare industry insiders to take advantage of in order to profile consumers and ultimately better serve them through programs such as digital dashboards that are easily accessible to consumers, employers and healthcare payers.

What Kind of Data is Most Useful?

Successful healthcare consumer centricity programs take many different kinds of information into account. Healthcare payers and providers can better serve consumers with tailored communications and personalized programs by first obtaining the following types of data in a central repository:

  • Behaviors – Information about lifestyle choices and behaviors that pertain to diet, exercise, activity, sleep patterns and other habits can be very helpful. These may be obtained through information from various databases, surveys and other records of interactions with consumers.
    Claims – All claims tell a story, and can be used to tailor more personalized experiences for and communication with consumers in the future. A well-managed electronic records database is essential here.
  • Rx – Tracking and measuring pharmacy metrics can be very beneficial to healthcare payers, not only because it provides an opportunity to streamline cost initiatives, but also because it provides another opportunity to see what health choices consumers are making and where they’re spending their healthcare dollars.
  • Biometric Devices – Since the dawn of the digital age, many advances have been made in the healthcare world, including the development of biometric devices that identify doctors and staff and gather vital information about patients. Statistics from these data records can be used to pinpoint trends, develop more customized healthcare products and services and make better predictions about healthcare outcomes.
  • Tests (Blood) – The records of blood tests can also be used to develop better products and services for consumers. The more information that healthcare payers and providers have about the unique populations they serve, the more personalized communications, experiences and programs they can provide.
  • Master Data (PHR, ethno-, techno-, socio- and demographic) – Perhaps the most useful chunk of data for profiling healthcare consumers is a master data file that includes demographics, personal health records, ethnographic information, socioeconomic information and all varieties of useful digital information about the group of consumers that a given healthcare organization serves.

What Can We Do With All This Data?

The goal of any successful consumer-profiling program should be to achieve the kind of strategic analytics that will support better health initiatives. Analytics can fuel tailored dashboards for consumers, employers and payers, which epitomize the new drive toward consumer centricity for healthcare payers. Such a dashboard provides a more convenient way for consumers to receive information from and communicate directly with healthcare payers and providers, which allows payers in particular to foster relationships with consumers that were not always possible in the past. These dashboards can also be used to gather more information about consumers in the future, and do so in a more organized, cost effective and streamlined way. In the end, the more insights a healthcare payer and/or provider can gain about the consumers they serve, the better prepared they will be to target personalized communications and develop more sustainable health programs in the future. It’s a win-win-win for the healthcare payer, the consumers who use their products and services and the employers who help provide health plans to their employees, when applicable.

Consumer Understanding and Intimacy Because Healthcare is Personal

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Describe healthcare from a personal view. Do terms such as fragmented, fractured experience, inconsistent communications, confusing, irrelevant information, and frustrating come to mind? Is healthcare a personal experience?

Questions arise from a consumer. “Don’t they know me yet? Why do I have to repeat entering the same information? What does this mean? Which one is right?”

Consumers place so much emphasis and energy on how to navigate through healthcare to the point that they hardly have time to focus on their health. Did you ever walk into a store and were overwhelmed by what you saw you forgot why you came in the first place? If health care were a collection of packaged goods in a store, we would walk out of the store.

What do consumers want from healthcare? Five basic words come to mind: Easy, consistent, coordinated, helpful, and connected. And if information and tools are required to make good decisions, they need to be relevant, useful, and personalized to me.

To address the consumer’s needs, we need four elegant solution engines and they form a consumer equation.

Consumer Insight + Customer Experience + Personalized Communications + Relevant Health Engagement

It is more than just adding four items; it is how those items are connected into an integrated consumer view of healthcare – the conduits and glue in healthcare. So, let’s choose one of the four and work our way through them. Why? It’s all about “me” in a consumer world and the “me’s” have choices in a b2c environment. Consumer centricity should drive the business for a payer as it does for CPG companies.

Health Engagement Programs and What Makes us Tick

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The shift toward consumer centricity in healthcare can be seen throughout the market, from providers to payers. The healthcare industry is in a state of transition, which is inevitable for any industry that has straddled generations of consumer, economic and societal trends. With a shift toward consumer engagement and digital communication, it is more important than ever for healthcare industry insiders to keep up with the times and develop programs that are relevant to today’s market. Health engagement programs are a big part of that. In order to develop useful and lasting health engagement programs, it is up to providers and payers to better understand what makes us tick, and provide products and services accordingly.

Health Engagement Programs: Segmentation is Essential

Healthcare providers and payers are now more focused on developing programs that drive healthier behaviors in consumers, whether they are in top shape, in need of a few healthy lifestyle adjustments, chronically ill or currently receiving treatment. Segmentation of the marketplace allows healthcare professionals to create more positive experiences for consumers from all walks of life and in all situations. This allows for a more personalized experience for the consumer, with health programs that are tailored for and marketed to different types of people based on their unique wants and needs.

What This Means for Healthcare Payers

The shift toward segmenting the healthcare market and creating more personalized experiences for patients provides a new opportunity for payers to move into the consumer health space, rather than just the health event and transaction spaces, as they have been limited to in the past. It is in everyone’s best interests for consumers to have as many tools and as much accurate information as possible in order to pursue their own good health, and payers can be a big part of this. Historically, however, consumers have not been pleased with the experiences they’ve had with the payers providing health benefit plans and services to them. Payers have not worked hard to build relationships with their customers, and thus do not differentiate themselves from one another, giving consumers little reason to switch from one payer to another. Consumer centricity for healthcare payers is essential as consumers continue to become savvier and demand more comprehensive services designed to meet their specific needs.

The Challenges in Engaging Healthcare Consumers

payer challenges 2

The fact of the matter is that many consumers are resistant to engaging with their health payers due to a number of factors, including negative past experiences and underdeveloped relationships. Even when payers try to reach out with information that can help consumers achieve healthier lives, they are faced with heavy resistance. It does not have to stay this way, though. Many payers are already beginning to embrace the shift toward healthcare consumer centricity and building the kinds of relationships that see results. There is still much that can be done to engage consumers, better understand what makes consumers tick, segment the market, provide more personalized products and offer better services overall.

The Road Ahead for Healthcare Payers

Focusing on consumer centricity in healthcare is going to become just as essential for payers as keeping costs down and increasing membership – this is how payers are going to keep their customers and attract new ones. In many ways, healthcare payers can benefit from looking at how various retailers handle their business. Many online retailers, for example, engage consumers throughout the processing and delivery steps, and update them as their packages are being shipped. The same model could be used in the claims processing lifecycle to keep consumers engaged, and not frustrated or alarmed. At the very least, healthcare payers will need to provide a more seamless and positive user experience for their members, and begin building a more optimistic relationship with consumers. Then, over time, it will be possible for health payers to design more consumer centric products, engage consumers in healthier behaviors, keep customers happy and distinguish themselves from the competition.

The Customer’s Point of View — Offering A Superior Online Experience

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In a changing world that is continually influenced by technology, fads and devices of convenience, health plans recognize that their customer relationships are forever evolving. Although the variables are always in motion, there is one constant that demands our focus — health plans must offer a superior customer experience.

As today’s customer service environment increasingly moves toward self-service, learning how to maintain a personal touch as we shift from people to technology is important. Although staying at the forefront of health care may seem complex, it boils down to a very simple solution — understanding the health plan members’ needs relative to the convenience they are accustomed to in virtually every other industry. With this understanding in mind, innovative solutions are the vehicle to driving member satisfaction and garnering loyalty, not to mention making a true improvement in quality of life.

The brutal truth is that most health plan members view their customer service experience as sub par, ranking last among all other major industries, according to a 2009 Forrester report, written by Elizabeth Boehm and titled “Health Plans Face a Member Experience Crisis.” As the report states, “It turns out that customer satisfaction decreases as consumers interact more with their health plan.” The report’s findings also show that members believe their “health plans make things more complicated than they need to be.”1 The question to ask is: How can we make health plan interactions easy, while providing a superior customer service experience?

IT’S AN ONLINE, SELF-SERVICE WORLD
Because we are a mobile society, information has to follow us in our busy lives and not the other way around. Although a health plan’s point of connection with its members occurs in three ways — through their online experience, call centers and mailed printed matter — it is the online experience that has become the primary focus for customer service delivery. Health plans are beginning to use the Web, mobile technology and kiosks to provide the information world to their members on their own terms.

Those of all ages have been able to enrich their lives by connecting to the online world. In fact, as we age and find our physical mobility becoming more limited, reaching out to the online world provides new opportunities for community connections. This is especially true for seniors who are learning to use online social networking as a way to find old and new friends. Instead of walking to the local coffee shop to meet friends and family, they can now chat online, thereby eliminating all physical barriers.

While the online world offers many advantages, using it to its full potential can be challenging. Creating a superior customer service experience requires skills in human factors as well as a comprehensive understanding of each audience. Health plans can realize customer service improvements by focusing their efforts on strategic, up-stream activities such as focus groups, usability testing and user experience architecture that will ultimately define the components of a superior experience.

RULES OF ONLINE USE ARE CHANGING
Now that health plan members are beginning to expect and even demand online options, the rules of customer service are changing. Today’s health plan member does not have the time or patience to figure out complex forms and processes. They expect access in real time, along with smart applications and dashboards, to help them make decisions. In addition, they want an interactive experience that engages them with others and immerses them in a supportive community rather than the stand-alone, impersonal pedestals of Web sites with complex navigational mazes that seem to hide information.

In other words, health plan members want a system that is easy to use, and they want to be in control. The table below shows how member expectations have changed over time:

industry shift table

ACTUALIZING INNOVATION
In order to drive customer service innovation, health plans need to define their many member interaction points and deploy focus groups that address the following questions:

  • What do we need to improve?
  • Where do we need to be?
  • How do we improve production to give our members conveniences already offered by other industries?

The lessons learned from these focus groups should be used to build a better model that includes improved online communications, concierge delivery, personalized communications, mobile technology and an expanded “HealthScape.” This will lead the way to an experience that is truly in tune with the customer’s needs.

Online Communications
What can health plans do to improve online communications? Hide the complexity by focusing on audience-centered design and create a simple user interface. This essential step can be accomplished by re-thinking processes in a way that transforms them into a customer point-of-view. Look at the logistics of building your online sites by using a “shopping mall” model that allows for entry at one portal and gives access to many areas. Combining the ports of entry into one area reduces the risk of a fragmented experience.

Navigating through an online maze is the number one frustration for users in all industries. In fact, customers would prefer to take many easy steps to gather information rather than a few difficult steps. Think of an encyclopedia as your model. Although you usually cannot get to a subject in two turns of a page, having the proper topology and guidance system makes it easy to find the information you need.

Concierge Model
Many hotels offer a superior customer service experience by using concierge services. They do not expect their customers to know how to find their way in a new town, who to call for reservations or how to use the hotel’s facilities. Concierge services are provided as a guide for navigating through unknown or complex structures.
Both outsiders and insiders often view their health plan as a complex structure; however, a self-service concierge model can be designed to navigate through this complexity. For example, customer service can take away the logistics issues that members suffer through when encountering a health event. If there is a hospital located many miles away that provides better quality for a better price, then the health plan should provide travel services so the member can focus on what is important to them — their health — and not on making travel arrangements. Taking logistic pain points out of the process enhances the customer service experience during a stressful health event.

Personalized Communications
Offering personalized communications as a standard across all platforms is a best practice in other industries and should be a standard practice for health plans as well. Enrollment forms, plan summaries and physician directories should include member information and data to assist in the decision making process. A personalized document is more appealing and garners better responses than a standardized form letter.
Some payers, such as Regency Blue Cross Blue Shield, no longer send out a traditional Explanation of Benefits. They have replaced them with easy-to-understand and personalized health statements embedded with marketing information. This communication now serves as an engagement tool that is useful to the member while providing an opportunity for the plan to sell additional services.

Mobility Anytime
Some estimates show that up to 50 percent of people will have smart phones within one year. Whether standing in line, traveling or waiting for children to finish school activities, people want the ability to connect online in real time. Health plan tools should take advantage of this technology and make smart applications available that enable members to easily manage their care.

Additionally, kiosks have been a major self-service delivery point in the banking industry for many years. Conveniently located, easy to use and available at all hours, customers love the convenience. Kiosks also entered the health care space a few years ago, offering applications such as way-finding and registration. Now is the perfect time for health plans to expand their kiosk capabilities by offering new, focused smart applications.

The HealthScape is Expanding
Health plans can no longer afford to limit their online customer service offerings to just health events and transactions. As health care priorities shift, members who previously used their plan’s Web site to find a new provider or review a claim now want the ability to do more. In fact, there is a need for a new term that encompasses all of the moving targets demanded by today’s consumers. HealthScape is a new term encompasses the three segments of a successful health plan Web site:

  • Health Events and Transactions
  • Wellness
  • Lifestyles

The primary challenge for health plans is to tie together all three segments into a uniform, connected Web site that provides a superior customer service experience for increased loyalty.

The following diagram shows the information that should be provided within each segment of the HealthScape:

HealthScape

Many Web sites began by providing member services in the health events and transaction segment of the HealthScape. Inquiries pertaining to claims, providers and benefits are the most utilized features of this segment. However, with the increasing popularity of HSA and HRA plans that are designed to lower costs by motivating members to stay healthy and follow wellness guidelines, some plans are adding wellness and lifestyle segments to their Web sites in order to provide a more robust user experience.

The wellness and lifestyle segments of the HealthScape can be linked through a variety of shared experiences. For example, when evaluating data aggregation, health plans can provide their members with high-tech wellness tools such as the Nike Triax Elite, pedometers, the Health Buddy, GlucoPhone, blood pressure monitors and a myriad of other devices designed to acquire personal health information. The health plan can then aggregate this data and make it available online so members can monitor their fitness and make any necessary lifestyle changes. The health plan can also offer incentives based on the member’s progress.

Another HealthScape experience that crosses multiple segments is “at home care.” This type of care increases quality of life while decreasing hospital costs. For example, at home care for diabetes includes the use of equipment to monitor blood sugar levels and medication delivery to patients while in the comfort of their home. Uploading the test results to an online portal offers the opportunity for physician review while results can be made available to the member.

A population that will play an increasingly important role in the HealthScape is that of the Millennials, also known as the “ME” generation. This group, ages 18–29 years old, numbers between 80 and 95 million. They work hard, play hard and consider their lifestyle when making health care decisions. In fact, they will even schedule business events to fit in with their lifestyle, such as scheduling a business meeting around a yoga class.2 The Millennials know their priorities and, as young people, they are tech savvy, “always on” and only take “yes” for an answer. Given their youthful feelings of invincibility, the wellness and lifestyle segments of the HealthScape are their primary areas of focus. An incredible opportunity exists for health plans to provide them with advice on nutrition, healthy living, traveling and more.

As the use of health plan Web sites migrates from health transactions and events to wellness and finally to lifestyles, the HealthScape becomes “stickier” and member retention becomes less of a problem. The plans that limit their Web sites to health events and transactions will only have members visiting their site a few times each year. With such low interaction, retention is difficult because so many alternatives for information exist elsewhere and members will gravitate toward plans with more informative Web sites. However, by providing a well-designed HealthScape, members will visit more often to seek advice and participate in healthy living programs. This, in turn, promotes a higher quality of life and lower health costs.

TRANSFORMATION
Convenience, simplicity and robustness are the building blocks of a superior online experience. As in virtually every other industry, health plan members have become savvy users of technology. Health plans must transform their approach to customer service and remove the current disconnect between customer service and technology and focus on making online customer service easy to use while improving functionality and content.

The challenge? The challenge is creating a “big picture,” self-service platform that satisfies member needs while providing a rich online experience. The bar for customer service has been raised, and plans should view this time as an inspirational turning point or risk missing the opportunity to truly enhance the lives of their members. In fact, the health plan customer service experience should be designed with the following motto in mind: Partners for Life.

Connection between Experience and Engagement Part 2

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Doing the job
There is a need to combine experience and function into a consumer model and I believe there is a strong use for it in health care to achieve member engagement. An idea came to me after I read about the work of Clayton Christensen and a fellow researcher. It was an article on Milkshake Marketing from Harvard Business School published in 2011. Clayton’s claim is 95% of new products fail and companies need to look at products in the way that customers do, or how a product “gets the job done.” Jobs have functional, emotional, and social dimensions.

I was fascinated by this article and followed the role of a milkshake in the eyes of a consumer. The goal was to increase the sales of milkshakes. The study found that consumers bought the most milkshakes in the morning and for common reason. Consumers faced a long commute and needed something to make their commute more interesting. They were not hungry but would be by 10:00 am. The milkshake was thick so sucking through a straw gave them something to do. They were in business clothes and the milkshake was less likely to get their clothes dirty than a donut or bagel would … it was contained enjoyment.

Traditional marketing says to segment the market by demographics and product. Clayton’s argument was to segment according to jobs-to-be-done. Focusing on the job, they found that by increasing the thickness and adding chunks of fruit, they enhanced the job-to-be-done and sales increased. They also had another version, a treat for children with a thinner consistency so parents would not have to wait for them to finish it. This shows two jobs that needed to be done. Now add experience.

Experience
I noticed a correlation between a product’s job and the overall experience the person has with it. It seems more than just user experience (usability), but also involves the journey or customer experience of the event before use, during use and after use. I observed that products that were lean on features but robust on the experience were more likely to be adopted and succeed. The concept of consumers choosing packaging over content has been around for a while. We choose a laundry detergent because our family used it when growing up (brand) or the color of the package is striking (packaging). Not many people actually read and understand the chemistry of the ingredients (content). Maybe we are seeing a shift in consumer behavior and the new form of “packaging” is the experience. Personally, I sacrifice features to remove the hassles of product selection, purchase and use. To me, experience became the product differentiator if nothing more than to avoid adding frustration to my busy lifestyle. If a vendor has a useful product with a great experience, then I do not mind waiting on lines to get it either. Even the wait can turn into an interesting experience if we design the experience well.

The figure below shows a model for connecting the experience and functionality with consumer relationships.

Job experience diagram

Legend: Blue – product type, Red – consumer feeling, Green – consumer mode

We can use the engagement diagram to review three scenarios relating to the job-to-be-done and the customer experience.

Scenario 1 – High excitement and limited use

Product type                Fad

Consumer feeling         Excited

Consumer mode          Courtship

A useful product that offers a great experience in purchasing and using it may show strong user adoption. The excitement may not be sustained over time as users realize the “fun” is gone and the usability of the product has waned. Remember the fads of yesteryear. Clothing can fit into the category of a fad. Articles of clothing that have lost their excitement include bleached jeans, penny loafers, and tie dye shirts. They were still functional, but a shift in the experience occurred. Experience can impact the functionality as well. If a style no longer creates a good feeling while wearing it, the clothing no longer “performs its job” to make the person feel good and it will be discarded for another piece of clothing. In this mode, you create a short-term relationship and the product seems more like a fad with a short product life cycle.

Scenario 2 – High use and limited experience

Product type                Commodity

Consumer feeling         Bored

Consumer mode          Acceptance

A product such as phone service or cable TV from a cable provider that does just an OK job and provides a poor customer experience may not have a foundation for a relationship to develop. Forrester reports the customer index for cable TV providers is in the poor range. From a consumer perspective, most will put up with the cable TV provider and accept what they are given, but will jump to another provider at an opportunity if the product stops performing or if they are fed up with their experience. This industry has retention issues, which could be even more severe, were there more vendors offering services. The barrier to switching to another provider is low.

Scenario 3 – High use and high experience

Product type                Valued

Consumer feeling         Satisfied

Consumer mode          Engagement

A service with great products and a satisfying experience, such as Amazon.com, provides a foundation on which to build a relationship … even online. Amazon ripped business away from brick and mortar stores and offers excellent customer service throughout a user’s shopping experience. They offer reviews of products, updates on orders, and an evolving shipping status in real time. The experience supports two tenants of consumerism … it is convenient and fast. Facebook is another example of a product that does the job without getting overly complicated and offers a good experience. Users of Facebook are truly engaged and we see this in how much time is spent on it. It has integrated into the user’s lifestyle … a powerful combination.

How do you think this concept applies to healthcare?

Is Customer Experience and Consumer Engagement linked? Part 1

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I call this health blog “Curved Roads”. Curved roads are not efficient; they take more tar to build. They are not the shortest way to a destination so they impact our gas use and they take more time to get somewhere. Yet, there is a grace and beauty in them as they follow the contours of the land and we enjoy them. Curved roads can offer an amazing experience for us. In healthcare, we forgot about the customer experience and we need some curved roads to remind us that efficiency is only part of the satisfaction equation. Consumer centricity needs to be embraced in a payer’s culture if payers wish to engage their members and providers.

LL Bean has been quoted in many industries. The L.L. Bean mission is to live this Golden Rule … “Sell good merchandise at a reasonable profit, treat your customers like human beings and they will always come back for more.” LL Bean’s definition of a customer is, “A customer is the most important person ever in this company – in person or by mail.” A simple understanding of consumer centricity. Do we treat customers like the most important person?

I’m going to spend some time over the next couple of weeks talking about this subject with a model that shows a connection. Are they connected?

An immediate answer comes to mind, “Yes, absolutely they are connected.” But how and why? What happens when you have a great product but a poor experience. Is it a commodity. Is experience the new differentiator? I have some ideas to share with you from a health care perspective.

Companies launch products and services to consumers with the thought that their product will offer so much value to the consumer without considering the bigger picture. It is a holistic view of the consumer experience that matters if consumer centricity is to be attained. The combination of a product’s functionally and the experience it offers sets a condition for potential consumer engagement and relationship development. Translating this to health care, it is important for payers in health care to focus on providing information and tools so members can do the job of managing their health while offering a connected experience to simplify and navigate the complex maze of health care.

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