The 7 Things Your Health Insurance Customers Are Not Telling You - And What To Do About Them

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The 7 Things Your Health Insurance Customers Are Not Telling You - And What To Do About Them
Insight Driven Health

The 7 Things Your Health
Insurance Customers Are
Not Telling You
And What To Do About Them
The 7 Things Your Health Insurance Customers Are Not Telling You - And What To Do About Them
The seismic shift in power     Right at the fore is customer service,   With customer service emerging as
                               the entrée to productive customer        the “X Factor” of high performance,
to the customer has come       relationships that will withstand the    health insurers must understand current
at last to the US Health       test of time. Customers have become      customer perceptions, as well as how to
                               more diverse and more demanding,         shape (and improve) these perceptions
Insurance market. With         wanting service offerings, experiences   for future growth. To help crystallize
The Patient Protection         and communications increasingly on       these factors, Accenture Healthcare
                               their own terms. They have also become   conducted a survey of customer attitudes
and Affordable Care Act        more technology savvy and less shy       toward the customer service practices
adding 40 million new          in broadcasting their experiences.       of US-based health insurance providers.
                               Technology trends like social media      Using a web-based questionnaire,
customers and with             have ignited a new consumer activism     we surveyed 1,000 customers in the
individual and Consumer        whose reverberations have only begun     US between late December 2010 and
                               to be felt. Insurers operating in this   early January 2011. From that research
Directed Health Care
                               “new normal” face an unprecedented       we distilled the surprises and secrets
(CDHC) plans exploding         level of competition, unparalleled       of customer service that together
in popularity, US health       opportunities to expand, and the         outline the alchemy behind superior
                               commensurate risks of failure.           customer service performance.
insurers will need to invent
new healthcare solutions
for competitive success.
The 7 Things Your Health Insurance Customers Are Not Telling You - And What To Do About Them
Seven Surprises About Customer Service
Surprise #1                                       Overall, customers feel satisfied with
                                                  their health insurance providers; in fact,
                                                  our research found that 42 percent
Being satisfied with high                         of customers have a high degree of
                                                  satisfaction, while only 7 percent
customer satisfaction                             have a high degree of dissatisfaction
is a mistake.                                     (Figure 1). However, current satisfaction
                                                  levels do not translate into loyalty and
                                                  revenue opportunities. Despite their
                                                  general satisfaction, customers are
                                                  divided about equally on their feeling
                                                  of loyalty to their health insurer.
                                                  Moreover, few would purchase more
                                                  services from their health insurer,
                                                  if offered. 41 percent of customers
                                                  indicated that if offered additional
                                                  services, they would be unwilling
                                                  to buy them, while only 7 percent
                                                  indicated that they would be willing.

Figure 1—Current State of Satisfaction, Loyalty and Advocacy

                                                                  Not at All                                             Extremely

How satisfied you are with the Health insurance
companies you do business with today?
                                                                                               7%                             42%

Do you trust Health insurance providers to keep
your personal Health information confidential?                                           14%                               39%

How loyal you feel to your
Health insurance provider?                                                       26%                             23%

The extent to which you will buy more
products/services from your Health                                41%                               7%
insurance provider?

                                                                                    % respondents giving top 3 of 10 boxes ratings
                                                                                    % respondents giving bottom 3 of 10 boxes ratings
The 7 Things Your Health Insurance Customers Are Not Telling You - And What To Do About Them
Surprise #2                                      The current tenuous nature of customer
                                                 loyalty to their health insurers may have
                                                                                                As customers are growing more exacting,
                                                                                                their health insurers are struggling to
                                                 its roots in their rapidly rising customer     pass service muster. In fact, our research
Payers are not keeping                           service expectations. We found that 20         found a large gap between what matters
                                                 percent of customers indicated that their      to the customer and the perceived
up with rising customer                          expectations of the customer service           performance of health insurance
expectations.                                    function increased, just in the past year.     companies. While “having employees who
                                                 Furthermore, 41 percent stated that            are knowledgeable and well-informed”
                                                 their expectations increased in the past       ranked as the most important customer
                                                 five years. They want greater ease and         service attribute, several other qualities
                                                 better support: When asked how their           were rated nearly as important, including
                                                 expectations increased, 80 percent said        “the amount of time I have to wait
                                                 that they “expect customer service to be       to be served.” Yet for all five of the
                                                 easier/more convenient to obtain” and 75       characteristics rated most important,
                                                 percent said that they “expect customer        the gap between customer expectations
                                                 service representatives to be more             and insurer performance was significant
                                                 knowledgeable and better trained.”             (Figure 2).

Figure 2—Customer Service Characteristic Importance & Satisfaction

                                                                                                                               85%
Having employees who are knowledgeable and well-informed?
                                                                                                  47%

Having customer service available at convenient times (for                                                                79%
example, after work and weekend support availability)                                               48%

                                                                                                                          79%
The amount of time I have to wait to be served
                                                                                              39%

The amount of time it takes to completely
                                                                                                                          78%
resolve my issue or problem                                                               37%

Having customer service people who can deal with my issue                                                               76%
                                                                     41%
without having to refer me to another person                                                  39%

                                                                % respondents rating characteristic as “important” (top 2 of 5 boxes)
                                                                % respondents rating “satisfied” with characteristic (top 2 of 5 boxes)
The 7 Things Your Health Insurance Customers Are Not Telling You - And What To Do About Them
Surprise #3                                     While it could be tempting to focus
                                                improvement efforts on areas where
                                                service expectations are changing, our
Most payers are                                 research suggests that health insurers
                                                will need a more balanced approach—
struggling with service                         one that does not lose sight of service
experience basics.                              fundamentals. In fact, our research shows
                                                that customers get highly frustrated
                                                when their basic expectations are not
                                                met. When asked to rate their most
                                                frustrating customer service experiences,
                                                the five that rose to the top are also the
                                                most basic building blocks of the service
                                                experience (Figure 3). Figure 3 also
                                                reveals that these frustrations happen
                                                far too often; for example, more than
                                                one-third of the people surveyed said
                                                they regularly experience long hold times
                                                and have to repeat information. Health
                                                insurers have no chance of beating
                                                the competition in a game of rising
                                                expectations if they cannot consistently
                                                meet the minimum requirements.

Figure 3—Top Five Frustrating Customer Experiences & Frequency of Occurrence

                                                                                                                             77%
Having to contact customer service multiple
times for the same reason                                                          30%

Dealing with customer service agents who                                                                                   76%
cannot answer my questions                                                        28%

Having to repeat the same information to
                                                                                                                           74%
multiple customer service agents                                                        35%

Being on-hold for a long time when contacting
                                                                                                                           74%
customer service                                                                             38%

Dealing with customer service agents who are                                                                             73%
                                                                  41%
unfriendly or impolite                                               17%

                                                  % respondents rating “extremely frustrating” with the situation (top 2 of 5 boxes)
                                                  % respondents rating “encounter this a lot” with the situation (top 2 of 5 boxes)
The 7 Things Your Health Insurance Customers Are Not Telling You - And What To Do About Them
Surprise #4                                 Payers have made a huge investment
                                            in customer service technologies over
                                                                                          To date, despite their willingness to
                                                                                          invest in service advances, health
                                            the years, implementing advances such         insurers seem to have failed to provide
The benefits of                             as automated phone attendants, live           the personalized experience customers
                                            chat via the Internet, self-service on a      crave. Only 10 percent of respondents
technology investments                      website and mobile applications. For the      strongly agreed their health insurers
have been decidedly                         most part, these technology advances          “tailor my customer experience to match
                                            have delivered tangible benefits in the       my needs, preferences, and/or value to
one-sided.                                  form of higher self-service rates and         them.” More than twice that amount (22
                                            lower handling time. What they have not       percent) strongly disagreed. Similarly,
                                            done, however, is dramatically improve        only 9 percent agreed that their health
                                            the customer service experience. While        insurers’ “communications make me feel
                                            technology lends itself to handling           a connection to them.” In contrast, 32
                                            higher service volume, it has tended          percent strongly disagreed.
                                            to have little impact on individual           Crafting a personalized service experience
                                            experience. Our research shows that           will only become more important in
                                            only 11 percent of respondents strongly       the post-reform marketplace, given
                                            agreed that the increased use of              an increased focus on “patient-
                                            technology in customer service has            centeredness” across the health system
                                            improved the level of service significantly   as a whole. From a service perspective, a
                                            in the past five years (Figure 4).            key tenet of consumerism is the ability
                                                                                          to tailor the experience to match the
                                                                                          customers’ needs, preferences, and/or
                                                                                          value to the business.

Figure 4—Use of Technology in Customer Service

                                                                 Disagree       Agree
The increased use of technology in
customer service (e.g. automated
phone attendant, live chat via the
internet, self-service on a web site,
                                                 17%            27%                       48%                  11%
mobile applications) has improved
the level of service significantly in
the past five years.

       Strongly Disagree                Somewhat Disagree                     Somewhat Agree                    Strongly Agree
Surprise #5                              The message that comes across loud and
                                         clear is that health insurance customers
                                         generally are more value-driven then
Service quality                          price-driven. Our research clearly shows
                                         that customers are not willing to trade
trumps price.                            off customer service options or quality in
                                         exchange for a lower price. In fact, our
                                         research shows that only 6 percent of
                                         customers are willing to compromise on
                                         levels of customer service in exchange
                                         for a lower price. In contrast, more than
                                         7 times as many customers (44 percent)
                                         strongly oppose degrading quality
                                         for the sake of price (Figure 5). Such
                                         findings should act as a wakeup call for
                                         those who make the service investment
                                         decisions.

Figure 5—Price Tradeoff Preferences

                                              Disagree                                                            Agree

Lower levels of product quality if it
ensures I get the lowest price
                                             61%                                           3%

Lower levels of customer service if it
ensures I get the lowest price
                                                            44%                                 6%

Lower levels of product options if it
ensures I get the lowest price
                                                              41%                                7%

Lower frequency of communications if
it ensures I get the lowest price
                                                         41%           28%                             23%

                                                              % respondents agreeing (top 3 of 10 box ratings)
                                                              % respondents disagreeing (bottom 3 of 10 boxes ratings)
Surprise #6                                        Social media has come of age and has
                                                   begun to redefine not just individuals’
                                                                                                  Yet our research also finds that, currently,
                                                                                                  health insurers are not leveraging social
                                                   personal relationships, but their business     media in any major way. Only 6 percent
Customers are social,                              ones as well. Our research shows that          of respondents agree that the use of
                                                   a majority of respondents (76 percent)         social media sites has increased their
yet payers are not                                 went online looking for information            overall awareness about products and
socially engaged.                                  about health insurers at least a few           services from health insurance companies
                                                   times during the past year. For these          that they did not know of before, and
                                                   respondents, social channels are               only 5 percent say that their use of social
                                                   becoming an increasingly important way         media sites has increased their overall
                                                   of sharing information—40 percent read         engagement with their current insurance
                                                   about healthcare through these channels        companies and their brands (Figure 6).
                                                   at least a few times during the year,
                                                   and 8 percent are actively engaging in
                                                   conversations about payers.

Figure 6—To what extent do you agree with the following statements?

                                                                  Disagree                                                    Agree
I tend to trust comments about Health insurance
companies/brands on social media sites posted by                         54%                                           5%
people I don’t know.

I tend to trust comments about Health insurance
companies/brands on social media sites posted by people                                         28%                               21%
I know (family, friends, co-workers...).

Comments posted on social media sites influence
my opinions about Health insurance companies or                           52%                                            8%
brands in general.

The use of social media sites has increased my overall
awareness about products and services from Health                     58%                                              6%
insurance companies I did not know of before.

The use of social media sites like blogs, bulletin boards,                                                         23%
Facebook, MySpace, Twitter, etc. has increased my              66%                                                    5%
overall engagement with my current insurance
company and their brands.

                                                                                            % respondents agreeing (top 3 boxes)
                                                                                            % respondents disagreeing (bottom 3 boxes)
Surprise #7                                  While poor customer service performance
                                             is not usually the driving factor for
                                                                                         Given the unique structure of the health
                                                                                         insurance marketplace, insurers so far
                                             switching insurance providers (Figure       have been granted some immunity
Customers are not                            7), our research has found it is the        against the impact of poor service
                                             driving factor in other industries. In      performance: the primary reason
voting with their feet                       fact, Accenture’s 2010 Global Customer      individuals switch health insurance
(yet), but they’re doing                     Multi-Industry Research Study found         companies is because they have been
                                             that 64 percent of consumers switched       required through changes in their
plenty of talking.                           from at least one service provider in       corporate enrollment options. However,
                                             the past 12 months—a bank, utility, or      as the “consumerism” trend in health
                                             wireless carrier, for example—due to poor   care increases in line with increased
                                             customer service.                           growth in the Individual market,
                                                                                         consumer-directed health plans and
                                                                                         the like, we expect customer service
                                                                                         performance to emerge as a source of
                                                                                         differentiation and contributing factor
                                                                                         to loyalty and retention—much like it is
                                                                                         in other industries today. The individual
                                                                                         consumer’s voice will undoubtedly gain
                                                                                         more influence, and already, people are
                                                                                         speaking up loud and clear.

Figure 7—Customer Motivations to Switch Providers

Required by change in company open enrollment options                                                                  45%

Other reason(s)                                                                             28%

Price                                                                           18%

Product/service options were too limited                       7%

I lost trust in the company                                    6%

Overall poor quality of the customer experience                5%
Our survey found that 40 percent of         Perhaps even more striking than the
customers told a friend, family member,     prevalence and importance of word-
or co-worker about a negative customer      of-mouth is the fact that 7 percent
service experience in the past year. As a   of our survey respondents reported
source of information, our respondents      posting negative comments about their
rank word of mouth in the top three,        experience online (Figure 9). While
by a margin four times greater than         the percentage posting online is still
their fourth most important information     comparatively small, the impact will be
source (Figure 8). As we move to a          much greater, as the posted comments
consumer-driven market, the importance      have the potential to reach a global
of word of mouth should only go up.         audience. Should the comments go viral,
                                            they have the potential to destroy a
                                            brand. As social media growth explodes,
                                            consumers are participating in activism
                                            at unprecedented levels. Here is where
                                            health insurers will find the real
                                            ramifications of having ill-conceived
                                            social media strategies.

Figure 8—How important were these information sources or channels to you in deciding to do business with the company?

Employer educational materials                                                                                   58%

Corporate web site                                                                                47%
Information from people I know                                                          40%

On-premise/in-store information from...           11%

Online information from other sources            9%

Direct mail or telemarketing                     9%

Print advertising                           5%

Online advertising                          4%

Paid advertising on TV or radio             4%

Others                                      3%
Figure 9—In the past year, have you done one of the following after having a bad experience with a Payer

                                                                                     41%
                                                                                                           59%
Told people around me
about the experience (e.g.,
friends, family, coworkers)                   40%

Posted negative comments
about the experience online
(e.g., blogs, Facebook,
                              7%
Twitter) − Yes

         Actions being taken by these % respondents after                                 Respondents who took no action
         having a bad experience online (one respondent
         can select multiple actions as response)                                         Unique respondents who took
                                                                                          at least one action
Seven Secrets to
Delivering Service the
Way Customers Demand

Secret #1                                                                                Secret #2
View customer service                       Accenture’s experience has shown             Rethink the service
                                            that by implementing established high
as a differentiator—not a                   performance workforce techniques payers      delivery model.
cost center.                                can better realize improved performance,
                                                                                         Many insurers organize their call centers
                                            decreased time to proficiency, and
                                                                                         along traditional member and provider
Often insurers treat customer service       greater employee engagement. For
                                                                                         dimensions; they train their customer
as a “check the box” reality versus         example, Accenture has seen that service
                                                                                         service representatives to handle all call
a differentiating capability, missing       supervisors often spend too much time
                                                                                         types in each of these areas. However, as
the valuable opportunities that can         performing administrative tasks and
                                                                                         the health care model changes, payers
come when service representatives are       too little time coaching. Furthermore,
                                                                                         need to optimize their service delivery
empowered to act as advocates for the       we often find that supervisors receive
                                                                                         model to keep pace. In this regard, the
consumer. Insurers should recognize         little to no training themselves on how
                                                                                         health insurance industry can learn
that controlling costs need not be          to perform their role. Implementing
                                                                                         valuable lessons from other industries.
mutually exclusive from meeting service     supervisory training programs and
                                                                                         For example, wireless providers have
expectations. By maximizing the value       setting measurable performance
                                                                                         learned that they get better customer
of their most important, influential (and   expectations can have a profound effect
                                                                                         retention and satisfaction by having a
fundamental) asset—their customer-          on operational performance, employee
                                                                                         dedicated group of customer service
facing employees—health insurance           morale and the customer experience.
                                                                                         representatives to welcome and educate
companies can realize immediate and         Similarly, high performance reporting,
                                                                                         new customers. New customers have
substantial improvements, in both service   analytics and quality monitoring
                                                                                         different needs than established
quality and cost.                           capabilities will help improve the overall
                                                                                         customers and the welcome call group
                                            quality of the interaction and reduce the
                                                                                         is trained to anticipate and meet these
                                            standard deviation of performance levels.
                                                                                         unique needs.
Secret #3
A similar opportunity exists in healthcare.   Drive to simplicity.                       Fortunately, advances in CRM
Payers should seek to identify unique                                                    technologies are giving companies the
customer needs (for example, those            Over the years, the systems and call-      tools to reduce complexity and improve
with chronic conditions) and build            handling processes implemented by          performance for consistent, integrated
unique capabilities around those needs.       health insurers have become more           multi-channel customer interactions. For
Such a capability will become a source        complex, which in turn drives longer       example, a workflow-enabled desktop
of competitive differentiation as the         training times, longer CSR time-to-        that presents the right information
individual market grows in popularity.        proficiency and large performance          and/or treatment recommendation at
                                              variations. CSRs spend too much time       the exact time in the process can be
                                              bouncing between systems or searching      implemented faster and at less cost than
                                              within a system to find the information    ever before.
                                              required by the customer—with the
                                              common result of a poor overall customer
                                              experience. These challenges will be
                                              further magnified with the introduction
                                              of ICD 10 (international standard
                                              diagnostic classification for diseases
                                              and other health problems), which will
                                              complicate the job on the insurers’ end.
Secret #4                                  Secret #5
Embrace an outside-in                      Don’t be anti-social.                        be modified to support their new social
                                                                                        media strategy. Then, they can launch,
view of self-service                       Although payers may not need to              refine and expand the initial strategy into
technology.                                invest in aggressive proactive social        other areas as they learn.
                                           media outreach right now, they should        A logical first step would be to
In the past, health insurance companies    invest in proactively developing a           focus on the marketing and public
have viewed self-service as a trade-off    comprehensive social media strategy          relations business domain to listen for
that balances the necessity to reduce      for their organizations. Accenture’s         conversations that mention a company’s
costs against decreasing customer          client experience across industries          brands. After analyzing conversations
satisfaction. Customers have viewed self   finds that companies often jump into         to understand the chatter, an insurer
service as trial and error: they embrace   creating a social media presence without     could implement tactics across customer
well-planned and well-designed channels    thinking through their strategy (a “Fire     service, both to reinforce positive
and reject those that are not.             . . . ready . . aim!” approach). Focusing    sentiment and quickly address negative
Given that the customer will look for      initially on how to use social media in      sentiment. From there, the company
the right tools to help themselves and     a single business domain (for example,       could begin expanding into health
help others, the new view is that the      marketing and sales, or customer service     management applications as part of an
voice of the customer should influence     and support) is one way to launch into       integrated multi-channel experience
technology investments and how the         social media and minimize the risk of        that allows people to connect with other
self-service experience is designed. By    fragmentation. It will also focus the        patients like them or access resources to
leading with what the customer wants,      organization on “what to listen to” to       meet a specific health goal.
the other benefits will follow: reduced    support identified business goals, without
costs, increased satisfaction, enhanced    drowning in social media noise. Insurers
brand image and differentiation from the   should proactively listen to and learn
competition.                               from customers to identify any current
                                           context, culture, processes, people,
                                           policies, and metrics that may need to
Secret #6                                    Secret #7
The challenge with social media is finding   Get analytical.                              Embrace consumerism.
a role to play while avoiding additional
fragmentation in the industry (and losing    Customer-facing channels such as the         Closing the gaps between customers’
the voice of the customer across different   web, IVR, mobile, contact centers and        service expectations and their
channels). In all cases, a key question      social media generate tremendous             experiences will not guarantee success
will be whether the company should           amounts of data, yet few companies           for health insurers. Fundamentally, they
use company owned and controlled             are good at turning this data into           need to become more customer-centric—
(on-board) social media tools or off-        insight. Without the ability to perform      not an easy task, particularly as health
board (not company owned) ones, such         enhanced analytics, high performance         payment and delivery reforms demand
as Facebook.                                 will remain elusive. First, payers need      new types of collaboration among
                                             the ability to merge disparate sources       payers and providers. It’s an expansive
                                             of data (call logs, contact records,         challenge that must be taken apart to
                                             customer satisfaction surveys, IVR logs,     manage well. To become customer-
                                             etc.) into a single data source. Second,     centric, insurers will need to develop
                                             payers need to develop the capability to     an integrated view of their customers,
                                             analyze, interpret and act on the new        segmented on values, behaviors,
                                             data and insights developed. Third, payers   attitudes and health attributes. They
                                             increasingly will need a way to analyze      will need to identify unique and unmet
                                             on-board and off-board data about their      customer needs, define segment-specific
                                             brand and customer experience.               treatment plans for all customer touch
                                                                                          points, and then develop the operational
                                                                                          capabilities to deliver these treatments
                                                                                          and monitor and learn from them.
Learn More                                Accenture: Insight Driven Health
                                          Insight driven health is the foundation of
To discuss how Accenture can help your    more effective, efficient and affordable
organization develop the right customer   healthcare. That’s why the world’s leading
relationship management solutions,        health care providers and health plans
please contact Doug VanWingerden at       choose Accenture for a wide range of
doug.vanwingerden@accenture.com or        insight driven health services that help
678.357.7902.                             them use knowledge in new ways—from
                                          the back office to the doctor’s office. Our
                                          committed professionals combine real-
                                          world experience, business and clinical
                                          insights and innovative technologies
                                          to deliver the power of insight driven
                                          health. For more information, visit:
                                          www.accenture.com/insightdrivenhealth.

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