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Tuesday, September 27, 2011

Inside consumer insight

by Torsten Bernewitz

With the implications of the Affordable Care Act, many payers are concluding that a key success factor for the health insurance industry is to create effective ways to win, retain and influence consumers, who for a long time have not enjoyed a lot of the payers' marketing attention. A number of companies have declared that they want to become "consumer-centric", but on average the industry has still a very long way to go to achieve such a vision.
What does it really mean to become "consumer-centric"? What new capabilities do we need to create? What can we learn from other industries that have a long history in engaging consumers effectively? What will be easy, what will be harder?
In a recent post (http://payer-strategies.blogspot.com/2011/09/what-does-it-mean-to-become-consumer.html), I proposed that to embrace the direct-to-consumer marketing model, payers must become excellent on four dimensions:
  1. Consumer insights
  2. Consumer engagement
  3. Simplicity and openness
  4. Stakeholder alignment
Today, I want to go deeper into the first dimension - gaining deep consumer insights:
If we want to engage consumers more effectively, we need to learn more about them first.
Deep insights about the consumer constitute the platform upon which we can build our customer relationships. They help prioritize the groups we want to target, and identify the leverage points we can use to attract and bind them to our offerings.
We need consumer insights to develop the right strategies to build the brand, develop and refine products and services, price them right and promote them effectively. We must understand the demographics, needs, resources, attitudes, choices and behaviors of different consumer groups. What are their channel preferences and service level expectations? How are they connected socially? How do they respond to different ways of interacting with them? How attractive is each segment for us, both in the short term and the long term? What will it take to identify, win and retain segment members?
Obtaining consumer insights - in particular insights that create competitive advantage - is much more than marketing research, more than “knowing the facts”.
Traditionally, market research tries to find an answer to a specific question, or test a hypothesis in a structured way. It is usually pre-defined, granular, focused on reporting back responses. Building customer insights goes significantly beyond this – it is the process of turning observations and signals into revelations about the consumer that inspire ideas and action:
  1. Consumer insights emerge from a holistic perspective and the integration of signals across a variety of sources.
  2. They include unprompted signals and can be – in contrast to periodic, individual studies to answer a specific business question – “always on”.
  3. Consumer insights search for the meaning of signals, and link them to a business decision and action.
  4. They include “Eureka” moments, where we discover something about the consumer that we did not know before, challenging our current thinking, and inspiring new ideas.
Gaining superior, game-winning consumer insights means looking where others don’t look, finding what others don’t find. Marketing gurus like Philip Kotler and Mohan Sawhney view this type of “consumer insight” as critical for marketing success.
If we want to make the transition to become more consumer-centric, we have to master this second, parallel, shift: the move from traditional marketing research approaches to building capabilities allowing us to “fish for knowledge” in vast, unstructured “oceans” of data and information. We may have some caching up to do, and perhaps it is beneficial to look over the fence and learn from other industries that already have a long history in engaging consumers effectively.
Ubiquitous internet access, online shopping channels for virtually anything, social media, GPS-enabled smartphones and other devices etc., are already transforming many retail markets. There is no reason to expect that healthcare will be an exception – health issues already count among the most researched topics on the internet.
User generated content on social networks, blogs, forums, chat rooms etc. provides previously unavailable opportunities to “listen in” - in real time - to the consumer and observe social habits and behaviors without bias. New streams of cheap, previously unavailable data are filling up and enriching the oceans of consumer information. Not only does this emphasize the need for integration of many disparate sources and synthesis of meaning to fish for valuable insights, it also creates innovative opportunities to engage with consumers, as illustrated by the following four examples:
  1. Geo-marketing: GPS enabled smartphones allow us not only to target the right consumer with the right messages, but now also at the right time and in the right location. A number of companies have begun using location based social networking services as a way to interact with consumers, offering discounts or other incentives to customers who “check-in” at their store (which means posting on a social networking site where they are). Last year retailer GAP attracted thousands of consumers into their stores through offering them the chance of winning a pair of jeans or receive a significant discount on any regularly priced item. Earlier this year, French automaker Peugeot started a campaign to target users when they are near one of their 400 dealers across France and invite them to make a small detour and test drive the Peugeot RCZ model. Geo-marketing could be an interesting opportunity for health insurers as well, for example enabling them to reach out to consumers with specific messages about adherence, coverage benefits, health maintenance questions etc. when they are near a pharmacy or “check-in” at a doctor’s office. It can also help to avoid sending messages when the time or place is not right, thus reducing the risk of annoying the consumer.
  2. Field experimentation: Consumer companies like Capital One, EBay and Google regularly engage small fractions of their customers in field experiments to test new business concepts. Health insurers could make use of consumer field experiments as well to test how consumers respond to communications, service offerings etc. The advantage of these experiments is that they test the actual behavior of the participants, e.g., show what choices they make under different circumstances, allowing to observe, in a contained, “safe” environment, what consumers actually do, not what they say they will do.
  3. Co-creation: Companies like P&G, Reebok and even Harley Davidson are taking consumer insights to the next level. These companies have created brand communities where they involve consumers in the creation of products and information. German cosmetics company Beiersdorf used co-creation with consumers to develop a new deodorant for its Nivea brand. Toymaker Lego has boosted sales significantly by recruiting fans to participate in its innovation effort. BMW calls their co-creation lab “a virtual meeting place for individuals interested in cars and all related topics, who want to share their ideas and opinions on tomorrow's automotive world”, and “invites people from all over the world to contribute their suggestions for specific topics and to connect with like-minded others.” This direct channel of two-way (or multi-way) communication provides immediate feedback, brings new ideas to the forefront, and creates a sense of consumer participation that goes a long way in building trust and loyalty. For health insurers, similar communities could significantly enhance the communication with and among consumers as well as healthcare providers.
  4. Crowd-sourcing: On a similar line as co-creation, companies like 3M, IBM, Dell or Starbucks proactively solicit from consumers proposals for solutions to specific challenges or problems. This approach of “crowd-sourcing” is based on the observation that consumers, as a large group, have specialized and accurate knowledge about issues that concern them, knowledge which they are amazingly motivated to share when given the opportunity. Ice cream maker Ben & Jerry’s used crowd-sourcing to develop new flavors, and Coca Cola solicited consumer ideas in the development of a new vitamin water drink, and the graphics and labels to go with it. A large number of open innovation websites facilitate crowd-sourcing in many areas ranging from R&D, software development and design to marketing and branding, trend prediction and general problem solving. Crowd-sourcing could be an interesting approach to engage both providers and consumers in the quest for win-win solutions to healthcare challenges.
How can we build the capability to create valuable consumer insights?
First of all, investment in technology is required to acquire state-of-the-art data integration and “insights fishing” tools. Second, employees’ knowledge and analytic skills may need to be enhanced as well, and perhaps hiring of experts from CPG or technology oriented companies could accelerate the transition to become more consumer focused.
Third, the holistic approach demands an effective cross-functional approach across intra-organizational boundaries, e.g., marketing, analytics, product development, database management, and IT. It may also create the need for increasing reliance on vendors with highly specialized expertise, for example in data integration, web-analytics, social media listening, or geo-marketing.
Finally, we may need to align on a new way of thinking and a new vocabulary about business information. For example, what exactly defines a “consumer insight” and how is it different from other information? How is a small insight different from a large one, i.e. how do we prioritize and rate them? Where do we store our consumer insights and how do we make them available to the right stakeholders and decision makers?
________________________

Torsten Bernewitz is a healthcare industry analyst and management consultant.
He is Managing Principal, Healthcare Insurers and Payers at
ZS Associates.


This post is the author’s own and does not necessarily represent ZS Associates’ positions, strategies or opinions.

Thursday, September 22, 2011

The spirit is willing, but...(or, what does it mean to become consumer-centric?)


by Torsten Bernewitz

Yesterday I mentioned that - for a number of reasons - it is a key success factor for the health insurance industry to create effective ways to win and retain consumers, who for a long time have not enjoyed a lot of the payers' marketing attention (
http://payer-strategies.blogspot.com/2011/09/winning-hearts-and-minds-of-consumer.html).
I also observed that although many companies proclaim their intent to be more consumer-centric, the industry still has a very long way to go to become really good at this. New capabilities will have to be created, and perhaps a change in culture is also necessary.
Direct-to-consumer marketing must not be misunderstood as running a TV campaign or placing radio spots, buying ad space in newspapers, sending direct mail or advertising on the internet. Although these means may create a “background noise” – albeit frequently for a significant price tag - they are much too crude to address the diverging needs, preferences, expectations and questions of many consumers, let alone influence their behaviors.
Modern direct-to-consumer marketing is something different: a continuous, multi-channel two-way (or even multi-way) relationship that integrates communication and feedback, sales and service, activities and measurement, in a synergistic way.
If we want to embrace the direct-to-consumer marketing model, we must excel at a number of things:
(1)   Consumer insights
(2)   Consumer engagement
(3)   Simplicity and openness
(4)   Stakeholder alignment
The first two elements will require building new analytic capabilities, channels and technologies. With the right resources, they should be relatively easy to achieve.

The third element will likely may require a significant culture shift – and will potentially be much harder.

The fourth element, finally, calls for a holistic and synergistic approach in the engagement of all stakeholders, not just consumers. Considering the exceedingly complex (and often conflicting) interests and influences across the healthcare supply chain - as well as differences in local markets - this may be a difficult task that requires careful attention, and time, in order to get it right.

Over the next few days, I will post a few more detailed thoughts about these four success factors.
________________________

Torsten Bernewitz is a healthcare industry analyst and management consultant.
He is Managing Principal, Healthcare Insurers and Payers at
ZS Associates.


This post is the author’s own and does not necessarily represent ZS Associates’ positions, strategies or opinions.

Wednesday, September 21, 2011

Winning the hearts and minds of the consumer – the battle is on!

by Torsten Bernewitz

Two days ago, health insurer Cigna announced a national brand campaign directed at consumers. With the theme “GO YOU” and to the tune of $25 million, national advertising will be on major television and cable networks including USA, CNN, Discovery and A&E. Print ads will appear in publications such as Time, Marie Claire, Family Circle and Runners World as well as online on Monster.com, SheKnows.com and iVillage.com. The company has also updated its logo to reflect its focus on individual customers.
Here’s the story: http://newsroom.cigna.com/NewsReleases/cigna-enhances-business-model-to-meet-changing-customer-needs.htm

It can be expected that this initiative – though certainly standing out as a high-profile move - will just be the kick-off to a series of similar activities by health insurers aimed at capturing the hearts and minds of the consumer. Or perhaps other strategies to achieve the same goal.
Why do health insurers all of a sudden care about consumers?
After the Affordable Care Act - in the new world of health insurance - individual consumers will have a much more prominent role. There will be more of them. They will be better informed, and with the exchanges they will have a market place that facilitates comparison-shopping. 
Consumers will have different and more heterogeneous profiles, needs and expectations than the people in the small individual market today. Their choices and behaviors are crucial for healthcare utilization and outcomes, which in turn are critical to contain medical costs.
For all these reasons it is obvious that a key success factor for the industry is to create effective ways to win and retain consumers, and to engage them in a mutually beneficial way that builds trust and loyalty, and that encourages the right behaviors to keep them as healthy as possible.
There is still a very long way to go!
Historically, the industry has not been very consumer-centric. And that shows. In a 2010/11 survey by consulting firm McKinsey, 72% of the 11,000 survey participants thought that plans were too complex to understand what was covered, and at what cost. 57% found the process of choosing a health plan “overwhelming”.
The prevailing health insurance go-to-market approach is not well suited to the retail space. The insurer perspective has historically been group focused and transaction based. Because insurers are relying on brokers, there is relatively little direct contact with the consumer. Worse, in the cases where there is contact – for example if there is a question regarding coverage or claims – the circumstances surrounding these interactions are usually negatively pre-loaded and stressful, not the natural habitat of trust and open exchange.
Perennially rising premiums, network constraints, administrative hassles, mediocre service levels and lack of transparency have all contributed to consumer relationships that are frequently adversarial.
So how do we change this?
Answer: we have to put the consumer more at the center of our marketing efforts!

OK- but what does this mean? What capabilities do we need to create?
I will post some thoughts about this over the following days.
________________________

Torsten Bernewitz is a healthcare industry analyst and management consultant.
He is Managing Principal, Health Insurers and Payers at
ZS Associates.


This post is the author’s own and does not necessarily represent ZS Associates’ positions, strategies or opinions.

Tuesday, September 20, 2011

Why health insurers are brushing up on marketing and sales


by Torsten Bernewitz

According to a recent industry survey
[1], more than two thirds of health insurers are planning to enhance their marketing and sales capabilities in the near term. They regard initiatives to drive higher effectiveness in customer acquisition and retention, brand development and go-to-market strategy as critical moves to create competitive advantage, moves that are perhaps as important as keeping medical costs in check.

There are at least three reasons why they are right:
  1. Individual consumers will be much more involved in health insurance choices. There will be more of them, they will be better informed and they will have a market place that facilitates comparison-shopping.  Engaging consumers effectively will also be critical to help manage outcomes, which in turn is an important element in containing medical costs. The industry is shifting from a business-to-business model to more of a business-to-consumer model. This requires significant transformation of consumer relationships that historically have frequently been more adversarial than built on trust. 
  2. Employers are rethinking their health benefit strategies. Depending on specific conditions like size, hiring and retention goals, labor market conditions etc., employers’ priorities and benefit strategies will change and diverge significantly.  Health insurers must keep the pulse on their evolving needs, create stronger differentiation through products and services, tailor their offering, and become more impactful in bringing the value proposition across. In many cases this means that insurers must get much closer to employers than they currently are.
  3. Health insurers have to build and diversify their revenue streams. Even though 30-plus million of formerly uninsured consumers will enter the market, growth in the core business will be primarily in the less profitable segments. In addition, the new net premium fee will significantly depress insurers’ margins, which with 4.4% today are already anything but stellar. To make up for the profit shortfall, health insurers are aggressively looking to drive incremental revenue through new customer segments, cross-selling new insurance products, offering new services like health IT and data solutions, or medical and wellness management. Going-to-market with new products, to new customers, in some cases to new geographies – all potentially in combination – is a significant challenge. It will stretch and may go beyond current marketing and sales capabilities – in particular of the broker channel.
 [1] Conducted by The Boston Consulting Group during March-April 2011, and published July 2011 in the paper “Innovation, Diversification and a Focus on Fundamentals – how health care reform will change the insurance landscape”
________________________

Torsten Bernewitz is a healthcare industry analyst and management consultant.
He is Managing Principal, Healthcare Insurers and Payers at
ZS Associates.


This post is the author’s own and does not necessarily represent ZS Associates’ positions, strategies or opinions.

Monday, September 19, 2011

A working experiment: replacing the fee-for-service model for providers

by Torsten Bernewitz

At the beginning of this year, Andrew Dreyfus, CEO of Blue Cross Blue Shield of Massachusetts (BCBSMA) had an important message to providers:  work with payers in a collaborative way to improve quality of care and contain the growth in healthcare costs – or else (http://articles.boston.com/2011-01-23/business/29346724_1_payment-system-global-payment-care-providers).


In this context he was also talking about a new payment model – BCBSMA call it Alternative Quality Contracting (AQC) – that replaces traditional fee-for-service contracts. BCBSMA is really pushing for this approach as the preferred model for the future – and warns that those insisting on fee-for-service will have to reduce their costs or at least freeze them.

Alternative Quality Contracting (AQC) is a global payment model that uses a budget-based methodology, combining a fixed per-patient payment with performance incentive payments.
The global budget is based on each organization's historical costs and is adjusted annually to reflect inflation. It includes a global payment for all services received by a BCBSMA member, including primary, specialty, and hospital care, as well as ancillary, behavioral health, and pharmacy services.

AQC offers hospitals and physicians the opportunity to increase their total payment by up to 10 percent based on their performance toward nationally accepted quality measures and improvements in the efficiency of the care delivered.

It seems to be working:

During a Healthcare Information and Management Systems (HIMSS) webinar last week, Dana Safran, SVP Performance Measurement & Mmprovement at BCBSMA, presented the results the program has been able to achieve so far:
  • In the first year, a reduction of medical spending by 2 percent. This is well in line with BCMSMA’s goal to cut spending growth by half (historically annual growth has been in the range of 8-12 percent.
  • All AQC reported budget surpluses, giving them the opportunity to make additional infrastructure investments.
  • Each AQC organization showed improvement of clinical quality measures. More than half approached or met the maximum performance target on diabetes and cardiovascular care.
  • AQC groups could reduce hospital re-admissions – one group by 15%.
  • For some preventive care metrics, like cancer screening and well-child visits, AQC group’s performance were three times that of non-AQC groups and more than twice the performance before joining the program.
  • Network participation rose to 44 percent in 2011 (up from 26% in 2009).
________________________

Torsten Bernewitz is a healthcare industry analyst and management consultant.
He is Managing Principal, Healthcare Insurers and Payers at
ZS Associates.


This post is the author’s own and does not necessarily represent ZS Associates’ positions, strategies or opinions.

Friday, September 16, 2011

Madness strikes! The new ICD-10 list

by Torsten Bernewitz

Doctor: “How did you get your S0010XA?”

Patient: “Well, you know that I have a Z9181, especially when I am doing F1010.  So I entered this Y92511, where I W51XXXA. In response, that person started Y042XXA which triggered my Y042XXD. This started Y040XXA and Y040XXD and that’s how I got the S0010XA, but the other person has S060X0A.”

(To decode see the end of this post. Or read on for hair-raising entertainment.)

If we thought healthcare is already caught up in red tape, we got another thing coming. 

You may know that today hospitals and doctors use a system of about 18,000 ICD-9 codes to describe medical services in bills they send to insurers. Apparently that’s not enough, so we’ll increase that by a factor of eight to about 140,000! These are the ICD-10 codes.

The Centers for Medicare & Medicaid Services (CMS) have set the ICD-10-CM/PCS compliance date to October 1, 2013. According to CMS there will be no delays and no grace period, i.e. after that date providers will no longer be able to report ICD-9-CM codes for services provided, if they want their claims to be paid.
What do we gain?

Well, for example, we can now use code Y9272 to indicate that a chicken coop was the place of occurrence of our injury. For a barn the code is Y9271, Y9273 for a farm field and Y9279 for other farm locations.

If you don’t hang out on a farm but follow more highbrow distractions, there’s a code for you, too. We have the gallery (Y92250), opera house (Y92253) and theater (Y92254). For a shop the code is Y92513 - but be careful to use Y92512 for a supermarket, store or market.

Codes Y92020-29 indicate various locations in a mobile home where an injury has occurred, in the order of kitchen, dining room, bathroom, bedroom, driveway, garage, swimming pool, garden and yard (can use the same code for these two), and including “other place” as well as “unspecified place”. Again – all of that in a mobile home; naturally there are specific codes for these locations if the home is single-family (private) house.

BTW, you’ll have noticed that these codes all start with “Y” – why indeed!

There are also codes for contact with powered household machinery - initial “encounter” (W292XXA) and contact with powered household machinery - subsequent “encounter” (W292XXA) - I guess if it doesn't kill you first time you can always get up and try again .

I also like “assault by hot household appliances - initial encounter (X983XXA).

There are three codes for walking into a lamppost – including, yes, you guessed it, initial and subsequent encounters.

We have three codes for falling from in-line roller skates, which are different from non-in-line rollerskates, which are different from heelies, skateboards (also three codes each), and, of course, “other rolling-type pedestrian conveyance” (love the language).

All this will make the mining of patient data even more interesting - hurray!

-----------------

So here are the codes for the story at the beginning:
S0010XA: Contusion of unspecified eyelid and periocular area (a.k.a. “black eye”), initial encounter
Z9181: History of falling
F1010: Alcohol abuse, uncomplicated
Y92511: Restaurant or cafe as the place of occurrence of the external cause
W51XXXA: Accidental striking against or bumped into by another person, initial encounter
Y042XXA: Assault by strike against or bumped into by another person, initial encounter
Y042XXD: Assault by strike against or bumped into by another person, subsequent encounter
Y040XXA: Assault by unarmed brawl or fight, initial encounter
Y040XXD: Assault by unarmed brawl or fight, subsequent  encounter
S060X0A: Concussion without loss of consciousness, initial encounter

Cheers!
________________________

Torsten Bernewitz is a healthcare industry analyst and management consultant.
He is Managing Principal, Healthcare Insurers and Payers at
ZS Associates.


This post is the author’s own and does not necessarily represent ZS Associates’ positions, strategies or opinions.

Contact: torsten.bernewitz@zsassociates.com
 

Accountable Care Organizations: Houston (or rather Washington), we have a problem!

by Torsten Bernewitz

During the debate about healthcare reform, institutions like the Mayo Clinic, the Cleveland Clinic, Geisinger Health System and Intermountain Healthcare were repeatedly showcased as models for a new health care delivery system dubbed “accountable care organizations” (ACO).

This new approach to delivering health care services rewards doctors and hospitals for providing high-quality care to Medicare beneficiaries while keeping costs down. In March CMS announced that it will allow up to 30 provider organizations to apply for "pioneer ACO" status and join the Shared Savings or Pioneer program this fall.

As it turns out, Mayo, Cleveland, Geisinger and Intermountain - considered the most likely candidates - have declined to apply for the “Pioneer” program. They complained that the draft CMS rules were too burdensome and didn't offer enough incentives.

Other stakeholders, such as the American College of Physicians, the American Academy of Family Physicians, the Medical Group Management Association, the American Medical Group Association, and the American Medical Association, voiced similar concerns.

CMS has not yet published how many health systems applied for the program (the deadline to apply was Aug. 19), but The Advisory Board Company, a hospital consulting firm, estimates based on surveys that between 30 and 50 organizations have applied for the Pioneer program. CMS goal was 30, so in terms of numbers they may be fine, however the composition of the group may be disappointing.
________________________

Torsten Bernewitz is a healthcare industry analyst and management consultant.
He is Managing Principal, Healthcare Insurers and Payers at
ZS Associates.


This post is the author’s own and does not necessarily represent ZS Associates’ positions, strategies or opinions.

Contact: torsten.bernewitz@zsassociates.com