How Smart CX Design Builds the Foundation for ROI

The Blueprint to Goal-Driven Engagement focuses on intelligence. Payers know that ROI is tied to their members’ consumer experience (CX) with their plan. This can make it tempting for payers to rush to find digital CX tools and make sure their members have 24/7 access to portals and apps. But, the foundation of successful CX and the related ROI is intelligent design. Intelligent design requires a thoughtful, but fortunately standard approach. This blueprint gives payers a six-point checklist to get their plans on the right CX track quickly.

ROI and CX not just alphabet soup

Return on investment (ROI) is the concept that drives almost every business decision. Organizations are looking to reduce expenditures and increase revenue while competing for more of their market’s consumers. Across industries, growth models and market-share predictions are increasingly based on an organization’s ability to know and successfully cater to their customers. This consumer experience (CX) is directly tied to ROI, and can make or break companies of all sizes, regardless of market tenure. The health insurance industry has been known for falling behind the CX curve, which creates a huge opportunity for payers who can get CX right – quickly.

This challenge can make it tempting for payers to rush to find digital CX tools and make sure their members have 24/7 access to portals and apps. But, the foundation of successful CX and the related ROI is intelligent design. Intelligent design means flipping the script on member experience. As a health plan, you don’t just want your members to have a positive experience with your brand. You want active and goal-driven engagement. You want your members to understand what actions will optimize their individual health and minimize their healthcare costs, and follow-through on the most personally-valuable actions.

The Payer Checklist for Intelligent CX Design

Intelligent design requires a thoughtful approach, but fortunately, the approach is pretty standard. This means that thoughtful doesn’t have to mean months of endless meetings. In fact, this six point checklist may be all you need to get your plan on the right track quickly.

1. Establish your organization’s strategic CX goals
2. Articulate the metrics you are using, or could use, to measure progress on CX goals
3. Identify all communication channels that your plan can leverage to increase member engagement
4. Get to know the key characteristics of your member population
5. Start a registry of member goals
6. Tie each member goal to a relative value

Here are some tips for each of these six steps.

Establish your strategic goals.

These are likely hierarchical, and may best be understood visually, using an org-chart structure. The top tier of this org-chart will specify the ROI potential, and the cascading tiers will articulate how you plan to engage members in behavior that forwards each goal. For example, a common strategic CX goal may be to reduce operational costs with digital CX. Under this larger goal you will nest more specific and related goals such as: Increase mobile app download rate, Shift administrative service center calls to self-service, and/ or Increase enrollment in electronic billing. This type of org-chart visual can help team-members across the organization see how CX efforts can serve larger, ROI-related goals. As a foundational component of this first step, identify what current engagement expenditures are the highest (i.e. printing and mailing paper bills and plastic IDs) and are amenable to digital self-service.

Articulate the metrics you are using, or could use, to measure progress on CX goals.

You are likely collecting some metrics already, and these offer a great starting point. For example, most call centers track the number of calls, call topic, as well as call hold-times. These centers are already able to track trends in overall call volume, and trends in the number of calls that are for basic administrative tasks, like checking on the status of a claim. A health-plan specific CX platform will give you the ability to further correlate those call center reductions with the number of members who click on Check Claim Status through a member app or portal. This sets you up to demonstrate direct cost savings and call center efficiencies, as well as to set and meet operational goals related to call wait-times.

Identify all communication channels that your plan can leverage to increase member engagement.

This step is focused on setting your baseline. First, do you know what channels your members prefer? Current survey data shows that many members want access and human connection through the call center, AND they want to be able to communicate with their plans via digital channels. As consumers increasingly rely on text and other digital notifications, is your plan prepared to facilitate this communication? If not, your intelligent design should identify and articulate this gap so that you can streamline opportunities for needed vendors and platforms. Do you know what your baseline rates are today using your existing communication channels? Track your current open rates and member follow-throughs so that you can measure improvements and start to define success. With this baseline data and strong Internal business collaboration, you’ll be able to refine an engagement strategy that matches member-cohorts and topics with their most effective channels.

Get to know the key characteristics of your member population.

And speaking of matching communication channels to member cohorts…how well do you know your members? Historically, there has been a focus on the highest risk members. But, COVID-related challenges to care access and decreases in preventative care have healthcare leaders increasingly recommending that plans create targeted outreach for members across the risk spectrum. Each health plan has a unique mix of members with demographic and clinical profiles that affect health plan priorities and programming. The better the understanding of your members’ issues, and which of those are most prevalent, expensive, and amenable to prevention and/or programming efforts, the better your organization can identify top, cross-departmental priorities to anchor your CX strategy within priority member cohorts.

Start your registry of member goals.

Your registry will document the comprehensive set of member behaviors that will drive your organization’s strategic goals, identified in step one above. These will include universal actions such as Enroll in Electronic Billing, Download Member App, and Complete Patient HSA. These will also include some very important actions that are only applicable to certain members, such as Schedule Mammogram or Enroll in Diabetes Management Program. Most health plans will share a common set of member goals. If you’re working with a health-insurance specific tech partner, you’ll have the option to start with a standard set of health-plan member goals. This can save your team a lot of time and brain power – while still allowing options for custom additions, (i.e. goals that are specific to your plan’s priority members or signature programs). The registry should include a comprehensive list of specific goals with clear definitions. Is the goal for members to eventually download the mobile app? Or download within 30 days of plan enrollment? Plan for the registry of member goals to be a living initiative, not a one-and-done effort. You’ll want to regularly review the registry for outdated or new goals, such as for new care management programs, screenings, or vaccination boosters. This is also a good point in your design process to think about what data elements you will need to pull together to identify which members are appropriate for each goal and how you will know when members successfully act on each of their goals. Answering these questions in advance will not only set the foundation for a strong registry, but also give you a comprehensive picture of the multiple platforms and/or data storage systems that you’ll need to connect to put the registry into action.

Tie each member goal to a relative value.

How do you know what goals should have which value? Fortunately, this is an exercise in relative and not absolute calculations. First, mine your own health plan’s historical data for which health conditions cost the most to the plan and member. Then, pair this cost data with information on the most effective set of health behaviors to prevent or mitigate those conditions. This will help your plan narrow-in on a scale of relative values for key health actions. For example, cigarette smoking is the leading cause of preventable disease in the United States. In fact, smoking is associated with an estimated $225 billion in potentially avoidable direct medical costs each year, and is a huge risk factor for heart disease and stroke which is, in turn, the highest-cost health condition in the US. If your membership has a high number of smokers, smoking cessation may be the most valuable goal for your plan. You might determine that it is twice as important as an annual flu shot, and assign Smoking Cessation a 100-point value, and a Flu Shot 50 points. If you do not have comprehensive information on which members smoke, you may need to prioritize getting members to complete a health survey assessment (HSA) to collect this information. If this becomes your plan’s most immediate and valuable priority, you would assign Complete HSA as the highest-value and highest-point member health action. Gathering this data would be foundational to the opportunity to implement targeted education and programming for members who smoke. Like the goal registry itself, assigned values will need regular review and revision to remain current and to optimize ongoing ROI.

Back to CX

Consumer experience does mean creating a positive brand experience for your members, and in this era, that most certainly includes high-tech, easy-to-use digital tools, and consistent, relevant messaging. But, in the health insurance industry, the stakes are higher.

In other industries, like retail or entertainment, failing to get consumers to engage can lead to lost revenue. In health insurance, it can lead to lost revenue (i.e. membership churn) and escalating operational expenditures, spent treating extremely expensive and potentially avoidable health conditions. In health insurance, effective CX means partnering with your members. Remember that the health actions that drive ROI for your plan are the same actions that drive ROI for your members themselves. When your CX strategy begins with thoughtful, intelligent design, you optimize the short and long-term benefits for all.

Some health plans may be so well-resourced, and already so far along their member-goal journey that they may have a strategy established, and a live registry of member goals. Others may benefit from the opportunity to work with a health-insurance specific tech partner and jump start their intelligent design process with a set of pre-built goals and supported goal customization. Wherever your plan is on this spectrum, we hope this six-step checklist will help keep you focused and on-track towards better health-plan experiences for members, better health outcomes, and lowered healthcare costs for all.