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Case Study

Customer Experience Strategy

Health Insurance from the Outside In

Through our Customer Experience Strategy Development Framework, we determined the most critical interactions, or “Moments of Truth,” customers have with their health insurance carrier. This new way of thinking informed us on how health plans fit into individual’s lives during stressful and emotional life changing events.

The end result was a Customer Experience Strategy that included tactical initiatives and a roadmap to deliver a simpler, more personalized customer experience.

This project has been so successful, people have gone, well, a little nutty. When our client was having a bad day, we left her a candy bar with a special note.

She said we made her day. That made ours.

Executive Summary

Andrew Reise Consulting was engaged by a large health plan to develop a Customer Experience strategy and roadmap for the Retail Under 65 segment. With the Affordable Care Act, the health insurance landscape is quickly evolving and becoming much more consumer centric as there is a shift from group plans to direct purchase plans. National individual membership is projected to grow from 15% to 29% by the year 2017. Our client wanted to use Customer Experience as a differentiator to compete in the new consumer-centric marketplace.
The strategy was focused on first understanding the company brand promise and corporate strategy, and identifying customer needs and expectations through consumer research, data and voice of customer tools such as personas. We then determined the most critical interactions, or Moments of Truth, customers have with their health insurance carrier. The end result was a Customer Experience Strategy with recommendations, tactical initiatives, and a roadmap to deliver a simpler, more personalized customer experience resulting in happier customers, lower costs, and increased membership.

Business Challenge

The health insurance industry is rapidly transforming to sell to an individual market and will be more competitive than ever. Traditional models focused on group coverage will not work in this new landscape. Customer expectations are being set by other companies such as Amazon, Southwest Airlines, and Zappos, and health insurance is at the bottom of all industries in Customer Experience rankings. In addition, with federal, state and private exchanges coming online, plans will offer very similar benefit plans at the same price.

More than ever, health plans must leverage their Brand and Customer Service focus to differentiate on this level playing field. Payers have a tremendous opportunity to not only make things better for their customers, but capture market share along the way. Designing the right experience can also lead to lower admin and medical costs. Transforming the enterprise to the consumer focus needed for success is a long, challenging journey, involving multiple partners in the ecosystem such as providers, brokers, and pharmacies. However, it is quickly becoming the new normal to compete in the new age of healthcare.

How Andrew Reise Helped

Andrew Reise was engaged to lead a cross functional team, in partnership with consumers at key points, to develop the strategy and roadmap. We focused on all aspects of the customer lifecycle, from the time consumers become aware of their insurance options and start shopping, through the time they make a purchase and start using their health insurance, to the time of possible departure. Andrew Reise used our Customer Experience Strategy Development Framework to facilitate the strategy development with the cross-functional team, looking outside in and putting the customer at center-stage.



Creating the Customer Experience Strategy

Andrew Reise worked with functional leaders across the enterprise, including representatives from Sales, Marketing, Web, Social, Customer Service, Operations and Market Research. Andrew Reise consultants facilitated multiple workshops and interviews with various subject matter experts and stakeholders. The work was broken down into the following areas.

1. North Star

It is our fundamental belief that the Customer Experience strategy must align with the corporate strategy and company’s brand promise. Executive interviews were conducted to understand the vision for the company, what is communicated internally to employees and what expectations are set with customers. A project mission statement was then developed to ensure alignment.

2. Customer Insights

In addition to analyzing existing industry and market research, we interviewed brokers, completed mystery shopping and conducted in-depth interviews with customers to better understand their needs, wants and expectations of a health insurance company. This provided consumer insights to guide our work and also highlighted the most critical customer touch points.

3. Customer Lifecycle Mapping (current state)

An end-to-end customer lifecycle (DISCOVER-SHOP-BUY-USE-DEPART) was developed to provide an outside-in perspective of current customer interactions with the company. This exercise identified existing pain points and opportunities including visiting the web site to get a quote, receiving an explanation of benefits and calling customer service about a claim. The result was a clear understanding of pain points and gaps in how they interact with customers today.

4. Moment of Truth

The next step was to identify which interactions were the most important to address first. The process of analyzing voice of customer data, talking to consumers, interviewing employees and documenting customer touch points allowed us to identify the most critical customer interactions, or Moments of Truth, that influence a customer’s decision to purchase, stay or leave. This allowed us to focus our attention in areas that will have the biggest impact from a customer and company perspective when making experience enhancements and recommendations.

5. Future State Ideation

We then had to come up with creative solutions to solve the pain points. A group of cross-industry experts, consumers and health plan SMEs were assembled to ideate new experience solutions for each Moment of Truth. Customer personas were used to look at each Moment of Truth from different consumer types and over 200 ideas were generated. Each participant voted on the best ideas, which were incorporated into the future experience design recommendations.

6. Strategic Themes

Andrew Reise then organized and analyzed all of the inputs to create a set of strategic recommendations that would address the customer pain points for each Moment of Truth. The strategic recommendations were grouped into strategic platforms or themes, such as:

  • Transform into a customer-centric organization
  • Deliver at critical customer interaction points, or Moments of Truth
  • Personalize and simplify the complex ecosystem
  • Facilitate transition across channels

7. Strategic Initiatives

In order to make the customer experience strategy achievable, detailed tactical initiatives were identified, scored and prioritized based on benefit to company and customer. Some initiatives were quick hits, which could be implemented in less than 90 days, and others were longer term. Initiatives addressed foundational capabilities such as developing a customer-centric culture, establishing governance and creating a CX scorecard. Other initiatives focused heavily on delivering a seamless, simple experience for each Moment of Truth, and better understanding consumers in order to provide a more tailored, personalized approach across sales, marketing and service.


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