Why Health Insurers Can’t Fix Claims And Benefits Self-Service Through Design Alone

Over the years, I have worked with dozens of health insurers on the usability of their member self-service sites. The sites have admittedly gotten better over the years — easier navigation, fewer confusing links, clearer presentation of information, and even better feedback in response to user actions. But most companies are still struggling to show the value of their self-service solutions. This breaks down into two fundamental problems. The first is measurement — a problem I’ll tackle in a future post. The second is a problem I can most succinctly describe as garbage in, garbage out.

Digital customer experience professionals and eBusiness professionals responsible for website design typically have no control over benefits and claims content. That means that while sites have arguably made users’ tasks of finding claims and benefits information more efficient, the information is just as useless as it is was a decade ago.

This content is rarely designed with the consumer in mind. It’s written by lawyers and for lawyers — and (sorry, Dad) lawyers don’t speak English. They usually speak CYA. But CYA doesn’t answer people’s questions — real average-reading-level human beings who just want to know what different procedures will cost before they blindly follow their doctors’ advice.

This is the fundamental problem with the majority of today’s health insurance member websites, at least as far as claims and benefits are concerned. Until insurers produce better, clearer information outlining what is covered, what is not, how much services will cost, and (for claims) who owes/paid how much and why, it is not possible to design a member site that drives self-service for these critical areas.

Pharmacy Customer Experience Flaws -- Why Communication Is Key In Healthcare

The other day I was at a major retailer’s pharmacy refilling a prescription. While I waited for my refill, a woman came in to refill her three prescriptions. She was clutching a $10 bill, and seemed to know exactly what she needed and what it would cost. The pharmacy tech found her scripts and informed her that she owed $17.35. The woman was shocked. She verified that the right scripts were in the bag and then asked what had happened. Two of the scripts, she said, were $4 each, and the other was usually $1.99. The pharmacist explained that one of the prescriptions had been taken off the $4 generic list.

The customer was both angry and scared. This was her essential heart medication, after all. Her frustration was understandable — the cost of one of her prescriptions had just nearly tripled, from $4 to $11.35. Likewise her fear. Prescription refill rules mean she can’t have a stockpile of pills at home to tide her over until she could find a more cost-effective option — not to mention that she might need to get a new prescription from her doctor or deal with the delay of transferring her script to another pharmacy. 

And, worse, no one had told her. She thought she had taken care of everything to manage her health — getting to the pharmacy, bringing her money, taking her pills faithfully as prescribed. She asked the pharmacist why no one had told her. He mumbled that they don’t do that.

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The Frustrating Pursuit Of Experience Design Excellence In Healthcare

I had a meeting yesterday with a very well-respected experience design agency. The purpose was to try to identify opportunities within the healthcare sector (writ large) for the kind of work that they do. Its approach sits between what a traditional agency does (which focuses on campaigns and visual design) and what a consultant/systems integrator does (which focuses on technical architecture and systems design). Its focus is on designing technology-based experiences that are engineered — from the back end to the front — to meet users’ needs.

We could collectively identify a plethora of opportunities where healthcare firms (payers and providers) could benefit from its services: health insurance member service sites that need a user-centered re-engineering to achieve their self-service mission; wellness initiatives that need to engage users in difficult and sometimes-unappealing tasks; patient communication platforms for hospitals; and even EMR interfaces to streamline clinician workflow.

Where we struggled was to find the buyers with the vision and appetite to undertake the kinds of changes these experience overhauls would entail. On the health insurance side, we stumbled up against the fact that the typical website/mobile solution owner has no control over the content presented on digital platforms (and most of that content can best be described as inscrutable). She also often has little ability to access the kinds of source data (read claims, billing, and benefits data and rules) that would enable her to display meaningful information online — as opposed to simply regurgitating the incomplete content that is distributed to health insurance consumers in offline media.

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Why Don’t CxPi and Website Scores Match Up?

A client recently asked me about an apparent discrepancy in two of my Forrester reports. The first was a report I co-authored with Megan Burns detailing the changes in Customer Experience Index (CxPi) scores among health insurers. This report showed, among other things, that Humana’s CxPi score dropped by 10 points from 2010 to 2011. My more recent report, "Best And Worst Of Website User Experience, 2011: Health Insurers," shows that Humana improved its online public site experience significantly from 2010 to 2011. How could this be?

There are two main reasons why these two data points are not in conflict with each other. The first is that the site we reviewed was Humana’s public site. People who visit this site do not necessarily join a Humana plan and only comprise a fraction of the total Humana customers captured in the CxPi. Humana’s membership comes from a variety of sources, including employers and the military. None of those members would use the public quoting capability, which makes up most of the experience we tested. So members who do join Humana via the public site experience would ultimately be dwarfed statistically by those who didn’t.

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The Intersection Of Healthcare And Aging-In-Place

For many years now, Forrester has been tracking a market we call healthcare unbound (sometimes also called remote monitoring or connected health). These are technologies and services that consumers and caregivers can use to track, manage, and improve health conditions outside of the traditional institutional walls of healthcare. It’s an interesting market to observe — filled with solutions that promise to address real health problems, boost consumers’ engagement and self-awareness, and ultimately save costs while improving quality of life.  What’s not to like?

Well, watching this market is a little like watching a snail race — or paint dry. Despite efforts to advance industry collaboration by groups such as Continua, and new ventures by tech-industry behemoths such as Intel and GE, there has been very little actual movement in this market. Consumers remain largely ignorant about healthcare-unbound solutions, and players have struggled to find the right confluence of need, willingness to pay, and infrastructure that will let these products and services flourish.

Recently, however, I’ve sensed a shift in the energy in this market — a revitalization, if you will. This can be partly attributed to the inexorable aging of baby boomers, and partly to the realization that the current healthcare and retirement funding systems are crumbling under their own weight. But I think it’s also due to an infusion of fresh thinking and a recognition that this market isn’t as straightforward as many once believed.

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Prevention And Consumer Self-Management

With the first round of health reform under our belts, it's time to shift attention from access to the real issue plaguing the American health system: cost. The cost issue is complex, spanning payment models, medical malpractice and defensive medicine, and the specialty versus primary care debate. But I want to focus on consumers, and the broader context in which they make their healthcare decisions.

A quick look at the list of the nation's most expensive health woes — which includes heart conditions, cancer, diabetes, and osteoarthritis — and it's hard to argue that consumers aren't at least partial architects of our own fates. Improvements in nutrition, exercise, weight control, stress management, smoking cessation, and sleep can put downward pressure on both severity and costs of all of those conditions.

Health plans, employers, and even policy makers aren't blind to the need to nudge consumers towards healthier behavior. But changing consumers' health behavior is hard. Program proponents bump up against consumers' self-awareness (most people think they behave better than they actually do), their perceptions (are they willing to trade off the short-term benefits of familiar habits for the long-term rewards of healthy behavior?), and even their psychology (consumers are risk averse, experiencing the pain of failure with more intensity than the joy of success).

All of this makes behavior change extremely difficult. But it's not even the whole story.

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The Myth Of Consumer-Directed Healthcare

At the heart of every healthcare expenditure is a consumer. This consumer determines whether and where to seek diagnosis, undergo tests, and follow up on the advice and treatment suggestions of medical professionals. Thus consumers have an enormous influence over medical costs. This fact is not lost on health plans, technology vendors, or even policy makers, all of whom have been seeking to enable "consumerism" by giving consumers tools to take more control over their healthcare decisions. But somehow these tools — which include tax-advantaged health savings accounts (HSAs), personal health records (PHRs), and even health coaching and behavior change support programs — never seem to unleash the consumer-driven revolution that proponents promise. For example, Forrester's research shows a decline in consumer engagement in the "consumer-directed health plan" market, even as adoption of health savings accounts increases. And despite pushes by both Google and Microsoft, only about 3% of US online consumers report having an Internet-based PHR.

Why is this? Are consumers incapable of taking charge of their healthcare decisions? Are they still shackled to the legacy of the Marcus Welby-era passive patient paradigm? Not likely. Successful campaigns by patient groups to accelerate market availability of treatments in the AIDS market suggest that motivated and empowered healthcare consumers can and do exist. And they can move mountains.

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What Customer Experience Professionals Can Learn From Kindergartners

Liz Boehm [Posted by Liz Boehm]

My nephew just started kindergarten this year and it got me thinking about some of the life lessons we learn in our early schooling.  Here’s a short list of some of the ideas that I think are most applicable to customer experience professionals.  As always, I’m thinking about healthcare CXPs, but these also apply more broadly.

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Can Customer Experience Fix Healthcare?

Liz Boehm [Posted by Liz Boehm]

This past Monday at Forrester's Customer Experience Forum, I was listening to Wayne Peacock of USAA and I found myself wishing that he could be a part of the healthcare reform debate.  Wayne was talking about how USAA weathered the trials an tribulations of 2008 -- fires in California, Hurricane Ike, and the collapse of the US financial infrastructure, just to name a few.  All of which left USAA significantly "over plan."

I couldn't help thinking about the parallels to the health plan and healthcare industries.  Where property and casualty gets hurricanes and fires, we get swine flu.  And while the financial crisis is universal (in healthcare we feel it as layoffs, loss of insurance coverage, and consumers cutting back on preventive care), we also have systemic issues like the obesity epidemic and lifestyle-related health issues.

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Is designing for seniors the same as designing for accessibility?

Liz Boehm [Posted by Liz Boehm]

Being the CXP analyst who focuses on the needs of seniors, I get a lot of questions about accessibility.  And I'll admit I can see the connection.  Among the other issues that most people face as they get older are decreasing eyesight and hearing.  But most seniors don't consider themselves disabled.  They find ways to work around their failing eyesight and less acute hearing (we've all seen -- or been -- the guy holding the menu at arm's length in the dim restaurant lighting).  But seniors won't bother to find a work-around if the technology in question doesn't tempt them with a strong enough value proposition to squint through the small font or risk a misclick.  And I don't mean a value proposition that a company wants to sell; I mean one that the senior wants to buy.  Because the senior will have to pay for it -- if not with money, then with the time it takes to learn how to use your solution.

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