It’s a big year for health care. With major provisions of the Affordable Care Act set to be enacted in 2014, change is all around, perhaps nowhere more than inside health insurance and pharmacy benefit organizations. The industry is poised for a massive shift to a consumer-centric approach, something experts say involves many moving parts and in many cases a rewriting of company DNA. Professionals will gather today at a consumer conference tied to Institute 2013, the annual gathering of industry association America’s Health Insurance Plans, to discuss the big-picture thinking and concrete details involved, and the theme will resonate throughout Institute. What is involved? In short, everything. “People, process and technology,” says Health Model Innovation founder Kevin Riley, who will speak at AHIP’s consumer conference today and at Institute on integrating those aspects of transformation. And it has to happen quickly. “I can’t think of any other industry that has had to go so forcefully and so quickly from a business-to-business model to a business-to-consumer model,” Riley says. If it sounds like a lot to do, it is. Modern consumers have expectations set by Apple, Facebook, Target and Google. “Everybody wants everything — rock star service at the lowest price if not for free, and they expect it now,” says Riley, who urges health plan leaders to prioritize. “You can’t be all things to all people,” he argues. “You have a line of expectation that is already set by other people. You have to decide along all the interaction points how far above, below or up to the line of expectation you’re going to go.” And health plans must be prepared to deliver in a single interaction with consumers. Health insurance companies interact with members 1.4 times a year, notes Ingrid Lindberg, who pioneered the role of chief customer experience officer in the health insurance world, first at Cigna and now with pharmacy benefit manager Prime Therapeutics. That’s not a lot of time to make an impression. Where should organizations start? With a careful look inward. “It has to do with what every single employee of that firm has to do differently every day. Everyone has to get rallied around that new cause,” Lindberg says. “It’s company strategy plus company DNA plus what do your customers want? There’s a bit of magic that has to occur across those things as you define what your road map is in order to deliver on your brand’s promise.” Lindberg, who will also speak at today’s consumer conference, advocates a concrete focus: “Culture, competency and credibility.” That is, thinking with a consumer focused-mindset, ensuring a company has the right people with the right skills to drive change and putting a vision for a great customer experience in action. Steps might include reworking hiring practices to prioritize customer-service skills or tying employee incentives to key customer loyalty metrics, she says. Riley and Lindberg note that health plans already have some of what they need in this transition. They have customers, and some are already hard-wired for a customer-service-oriented approach. They just need to shift in a way that positions them for a market with abundant consumer choice. And they can borrow from across industries to do so, Riley and Lindberg say. “We’re not reinventing the wheel; we’re only adding new spokes,” Riley says. Most important for insurers, they say, is for companies to focus on their core product — be the best at what they already do well. “Help me choose the right plan, make sure enrollment is good, help me pay my bills, make it clear who I can see and how and what it will cost,” Riley says. And understand the viewpoint of the consumer. Lindberg notes that the vast majority of health care decisions today are being made by women in their 30s, 40s and early 50s. What do their lives look like? They’re swamped, balancing careers, aging parents, children and everything else in life. To her colleagues in the industry, Lindberg says: “Make it easy for me.”
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