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Insight Driven Health

The 7 Things Your Health Insurance Customers Are Not Telling You

And What To Do About Them

The seismic shift in power to the customer has come at last to the US Health Insurance market. With The Patient Protection and Affordable Care Act adding 40 million new customers and with individual and Consumer Directed Health Care (CDHC) plans exploding in popularity, US health insurers will need to invent new healthcare solutions for competitive success.

Right at the fore is customer service, the entrée to productive customer relationships that will withstand the test of time. Customers have become more diverse and more demanding, wanting service offerings, experiences and communications increasingly on their own terms. They have also become more technology savvy and less shy in broadcasting their experiences. Technology trends like social media have ignited a new consumer activism whose reverberations have only begun to be felt. Insurers operating in this "new normal" face an unprecedented level of competition, unparalleled opportunities to expand, and the commensurate risks of failure.

With customer service emerging as the "X Factor" of high performance, health insurers must understand current customer perceptions, as well as how to shape (and improve) these perceptions for future growth. To help crystallize these factors, Accenture Healthcare conducted a survey of customer attitudes toward the customer service practices of US-based health insurance providers. Using a web-based questionnaire, we surveyed 1,000 customers in the US between late December 2010 and early January 2011. From that research we distilled the surprises and secrets of customer service that together outline the alchemy behind superior customer service performance.

Seven Surprises About Customer Service

Surprise #1

Being satisfied with high customer satisfaction is a mistake.

Overall, customers feel satisfied with their health insurance providers; in fact, our research found that 42 percent of customers have a high degree of satisfaction, while only 7 percent have a high degree of dissatisfaction (Figure 1). However, current satisfaction levels do not translate into loyalty and revenue opportunities. Despite their general satisfaction, customers are divided about equally on their feeling of loyalty to their health insurer. Moreover, few would purchase more services from their health insurer, if offered. 41 percent of customers indicated that if offered additional services, they would be unwilling to buy them, while only 7 percent indicated that they would be willing.

Figure 1--Current State of Satisfaction, Loyalty and Advocacy

Not at All

How satisfied you are with the Health insurance companies you do business with today?




Do you trust Health insurance providers to keep your personal Health information confidential?



How loyal you feel to your Health insurance provider?



The extent to which you will buy more products/services from your Health insurance provider?



% respondents giving top 3 of 10 boxes ratings % respondents giving bottom 3 of 10 boxes ratings

Surprise #2

Payers are not keeping up with rising customer expectations.

The current tenuous nature of customer loyalty to their health insurers may have its roots in their rapidly rising customer service expectations. We found that 20 percent of customers indicated that their expectations of the customer service function increased, just in the past year. Furthermore, 41 percent stated that their expectations increased in the past five years. They want greater ease and better support: When asked how their expectations increased, 80 percent said that they "expect customer service to be easier/more convenient to obtain" and 75 percent said that they "expect customer service representatives to be more knowledgeable and better trained."

As customers are growing more exacting, their health insurers are struggling to pass service muster. In fact, our research found a large gap between what matters to the customer and the perceived performance of health insurance companies. While "having employees who are knowledgeable and well-informed" ranked as the most important customer service attribute, several other qualities were rated nearly as important, including "the amount of time I have to wait to be served." Yet for all five of the characteristics rated most important, the gap between customer expectations and insurer performance was significant (Figure 2).

Figure 2--Customer Service Characteristic Importance & Satisfaction

Having employees who are knowledgeable and well-informed?

85% 47% 79% 48% 79% 39% 78% 37% 41% 76% 39%

Having customer service available at convenient times (for example, after work and weekend support availability)

The amount of time I have to wait to be served

The amount of time it takes to completely resolve my issue or problem Having customer service people who can deal with my issue without having to refer me to another person

% respondents rating characteristic as "important" (top 2 of 5 boxes) % respondents rating "satisfied" with characteristic (top 2 of 5 boxes)

Surprise #3

Most payers are struggling with service experience basics.

While it could be tempting to focus improvement efforts on areas where service expectations are changing, our research suggests that health insurers will need a more balanced approach-- one that does not lose sight of service fundamentals. In fact, our research shows that customers get highly frustrated when their basic expectations are not met. When asked to rate their most frustrating customer service experiences, the five that rose to the top are also the most basic building blocks of the service experience (Figure 3). Figure 3 also reveals that these frustrations happen far too often; for example, more than one-third of the people surveyed said they regularly experience long hold times and have to repeat information. Health insurers have no chance of beating the competition in a game of rising expectations if they cannot consistently meet the minimum requirements.

Figure 3--Top Five Frustrating Customer Experiences & Frequency of Occurrence

Having to contact customer service multiple times for the same reason Dealing with customer service agents who cannot answer my questions

77% 30% 76% 28% 74% 35% 74% 38% 41% 17% 73%

Having to repeat the same information to multiple customer service agents

Being on-hold for a long time when contacting customer service Dealing with customer service agents who are unfriendly or impolite

% respondents rating "extremely frustrating" with the situation (top 2 of 5 boxes) % respondents rating "encounter this a lot" with the situation (top 2 of 5 boxes)

Surprise #4

The benefits of technology investments have been decidedly one-sided.

Payers have made a huge investment in customer service technologies over the years, implementing advances such as automated phone attendants, live chat via the Internet, self-service on a website and mobile applications. For the most part, these technology advances have delivered tangible benefits in the form of higher self-service rates and lower handling time. What they have not done, however, is dramatically improve the customer service experience. While technology lends itself to handling higher service volume, it has tended to have little impact on individual experience. Our research shows that only 11 percent of respondents strongly agreed that the increased use of technology in customer service has improved the level of service significantly in the past five years (Figure 4).

To date, despite their willingness to invest in service advances, health insurers seem to have failed to provide the personalized experience customers crave. Only 10 percent of respondents strongly agreed their health insurers "tailor my customer experience to match my needs, preferences, and/or value to them." More than twice that amount (22 percent) strongly disagreed. Similarly, only 9 percent agreed that their health insurers' "communications make me feel a connection to them." In contrast, 32 percent strongly disagreed. Crafting a personalized service experience will only become more important in the post-reform marketplace, given an increased focus on "patientcenteredness" across the health system as a whole. From a service perspective, a key tenet of consumerism is the ability to tailor the experience to match the customers' needs, preferences, and/or value to the business.

Figure 4--Use of Technology in Customer Service


The increased use of technology in customer service (e.g. automated phone attendant, live chat via the internet, self-service on a web site, mobile applications) has improved the level of service significantly in the past five years.






Strongly Disagree

Somewhat Disagree

Somewhat Agree

Strongly Agree

Surprise #5

Service quality trumps price.

The message that comes across loud and clear is that health insurance customers generally are more value-driven then price-driven. Our research clearly shows that customers are not willing to trade off customer service options or quality in exchange for a lower price. In fact, our research shows that only 6 percent of customers are willing to compromise on levels of customer service in exchange for a lower price. In contrast, more than 7 times as many customers (44 percent) strongly oppose degrading quality for the sake of price (Figure 5). Such findings should act as a wakeup call for those who make the service investment decisions.

Figure 5--Price Tradeoff Preferences


Lower levels of product quality if it ensures I get the lowest price




Lower levels of customer service if it ensures I get the lowest price



Lower levels of product options if it ensures I get the lowest price



Lower frequency of communications if it ensures I get the lowest price




% respondents agreeing (top 3 of 10 box ratings) % respondents disagreeing (bottom 3 of 10 boxes ratings)

Surprise #6

Customers are social, yet payers are not socially engaged.

Social media has come of age and has begun to redefine not just individuals' personal relationships, but their business ones as well. Our research shows that a majority of respondents (76 percent) went online looking for information about health insurers at least a few times during the past year. For these respondents, social channels are becoming an increasingly important way of sharing information--40 percent read about healthcare through these channels at least a few times during the year, and 8 percent are actively engaging in conversations about payers.

Yet our research also finds that, currently, health insurers are not leveraging social media in any major way. Only 6 percent of respondents agree that the use of social media sites has increased their overall awareness about products and services from health insurance companies that they did not know of before, and only 5 percent say that their use of social media sites has increased their overall engagement with their current insurance companies and their brands (Figure 6).

Figure 6--To what extent do you agree with the following statements?


I tend to trust comments about Health insurance companies/brands on social media sites posted by people I don't know. I tend to trust comments about Health insurance companies/brands on social media sites posted by people I know (family, friends, co-workers...). Comments posted on social media sites influence my opinions about Health insurance companies or brands in general. The use of social media sites has increased my overall awareness about products and services from Health insurance companies I did not know of before. The use of social media sites like blogs, bulletin boards, Facebook, MySpace, Twitter, etc. has increased my overall engagement with my current insurance company and their brands.

54% 5%







6% 23%



% respondents agreeing (top 3 boxes) % respondents disagreeing (bottom 3 boxes)

Surprise #7

Customers are not voting with their feet (yet), but they're doing plenty of talking.

While poor customer service performance is not usually the driving factor for switching insurance providers (Figure 7), our research has found it is the driving factor in other industries. In fact, Accenture's 2010 Global Customer Multi-Industry Research Study found that 64 percent of consumers switched from at least one service provider in the past 12 months--a bank, utility, or wireless carrier, for example--due to poor customer service.

Given the unique structure of the health insurance marketplace, insurers so far have been granted some immunity against the impact of poor service performance: the primary reason individuals switch health insurance companies is because they have been required through changes in their corporate enrollment options. However, as the "consumerism" trend in health care increases in line with increased growth in the Individual market, consumer-directed health plans and the like, we expect customer service performance to emerge as a source of differentiation and contributing factor to loyalty and retention--much like it is in other industries today. The individual consumer's voice will undoubtedly gain more influence, and already, people are speaking up loud and clear.

Figure 7--Customer Motivations to Switch Providers

Required by change in company open enrollment options


Other reason(s)

28% 18%


Product/service options were too limited

7% 6% 5%

I lost trust in the company

Overall poor quality of the customer experience

Our survey found that 40 percent of customers told a friend, family member, or co-worker about a negative customer service experience in the past year. As a source of information, our respondents rank word of mouth in the top three, by a margin four times greater than their fourth most important information source (Figure 8). As we move to a consumer-driven market, the importance of word of mouth should only go up.

Perhaps even more striking than the prevalence and importance of wordof-mouth is the fact that 7 percent of our survey respondents reported posting negative comments about their experience online (Figure 9). While the percentage posting online is still comparatively small, the impact will be much greater, as the posted comments have the potential to reach a global audience. Should the comments go viral, they have the potential to destroy a brand. As social media growth explodes, consumers are participating in activism at unprecedented levels. Here is where health insurers will find the real ramifications of having ill-conceived social media strategies.

Figure 8--How important were these information sources or channels to you in deciding to do business with the company?

Employer educational materials Corporate web site Information from people I know On-premise/in-store information from... Online information from other sources Direct mail or telemarketing Print advertising Online advertising Paid advertising on TV or radio Others

58% 47% 40% 11% 9% 9% 5% 4% 4% 3%

Figure 9--In the past year, have you done one of the following after having a bad experience with a Payer


Told people around me about the experience (e.g., friends, family, coworkers)

59% 40%

Posted negative comments about the experience online (e.g., blogs, Facebook, Twitter) - Yes


Actions being taken by these % respondents after having a bad experience online (one respondent can select multiple actions as response)

Respondents who took no action Unique respondents who took at least one action

Seven Secrets to Delivering Service the Way Customers Demand

Secret #1

View customer service as a differentiator--not a cost center.

Often insurers treat customer service as a "check the box" reality versus a differentiating capability, missing the valuable opportunities that can come when service representatives are empowered to act as advocates for the consumer. Insurers should recognize that controlling costs need not be mutually exclusive from meeting service expectations. By maximizing the value of their most important, influential (and fundamental) asset--their customerfacing employees--health insurance companies can realize immediate and substantial improvements, in both service quality and cost. Accenture's experience has shown that by implementing established high performance workforce techniques payers can better realize improved performance, decreased time to proficiency, and greater employee engagement. For example, Accenture has seen that service supervisors often spend too much time performing administrative tasks and too little time coaching. Furthermore, we often find that supervisors receive little to no training themselves on how to perform their role. Implementing supervisory training programs and setting measurable performance expectations can have a profound effect on operational performance, employee morale and the customer experience. Similarly, high performance reporting, analytics and quality monitoring capabilities will help improve the overall quality of the interaction and reduce the standard deviation of performance levels.

Secret #2

Rethink the service delivery model.

Many insurers organize their call centers along traditional member and provider dimensions; they train their customer service representatives to handle all call types in each of these areas. However, as the health care model changes, payers need to optimize their service delivery model to keep pace. In this regard, the health insurance industry can learn valuable lessons from other industries. For example, wireless providers have learned that they get better customer retention and satisfaction by having a dedicated group of customer service representatives to welcome and educate new customers. New customers have different needs than established customers and the welcome call group is trained to anticipate and meet these unique needs.

Secret #3

A similar opportunity exists in healthcare. Payers should seek to identify unique customer needs (for example, those with chronic conditions) and build unique capabilities around those needs. Such a capability will become a source of competitive differentiation as the individual market grows in popularity.

Drive to simplicity.

Over the years, the systems and callhandling processes implemented by health insurers have become more complex, which in turn drives longer training times, longer CSR time-toproficiency and large performance variations. CSRs spend too much time bouncing between systems or searching within a system to find the information required by the customer--with the common result of a poor overall customer experience. These challenges will be further magnified with the introduction of ICD 10 (international standard diagnostic classification for diseases and other health problems), which will complicate the job on the insurers' end.

Fortunately, advances in CRM technologies are giving companies the tools to reduce complexity and improve performance for consistent, integrated multi-channel customer interactions. For example, a workflow-enabled desktop that presents the right information and/or treatment recommendation at the exact time in the process can be implemented faster and at less cost than ever before.

Secret #4

Embrace an outside-in view of self-service technology.

In the past, health insurance companies have viewed self-service as a trade-off that balances the necessity to reduce costs against decreasing customer satisfaction. Customers have viewed self service as trial and error: they embrace well-planned and well-designed channels and reject those that are not. Given that the customer will look for the right tools to help themselves and help others, the new view is that the voice of the customer should influence technology investments and how the self-service experience is designed. By leading with what the customer wants, the other benefits will follow: reduced costs, increased satisfaction, enhanced brand image and differentiation from the competition.

Secret #5

Don't be anti-social.

Although payers may not need to invest in aggressive proactive social media outreach right now, they should invest in proactively developing a comprehensive social media strategy for their organizations. Accenture's client experience across industries finds that companies often jump into creating a social media presence without thinking through their strategy (a "Fire . . . ready . . aim!" approach). Focusing initially on how to use social media in a single business domain (for example, marketing and sales, or customer service and support) is one way to launch into social media and minimize the risk of fragmentation. It will also focus the organization on "what to listen to" to support identified business goals, without drowning in social media noise. Insurers should proactively listen to and learn from customers to identify any current context, culture, processes, people, policies, and metrics that may need to be modified to support their new social media strategy. Then, they can launch, refine and expand the initial strategy into other areas as they learn. A logical first step would be to focus on the marketing and public relations business domain to listen for conversations that mention a company's brands. After analyzing conversations to understand the chatter, an insurer could implement tactics across customer service, both to reinforce positive sentiment and quickly address negative sentiment. From there, the company could begin expanding into health management applications as part of an integrated multi-channel experience that allows people to connect with other patients like them or access resources to meet a specific health goal.

Secret #6

The challenge with social media is finding a role to play while avoiding additional fragmentation in the industry (and losing the voice of the customer across different channels). In all cases, a key question will be whether the company should use company owned and controlled (on-board) social media tools or offboard (not company owned) ones, such as Facebook.

Secret #7

Embrace consumerism.

Closing the gaps between customers' service expectations and their experiences will not guarantee success for health insurers. Fundamentally, they need to become more customer-centric-- not an easy task, particularly as health payment and delivery reforms demand new types of collaboration among payers and providers. It's an expansive challenge that must be taken apart to manage well. To become customercentric, insurers will need to develop an integrated view of their customers, segmented on values, behaviors, attitudes and health attributes. They will need to identify unique and unmet customer needs, define segment-specific treatment plans for all customer touch points, and then develop the operational capabilities to deliver these treatments and monitor and learn from them.

Get analytical.

Customer-facing channels such as the web, IVR, mobile, contact centers and social media generate tremendous amounts of data, yet few companies are good at turning this data into insight. Without the ability to perform enhanced analytics, high performance will remain elusive. First, payers need the ability to merge disparate sources of data (call logs, contact records, customer satisfaction surveys, IVR logs, etc.) into a single data source. Second, payers need to develop the capability to analyze, interpret and act on the new data and insights developed. Third, payers increasingly will need a way to analyze on-board and off-board data about their brand and customer experience.

Learn More

To discuss how Accenture can help your organization develop the right customer relationship management solutions, please contact Doug VanWingerden at [email protected] or 678.357.7902.

Accenture: Insight Driven Health Insight driven health is the foundation of more effective, efficient and affordable healthcare. That's why the world's leading health care providers and health plans choose Accenture for a wide range of insight driven health services that help them use knowledge in new ways--from the back office to the doctor's office. Our committed professionals combine realworld experience, business and clinical insights and innovative technologies to deliver the power of insight driven health. For more information, visit:

Copyright © 2011 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture.

About Accenture Accenture is a global management consulting, technology services and outsourcing company, with with more than 223,000 people serving clients in more than 120 countries. Combining unparalleled experience, comprehensive capabilities across all industries and business functions, and extensive research on the world's most successful companies, Accenture collaborates with clients to help them become high-performance businesses and governments. The company generated net revenues of US$21.6 billion for the fiscal year ended August 31, 2010. Its home page is


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