Episode Transcript
[00:00:02] Speaker A: Welcome to PG Pulse Press Ganey's podcast on all things healthcare, tech and human experience. In this podcast, we'll be joined by some of the best and brightest minds in the industry to discuss challenges, share insights, and innovate the future of healthcare. Thanks for tuning in. We hope you enjoy the conversation.
[00:00:22] Speaker B: Welcome to another episode of PG Pulse. My name is David Shapiro. I'm Press Ganey's general manager of member Experience, which is really all things focused on health plans and the payer market.
Thrilled today to have Christine McKinney, the VP of marketing and member experience at Blue Shield of California, joining me today. So thank you, Christine. Blue Shield of California represents over 4.6 million covered lives and I one of the nation's most diverse, complex populations that are out there. And I appreciate you spending the time, but before we dig into the world of health plan member experience, maybe you can do a quick introduction of yourself.
[00:01:08] Speaker C: Christine absolutely. I have been at blue shield about six years and we have seen a lot of changes take place in healthcare over that time. We always say change is the only constant in healthcare. So it's a provides great job security, especially when it pertains to member experience. And how do we continue to make sure that we're meeting the members where they are? Because as you know better than anyone, those consumers are always changing the goalposts on us. And so it's a great field to be in and a wonderful opportunity for us all.
[00:01:43] Speaker B: Anything, Christine, you want to share just about the company of Blue Shield of California beside the 4.6 million lives I shared?
[00:01:52] Speaker C: Yes. We are a not for profit, mission driven company.
We are all tied to our north Star of delivering healthcare, affordable healthcare for our friends and family.
So that is something. As you mentioned, we have a lot of diversity in the state of California and we service all those members, whether they're insured through their employers, whether they're buying it from the exchange, or they're through government programs, Medicare or Medical. So we run the gamut and we service them all.
[00:02:24] Speaker B: How long has your team, Blue Shield of California, really been focused on this member experience space and maybe just any key priorities that are top of mind for you guys right now?
[00:02:37] Speaker C: Absolutely. We've been looking at it. We formalized our net promoter score program in 2019 and we've been tracking it for longer than that. But this was really where it was an enterprise wide initiative and where we started to say, okay, this is a cross functional effort. As an enterprise, we all need to be committed to the member experience. And we then started our journey I would say to become member obsessed. So it's in all functions, all teams that service the member, whether they're on the front lines to processing claims to in our sales organization. So we really look at it as an enterprise wide focus. And so our journey, we continue to mature. I think that there's a lot that we have done from an investment standpoint to ensure that not only are we becoming member obsessed, but we're really outside in and we're using data to really drive our strategies and driving our focus. And there's two ways that we've been approaching that. One is the short term. What do we need to fix now to get it right for the members? Where are the gaps that the members are seeing? Whether it's in understanding the value that the plan's delivering to? Are we answering the phones in the right way and answering their questions in the right way to what do we need to do to transform healthcare? At the same time, maybe the members don't even realize that we don't just have to accept the status quo in our healthcare journey. And so we're always looking out and saying, okay, how can we also disrupt the ecosystem? Because as we know, a member's experience with a health plan, we can only control so much. We have a lot of partners and stakeholders in, in our ecosystem. So how do we make sure we're talking to the providers, we're talking to the brokers, we're talking to the employers and making sure that by a design, we're not just looking at are they able to access care, but are they able to access it in a sustainable, financially affordable way? So we really try to look at it both for the members that we have this year in our plans versus what's the future? And how can we, how can we continue to make healthcare accessible to all?
[00:04:46] Speaker B: I love it. I often say, first you got to get the basics right, you got to make sure you're paying claims correctly.
[00:04:54] Speaker C: And then it's like, as it seems.
[00:04:59] Speaker B: Then you got to get to personalizing experiences, experiences and building capabilities that are differentiating the market. So completely appreciate that.
So let's talk about general landscape of member experience across health plans. You used the word North Star before. I often think it starts there when I listen, in fact, not too long ago, listen to a bunch of earnings calls and I hear a lot of the same themes. And I think they apply to experience teams. Things like, obviously experience NP's growth, retention, engagement, reducing operational costs, affordability, etcetera.
You mentioned NP's before, but when you think about your experience world, whether what's is there one or two things you're focused on or really you are focused on them all?
[00:05:53] Speaker C: I would say that we are focused on them all. I think that we're continuing to move and advance our maturity in translating net promoter score to business outcomes. And so we are seeing that if we are improving a member's how they rate us from a net promoter score perspective, we are reducing or improving our retention. So we do see it being a direct tie to improved retention. So that was a great momentum for us to be able to start to quantify the value of experience.
Our next step that we're looking at is, as you mentioned, administrative cost. That's a key focus for our plans, for health plans. So are we actually lowering the cost to actually service those members if we're getting the experience right upfront, if we're looking at the root causes of what's causing a member to call into our call center, if we know they're coming to our digital channels first and then ending up calling into the call center, that's a lost opportunity and it's costing us money. So how do we make sure we're servicing the members in the right way where they want to be receiving the information upfront? And then we just find that a lot of the business outcomes we all win when the member experiences what it's supposed to be. If a member can access care and we're going to lower the cost of health care because they're getting the care that they need and we're making sure that care is not deferred. So once we remove those barriers, we see that if you put the member at the forefront of it and you design around that, it is a win win up and down those KPI's.
[00:07:35] Speaker B: Agreed. And you talk about NP's as a North Star for your organization. It's a lot of the way I think about things. I don't care what is the North Star, but I also kind of grew up focusing a lot on NP's and really trying to understand the moments that matter across really a truly end to end member journey. Because it's those things. It's those moments that really are the key drivers ultimately to improving those experiences. You even started all the way up front the sales enrollment experience with brokers, to onboarding, to finding care, to pricing care, to paying for care. Accessing care, of course, is a moment. So I know that there are lots of those moments across. I thought we'd just pick two today and I thought I'd start with access to care and part of the reason I want to. And maybe it's a little around understanding benefits and accessing care. Cause I think those are two really important, those are challenges that a lot of, I see a lot of health plans have. And part of it I used to say to people, unfortunately, as much as members, as much as you try and educate members, members too often don't really understand their benefits until they need it, and then they really need it and it's urgent and you're playing a really important role in that moment for a member. And I also know that understanding benefits has such a strong correlation to other important things in health plans, like star ratings. The correlation is extremely strong. We see it across many clients.
I'm curious, in this space of understanding benefits and ultimately accessing care, do you see that as a challenging moment that matters for your clients? Do you see that in your data and even any populate specific populations or Personas that that really impacts?
[00:09:32] Speaker C: Yeah, I'll start with the benefits piece.
We saw after Covid that we were starting to see our NP's was on the decline, but more so, we saw that the value that members perceived of receiving from their health plan was declining and the most correlated to our net promoter score. So at the same time, we were building out our market research and insights function. So we did a lot of research with our members to understand from a member's perspective, how do they define value from a health plan. And so a lot of it was those benefits and it was benefits that we were already providing. It's just their awareness was so low. And then we also saw that members with lower tenure had the, had the lowest plan literacy or awareness of their benefits. So we launched an integrated campaign, marketing campaign that was both digital email hits all about benefits. And so we were just really trying to capture them at the forefront of how to use your plan and really talk about the benefits that we knew were the most important to the members. We really led with them and we kind of just made sure that it was in digestible amounts. Yes, they have access to all their benefits, but what are the key ones that are most meaningful to them based on this research? And we saw a tremendous lift in our net promoter score around value and then it lifted to the net promoter score. So that we saw over the course of the last few years and we continue to get mileage from that investment. And then we're actually now seeing, we went from like, okay, let's get those new members. And then we're like, uh oh, now we have a sophomore slump because we fixed it with the zero to six months. But we're actually seeing now that the cohorts that we started this welcome experience with are carrying through and we no longer have a sophomore slump for those members. So now how do we get to those later tenures and make sure that they have that information when they need it and that. But as you said, that does. It's not a silver bullet because they might not need their benefits in that 1st, 90 days. It certainly helped close the gap. But how do you make sure that in your digital channels it's very easy for them to find their benefits and that it's very, it's written in a very consumable way because a lot of us, we make sure that we're not a lot of legalese in how we present the benefit information, but we really needed to make it at the right reading level and that the members could really digest it. So that was probably the first strategy that we saw a couple years ago. And then going into the access to care piece in the state of California since COVID we've seen it's just really hard for members to find care. So we're doing a lot to make sure that they're educated and informed of all the different options that we have, whether it's seeing your primary care provider or is it going to. We have a lot of tele or virtual care options and we're investing a lot in that so that we can always make sure that the members have access. And we're doing a lot to promote that. We actually have a standalone plan now called virtual blue that is really trying to strengthen the relationships between members and the comfort level with members and virtual providers because we see that that's a model that actually is very successful.
And then we're doing the more support. You mentioned star ratings earlier for our Medicare Advantage members, we have a dedicated team. If they can't find an appointment, call us, we'll call the provider, we'll work with them. Cause maybe your primary care physician doesn't have an appointment, but somebody else in the practice does. And so we know how to. What are the best practices for making sure that they can get that appointment within, say, 14 days or whatever it is that we wanna make sure that the members get the care when and where they need it. So it's two bodies of work that are very important and they go hand in hand. And then I will add a third that I think as we've really built up the benefit literacy, we now realize we need to do more on the coverage literacy, because that's where like what are the tools that we can add to our digital experience to help with the transparency of costs and let them understand the difference between coinsurance and co payments and deductibles? And how does that all work together? Because that's the benefits is just one piece of it. They want to understand the entire out of pocket cost situation, that they'll have.
[00:14:09] Speaker B: The role of data, the role of technology to really garner those insights. It's where we at Press Ganey really like to take advantage of our data sets and support our clients, our platforms and capabilities of bringing new and differentiated insights and leveraging the capabilities of having our clients take advantage of those capabilities.
Obviously, you're leveraging technology, you're analyzing. Maybe you can just go a little bit more into detail of how you approach the listening, analyzing, interpreting those results and ultimately taking it to action.
[00:14:52] Speaker C: Yeah, and we partner closely with your team on, we look at net promoter score and we look at the different segments. So what are the different lines of business that we have? And they all have different cost structures, they have different plan designs. So some of their experiences are differentiated from each other. So we actually have to be very targeted in our action plans to understand. Healthcare is complicated and not every plan design is created equal. So members just have different, face different challenges. I mean, obviously our Medi cal population is very different from our large group employers who are just more technically savvy or have better plan options, and they're all structured different ways. So we really have to look at the data and we partner with our line of business, like the folks who own the success of their population, and we really like partner with them on those action plans.
And so we help use the data to say, okay, this pocket of population is emerging as a new problem. We always know where the problems are and we're working on them, but we're also always looking ahead to say, okay, you're helping this but them, but now we see you've got new things emerging. So the data is always helping us and the survey data helps us quantify and look at the trends. But we really need to mine the verbatims to understand what is the voice of the member, what is the impact, say if we have a provider termination mid year, feel the pain of the member, and sometimes it's a lack of trust. We've lost trust with a member from a decision that wasn't necessarily ours. But how could we have better mitigated that upfront? How could we have better seen this, seeing this coming from a member's perspective. So the verbatims really keep us very tied to the, to the hearts of the members and the emotional impact, positive and negative. I mean, it's not always what should we fix, but what should we continue? And maybe there's a best practice in one line of business that we should bring to another segment of the population. And so you always want to look at both the positives and the negatives because you can sometimes just get mired in the negative. And there's a lot of positive things. We do try to also append our NP's data to look at what's the claims activities. What more can we learn? These members, have they filed an appeals and grievance? Did they need a prior authorization on their prescription? Was it approved? Was it denied? And so you can kind of get that full picture and then you can start to quantify like every time you put a prior authorization on a prescription, your IPO.
And so it's not easy to do that.
It takes time and you need resources and you kind of like just start to pull the thread and see where the thread takes you because you don't always know what data you're going to need to complete the full picture. But I think as long as you're open to following the breadcrumbs that the data will tell you in NP's, because I think that's really what NP's does is it like starts to shine a spotlight on something, but you're always going to need more of your own data to tell the full story. And so it's just very important to follow the breadcrumbs and really see if there's a there there. And then what is that impact to your membership? Because you might be losing members that you could with a little re looking at a policy that you might be.
[00:18:29] Speaker B: Able to save one more space in this technology area that I think is important, which is the speed of the data and the continued direction. I know plans, it's always been hard for so many plans out there. I continue to have conversations of do they have all the email addresses, the ability, the permissions to text and the challenge of a TCPA and all of those things. But maybe you can talk a little bit about just the importance of how you've evolved and getting data faster and your evolution of being able to use more digital to capture some of that feedback.
[00:19:15] Speaker C: Ongoing struggle we do better in different lines of business, so our data availability or in our permissions just vary by demographic and different lines of business. We're able to capture different information on different enrollment forms. And so some process wise we're okay or we have more access to data. So we're always in contact with our privacy team to study the TCPA guidelines. We find that a lot of the information and reasons why we want to message with members is so that we can help support their quality and their health outcomes. So we're learning a lot in what we can message and what data we can use for those types of messages.
And then a lot of the other opportunities around that we talked about before of just having the member have a better experience starts with them understanding their benefits. And so how do we make sure that we invest the money and we do get that information to the member in the channels that we do have permission for. So some lines of business will spend more on direct mail because they're not as digitally savvy and to get that information to them. But we are always driving to digital. First, we do the activation on the id card so that we can try to capture information. We have our call centers on the inbound, validating information and confirming preferences. We're investing in our infrastructure to ensure that we have the right level of preferences so it's not just a global opt out and that we can opt out by channel. And so all of that works so that we can communicate with the member in the channel of their preference. And so some of it, we have members for a long time. So when was the last time that they went in and refreshed their preferences? So we tried a segment and message to the members based on different use cases of why we don't have the data and what barriers we may need to overcome to get the data. So we're doing a lot of, with seniors, like using QR codes to make it easy to get to the digital page that we need for them to create a login or give us the permissions.
But it's a challenge.
Just talking to some at a convention earlier this week and a lot of the plans were saying, like, the amount of, the percentage of usable data that they have permission to use. It's a challenge for everyone, and it's something especially with seniors. With our Medicare population, we really see those who are digitally engaged are more satisfied. So it's not so much that we just want them to be digitally engaged, it's actually a benefit to them. And so we need to start to look at the different segments of, okay, what are the new members who have recently aged into Medicare? And let's go after them because it probably makes the most sense for them. And then let's really lean into those members who call in and spend the time with them because that's the channel that they're most comfortable with.
[00:22:22] Speaker B: We'll just look a little bit of future plans are.
I think the health plans have become more and more commoditized.
They need to differentiate themselves in unique ways. We've talked about data technology earlier. You mentioned one. I've done some, I did a little work looking at some of the things that you've announced.
You talked about your virtual plan, which I thought was interesting.
You also announced something about a member health record that I thought was also interesting. I loved seeing what plans are doing to differentiate themselves and create new experiences, new products and market that drive that differentiation, improve that overall NP's experience.
Anything you want to share about how you're working with those teams or how those are helping you continue to bring better information, insights, data to your customers each and every day?
[00:23:19] Speaker C: Absolutely. When we look at our member experience strategy and we have the, the pyramid chart and trust is at the top and really the member health record is a great example of that. We all know that you go to one doctor, you have your medical health record, you go to a different doctor in a different system, you have a different medical health record. So this is a way to integrate the data that we have in our four walls, but we're also getting the data from external sources as well, so that a member has one spot that they can go to to see their entire integrated their member health record. And so it's really a way that we can then also use that information to say, hey, you've got a gap in care. It's time for you to get your mammogram. And they can then log in, see, oh, yeah, I am, I've lapsed there, but they can also see, oh, there are my lab results there when I went to the doctor. And so it's just a way that it reinforces that blue Shield is there to support them and to make sure that we are looking at their health from an end to end perspective and we are supporting them along that journey. And it's really just the beginning. We have a pretty ambitious digital roadmap in the next few years. So you'll be seeing more and more investments of the way that we're looking at. Just end to end. The entire member journey can be managed through that one app for our members. So we're really excited what the future holds for us from a digital perspective for our members.
[00:24:52] Speaker B: That's great. Again, what I've heard is you continue to use NP's or any north star as a monitoring mechanism. But ultimately you invest in the insights, in the research or the research and making sure that you're listening across the journey. You've made some big improvements in some key areas. Access to care. I heard a couple of key things there.
Data, data, consumer data, bringing it together, appending data. It seems like it starts there. It leads you to fruition to good things.
Obviously, continuous listening in real time becomes an important piece of this. And just having those right tools and the teams and the analytics and the support goes a long way, which I know is not always easy for plans to do, obviously. At press Ganey we're here to support clients like Blue Steel of California achieve their experience, their quality, their star ratings, improvement calls. And I know that there's a lot of data coming out in the past month on new Haas health outcomes survey results came out.
Star rating results are being distributed to health plans. And whether it's listening, voice of consumer capabilities, star rating analytics support, or just general health plan consulting, we're obviously here to help our clients get the most out of their data and the insights and just the overall listening strategy that they're trying to do. So appreciate you can check out pressgainey.com to learn more about us. Obviously, feel free to reach out to myself, David Shapiro on LinkedIn. But I really appreciate the time, your insights, it just brought back so many memories of being in the health plan, to be honest with you.
[00:27:00] Speaker C: Well, it was a pleasure talking to you, David, and we love the partner. We love and appreciate the partnership we have with press Ganey. So thank you.
[00:27:07] Speaker B: Well, thank you very much for your time. Take care.
[00:27:10] Speaker C: You, too.
[00:27:11] Speaker A: That's a wrap. Thank you for joining us today, and special thanks to our guests for sharing their time and insights. Stay tuned for our next episode, which will be released soon. In the meantime, visit our website where you'll find more information on the human experience and a lot more.
