Why Improving Customer Experience Is So Hard In Healthcare

By Bernie Kuhn and Anthony Zanotti

One of the most frequent topics of conversation in healthcare today, and often somewhat controversial depending on who you are speaking with, is the notion of improving the customer experience (CX). For some, perhaps it’s just top of mind given the number of traditionally customer-centric companies trying to pave a new path forward in healthcare including Walmart, Amazon, and CVS. But for those of us who have grown up in healthcare, we know this conversation isn’t new.

CX is the next unknown frontier in healthcare—not just because we don’t have a clear line of sight on how we will get there, but because we really don’t know what lies on the other side. Stated or not, there’s a fear of what happens to the rest of us when someone else figures this out first. And most health systems are spending hundreds of thousands, if not millions, of dollars to ensure they are the leader in CX.

Good CX translates into positive online reviews, word of mouth and employee satisfaction. In other words, good CX is good business.

Consumerism: Consider the Reimbursement Implications

We know the shift toward consumerism thus far has been gradual, but it doesn’t change the fact that patients aren’t the by-product of the healthcare system, they are the reason it exists. Patients are why we got into this business and initiatives to improve the patient experience have been around for a long time. Consumer Assessment of Healthcare Providers and Systems (CAHPS) has been around since 1995. Health and Human Services (HHS) started developing the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) framework in 2002, and is included in Medicare and private payer quality assessment programs, and scores are a core component of the Value-Based Purchasing (VBP) program. Important to note; questions are directly relevant to the experience, but they don’t actually speak to Customer Satisfaction (*for a later discussion).

Today, HCAHPS Star Ratings are publicly reported on the Hospital Compare web site. Payers have begun to tie incentives to HCAHPS scores, and the Medicare Payment Advisory Commission (MedPAC) is evaluating which HCAHPS question(s) to include in their proposal for the Hospital Value Improvement Program (HVIP). Despite significant focus, CX continues to stagnate.

Evaluating the most recent HCAHPS Star Rating release, 66 percent of the 3,528 hospitals scored at or below the program average. There’s very little differentiation from an experience perspective in healthcare today when stacking hospitals against each other. There’s plenty of variation when looking at healthcare organizations relative to other industries, unfortunately it’s not the kind of differentiation we’d like to see.

J.D. Power, a global market research firm that touts itself as being the world’s most trusted source of consumer ratings has healthcare industries largely ranked lower than other industries. Calling your cable company is still comparatively a more enjoyable experience when compared to healthcare.

Figure 1. J.D. Power Cross-Industry Study Excerpt

Figure 1. J.D. Power Cross-Industry Study Excerpt

Looking at health insurance plans, few have made headway in improving the customer experience, and definitely not to the degree that other industries have been able to innovate and adapt. Those that have improved tend to be integrated delivery systems with the ability to garner efficiencies in billing and care coordination. “We know from our market research that affordability, coverage and care coordination represent the three most impactful metrics in terms of consumer satisfaction,” says James Beem, J.D. Power’s managing director of health insurance. “However, less than 50 percent of all healthcare insurance consumers experience satisfaction across all three categories. In our J.D. Power 1,000-Point Consumer Index Model, delivering high value in each category could mean a greater than 300-point improvement in satisfaction”.

HCAHPS remains an important element of CX today, but the bulk of the survey questions were developed more than 15 years ago. Data collection modes are traditional (live phone and mail), have a lagged response time, and the survey itself is lengthy. We still need to get the basics right, yet there is an inherent question of whether it will be enough to satisfy the evolving needs and expectations of consumers. Further, the pace of change may not be sufficient for average and lower than average scoring healthcare facilities to stay afloat.

Start with Consumer-Facing Assets

There are a number of firms offering customer experience management solutions that take a different approach. Calibrater Health, for example, offers a stream-lined text message-based solution combined with a suite of AI-powered tools that help distributed healthcare organizations improve customer service and team culture in the moment.

“We collect data using automated text message conversations, not just by texting patients a link,” says Tim Dybvig, CEO of Calibrater Health. “As a result we see 35 percent response rates and – surprisingly to some – participation from all ages.”

Dybvig says Calibrater’s data show that 70-year-olds are as likely as 30-year-olds to respond to texts.

“As a company we’re very focused on the urgent care market since they are leading the charge on the ‘patient experience revolution’” he says. ”And we’ve been extremely fortunate to work with some of the top brands in the country to help us constantly improve the product.”

Blake Bishop, regional manager for MultiCare Health System in Seattle oversees multiple brands and service lines (including urgent care and occupational medicine) where they use Calibrater Health to react quickly to service issues and keep the customer experience top of mind. “NPS® has become an important metric for MultiCare that Calibrater Health measures at a very granular level, but it's their tools for managing patient feedback that really help accelerate organizational change,” he says. “We love how it allows us to move fast and make changes as soon as we see issues, and improve together as a team.”

Another CX measurement system is the Enterprise Feedback Management system by Medallia . Medallia made its name in hospitality, retail, and financial services, and recently announced major investments in healthcare.

“Changing consumer expectations continues to propel disruption in healthcare,” says Belinda Simmons, healthcare practice lead at Medallia. “Those that take advantage of this opportunity will not only meet their customers increasing expectations but protect and improve market share.”

Simmons says that Medallia creates a frictionless way to listen and act on feedback from customers and highlight what's working and what’s not. Medallia captures real-time feedback and pushes it to those healthcare workers that are creating the experiences.

“It sounds simple but is hard to do at-scale across hundreds of thousands of encounters,” she says.

Atrium Health, a large health system in North and South Carolina uses the Medallia system. Tom Laymon, senior vice president and chief of care delivery operations at Atrium Health says, “With Medallia, we are now able to get feedback and take action on it, with a focus to improve and/or change processes and behaviors.”

More and more often, health systems and practices are using a balanced approach. Leveraging the tried and true systems for long term trends and benchmarking, but also working with firms to get a transactional read on CX.

What “Great” Looks Like

Some firms publish an NPS number publicly and it is typically the “best” number that gets published. But we know these numbers fluctuate seasonally, and there are often gaps across facilities and providers.

Merchant Medicine is working on a national survey of urgent care chains. Our hope is to create a benchmark for performance that would classifies what the top performers are actually doing. If a firm has measurement processes in place, would they line up against public data? We often see simple things like NPS not being calculated correctly, or an NPS question inappropriately buried in the middle of a survey).

Healthcare professionals are in the business of caring and sometimes in doing so they run fast and furious toward a quick solution. Digital technology is the perfect example. Regardless of whether you believe “chat bots” will save the day, we know technology is an important lever that allows us to increase access, improve communication and make receiving and coordinating care more convenient. However, few organizations have programs in place that connect these expensive and labor-intensive initiatives to CX or health outcomes. CX programs done right, don’t just tell us a score, they help us to understand if we are doing what customers want and need. They help us to prioritize, and they tell us if our efforts are effective.

Is NPS the Perfect Measure?

We would be remiss not to discuss the measurement approach. Customers of both Medallia and Calibrater Health often use an NPS approach. Many people may have seen the recent Wall Street Journal article that highlights methodological challenges with NPS as a measure, including the implications of integrating this measure into executive and physician compensation. In short, the most notable challenge is that the results are easy to manipulate, whether intentionally or unintentionally .

Calibrater’s Tim Dybvig says that it's important to point out that Bain & Company, one of the co-creators of NPS® along with Satmetrix, more commonly refers to NPS as the Net Promoter System (http://www.netpromotersystem.com/) since it's more about setting up a feedback loop of constant measurement and action than it is about a perfect score.

“Customers ask us all the time what the "right" NPS is, but that's not entirely how it works,” he says. “Of course you do want to try to improve your scores, but it's much more about being able to establish a baseline so you can measure change from that baseline rather than hitting a specific number.

Dybvig says that if you update your check-in process and your scores start to drop, you'll know in the first few days and can dig into the comments to figure out what went wrong. But if you test out a new process and the scores improve then you know it's time to roll it out to the rest of the company. Being able to constantly measure and respond quickly is a very powerful combination.

Live or Die by CX Scores?

Consumers are becoming much more aware of their healthcare options and are demanding the kinds of experiences that have become common in other industries. And as customers are clamoring for more, the government is pushing us to do more as well. On June 24, 2019, President Donald Trump signed an executive order that directs agencies to draw up rules requiring hospitals and insurers to make public more information on the negotiated prices they hammer out in contract negotiations. Hospitals and insurers would also be required to give estimates to patients on out-of-pocket costs before they go in for nonemergency medical care.

There is no evidence that consumerism in healthcare is a passing fad. We know that experience drives most industries; it is arguably even more important in a healthcare setting. The real question for healthcare professionals is whether you have the insight to ensure you will be a leader in delivering the outstanding experiences that customers demand as the industry continues to transform.

The United States Department of Veterans Affairs are “hardwiring” customer service into everything they do. They get feedback throughout the customer journey and share it with the relevant parties to take near real-time action. This enables them to intercept a poor journey and get it back on track before it escalates, impacting their care and ultimately their health outcome(s). It really is about getting feedback and taking action so every person matters.

One of our keynotes at the 2020 Strategy Symposium is Michael Renfrow, Chief, PX Consultation, VA Patient Experience Program. Stay tuned for more information. Our Symposium is returning to Scottsdale, AZ, January 27-29, 2020, and is going to be heavily focused on CX, segmentation, and performance. We hope you can join us for a deep dive with industry experts there!

Interested in CX, Star Ratings, and other performance analytics? Drop us a line and we can get you some metrics with trending – Anthony@merchantmedicine.com.