Evolving the Healthcare Digital Customer Experience

DCX Podcast #2

Jul 26, 2022

I recently had the pleasure of speaking with David Edelman, a highly sought-after marketing and digital transformation advisor and lecturer, about how healthcare journeys can be improved and how AI is evolving healthcare to new levels.

7 Key takeaways from the conversation:

  • Knowing where the value is, is key to starting a digital transformation

  • An aligned leadership group is required for a successful transformation

  • Focus on the customer journeys

  • Engage and incentivize employees to ensure momentum, as these projects can take years to deliver

  • Customer expectations have increased due to the pandemic including their demand for more transparency, especially in pricing

  • AI is going to enable incredible leaps in healthcare processes and outcomes

  • Extra: The economics and experience behind the long CVS receipt

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Mark Levy 

Welcome to the DCX podcast where I interview leaders in the customer experience base about how digital is changing the landscape and how you can leverage these changes for success in your business.

Today. I'm excited to be talking with David Edelman, currently a senior lecturer on marketing at Harvard Business School. David is a sought-after adviser on digital transformation and marketing strategy. Most recently guided Aetna, now part of CVS Health, through becoming a digitally oriented customer-centric enterprise. And David has repeatedly been recognized by Forbes as one of the most influential CMOs in the world, and by Adweek as one of the top 20 marketing and technology executives. So very excited to have David here to talk with us about digital and the experiences he's had in that space. So David, welcome.

David Edelman 

Thank you, Mark. Pleasure to be here.

Mark Levy 

Thank you. So you advise CEOs in health care about digital transformation. And so when you speak to them, what do they say their biggest challenges are related to customer experience?

David Edelman 

The biggest challenges are knowing where to start. There are so many different opportunities. Prioritizing is really a challenge, especially when in many cases, it's not always easy to figure out value and to define what value really means. Is value something, I mean in healthcare especially is value something that only focuses on improving health outcomes? Does it save customers money does it save you money does it drive revenues?

There are so many different objective functions to sort through that prioritizing is really a challenge and it gets down in many cases to push on what is the strategy of the company? How does the company overall think about its priorities and the sequencing of what it wants to do in the market. So that's often one of the first things that you've got to really think through.

Mark Levy 

And so that's not just the CEO, but that's like the entire C-suite, right. So you've got to get everybody aligned. And I can imagine that's a process as well.

David Edelman 

Yeah, well, customer experience, in general, takes a village in almost all companies. It's not just one function. In healthcare, especially, it's quite complex in terms of the interactions. It also depends on whether you're a health plan like Aetna, where I used to work. So let's call those a payer, whether you're a provider, somebody who's actually a hospital and medical system, like here in Massachusetts, Mass General Brigham would be a good example of that.

And so depending on where you sit, you are going to have different types of issues, some of which revolve around the actual access and giving of care, some of it around all the financial support. So you know, how to pay bills, how if somebody calls in with a question, how to deal with that. And then some of it's all about engagement in between, because both the payers as well as the providers are trying to help people take healthier actions, not just when bad stuff happens.

So if we can keep you healthy, that means you're healthy. It'll save you money. It'll save the healthcare system money. I mean, all good things happen if we can do that. So there's a whole bunch of things around engagement that are also part of the customer experience as well.

Mark Levy 

Around the organization of these leadership teams, what challenges do they face and how do they overcome them? How did they get aligned to determine what is most important to focus on where to put their investments?

David Edelman 

One of the first things that a lot of executive teams have to do is actually step back and look at first and foremost, the end-to-end customer, patient, member; depending on where you sit, you might use a different label, but the experience for that constituent and what is that end to end? And if you’re a health plan, for example, like we were like I was at Aetna, we thought about the journey is having several stages.

The first is some type of marketing and enrollment. And for commercial plans, which you get through your employer that happens in the workplace. There's also Medicare where Medicare Advantage is sold directly to a consumer or possibly through a broker but not mediated by a business.

So there's enrollment then there's onboarding. So once you've signed up, you get your ID card, you often get a whole stack of paper and you may even get papers from the dental plan, the debit card, the this, the that and it's all just coming at you. You have no idea how to sort all through that. You don't really understand at all. So that's a bit of a mess and I'll come back to that.

Then, after onboarding, you're going to have experiences where you're going to get care, some of which may be more acute, some of which may be more chronic. There'll be different kinds of situations where you get care, and you're expecting the insurance company to approve that care, to pay for that. When you get that care, you may or may not be that concerned with what it's going to cost you out of pocket. And that's going to be an issue as well, which leads to the next journey, which is around payment and inquiries relating to payment. So that's often in healthcare, amazingly complicated, because most people really have no sense of what they're being charged for.

Until extremely recently, hospital charges were not very transparent. The government is taking some big steps though now to make those transparent. But then so you've got that. Then you have this which I talked about before, possibly a whole experience about ongoing engagement, where you want a relationship, depending on who the person is. And what they need to encourage them to take healthier actions, get their flu shot, get their COVID shot. If you're over a certain age, get a colonoscopy, get a breast cancer screening. Stay on your meds if you're on your meds. If you're diabetic, get your levels checked. There's over 100 of these different actions that a healthcare payer can encourage a consumer to do that are in their best interests.

So you've got these different stages of the customer experience. And so as an executive team coming back to the original question, you've got to figure out where is value in that.

What we actually found that one of the most important places for value was onboarding. Because you want an educated member, an educated member will know how to use the health plan appropriately, will understand how the finances work. They'll understand the value of certain kinds of support programs that you provide. They'll be happier, they’ll call in less, they'll sign up for the app, they'll register online. If you do all of that, right, you can set up an educated digital relationship up front.

So we aligned as an executive team saying onboarding was going to be a major, major priority. And we actually invested in creating personalized videos using a company called Sunday Sky. It was incredibly effective. So we send people links to a personalized video. That would tell them their exact economics, whether or not they were signed up for a primary care provider, and if they weren't, here's one that's accepting new patients in your area who is in network. We'd let them know about the nearest urgent care centers they could go to so they wouldn't have to go to an emergency room that were in network and all the other benefits that they could get.

70% of the people we sent that link to watch the entire four-minute video. Pretty amazing statistic. And those people who watched the video versus those who didn't retain better called the customer service last signed up online at a higher rate and interestingly, were in the emergency room less. Which is so much better for everybody around, especially them for their own health.

So that's an example where we really aligned, we decided we wanted to invest we set a priority and the whole executive team was behind that. And that's the kind of thing you and whoever is the point person, in this case it was myself as chief marketing officer has to put the data, the story on the table and get the team aligned to get going around a major priority.

Mark Levy 

And how do you keep the teams aligned over time because these are not overnight transformations? These are things that take time, require research, require journey mapping, require all those pieces to come together and turn into the experience and testing and everything else. So given the timeframes for programs like this, how do you keep everyone aligned along the way?

David Edelman 

So keeping the momentum going takes a few things. One is certainly big support from the top. So when Karen Lynch became CEO of Aetna, she's now CEO of CVS, one of the things she did was say 20% of the bonus compensation for the executive team is going to be based on customer experience metrics. We needed to figure out what those metrics would be between Net Promoter Score customer satisfaction, it varied depending on the line of business and such. And sometimes our priorities change.

So we would change the metrics but one thing was getting people's attention through 20% of their bonus tied to customer experience measures. That's a big deal. So that was pretty important.

The other was setting up a regular cadence. So every two or three months, I had time on the executive team agenda, to talk about what were we doing? What are we learning? So what's the impact of what we've been doing? What are new things we're learning? Where do we want to focus next? What could be the economics of that? And then we would rally initiatives against that really focused from a journey perspective.

So I mentioned onboarding before, another whole journey that's absolutely critical for people is getting care, which from a payer perspective means you want to approve getting, care giving people access to care for things that are appropriate to approve, and you want to do it incredibly rapidly. You don't want faxes flying around. You don't want things trapped in cycles. Now, there are some issues because sometimes people are trying to get care for which it isn't necessarily medically indicated. It could be more experimental before trying more traditional things that are proven to work. And so there are some trade offs in terms of approval. So we wanted to make sure we communicated that to all the parties involved, especially the member. But the main thing was working through to get approvals.

And so for example, there were large numbers of doctors we worked with whom we've never turned down. They always are appropriate. They always are quick. Outcomes are really high from a quality perspective. So they've got a Golden Pass. So we set up a Golden Pass program. So that anything they want would be approved. We might check a few on the back end, but it never was a problem. For more and more of the doctors also we really made sure that they were going to be electronically connected, and if they weren't, that would affect reimbursement rates. So we wanted to speed up that whole process, get away from faxes.

So, you know, we went methodically through journeys. We also looked at ongoing engagement as another journey where we had a program going so it was very deliberate, keeping the focus on those journeys, and the metrics that would be important to those journeys.

Mark Levy 

How about the customer side of that, looking for a doctor, making appointments, getting appointment reminders, post the appointment, getting information back from tests from results, getting access to the information that was discussed, those types of parts of the customer side of the journey?

David Edelman 

Yeah, those are really critical. And this is part of the complexity of the healthcare system, because most of those are really in control of the provider, not the payer. So that was an issue. But again, for providers in network who would digitize all of those programs, we created, we gave them priority in terms of if customers were looking up doctors in network, those who had digital enablement would be top on the list.

So we created certain kinds of prioritizations for that. We also encourage them in terms of best practices. It generally became one of the screening criteria for adding new doctors, new providers into the network. So it's part of the complexity though, that some things happen at the provider side, some things happen at the payer side. we do not have an integrated national system.

There are some healthcare delivery systems that are unified. Kaiser Permanente is a good example of on where they're both the payer and the provider, so they can do all of that that you described in an integrated way. But the vast majority of people in the United States are not covered by an integrated payer provider. So they got some things from one and some things from the other

Mark Levy 

Or they see doctors from different groups and different systems and then they've got a login for this one, a login for that one, and no way to check in a consistent cohesive manner, their experience it's very much focused on the provider that you're working with, and how they've set up things. I can see that as a future enhancement, the opportunity for me as a customer.

I am a human being and I go see a lot of doctors or I have medications in different places. I want a centralized place to manage my care versus being focused on was that at Jefferson or was that at Penn? I can't remember where that doctor was and where to go find my records and things like that. Do you see a future where that comes to life?

David Edelman 

No question. And in fact, Aetna together with CVS has started incorporating and servicing, surfacing, links to things like scheduling systems and such in the Aetna app when you pick a particular provider, you can actually now, and this is more recent, for a certain range of providers do the scheduling. The aspect though of linking the data across is an interesting and tricky one. That the providers try to keep you within their system. So that it because they're all on the same electronic health records, so they can move it around.

Now recently, there's been a new set of interoperability standards that have been released by the government that all providers, and soon also the health plans all have to adhere to a standard way of putting data in files and they have to move it to where a consumer wants that data to be moved. So that is rolling out as we speak. That is becoming a government standard. First, starting with government funded programs, Medicare and Medicaid. It'll go down to commercial pretty sure it will so that is starting to rollout including actually surfacing the prices of care as well, which has been quite controversial, but appears to be happening. So things are moving from a data perspective as interoperability standards happen the consumers, the one who's going to be on has to say I want to move it, but it should get easier as time moves on.

Mark Levy 

So CVS has a different model that was that's more, you know, it's pharmacies and stores. You were involved in leading the digital transformation there as well. What did you find when you when you first got there, in terms of digital?

David Edelman 

Yeah, so I was for a year and a half after the merger. I was part of the combined entity and led essentially, getting rid of paper was the program and we looked at it from the perspective of everything that had paper as part of an experience or a transaction, we were going to put it under the microscope and figure out how to change it. So across the board, I mean, that was a shared goal. We all believed it was in everyone's interest.

I think one of the biggest challenges of putting together any two companies is that their mindset and the way they think about things often starts from a different place. CVS was much more focused on transactions. They're a retailer. They have low margin, very high volume transactions. Aetna is about membership and a relationship business and focused on lifetime value, more so than CVS was. so bringing together the mindsets to think about how you build the, for example, the business case for making an investment.

You know, timeframes are different. CVS was a bit more short term than Aetna. But gradually, you start to realize the combined value and that was a big part of the merger was bringing the combined entity together. So we got there. And we made a hell of a lot of progress on it. But when you do bring any two different companies together, especially when they're in different parts of the value chain, you know, their economic perspectives are going to be different

Mark Levy 

Yeah. Well, they still haven't figured out the receipt yet at CVS.

David Edelman 

Well, the receipt has a whole lot of economics behind it. So I wanted to get rid of paper, which definitely we were trying to encourage email receipts at the checkout. The reality is a lot of people want that paper because they want the physical coupons. It's easier for them. They feel it's easier for them to use. The manufacturers who fund those coupons like it because they like being top of mind on the piece of paper. So there's a whole lot of things behind that that conspire to slow down the digitization of it.

Mark Levy 

How do you think patient’s expectations are impacting the businesses both from the payer side and the provider side in terms of digital, what customers are expecting or your patients are expecting from these companies? And how are you hearing that or how are these companies hearing what the customer expectations are?

David Edelman 

Well, I think customer expectations for digital skyrocketed during COVID and COVID accelerated the demand for doing as much as possible online. So all of the stuff Mark that you talked about a bit earlier, such as scheduling appointment, getting appointment reminders, and in many cases getting access to telehealth, you know in the moment, on the spot, you know, those are all expectations that consumers have. And now it's just part of what they standard expect. If I need care, after six o'clock, I shouldn't be stuck. I should be able to get telehealth, for example, if there's an urgent care center nearby, I want to know if I can go in right now. What's the waiting line for it? I want to also make sure I know right away what's covered and what's the network you know all of that.

So the tools have adapted and certainly, COVID accelerated everything really plowed in all of the capability development. Where I still think there are challenges where consumers are, there still a gap, is all of the economics behind it. Still, consumers feel that there's a lot of mystery in terms of what they are charged. How they can manage avoiding charges as much as we may educate them.

There's still a lot of really basic things in the healthcare system that are hidden charges that are taking the legal system and legislatures things to work through. Like the fact that your anesthesiologist may not be employed by the hospital you're in and could be part of a large chain of doctors managed by a private equity firm that's not part of the network. But, yet that anesthesiologist is seeing you in the hospital and you don't have much choice. It's a separate bill.

And so you're seeing Congress dealing with those kinds of charges. You know, people want transparency. I mean, what else do you buy where you're not going to be told the cost until six weeks later? I mean, what else? So that's where things have gotten. Still, they're still out of control. There'll be more transparency with interoperability, but still a lot of aspects of the system do not make it easy for people to navigate from a cost perspective.

Mark Levy 

Within the running of any of these businesses data is hugely important. So I find a lot of companies still have data silos where they're not able to understand the journey of a customer whether they went online, went into the store went to the doctor, what happened. There's that then there's artificial intelligence and machine learning opportunities. There's conversational design, where do you see a lot of that going in terms of data, AI, and machine learning in the digital experience for healthcare?

David Edelman 

Oh, it's becoming absolutely critical and one of the first areas, for example, where we leaned in heavily on AI was the journey that I talked about in terms of ongoing member engagement. Where we know that you're of a certain age, over 45, let's say, time to get to go and ask to be we know we want you to get that, but we don't know how to get you to do it. And we want to do it in a way that also doesn't piss you off. And doesn't just make you think we're spamming you and turn you off to all the messages we might send and so AI is absolutely critical to drive the experimentation, the personalization, the managing massive multivariable testing at scale that's required to manage that.

So we set up, we call them pods, behavior change pods, where we had integrated teams of marketing strategists, analytics, creative we had support from compliance and IT, there was marketing operations in there. And they would take a basket of particular actions that we wanted to get various people to do. And they would be driving every single week programs going out the door on a very rapid basis, and they built AI tools that would help them set up the sample sizes for the tests, manage the complexity of having all this stuff going out the door at the same time. They started utilizing also Salesforce marketing cloud, which was one of the tools that they use, develop more AI capabilities, you can use that to think about things like time of day management and stuff that were built into that.

And so, more and more AI was used to figure out how things go out the door. And based on how people respond, learn more about them in an individual fashion, and then optimize the next. And the beauty of AI and this kind of system is it allows a lot of creativity and innovation. So you can come up with new ideas every week that we can throw into the hopper and then see for whom did it work for whom did it not? Versus before it was all just simple A/B testing. So you take a whole population, and you try to come up with something better. Maybe it worked, maybe it didn't but it was all averages, and the key is aligning it to different people's needs. And so managing that complexity is what AI enables you to do.

And now, for example, there's a whole business and I will confess I am an advisor to this company called Icario health that actually created a whole business supporting health plans on doing behavior change marketing. So they've built a whole set of ai engines and there's a number of them along the way to help payers manage this whole process. And so that's an example.

I think you're going to see it also in terms of the back end I talked about approving whether or not somebody should have access to certain kinds of care. Increasingly, that's not going to be done by doctors in the back room. It'll start with AI screening it based on a whole lot of factors. And then for the things that the AI thinks might be turned down, those will get kicked up to a human for final approval. So the AI wouldn't do the negative but it can approve the positive.

And then you're also seeing things like AI being used to screen things like X-rays and to see did the right thing be found another company I actually work with Videa Health does AI for dental X-rays, and that allows dentists to get a dramatically better view of what's going on in someone's mouth and it even shows things that can lead to help them with broader health implications downstream. And it's proven that together between the dentist and the AI they find more things.

On the other side, though tools like that also help the insurers in case there's problems with the X-rays coming in, duplicate X-rays. You know, there's sometimes waste abuse and fraud that comes in and so the insurer is going to use that to screen it. And all of that works to the benefit of the patient. You're getting higher rates of health outcomes. You're getting lower cost along the way. And I think we are just seeing the tip of what AI can do.

Mark Levy 

Yeah, that's all of that's super exciting. David, I really appreciate you taking the time to share with us your experience and your thoughts on the healthcare environment and where things are going. It’s been great to speak with you. I wish you all the best.

David Edelman 

Thank you so much, Mark. My pleasure.

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