Establishing a shared framework for understanding and improving Member Experience from the right data
Through the pandemic customer adoption of digital-first healthcare increased significantly. In response, customer feedback on these tools increased and health plans recognized the strategic business value impact of member satisfaction on renewals. For many organizations to that point, the tooling, and analytics to understand member satisfaction was limited to behavior flow analysis tools like Google Analytics.
On their own, health plan clients were struggling to get the visibility they needed to respond to customer friction. As members tried to navigate health care, the NPS surveys popping over web pages at random times throughout a member experience were cataloging client issues into the wrong journeys and the system to classify small qualitative data sets was creating undue urgency to address product improvements.
Recognizing the strategic importance of finding care and cost in the end-to-end member journey of healthcare, clients asked Zelis to build a better method of understanding members within our embedded experience.
Member confusion in healthcare is real
75%
of people on a family member’s job-based insurance reported feeling “completely lost” in trying to understand health insurance
Building a Member Experience Insights Engine based on the combined power of qualitative and quantitative data.
With a curated set of clients from across the country, we established a working group to build a new measurement model. This group came together to agree on the end-to-end customer journey common across their businesses—and specifically where finding care and cost started and stopped within that broader health plan consumer journey. They aligned on the consumer goals and business outcomes within the “shopping journey” in order to develop a bottom-up member experience (Mx) measurement model. We then led the co-design of a three dimensional model for customer measurement rooted in prioritized “micro-journeys.”
Within 6 months, we launched the “MX Index” using Pendo and PowerBI. The upgraded analytics solution captured member satisfaction along three dimensions (CSAT, GCR, CES) across 5 initial micro-journeys. This shared measurement architecture was made available to all clients which enabled us to generate an annual member satisfaction baseline and quarterly member experience insights reports for use internally with key internal stakeholders and for clients to use within their own organizations as they continued to advocate for customer-centered improvements.
For our product management practices, the data and insights generated through these new tools became the foundation of our continuous discovery process. Monthly UX sessions hosted by our UX Research and Design team engaged clients in open discussion and review of the qualitative and quantitative results to categorize and prioritize product improvements.
Establishing a unified view of continuous improvement value cycle
In consumer-facing white label solutions, changing elements of an experience can be complex—especially when those solutions are coordinated with other systems to deliver for the end users. Regional differences, account specific needs, and product configurations all impact what the end user sees. Establishing a simplified data-driven continuous improvement value loop allowed the team to:
Focus on the user goal and ensure that the decisions being made help that end user accomplish a goal.
Consider the experience in relationship to other micro-journeys to ensure that decisions made to optimize one experience don’t erode another part of the journey.
Align nested consumer journey across coordinated experiences
Shopping experience can be different for everyone. Age, plan type, technology savvy and other factors have an impact on how people react to stimulus and engage with tools. The S365 and SmartShopper member journeys nests within the plan journey.
Plans measure tNPS of provider finder through surveys outside of S365, allowing Zelis to capture micro-journey CSAT and baseline the plan against other clients.
The plan/client measures are captured outside of the S365 experience
Mx Index captures inside of the S365 experience
SmartShopper Program NPS creates additional signal on member satisfaction.
Establishing the Experience Levers for change within the system
To drive meaningful MX improvement, we defined that the member experience must be evaluated by looking at five interconnected levers to plan and prioritize change that has the most impact.
INHERITANCE ISSUES: Issues impacting member satisfaction with the provider finder experience starting before entry into S365.
EXAMPLES: SSO payload load time, portal placement and visibility
CONFIGURATION ISSUES: Config decisions related to feature functionality, messaging, or things like specialty mapping. EXAMPLE: business reason to not display OON providers in result set, specialty keyword mapping, confusing banner language
USER INTERFACE/USER EXPERIENCE ISSUES: The components, information hierarchy, content layout, or general accessibility of a page design are impacting a user’s ability to accomplish their goal(s).
DATA ISSUES: Data displayed within the UI components (both local and national) is either out of date, incorrect, or missing. EXAMPLE: Out of date ANP data
PERFORMANCE ISSUES: Issues with overall application performance from a code perspective (can be related to SLA and impacting SLOs and SLIs). EXAMPLES: latency issues, data won’t load
The Mx Index Improvement Cycle
Micro-journey-level Survey Placement
Continuous Discovery from Synthesis
Validated Improvements Delivered
Pendo Guide surveys placed at the end of the micro-journey allows for the highest likelihood of collecting accurate qualitative and quantitative information about the experience because it happens both in the in context of the outcome the member is seeking.
Product & Design adopted a shared "continuous discovery" methodology to support better alignment to strategy, an outcome-driven mindset, and clear visualization of opportunities and alternatives.
Prioritized and validated UI solutions are pulled through to the continuous improvement backlog and prioritized into the next available release.
Product Manager, Find Care at CareFirst
“The MX Index was instrumental in helping our leadership refocus our member experience improvement goals on the right measures. By having this better alternative, we were able to remove NPS from our executive metrics in favor of CSAT.”
Capability Product Manager, Premera
“These Mx Workshop discussions have been really great discussions, especially with the research orientation behind them rather than some time ago where they were more general discussions. Having it grounded in that research and what have you found and then giving us a chance to react to it and consider our reactions has been really valuable.”
Results
Outcomes
Demonstrated thought leadership and analysis for trends in our product.
Surfaced already available configurable features that clients may have missed in set up or day -to-day tool management.
Drove alignment between Zelis and client roadmaps for continuous improvement updates—bringing greater clarity to the specific category for improvement—inheritance, data, configuration, UI, performance.
Enabled Sales, Account Management, and ICS to drive client conversations about activating available features and capabilities correlated to their member satisfaction issues.
Validate UI concepts and drive client adoption for recommend experience improvements.
Surface UX research in the context of recommended improvements.
Recommend measurable roadmap candidates for the annual roadmap process
Key Measures within the First 6 Months of Launch
8 Health Plans onboarded enabling access to a potential 40M members
18.9K respondents across all live MX clients
558 user research participants (moderated & unmoderated) provided input on prioritized MX Index scopes
6,000 text responses with qualitative feedback
Established average baseline CSAT for finding care at 50
Shipped 8 prioritized data-driven continuous improvement scopes based on the results and client validation