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Becker’s Healthcare Podcast
Healthcare Upside / Down: How BCBS Massachusetts Predicts Churn, Empowers Brokers, and Wins More Business
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- [00:00]
A
Hello everyone and welcome to Healthcare Upside Down, a podcast by Becker's Healthcare and ECG Management Consultants, where we'll explore the upsides and the downsides of healthcare and the industry's most current trends. I'm Erica Spicer Mason from Beckers and today I'm joined by two guests to discuss a growing challenge for health plans and that is client retention. So today we'll explore why staying ahead of risk is so difficult right now and how organizations can take a more proactive, data driven approach to understanding customer sentiment and improving long term performance. So the two special guests who will walk us through this today are Steve Moorhead, the Vice President of Product Strategic Planning and Performance Management at Blue Cross Blue Shield of Massachusetts, and Mark Pierce, Principal at ECG Management Consultants. Steve. Mark, welcome to the podcast. Thank you so much for being here today.
- [00:54]
B
Thanks for having us, Erika.
- [00:55]
C
Thank you. Great to be here.
- [00:58]
A
Well, it's great to have you both. And before we get into the meat of the conversation today, I wanted to see if you could both just share a little bit more about your background, our listeners, a little bit more context on where you're coming from. Steve, do you want to get us kicked off with intros?
- [01:13]
B
Yeah, sure, I'd be happy to. So, Steve Moorhead, Vice President of Products Strategic Planning and Performance Management at Blue Cross of Massachusetts. Hate to say, but I'm hitting my 30 year mark in the payer space. Throughout that history I've had great opportunities to work across a number of different spectrums, whether it's on the network side dealing with our provider community. Spent some time in the clinical ops area and then most recently on the commercial side of the house. So where I work today is with our commercial sales and marketing teams. Obviously with the three areas of my focus, we help build the commercial products as we bring them to market to help meet our clients needs. We evaluate where we need to make some strategic investments and where we really need to focus to continue to hit the value that the market's demanding of us. And on the performance management side, we evaluate how we're doing on metrics, whether it's close ratios, membership retention, financials, and really look to drill into specifics at segment levels, industry levels, all the way down to account levels to really determine how do we best hit the market. So a lot of that work comes together to sort of figure out how do we best drive value for our accounts. So throughout my continuum of my career, a lot of my focus has been on value. How do you make sure that we're hitting the marks when it comes to value in the healthcare space, not an easy challenge, but it's something that I think keeps me coming back every day.
- [02:24]
A
Well, that's great to learn about you, Steve. Thank you so much, Mark. I'd like to turn it over to you next. Can you share a little bit more about yourself and your work?
- [02:33]
C
Sounds good. I'm right behind Steve. So I'm approaching 27 years in the industry. I'm a principal with ECG. Over the last 27 years, I've worked with just about every health plan, so all the nationals, most of the blues, a number of the provider sponsored local and regional carriers. And my focus has always been on driving profitable growth. So a lot on acquisition, retention, new product, innovation. Been working with Steve for many years and just a pleasure to be here today.
- [03:06]
A
Well, Mark, thank you so much. It's a pleasure to have you both on the line. And I know in the beginning of my remarks I had kind of hinted at this, this issue that many organizations in the industry are facing right now, and that is client retention at health plans. So I'd love to know from where both of you sit, why is client retention such a pressing challenge for plans right now? And what does it look like when a plan is struggling to get ahead of it?
- [03:35]
B
Yeah, I can chime in here if you want. So, in the commercial markets, our clients are always pushing for value. I think as you start to see medical expenses climbing, that pressure on value continues to grow. Our experience has been as that emphasis on value drives more and more across the market. You're seeing more and more movement, more and more activity. So a lot of accounts are going up to bids that have been with us for a long period of time. There's a lot of opportunity for new business acquisitions as part of this. So there's definitely a risk when it comes to the health plan space, when you're talking about sort of increased expenses and activity in the market. But it also creates opportunities for us for growth and retention as a blues plan. I'm very fortunate to say that we have some strong products and some strong network and a great discount, but there's a lot of demand out there for value. So understanding really what's driving decision making and what's most important to the accounts in aggregate, again at segment levels or even down to the individual account basis, is really critical for us to make strategic plays on where we're going from a strategic direction, but also what's best for that individual account. Getting more insight there really helps us sort of cultivate an approach and strategy direct to the consumer's need and direct to the market's needs. So it's really critical, particularly in moments where the market is increasingly active, like it is right now.
- [04:49]
A
And Steve, you mentioned this kind of need for insights on a regular basis here. I would love to know what you've faced in terms of specific gaps in that realm, whether it's data visibility or even processes that have made it hard for. For Blue Cross Blue Shield, Massachusetts to be maybe as proactive as you've wanted to be.
- [05:12]
B
Yeah, it's a great question. And I think that the gaps are a little bit across the board from the data, the process, and the insights across. It's really challenging with a diverse set of clients to really understand what their specific needs are. Obviously, if you look at segments, there's some similarities there, but not every client and not every account is the same. So to be able to get to that specificity of what's really driving that is really important. We have really strong relationships. I'm very proud of the sales team that we have in place. They know their accounts well, they work well with the accounts. We work well with our brokers and consultants in addition, and they provide us a lot of insights. But being able to really get some candid feedback that you might not get into face to face, but really insight that you can really understand what's driving account decisions, what's important to them. How we're doing on those things that are important in a really unblinded manner helps us a ton of. It also allows us to roll that up into different cuts. You have to be able to really get that candid feedback in a way that's structured and digestible and a way that you can aggregate and really make some informed decisions. In the past, a lot of this feedback was coming from conversations. It can be a little bit anecdotal. Again, we know the market well, we know our clients well. But sometimes a squeaky wheel might skew a perception. Sometimes you may hear two or three clients that are saying they have an issue here and it might be explored to those particular clients. So being able to take a step back and look holistically at the market really is important. You don't want to chase sort of false negatives. You don't want to react on things that are minor blips. You really want to sort of pinpoint where you're investing your resources and your focus on where the true problems are. And we have a pretty good sense, but you really need the data to validate that.
- [06:46]
A
Yeah, Great points and I appreciate the overview, Steve. Mark, I want to turn it over to you next. You know, I'd like to hear your, your high level perspective on this issue of client retention at health plans, but also from where you sit working with payer and provider organizations alike. How common are these gaps that Steve is describing and how are you addressing that at ecg?
- [07:09]
C
Yeah, no, I think Steve is spot on. You know, over the years we recognize that health plans put a lot more emphasis into acquisition and far less into retention. And as Steve noted, they tended to rely on more ad hoc or less structured approaches. It could be account manager feedback, could be broker feedback. It could be doing a net promoter study, which, you know, I'm not a big fan of the net promoter score because I do not think that it's a great indicator of client retention. And so for that reason they would find themselves often as leaky buckets. Often the clients that make the most noise are the ones that get the most attention. But the hundreds or even thousands of other accounts that fall below the radar, they get to contract renewal only to find out that they're not going to renew and by then it's too late. So I follow up right, with what Steve's saying. And on the provider side, it's a little bit different for the provider because the primary client is the patient. Then it's more about patient retention, which is also an equally if not more important issue, which is how do you engage and retain that patient. So that's why at ecg, the software that we've built and we'll talk about in a bit works both on the client side of retaining customers, but also on the patient side.
- [08:40]
A
Fantastic. And excited to learn more about that. Mark. Steve, I want to loop back with you to just learn a little bit more about how your thinking has evolved. You know, you've, you've touched on this need to close some of those visibility and those data gaps with greater insights. What approaches did you try before landing on your current approach to customer sentiment tracking and retention? And can you tell us more about the approach that you're using right now?
- [09:08]
B
Yeah, a lot of the insight we gathered before was coming from conversations. It was coming from again, our sales team, our market facing team, looking at what we're hearing as far as calls on our member service areas. Just pain points that you sort of come across as you're doing your day to day business. And that's all great. It's all anecdotal insight, oftentimes always on the mark. It makes it kind of hard to prioritize. Unfortunately, it's not always one issue. Sometimes you hear multiple issues and then which one's the biggest. If you're hearing feedback on three things, who happened to be loudest in the conversation. The data really helps you quantify that and help set priorities. It also helps build business cases. It helps us to understand, you know, what could be the impact if we solve a solution. We don't solve a solution. So really what we've tried to do is in working with Mark is leverage the data to identify if there are issues with a particular account and can we get that over to our account management team to help close gaps and really address some of those concerns. And some of those might be as minor as an education opportunity where the client may not have known that we have a solution in place that does X, Y and Z and their problem is X, Y and Z. So it's really a matter of education or getting them on the right path to an answer that goes a long way. And then what we often do is we take that data and we look to roll it up into different cuts. And based on that rolled up data, we start to see when we pair it with other performance data, if we're falling behind on our desired new business in a particular area, what are those types of clients saying about us and, and what could we do to help sort of boost our offerings and drive the value that they're seeking. I mentioned earlier, while we serve a variety of clients, there are some similarities, but every client is somewhat diverse. So the ability to flex down to the individual accounts needs, but also up to that sort of subsegment need allows us to both meet from a relationship perspective, account specific strategies, but also prioritize where we're making investments and prioritizing our own work to meet larger market needs. So that's really where we sort of evolved in the last few years.
- [10:55]
A
Yeah. I appreciate you shedding some light on what that evolution has looked like. And I understand this partnership with Mark's team and leveraging the stamp software, which is the software that Mark had alluded to just a moment ago. Can you share a bit more about how you're applying that software's capabilities in practice? You know, is it around retention, broker relationships, even competitive strategy? I would love to know just a little bit more granular detail on what acting on those insights look looks like for your teams who are in the field?
- [11:25]
B
Yeah, sure. So we work with Mark on assessments of our accounts in the retention area. We also have done some work on our broker and consultants feedback and get some insights there. We also work with Mark on a couple other fronts, looking at some loss reasons for accounts and prospects that we have not retained or won. I'll take the assessment on the retention side and what will happen is if we have a response come in through that assessment where the scores might come in lower than we'd expect or we'd like, we immediately flip that over to our account manager and we say account X had responded and the survey is below what we would like. We then use that data to help define what our outreach plan is, what our mitigation plan is, and really how do we meet those accounts needs. We meet with our accounts regularly, usually operational meetings, and we understand what their pain points are. But this really gives us some candid insights that we might not get in those day to day meetings. I'm asking questions that they may not bring to the table. So it does provide added insights. So that's what we sort of handle on the individual basis. And then on the prioritization side, I mentioned this a little bit earlier where we'll look at themes, we'll look at themes that are coming up across segments or sub segments, we'll evaluate the data and we'll start to see what are the types of accounts that we're targeting or we're building a particular solution on, what are they looking for and are we hitting the needs for what they're looking for. And those are really the kind of the two big pieces in which we were sort of putting the data in place today. It's as results come in, we flag them right away and get them to the account managers. And then as we do our annual plans or our periodic plannings, we roll up the data to sort of inform that and provide guidance from that front.
- [12:52]
A
Steve, thanks so much. And Mark, I want to give you the opportunity to weigh in as well. Whether it's, you know, some of the capabilities that Steve is talking to with stamp or even other outcomes or efficiencies, you've seen other partners gain with this approach.
- [13:07]
C
Great. Yeah. Steve mentioned one of the components is an assessment and that's spot on. We systematically will reach directly out to the decision makers in the accounts. And what we're really trying to find out is what is driving their decision to renew. And then we're assessing how well in this case Blue Cross and Mass is delivering on those needs. And then we're looking at the gap between what their expectation is and what delivery looks like. And from that data we're able to aggregate it and develop a score. And that score essentially tells you the risk of churn. And then further what we'll get is a bunch of other data such as the segment they're in, the size, who the account manager is, the account value. And so Steve is able to take that data slice and dice it. So as he mentioned being able to drill down, he's able to see is it a very client specific issue or is an issue to some critical sub segment such as a self insured account or a mid size account. So by having all that data he has something that is far more powerful than the anecdotal data that he mentioned that they used to use. Where, you know, we're all sort of data jockeys. Data is proof and so this data can be used to fuel greater buy in and decision making across the organization.
- [14:40]
A
Yeah, great perspective, Mark. Thank you. And Steve, I know a lot of what we've been focusing our conversation on is really this ability to look ahead and not have to react to churn or retention issues, but to get ahead of them. So in that spirit of proactivity, can you share an example of what an early warning sign that surfaced when using stamp, what that has looked like and what happened as a result. And more broadly, what impact are you seeing in those early catches?
- [15:12]
B
Yeah, great question. One of them I alluded to earlier. We may have an account that we think we have a great relationship with and we get some candid feedback in the score, in the assessment and the STAMP score is low. And when that STAMP score is low, it immediately sort of draws attention to folks like, whoa, we thought we were doing great with this account and we're getting some really negative feedback. It allows us to really lean in quick. So those are really valuable opportunities because sometimes we won't know that until we come up for the renewal and we start to talk to them about staying with us and they'll bring back issues that they've had with an experience or something that wasn't meeting their specific level of satisfaction. We're getting that a little bit more real time with the stamp assessment and we're able to act on it quickly. Other things that we're able to see, because we've been working with Mark for a couple of years is some trends we're able to see if we're seeing a particular score start to decline or if we're starting to see some impacts from work that we put in place and we see a score starting to increase. We often look at a number of capabilities and what capabilities are important to our clients and then how well we're doing on those capabilities and looking at some of the trend numbers of those allow us early indications to say, hey, this is becoming more and more important to the market. And it's an area where we may not be scoring as great as we'd like, or this is an area we're really strong, but the importance of that might be dropping and maybe we need to invest somewhere else. So it does allow us to get a sense of where the market's moving and what the market's feeling. The big thing for me that I think we use this for, and Mark kind of touched on this is prioritization around initiatives where we always have a laundry list of things we want to do. We have a lot of really creative people at the plan that really want to sort of continue to evolve what we're offering. But there is a finite amount of resources and capacity each year to do those things. We're able to use this data to say, here's what the market is saying as far as importance or performance or where they're seeing their gaps, either from the quantifiable data that Mark talked about or even from some of the verbatim feedbacks. And then we're able to sort of identify how do you prioritize among those lists of really good ideas? And we try to do that on a proactive basis. A lot of what happens in healthcare is reactive based on claims data and claims experience. This gives us a little bit more insight into what the market's actually asking for.
- [17:12]
A
Yeah, that prioritization piece. Just hearing in this small conversation today, what it sounds like is on your plate. Being able to narrow it down to the most important things, I imagine goes a long way. Mark, have you noticed similar benefits arise in. In other partners or anything else that you'd like to highlight in addition to what Steve has said?
- [17:32]
C
Yeah, no, I agree. Steve is spot on. That ability to really hone in and identify the top 1, 2, or 3 things to focus on. These are turbulent times in the health industry. Lots of plans are losing money, growth is complex, government regulation changes constantly. And so knowing how to reinvest the, you know, precious or limited dollars that you have in the right areas where you can get the. The best ROI is critical. And so having that data and informing those decisions gives you a great leg up.
- [18:13]
A
Yeah, absolutely. Well, it's been a great conversation with you both today as we wrap for health plan leaders who are still managing these relationships with their clients more reactively. Would love to know if you have Any parting advice for those leaders and is there anything else that we haven't touched on that you think deserves more attention in this conversation?
- [18:35]
B
One piece of advice I would have is the granularity that we need to really hit the market needs. In my experience, it's getting greater and greater. It's not as simple as the old days of an indemnity health plan. The needs are very diverse and you really need to understand your clients as close and as grand as you can. The other thing is timing. Timing is key here. I think there is value in looking at the data you have, but there's also value in sort of understanding where the market is going. And the more data you can get on where the market's going, I think the better decisions you can make and the more quickly you can make those decisions. And when we're looking at how to best meet the market needs, it's really about that timing aspect of its speed to market and making sure we're hitting the mark. The marks are different. It's not as simple as everybody wants. X. There's some similarities. I'm not going to lie. There's a lot of similarities here, but you really need to be precise in where you're going and where you're targeting. Data is king here. We see it. Whether it's advancements in AI or the usage of data across the board, the more informed you can make your decisions, the better off you'll be in the long run.
- [19:36]
A
Yeah, great. Final notes. And Mark, what would you add to close us out?
- [19:41]
C
Often I'll hear that senior leaders will say, well, we don't have a retention problem. Our retention is at 98 or 99, 9%. And when you dive into that, what you actually find is, yeah, the net retention is. So they look at how many accounts they lost and how many accounts they brought in and they're like, oh, we, we netted out about even. Well, imagine if you didn't lose any accounts and you grew more, then you're talking about significant additions to your top line. So that's probably one big point is to reinvesticate how it is that you're viewing retention. And then the other thing is that given that these accounts in many cases are worth tens of thousands, and when you get into larger accounts, I mean, they could be millions and millions of dollars. So we find out for many of our clients that the ROI is significant, hundreds, if not thousands, because the software that we provide is not very expensive. And so if you save just one account, we often find that it will pay for itself 10, 15, 20 fold.
- [20:48]
A
Yeah, some impressive outcomes you're touching on there, Mark. And I just want to thank you both for highlighting this issue for our listeners and talking through what you're seeing work. It's been great having you spend time with Beckers today, so thank you again for making the time.
- [21:03]
C
Thank you. Appreciate it.
- [21:05]
B
Yeah, appreciate it, Erica. Thanks for the opportunity.
- [21:07]
A
And we'd also like to thank our podcast sponsor for today, ECG Management Consultants. Listeners, be sure to tune into more podcasts from Becker's Healthcare by visiting our podcast page@beckershospitalreview.com.