Reconciling the Great Healthcare Consumer Paradox: Are consumers willing to change to get what they


About the Accenture Health Consumer Survey
Accenture conducted an online survey of 3,209 healthcare consumers over 18 years of age in the United States. Insured members included Medicare, Medicaid, Group (Defined Benefit and Defined  contribution),

Individual (purchased directly through Insurer and purchased through Broker), Uninsured Consumers(subsidy eligible and non-subsidy individuals) and small group decision makers. The survey was conducted in June of 2012. The analysis included advanced analytics to draw insights as well as develop healthcare consumer needs-based segments that transcend traditional market/product segments.

The Affordable Care Act (ACA) will introduce approximately 51 million people to the individual healthcare marketplace, 34 million who are currently uninsured and 17 million employees of small businesses1.

As the individual healthcare insurance market expands, so do the challenges these healthcare consumers present. According to Accenture experience, individually insured members contact call centers up to six times more than employer group members. Other research shows that nearly one-quarter of uninsured adults go without needed care due to cost, compared to only 4 percent of those with private insurance.

The uninsured are at higher risk for preventable hospitalizations and for missed diagnoses of serious health conditions. After a chronic condition is diagnosed, they are less likely to receive follow-up care2. The newly insured are 32 percent more likely to go to the emergency room than continually insured consumers3.

When these consumers enter the retail healthcare marketplace for the first time, it will be critical for healthcare insurers to engage them in making good healthcare decisions. In today’s marketplace, healthcare insurers are struggling with the right way to engage consumers. In fact, 57 percent of employers say that lack of engagement is their biggest obstacle to changing their employees’ health habits, however, just 12 percent say their healthcare insurers are delivering effective engagementcapabilities4.

What do retail consumers want, and are they willing to change?What is getting in the way of effective consumer engagement?

Accenture set out to answer this question by asking 1,900 U.S. retail5 healthcare consumers about their healthcare needs and behaviors. This paper explores the paradox of what healthcare consumers want and how they behave, and the barriers that insurers face in effectively engaging them.

Retail healthcare consumers value affordability above all, but aren’t willing to make certain tradeoffs that impact health care costs.

For retail consumers, their number one concern with healthcare today is affordability. Nearly three out of four retail consumers cite affordability as a bigger concern than access or quality of care, compared with less than half of non-retail consumers6.

The subset of the retail healthcare marketplace that is uninsured and eligible for government subsidy7 feels even more strongly, with 84 percent citing affordability as their chief concern.

Consumers want low monthly premiums–80 What healthcare consumers find most important when purchasing health insurance percent of subsidy eligible consumers within the retail marketplace rank it as the most important consideration when purchasing healthcare insurance.

The second most important consideration for retail healthcare consumers is low out of pocket costs when they go to the doctor. However, less than 20 percent of these consumers believe it is important to understand the cost of care in advance, or to track and budget their healthcare expenses.

Despite cost being paramount, less than half of consumers are willing to change brand prescriptions, or use a nurse practitioner instead of a doctor for routine visits, and less than a third are willing to change hospitals or primary care doctors.

In most health plans today, the benefit from consumers making these sorts of cost-saving tradeoffs goesprimarily to the insurer or employer. To effectively engage consumers in making care decisions that can reduce medical costs, insurers will need to apply the appropriate level of incentives to ensure that there is a direct benefit to the consumer. Effective engagement will also require that insurers clearly communicate the value of these cost saving opportunities to the consumer at the right time.

Retail healthcare consumers are digitally savvy, but continue to demand live service from their healthcare insurer.Nearly three out of four retail healthcare consumers want a live person to answer their questions and resolve their issues, and only a third think it is important to have self-service options for resolving their own issues.

These same consumers are using technology Channel usage by retail healthcare consumers in their everyday lives, with more than four out of five emailing and spending time online daily, and more than half texting and visiting social media sites daily. Unfortunately, retail healthcare consumers’ digital proclivities are not carrying over into their interactions with their healthcare insurer. An earlier Accenture survey showed that most patients want to self-manage healthcare online8, and this survey finds that nearly 60 percent of retail healthcare consumers use mobile apps. However,fewer than 10 percent of retail healthcare consumers use their healthcare insurer’s mobile app.

Only about half of retail healthcare consumers who interact with their insurer via any channel are satisfied with the interaction, although satisfaction with web chat is slightly higher (54 percent) than satisfaction with customer service calls (52 percent), and satisfaction with email interactions is the lowest of all channels (50 percent).

As other industries serving the same consumers continue to advance their own digital capabilities,they raise the bar on retail consumer expectations.

Accenture’s digital diagnostic tools have shown that healthcare insurers’ digital capabilities significantly lag other industries.

Retail healthcare consumers are likely to continue demanding live customer service and resisting self-service until insurers’ digital tools and capabilities become more relevant and effective. As insurers continue to invest in digital capabilities, it is crucial to understand what consumers are trying to accomplish in each interaction, and ensure that tools are designed in a way that easily meets consumers’ needs.

Healthcare consumers want guidance on improving health and wellness, but aren’t following the guidance that’s given.

More than three in four retail healthcare consumers say that the most important thing when receiving healthcare is help improving their health and wellness, and 65 percent need support and guidance after a major diagnosis or treatment. However, few consumers are satisfied with the support they receive from their insurer in these areas.

Complicating matters for insurers is that only one out of four retail consumers say they trust insurers to provide guidance on improving their health, compared to 54 percent who trust healthcare professionals to provide this type of guidance. In addition, although 81 percent of subsidy eligible healthcare consumers surveyed want help finding ways to improve their health and wellness, 40 percent of these same consumers don’t identify going to the doctor for regular checkups as a priority,and 26 percent say they do not do anything about their health until they are sick.

As new retail healthcare consumers enter the market without employer support, it will be even more critical for healthcare insurers to engage these consumers directly in ways that are relevant to them. Insurers will need to build consumers’ trust in order to advise, and ultimately motivate, consumers to change their behaviors in ways that improve their health and the affordability of healthcare.

How to Solve the Great Healthcare Consumer Paradox
The shift from a wholesale to retail model in healthcare insurance has prompted significant investments in consumer technologies and infrastructure. Health insurers have been busy developing multi-channel retail marketing capabilities, implementing new retail sales platforms, upgrading customer service desktops, and deploying member tools to increase transparency in cost and quality of care. In the near term, the typical focus for these insurers is increasing retail consumer acquisition and scaling their infrastructure to meet the new demands of the retail marketplace.

The larger, more transformative opportunity for healthcare insurers is to leverage these investments to positively influence consumer health and healthcare behaviors. This will require effective engagement, education and motivation of consumers through relevant product offers, services and information, and timely and personalized interactions.Insurers will also need to adopt new consumer competencies

across their organizations and consider leading practices from more consumer-oriented industries such as financial services, hospitality, retail, and consumer products.

Becoming customer-centric
A customer-centric transformation will enable insurers to effectively engage retail consumers in smart healthcare choices to improve their health and save them money;solving the consumer engagement paradox and helping insurers build brand loyalty in meaningful ways. This transformation is all about aligning a health insurer’s investments, products, services and processes with the needs of its consumer segments to maximize value. In healthcare, the definition of value may involve multiple dimensions including financial, health, quality of life and community outcomes.Customer-centricity is a C-suite imperative, and for health insurers, it requires new enterprise-level competencies.

Accenture’s Customer-Centricity Model defined:
Know the Consumer: Customer-centric organizations establish a centralized consumer profile and develop an integrated view of their consumers over time and across channels, products and lines of business. This becomes the foundation for consumer segmentation and advanced analytics to understand consumer needs, expectations and value potential.

Tailor and Innovate the Offer: Once customer-centric organizations know their consumers, they apply this knowledge to design, package, market, and evaluate relevant consumer products and services.

Personalize the Experience: Customer-centric companies also apply consumer insight to deliver a multi-channel experience that enhances consumer interactions and exceeds expectations. This requires that segmentation and consumer knowledge be operationalized for use in consumer-facing channels, and often requires centralized interaction management and decision logic.

Align and Empower the Organization: A key success factor in operationalizing and delivering relevant products and a superior consumer experience is engaging the insurer’s employees. Without organizational alignment and governance, even best-in-class capabilities are not likely to move beyond the department that created them,or to be sustained over time.

Barriers to customer-centricity
Many health insurers have recently made customer-centricity a top priority in the face of healthcare reform and the new retail marketplace. Some have made great strides in developing consumer-oriented branding,public relations messaging or appointing a consumer experience officer. Others have launched consumer data infrastructure and analytics initiatives, and have begun re-platforming marketing, sales and service solutions. The progress is promising; however barriers in these organizations still exist.

Accenture’s extensive experience with health insurers, as well as with leading customer-centric organizations in other industries, suggests there is a path forward.

Health insurers have the opportunity to embrace the key elements of successful transformations that have been tested and proven outside of healthcare for years. How these elements are addressed and the relative energy and investment required will depend on the health insurer’s strategic objectives, where they are in the customercentricity journey, the organization’s current capabilities and its capacity to change. Removing these barriers will require a coordinated, purposeful change agenda that takes into account people and processes, as well as technology. By reconciling the new healthcare paradox, health insurers can be better positioned to achieve high performance.

1 Mannatt Health Solutions, 2012. The Supreme Court Decision on Healthcare Reform.

2 Kaiser Commission on Medicaid and the Uninsured, 2012. Five Facts about the Uninsured Population.

3 Archives of Internal Medicine, March 26, 2012 “Health insurance status change and emergency department use among U.S. adults”

4 17th Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care, 2012.

5 Retail healthcare consumers are defined as consumers under 65 years of age who are uninsured, have individual coverage, or insured through their Small Group Employer (<100 employees). These consumer groups are widely assumed to make up the majority of the individual healthcare marketplace by 2014.

6 Non-retail healthcare consumers are defined as consumers under 65 years of age, covered by Medicaid or insured through a medium to large employer group.

7 Subsidy-eligible consumers have incomes between 133 percent and 400 percent of federal poverty level in the 48 contiguous states, based on household size, estimated from the Congressional Research Services report, “Health Insurance Premium Credits in the Patient Protection and Affordable Care Act (ACA)” June 13, 2012

8 Accenture news release: Most Patients Want to Self-Manage Healthcare Online, Accenture Survey Finds. June 20, 2012.


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