The Next Big Thing in Health is a podcast where we explore the new big ideas that will help make health care more affordable, more available, and more effective.
AHIP President and CEO Matt Eyles and co-host Laura Evans were joined by Tabatha Erck CEO of Zipari, for a wide-ranging discussion on the importance of the digital customer experience and the keys to a successful customer experience for health insurance providers.
Eyles:
Hi everyone and welcome to the Next Big Thing in Health, a podcast from AHIP. I'm your co-host Matt Eyles.
Evans:
And I'm Laura Evans.
Eyles:
Today our guest is Tabatha Erck, CEO of Zipari. Tabatha has over 25 years of experience in health care and is focused on reducing health care costs, while increasing quality and access.
Spotlight: Zipari
Meet Zipari, the first and only CX platform created for health insurance. When it comes to building a better member experience, having the right tech is everything. With Zipari's CX platform, you're plugged into a powerful set of modern technology built specifically for this industry. With the member at the center of a well-orchestrated and personalized experience, everyone benefits. Meet your members where they are with engagement that has purpose. Zipari, let's break through together.
Eyles:
Welcome to the podcast, Tab.
Erck:
Hey Matt, it is great, Laura, to see you and talk with you, excited about this conversation.
Eyles:
Yeah, we are too, we are too. And maybe just a good place to start would be to share just a little bit of background and information about Zipari for us.
Erck:
Sure, that'd be great. I think there's a lot of individuals in the industry who may have heard about us, but we are the first and only consumer experience platform built specifically for the health insurance industry. There are a lot of consumer experience platforms out there but this one we only focus on the health insurance industry. And includes things like CRM to sales to digital experiences. You'll hear more in a little bit. I think we'll probably dive deeper into you know, what is consumer engagement includes portals and those things. Zipari has over 150 health plan and TPN clients, all focusing on lowering costs while improving the ROI and ensuring an efficient and meaningful conversations and outcomes between payers, members, and providers.
Evans:
So, Tab let's talk about why the digital customer experience in healthcare is so important today. And studies are really showing that consumers are preferring and are increasingly using digital means to access health care. So what is it that you're doing that's different and why our customers kind of going in that direction right now?
Erck:
Wow, that's a great question. There's a couple of dynamics that are going on right now. The first of which is the other industries that we partner with have are and have been leveraging digital. So when you think about organizations, Amazon and Google and Zappos and all these others, consumers and I would even say Walmart and others, consumers have come to appreciate and expect a digital experience. So health plans now are setting this as their number one priority and 23 and beyond. They want to engage with our members. They want to they want to get them more involved. They want to have more of an experience, but the telephone is a very expensive option. And believe it or not, most consumers don't want to call their health plan. Put on top of that there's more competition and different competition than ever before. As you heard earlier, I've got over 25 years of experience, majority of it, which is in the health plan space. The competition and the type of organizations that are coming out that are competing for these members is very different than we've ever experienced in my entire experience within the health plan space. There's a need to push down costs employers and others are looking for lower costs, including the consumer. The consumer is paying more than they've ever came before. Everybody wants more transparency. I want to understand what I'm paying for and what I'm getting in return for that. That's that value-based exchange that's there. The word trust comes up quite a bit. I want to be able to trust my health plan, trust my provider, get information so that I'm making informed decisions for myself and my family.
What's also really interesting is the Medicare market is also changing, the Medicare Advantage space, it's become more competitive than ever. It's also a highly regulated business. And we've got different consumers coming into that industry. They have different expectations. I like to joke around the Medicare Advantage plan today is not the plan and my grandfather. Not at all. It's very different and that competition also calls into star ratings and CAP scores. So plans are coming back and saying how do I increase these while not blowing my whole budget because I have a limited number of dollars of what I can do. When consumer engagement is done right and this is a lot of what we've been working on, health plans are going to get a higher ROI, better outcomes, higher member satisfaction, and lower costs. Give you some examples. We've increased one health plan I'm thinking specifically year over year their self-service tools have increased by 55%. That is significant. Those are real dollars. Those are phone calls. Not coming into the call center. So the call center folks can focus on other calls and spend more time with members who need more time. And another example we increased the usage of the telemedicine tools that they purchased, this health plan purchased, by 115% increase year over year. We've got many of our health plans that have gone from four to five in their Medicare Advantage star rating. And then last one which this number seems really insane. I always have to chuckle what I see it. How about a 1200% increase in closed medication adherence gaps. These are very significant real savings and improvements we've been able to make with our tools specifically around digital and consumer engagement.
Eyles:
You highlight some really great examples there, Tab. And maybe you could just dig a little deeper into, I mean I know we hear a lot about you know telehealth and telemedicine and consumer engagement across different platforms, but maybe could you just give a little bit more detail about some of these examples?
Erck:
Yeah, that's a really good point. I think when people think about consumer engagement, it's this ambiguous kind of term, but it really comes down to a member portal, a mobile app, a member service center, IVR, care and disease management, chat bots, email, texts, and even paper communications. It doesn't always have to be digital. What's really important is how do you get all of these tools communicating a clear, concise message that's very specialized to that particular member. So let's take the diabetes as a really good example. Let's say that you purchased a software or a digital experience that you would like to bring into your members, and you want them to engage especially obviously those with diabetes. Plugging that tool into all of these different channels and setting up a communication that's specialized for that particular member that's meaningful for them, is how you're going to engage with that member. Getting them engaged, making sure that they remember. We call some of these next best actions, to have the next thing I need you to do is this and this is how it's good for you and this is why your doctor thinks it's important. So bringing all of these things together in a meaningful way is really important.
I mean, I'll tell you a personal story a few years ago when I elected my health plan coverage through my employer, I went in and set up my own personal member portal. When I did that, my member portal after I signed in and got it all set up, which I was navigating around looking at some of the tools, I instantly want to put 47 messages in my inbox. I could never imagine how they were able to send 47 messages instantaneously. But they did. The first one I clicked on to implied but not stated that somebody of my age needed all of these procedures. I couldn't believe that that was the message that I was getting. First, I was a little unhappy about the fact that they were implying that I was old, and then the second of which was implying that I hadn't already had these procedures. I was new to this health plan. What I would have preferred as a communication that basically said, "Hi, welcome. Let me help you navigate this tool. Let's just start there. Here's some key things that we think you might find valuable in the tool," and kind of partner with me through this process. Ask questions as for validation of different data points, I'm new to your plan. How do you know I haven't had a mammogram? I might have actually had one just because you don't know about it doesn't mean it didn't happen. And so form this kind of collaborative relationship, partnership around my care and the needs for myself and my family.
Eyles:
Yeah, no one wants 47 messages into their email about anything.
Evans:
Who has time for that?
Eyles:
Right. That's a really great example of just you know, trying to have a real connection and let the customer and consumer understand you know how to navigate and use these tools. But maybe what are some of the other sort of keys for successful customer experience for health insurance? We hear so much about consumer experience and how much focus there is, but what are some of the ways to think about being successful?
Erck:
That's a really good point. So I looked at it through the lens of the consumer. Maybe for this moment, let's look through the lens of the health insurer for a second. Bear with me. I have an example here that I use quite a bit so I like to reflect on consumer engagement if I'm sitting in a health plan through the example of a beauty pageant, so bear with me for a second so you've got a beauty pageant, and all the contestants are up there and one of the questions they always get asked at any beauty pageant, or any pageant in general, is if you win what are you going to do with this newfound position that you're in? And what almost all of them say whether it's a joke on a movie, or in reality is world peace. I always have to smile when I hear it. As an executive and it has been an executive in the payer space for a good portion of my career. In that C suite, from a strategic standpoint, consumer experience can sound like the answer world peace. And what I mean by that is, when you think about consumer experience, it seems very ambiguous it seems big and audacious goal at the end of the day, it also sounds extremely expensive. And is it even reasonable? How are we going to solve for consumer engagement? That seems so huge, and I think depending on who's presenting it, it can be even bigger, daunting task. And is there really an ROI there?
So from my perspective, Matt, it starts with the strategy. It's what are you trying to achieve in 23 and beyond? Is it better outcomes for your patients with diabetes? Is it increasing your member retention? Is it improving your star ratings, as I talked about earlier? Is it getting consumers more engaged in your health plan? Maybe members who don't engage with you because so many times we focus on those that are in our higher risk categories. You want to think about your consumer from a very different perspective.
Again, I'll go to a personal story. I'm married, I have children, so I'm a wife, I'm a mom. I'm a daughter, I take care of not only my family as older adults, I'm that sandwich generation we talk about quite a bit. When a health plan thinks about the consumer, I want to make sure and again they're the subject matter experts many which know exactly what I'm talking about. It's not just the person who holds the ID card, but it can be the individuals who support that person in their community. Are we stopping and thinking about these things? I'll tell you that personal story perspective. So my mother in law, and I have her permission from a HIPAA perspective to share this so full qualification here. We call her the Jude, love her to death, she's fabulous, but many times I help her on her health care decisions, whether it's purchasing a new health plan or getting care. There are tools that I wish her Medicare Advantage plan would offer when I have conversations with them as a daughter-in-law helping my mother-in-law. Obviously, the CEO of Zipari does come into play, I'm not going to lie. What I will hear is, our Medicare Advantage members, the majority of which are over 75 and they don't use digital tools. Wow. Yeah, they do. They do. I do. She does. She books her airline flight. She's in her 80s. She is very involved on social media and those things.
So making sure you know who your consumer is. Know your data. If you have a mobile app and a member portal today, who is using them, why are they using them and how are they using them? All those data points are important. And then break your strategy in a bite-sized pieces. What we call as goals. Start with increasing potentially simple as increase the number of members who engage in the portal, download your mobile app, and then we start getting visibility and engagement from there. It starts as many people like to say you take the elephant and you break it down into bite-sized pieces.
Spotlight: Zipari
At Zipari we're on a mission to make health insurance better for everyone. Our unique and exclusive health insurance focus allows us to create solutions that help you acquire and retain members, capitalize on operational efficiencies, boost satisfaction, and improve member outcomes. We offer unparalleled consumer insights and API-first, configurable solutions that add lift to your existing investments with experts that passionately advocate for technology that does what it promises, deliver value and improve the health insurance experience. Zipari, let's break through together.
Evans:
So maybe 70s, but I would wonder like going you know into later years that maybe there is an older population that is not as savvy with technology, so I've got to think that that's one of the challenges. And I want to ask you about the challenges because you know you're talking about the keys to success and that all sounds great. But you know, the reality is that there is there are a lot of health plan members. In fact, there was a recent survey that showed that a lot of health plan members show that 78% of respondents are less than happy with their experiences. It was like 78% of respondents say that recent experiences with insurance were less than seamless, while 28% reported that interactions with health plans were very frustrating. So my question to you is regarding the challenges, how do you implement digital customer experiences and try to overcome those challenges? And what are the biggest challenges that you're facing right now? And I'd love to hear from you too about those older populations because I'm sure there are a lot of frustrations with a lot of communities that really are not connected these days.
Erck:
That's just a very thick, rich question. I could spend two hours on. Let me let me break it down because you're hitting at the core of exactly why, one, Zipari was even founded, and then two, what we're trying to achieve as an organization. That seamless piece you're talking about is so real. So you think about it. I personally have a mobile app and a member portal and so does my provider. I go in for care, I check before I get there, I download my ID card into my Apple Pay which is awesome. Thank you very much health plan. So I have the tools that I need to be able to do those things.
Can you imagine for a second: Tab has taken six months to get in to see a specialist, I don't know if we can say we've come out of COVID yet, I'm not sure what the proper terms are. We're in a different stage where things are open now, how about I frame it that way? But there's a backlog of needs for care. It may take me six to nine months to get a visit in with my specialist. And with my schedule, I might need to be there first thing in the morning. I always say what's the earliest appointment you've got? And they say eight o'clock. Great. I show up at 7:45 because they've asked me to be there 15 minutes early. I panic when I walk in the door because I grabbed the wrong wallet. My insurance card is in my other wallet. What do I do? What if the company that I work with doesn't have a mobile app and I can't download my ID character virtually.? I'm now standing inside of a provider's office, who is not going to be super warm and friendly when I get there and they realize I don't have my ID card. I might actually have to reschedule my visit. And do I have to pay anything because I didn't cancel my visit 24 hours before I got there. That doesn't seem like a very consumer-focused type of environment.
So your question is just so meaningful. How do you make it easy for people to do business with you as a health plan? Think about all those kind of gotcha moments that you could write in and be that plan that helps that member at that moment. Those types of simple tools that makes it really easy for them to do business with you. Make sure that the information is consistent whether I'm on the mobile app, I'm in the member portal, or if I'm the provider walking in the door. I want to make sure that that data is consistent because I don't know about you, but I might actually have anxiety going to the doctor's office and I might want to make sure if I met my out of pocket maximum, if I met my deductible yet, what am I going to have to pay?
You know, we're on the verge of holidays right now. And I don't think I have to tell everybody about what's going on with the economy today. You know, knowing if whether or not I have to pay zero, or I have to pay $1,000 might be really, really important in my life. That's really important right now when it comes to my experience within the health plan. So that's a consumer lens. Within the health plan, we talk about competing priorities in play here. You've also potentially got health plans where products, departments, environments are siloed. This product has its own series of leadership strategies and goals. And well another one might have a different one. The clinical team might want to take action and drive different decisions and get certain actions taken that may or may not align with whoever's leading the focus around engaging the consumer. Lay on top of that you've got legacy technology systems, those systems might be outdated. Truly, I kid you not we work with health plans that are still in AS 400 systems. So how do you take a legacy, old technology and still get them up to speed as quickly? Do it fast, efficient and cost effective.
You could also have a health plan that just spent 10s of millions of dollars investing in their technology. They don't want to replace it. Are there options out there to plug and play, and the answer is yes. But knowing that information. There's this belief out there that when it comes to the work that you know companies like Zipari and others do is that it's a buy or build type model, and you guys it's not, it's both. It's how do you plug and play at the same time where you don't have something we can bring it in, where you have something, how can we enhance it, plug in our system so that you can take advantage of it right away.
The last one that's a really, really big one is staffing. Staffing is a challenge. I kid you not I was just talking to health plan just couple weeks ago that said where they're physically located and since COVID, they're now dealing with things they've never dealt with before. They're competing with organizations for staff that they've never competed with before. And the compensation that those organizations are paying, they brought up Hobby Lobby, they talked about Home Depot, they talked about other organizations that are paying, you know, $23 to $25 an hour. And as a call center representative, to try to keep their costs down, how do I compete against that, Tab? And one of the things that we've looked at is are there certain phone calls we can get out of your call center and move digital that your consumer is telling us that want to go digital. You mentioned that earlier. We've got a different consumer. That consumer is saying hey, I want to be able to work with my health plan 24/7 365. And there's about 47% of the calls that they put in the call center that they've told us in our annual survey, "I'd rather just go out to a member portal or mobile app and do that myself." And one of my favorite ones personally, is changing my address. For some reason you guys it takes a major task to change my address. Why couldn't I just sign in my portal and change my address or get a new ID card? Even if I want paper? Can I get a digital image that I can print out and take with me?
Evans:
It's like dealing with the government.
Erck:
Feels like it, yeah.
Evans:
Get married and go to the DMV and it's all the red tape. Let me talk about Medicare Advantage because you were talking about Medicare Advantage Plans earlier, which have taken off in recent years so the market has become increasingly saturated. How can health plans stay competitive in this market?
Erck:
Gosh, what a great question. Medicare Advantage looks so different. Gosh, I remember when Medicare Advantage was just coming out and becoming you know, seeing what it is today is just mind blowing of what, and it's fantastic. There's new products and services that are offered that have never been offered before, which I think is fantastic and exciting. At the same time, there's a significant number of choices that a member has. I remember back in that like 80s and 90s where Medicare Advantage was really focused on large cities, and you'd look at rural areas and people would say I don't even know what Medicare Advantage is and it took 10 or 20 years for some of these markets to now get plan options to where today there's multiple different options in play. Consumers are different than they were back in the 80s and 90s. They're demanding different experiences. And a lot of it is because of other industries. It's also because they're now paying more than they ever have. And they have a vested interest and an awareness of the way things work and how things function and consumers are more focused on health and wellness than ever before. I want to take control over my health and wellness, and I want my health plan to be my partner in this process. I want my provider to be a partner in this process. So consumer engagement is just really a top priority.
For most Medicare Advantage plans, they've told us very clearly, not only do I want to retain those members, I also want to grow my business. As we all know I'm preaching to the experts in the industry, you know that this market is growing. We have more than 28 million people currently enrolled in Medicare Advantage plans. And that accounts for almost 48% of the Medicare population is enrolled in a plan, that's significant. And it's only expected to grow not only in the number of people who are eligible for Medicare Advantage plans, but those who are actually purchasing them. That competitive environment is forcing health plans to focus on consumer engagement and member engagement to drive down costs, improve satisfaction and improve outcomes at the end of the day.
Eyles:
It really is such a different environment in MA now and we know that right? We're in the midst of open enrollment both for Medicare, which goes through December, ACA marketplace, which goes into the next year. I know here at AHIP, we're doing our own open enrollment for our employees. So I mean, you've talked a lot about the consumer experience. How should plans think about initiating digital experiences now as this open enrollment period is beginning to wrap up?
Erck:
That's a great question because I think you've really hit the core on its head, and just full disclosure, we have just successfully finished our open enrollment here at Zipari, so it's a good day on a personal level to have that behind us, which is always a lot of fun.
But honestly Matt, you've nailed it right on its head. It's planning now, don't wait until June when you put your bids in and you know what you're going to be doing. Start the planning process now. Engage with organizations like Zipari, look at what you want to try to achieve, share what your strategic goals are, as well as honestly most health plans, not only because it's not done, but they're also taking time right now to reflect on what's gone well, taking those moments of reflection. Share those with organizations like Zipari, so we can understand where things have gone really well, as well as where there's areas of opportunity for improvement because nobody wants to break what's working. What you want to do is enhance what you've already got put into place. But that strategic planning process is really important. What is it you're trying to achieve in 23, 24? And so on. Because the wheels and the motions we put in place are going to be the areas that you're going to be able to build on as you go along. And the earlier we get started in the process, the easier it's going to be when it comes to open enrollment for next year, which will be here before we know it.
Eyles:
Yeah, so it always does sort of sneak up on you, it’s here before you know it. No doubt. Tab, you've covered so much ground today, but there's one important question we always ask our guests at the end so I'm gonna put it out there now. What's the next big thing in health?
Erck:
What's the next big thing in health? Oh, wow. What a great question. Honestly, I really think it's, it's consumer engagement, but it's breaking consumer engagement into bite-sized pieces. How can we really start delivering on the things that we've been talking about for the last 20 years? How do we engage that consumer, how do we get that consumer more involved in their health care? How do we educate and inform them so that everybody around that consumer is helping facilitate the needs wants and desires of that consumer. Leveraging digital as that platform we're going to be able to do it in a smart and meaningful way, is where I think the next big thing and health is going to be, and I'm excited to be a consumer of it. I'm excited to be a business partner, as well as a partner with the health plans and providers. To help make this come real.
Spotlight: Zipari
Zipari helps health plans break through barriers and empower members to take charge of their own health care journeys. Our superior member experience solution is the one stop shop for CX with intuitive portals, robust and data-driven CRM systems, and a CX engagement hub. Plans can break through the barriers to drive members toward healthier actions through optimized self service, fewer calls, less paper, reduced overall costs, higher star ratings, and best-in-class management. Zipari, let's break through together.
Evans:
Tab, it's so nice to have you on today and to hear all of your insight. Appreciate it.
Erck:
Cool. Thank you for the opportunity.
Eyles:
And thank you for being such a great partner with AHIP too, Tab. Really great working with you.
Erck:
Feeling's mutual, looking forward to 23.