Ingrid Lindberg, Chief Experience Officer, Cigna

This was definitely my favorite and most interesting presentation and discussion from the World Health Care Congress in DC.  Ingrid presented and subsequently spent some time talking with me.  She has what I would consider one of the coolest jobs – transforming a large company to be consumer centric and radically changing the way they think, speak, and act. 

From her presentation, here were a few notes:

• There are 337 languages spoken in the US today. (health literacy issue?)
• Only 23% of people understand what their health insurance policy means.
• Most patients appear to be unaware of their lack of understanding in physician instructions and are inappropriately confident.
• 35% of consumers spend less than 30 minutes reading their health benefit information.
• Only 7% of people trust their insurer.
• Trust translates to loyalty and satisfaction.
• It’s a mix of quantitative and qualitative research.
• They spent time monitoring sites like – www.pissedconsumer.com.  (do you?)
• Their senior staff has to spend time listening to member calls each week.
• They spent lots of time on ethographic research and identified 6 personas that they use for defining products – Busy Mom, Skeptic, CareGiver, Controller, Athlete, and Bargain Shopper.
• They identified the #1 dissatisfier was language.  Plans talk to them in a language they don’t understand.  (For example, consumers think of providers as the insurer not a physician.)
• Consumers didn’t want to be called members since it’s not a health club.  They didn’t want anyone other than their physician to call them patient.  They’ve elected to go with “customer”.
• She talked a lot about how they’ve changed their EOB (explanation of benefits) and their plan overview to address things like what’s not covered.  She talked about how customers think of the EOB as the “this is not a bill form”.
• They identified 10,000 separate letters that could go out to a customer.  They’ve re-written 9,000 of them. 
• She talked about changing their call centers to 24/7 and the fact that they’ve now taken their 1M call in what used to be considered “after hours”.
• She talked about re-designing their IVR to offer you a self-service option (press 1) or a talk to agent option.
• She talked about their website and YouTube channel – www.ItsTimeToFeelBetter.com.
• She talked about their understanding level being around 70% while the industry average is around 15% [of communications sent out].
• This was in a 15 minute presentation and summarized only 2 years of work. 
• She also shared some metrics that they use and improvements such as a 8 point improvement in one year of “values me as a customer”. 

And, they’ve shared some of this information in their press kit.  There is also an IBM white paper about some of the technology they’ve implemented.

I think the following slide from her deck sums it up well.

Then I sat down with Ingrid to talk with her.  I had a thousand questions which I limited to about 10.  This is a topic I love and is why I love what I do – work with companies to help them develop consumer communication strategies and implement those strategies to improve the consumer experience and drive better health outcomes. 

1. How long did it take?  This is about a 3-5 year effort which is complicated by the fact that people in these types of roles typically only last about 28 months.
2. Did you do it all internally?  No.  They worked with Peppers & Rogers on a Touchpoint Map and used an IBM tool called Moment of Truth.  They also worked with IBM on a new desktop solution.  BUT, she was quick to talk about the fact that those were enablers while the majority of work had to be done by internal change agents since this is a cultural change.  She said that now almost 80% of Cigna people are using their recommended language and are aware of the changes made by her group.
3. Why haven’t others followed?  It’s hard work. 
4. How do you deal with consumer preferences?  This is one of my favorite topics to debate.  Should you offer consumers options on how you communicate even if you know that they might not pick one that is the most effective.  For example, I might say to send me an e-mail, but they get lost, they can’t contain PHI, etc.  She said that you have to ask but you have to navigate the path.  She seemed to agree with me that there are some communications where you want to ask (e.g., order status at mail) and others where you want the right to contact them (e.g., drug-drug interaction).  She talked about the fact that it’s all in the framing (e.g., if we have a message for you that could affect your safety, is it okay if we ignore your do not call request?).
5. Are you changing Cigna’s physician communications also?  Yes.  The changes have become the “language of Cigna”.  Physicians are people, and they are also trying to educate physicians on what they’ve learned about how to communicate with customers.  She mentioned that the most difficult groups to change were the people that were knee deep in this healthcare language – internal people and consultants. 
6. Based on my discussion with Andy Webber, I asked her if she thought that today’s fragmented environment would allow for a coordinated consumer experience.  She agreed that it’s difficult and that the consumer sees everything as their benefit.  They don’t see the piecemeal parts.  She mentioned that one of their clients had held a “vendor fair” to kickoff the plan year where she presented their learnings and all the vendors were told to use them immediately.  [Maybe that’s part of the solution.]

We then bounced around on a couple of interesting topics:

• We talked about the fact that lots of companies are hiring non-healthcare people to help them better understand the consumer.  These include consultants, database people, marketing people, and innovators.  My personal opinion is that you need people that have worked in or around healthcare AND outside healthcare.  They also need to have consulting and line management experience.
• She talked about their war room (she used another term) where they had a current state and future state (of patient experience) and showed all the 10,000 current communications as a waterfall. 
• We talked a little about some of the things we’d done at Express Scripts when I was there including changing the way we referred to members at the call center to patients and the impact that had. 
• I shared with her that our biggest difficulty was making web changes at Express Scripts which I thought would be the easiest to do.  She shared that changes on the web were one area where they were lagging and is difficult. 
• She talked about trying to get innovation from customers by understanding what they want and giving it to them.