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Customer Experience (CX) in Payer and Provider Engagement: How to Score Highly
June 2016
A FirstWord ExpertViews Report
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Customer Experience (CX) in Payer and Provider Engagement:How to Score Highly
Published June 2016© Copyright 2016 Doctor’s Guide Publishing Limited
All rights reserved. No part of this publication may be reproduced or used in any form or by any means graphic, electronic or mechanical, including photocopying, recording, taping or storage in information retrieval systems without the express permission of the publisher.
This report contains information from numerous sources that Doctor’s Guide Publishing Limited believes to be reliable but for which accuracy cannot be guaranteed. Doctor’s Guide Publishing Limited does not accept responsibility for any loss incurred by any person who acts or who fails to act as a result of information published in this document. Any views and opinions expressed by third parties and reproduced in this document are not necessarily the views and opinions of Doctor’s Guide Publishing Limited. Any views and opinions expressed by individuals and reproduced in this document are not necessarily the views and opinions of their employers.
Cover image: © anawat_s | AdobeStock
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All Contents Copyright © 2016 Doctor’s Guide Publishing Limited. All Rights Reserved
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Customer Experience (CX) in Payer and Provider Engagement:
How to Score Highly
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ContentsExecutive summary .............................................................................................................................. 1
Research objectives .............................................................................................................................3
Research methodology ......................................................................................................................5
Experts interviewed ..............................................................................................................................6
Definitions ................................................................................................................................................... 7
The current dynamics of payer customer experience .................................................9
Customer experience is becoming more important than product or price ................................9
Increasing spending on pharmaceuticals has become a global concern ...............................10
More emphasis on delivering outcomes-based value ..................................................................13
Real-world evidence is increasing in importance ...........................................................................14
The drive towards affordability and the expiration of several patents have increased the traction of generic drugs ..................................................................................16
Shift from developing blockbusters towards precision medicines .............................................18
Multichannel and mobile technology is enabling pay-for-performance models ....................19
Payer CX and organisation ........................................................................................................... 21
Key insights ............................................................................................................................................... 21
Payer CX is a dialogue ..........................................................................................................................22
A relationship beyond price negotiation ............................................................................................23
An engagement with powerful organisations with varying needs ..............................................24
Different from physician CX .................................................................................................................25
Effective payer CX leads to commercial success .......................................................................... 27
Internal functions required for effective payer CX .........................................................................30
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Customer Experience (CX) in Payer and Provider Engagement:
How to Score Highly
Market access teams ........................................................................................................................ 31
Key account management ..............................................................................................................32
Health economics and outcomes research team ......................................................................34
Effective CX measured by payer access ..........................................................................................35
The state of payer CX today .................................................................................................................35
SWOT analysis for payer CX ............................................................................................................... 37
The challenges in payer CX and overcoming them .....................................................40
Key insights ...............................................................................................................................................40
Lack of trust ...............................................................................................................................................40
Lack of mutual understanding ..............................................................................................................42
A different concept of ‘value’ .................................................................................................................43
An uncompromising focus on price by some payers .....................................................................45
Low priority for market access .............................................................................................................46
Leadership and organisational hurdles ............................................................................................. 47
Pharma’s responsibility ................................................................................................................. 51
Key insights ............................................................................................................................................... 51
Getting into the mindset of payers ......................................................................................................52
Listening ................................................................................................................................................53
Benchmarking ......................................................................................................................................54
Using analytics to stratify payer/provider needs ........................................................................ 57
Targeting national and sub-national levels ....................................................................................... 57
Adopt a KAM strategy properly ............................................................................................................ 61
Create internal alignment ......................................................................................................................64
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Customer Experience (CX) in Payer and Provider Engagement:
How to Score Highly
Early involvement of market access .............................................................................................64
A cross-functional framework to support KAMs ........................................................................66
Leadership buy-in ...............................................................................................................................68
Presenting a variety of evidence .........................................................................................................69
Providing data support for formulary decision-making ............................................................70
Providing real-world data on health outcomes ......................................................................... 71
Providing evidence of the sustained trajectory of costs ..........................................................73
Innovative Pricing/Payment Agreements ..........................................................................................74
Pricing/Payment Models
‘Test driving’ a new drug .................................................................................................................... 77
Assisting in the adoption of value-based pricing and reimbursement ................................78
Opportunities for effective payer CX ....................................................................................80
Key insights ...............................................................................................................................................80
Becoming an impartial consultant who educates payers ............................................................. 81
Collaborating on data aggregation and analytics ...........................................................................83
Creating mutual value zones with payers to drive innovation ....................................................86
Creating mutual value zones through savings ................................................................................88
Ensuring value is realised through patient monitoring, adherence and compliance ...........90
Working with other key stakeholders who engage with payers .................................................93
Future Trends in payer CX .............................................................................................................96
Key insights ...............................................................................................................................................96
Increased interaction points with payers .......................................................................................... 97
Cognitive computing ...............................................................................................................................99
Deep and strategic relationships with KAM ...................................................................................100
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Customer Experience (CX) in Payer and Provider Engagement:
How to Score Highly
Integrated systems towards care management ............................................................................ 101
Flexible and conditional pricing .........................................................................................................102
A change in the pipeline .......................................................................................................................103
Best practice in payer CX .............................................................................................................104
Conduct a payer landscape analysis ...............................................................................................104
Understand and navigate through the interaction preferences of each local payer ..........105
Embed measures for payer outcomes early ..................................................................................105
Inject efficiency into payers and their partners’ workflow ...........................................................106
Engage beyond the payer/provider and towards other stakeholders ..................................... 107
Conclusion ..............................................................................................................................................108
Appendix ................................................................................................................................................... 110
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Customer Experience (CX) in Payer and Provider Engagement:
How to Score Highly
Research objectivesThis FirstWord Dossier report provides a qualitative analysis of customer experience in payer and provider engagement and how pharma can score more highly with this customer group. It explores and assesses the approach and progress of industry in improving and managing the CX of the payers they engage with, including their CX strategy and the collection and use of CX data. Pharma’s commitment to, and investment in, payer customer experience management (CXM) is also explored.
Key questions posed as part of the research include:
1. What does CX mean in the context of pharma-payer engagement?
2. What is driving the need for pharma to deliver better payer/provider CX?
3. Do payers from different clinical areas require different CX approaches?
4. What value does highly effective payer CX bring as a differentiator?
5. Which internal functions, teams or key positions play a role in payer CX (market access, medical affairs, etc.)?
6. What are the critical success factors of effective payer CX?
7. What are some of the key challenges and solutions – both internal and external – to successful CXM and how can pharma overcome these challenges?
8. How can payer engagement evolve from simple price negotiations towards building relationships, creating value-adding initiatives and implementing healthcare reforms?
9. What is the role of multichannels, cognitive computing and mobile technology in enhancing payer engagement and their overall CX?
10. What can other stakeholders do to advance payer CX?
11. What changes might we see in pharma-payer engagement over the next five years as a result of CXM?
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Customer Experience (CX) in Payer and Provider Engagement:
How to Score Highly
12. What future opportunities might effective CXM of payer engagement bring for pharma?
13. How are pharma companies measuring CX in payer engagement, and how are they using these data to drive CX improvements?
This report is the second in a series of three reports that analyse pharma’s CX strategies and performance in engaging with key stakeholder groups. A previous report covered CX in physician and healthcare professional (HCP) engagement, while a future report will cover patient engagement.1
1 FirstWord. (2016). Customer Experience (CX) in Physician and HCP Engagement: Meeting expectations at every level. Available at http://uk.fwreports.com/customer-experience-cx-in-physician-and-hcp-engagement/#.V0QVQ51wZYc
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Customer Experience (CX) in Payer and Provider Engagement:
How to Score Highly
Effective CX measured by payer access“The principle of using regular customer feedback allows us to be consistently relevant and valuable in our customer’s lives,” says Neil Aubuchon, but he points out that the specific metrics for measuring payer interactions continually evolve. As Leslie Pagel, the Vice President for Customer Experience of the customer intelligence firm Walker, points out, there is a need to evolve from simple information delivery towards enterprise accessibility, where a company has a better view of what is going on inside the payer’s enterprise.79
Chris Isler recommends using the most basic metric: payer access. “If the provider is not talking to you, probably your CX is not good enough because people are not interested in what you have to say,” he explains. While pharma can use omnibus research (a type of qualitative research utilising a survey), forensic research (the application of social work theories in clinical settings), perception of most admired company and others, it all must go back to being able to set one foot at the payer’s door. Isler explains, “It’s very easy to tick a box, but the question that really matters is ‘Does your customer open doors for you when you knock?’ Or do they say come back another time?” Isler has observed that there is a good level of engagement with payers in the UK, but the same cannot be said for most other countries.
The state of payer CX todayIn gathering potential interviewees for this report, at first many experts expressed great interest in sharing their thoughts. Upon seeing the interview questions, which aimed to gain in-depth insights into the relationship between payer and pharma and the steps pharma must take to deepen the engagement of payers, however, many of these experts decided not to continue with their participation. Perhaps this provides an initial diagnosis of how much pharma truly knows about the needs of payers or how well they can communicate those needs (as well as pharma’s efforts to address them) to other people.
Despite the current efforts of some companies to introduce KAM and improve their market access teams, most of the interviewees are of the opinion that there
79 Walker. (2013). Customers 2020. Acquired from video in http://www.walkerinfo.com/customers2020/
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Customer Experience (CX) in Payer and Provider Engagement:
How to Score Highly
Getting into the mindset of payersAccording to Mete Saylan from Merck & Co., “Analysis of the needs and priorities of payers by manufacturers and providing solutions that match these needs is a very important step.” Gathering data about payers/providers may sound simple, but it is essential if pharma is to get into the former’s mindset. Designing and implementing an effective CX strategy for payers has become more relevant and urgent in recent years. Re-emphasising the need to understand them better is now integral to pharma’s success.
Some payers like to keep pharma at arm’s length because of trust issues or it being the traditional practice in their organisation. In the short survey conducted by Cello Health Insight on their payer community, one unnamed payer commented: “Most of the pharmaceutical companies I have dealings with via appointment or email/mail are very professional, knowledgeable and nice. Unfortunately, some of the representatives I have dealings with give their companies a bad name by turning up unannounced and are very ‘in your face’. Others don’t know the answers to basic questions.”109
Ellie Saxer from Daiichi Sankyo advises thinking outside the box and identifying other avenues to create a contact within that payer organisation. It takes a lot of time and persistence to demonstrate pharma’s desire to support and align with the goals of such payers, but once one foot is in the door, it becomes easier to gain a better understanding of their needs and to introduce new pieces of information.
According to Saylan, pharma must undergo a high-level policy analysis in order to expand their knowledge about the changing environmental factors. To address the needs of payers amidst a volatile environment, payer insights will be essential. Since the engagement between companies and payers has never been given as much attention as it is getting now, very few in pharma may have the skill and capability to gather data about the criteria and processes involved in payer decision-making.110 To broaden their understanding about payers, pharma first needs to gather data about their preferences, priorities, attitudes and behaviours.
109 Fletcher, J. (May, 2015). Payers reveal all about their relationship with Pharma. Retrieved from http://www.cellohealthinsight.com/opinion/payers-reveal-all-about-their-relationship-with-pharma/
110 Ibid.
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