Cost-cutting pressures and new care structures in the statutory health insurance system are posing a risk to customer relationships. Instead of being at the center of all efforts to protect the valuable asset of health, the patient is being sidelined. Fundamental human values such as time and empathy, as well as transparent treatment paths and the respectful consideration of patient wishes, are increasingly neglected. This is the conclusion of the current study by Terra Consulting Partners (TCP), Berlin, for which a total of 2,052 statutory health insurance policyholders were surveyed representatively in spring 2011. The study confirms the need to re-examine existing statutory health insurance management concepts in order to place people's needs more strongly at the center of action. One result is the further development of the HealthCare Relationship Management concept into the "People-Centered Principle" (MiM) as an option for comprehensive and holistic care management.
>> Health funds and Morbi-RSA have been a reality for more than two years. Competition in the statutory health insurance market has changed. Mergers, additional contributions, and cost-cutting pressures on the part of health insurance funds leave insured members and patients with a disturbing aftertaste that their precious commodity, health, is no longer in the best hands (Sander/Kade-Lamprecht 2009: page 27).
The difficult balancing act that health insurance companies must navigate between cost and customer excellence is far from perfected. Viewing the insured and patient as a "case" or even merely as an "insured relationship" places even greater strain on the customer relationship.
Unfortunately, the current structures and processes of our healthcare system are historically geared toward this rather technocratic perspective. Placing the individual at the center of healthcare means considering them holistically, both as insured persons and patients. In a holistic perspective, a person has both a rational, objective, and performance-oriented side and an emotional, individually personal side. A holistic view also requires considering the individual's individual environment, their family, their social network, their career, and their personal life goals. Health insurance companies that place the individual at the center do not primarily subordinate the customer relationship to a "profit-oriented, competitive rationality" (Wädle 2009: page 20). To also satisfy the insured emotionally, the benefit-maximizing balancing of coverage contributions is no longer sufficient.
The individual, personal and humane side of the customer relationship is reflected from the perspective of the insured and patients in elementary human values such as:
• Understanding, empathy, compassion for patient concerns
• Time and patience of doctors, nursing staff, health insurance advisors
• Incorporating individual patient wishes into treatment
• sincere efforts by the health insurance company to protect the precious commodity of health
• honest, cooperative communication at eye level
• transparent treatment processes
• responsible use of technical and technological aids in the treatment process
• Maintaining privacy and data protection
The human being is the focus when medical options and therapies are tailored to the individual's life, when people and their health are given unconditional value.
So much for the theory.
But what does it look like in practice? How humanely do policyholders feel they are cared for by their health insurance company?
Traditional market research studies for the statutory health insurance sector have so far touched on this question only marginally. With a strategic baseline study, TCP closes this knowledge gap and analyzes current market facts from the policyholder perspective. The statistical data was obtained from a representative survey of 2,052 statutory health insurance policyholders, conducted in February 2011 in cooperation with panelbiz GmbH Berlin.
The overall finding is sobering: For only 21% of GKV members, attentiveness and humane care for patients are already a well-practiced reality of their health insurance company. While those insured by the Knappschaft (mining social security) and TK (those insured by the public health insurance) most strongly identify with this, 30% of AOK and DAK members each feel completely unappreciated. None of the health insurance companies surveyed achieved a top level for humane appreciation of their members above the 50% mark (see Figure 1).
The explanations for the lack of human appreciation lie in the areas of supply management, organization and IT as well as communication and are explained below using examples.
The patient as a case
Around a quarter of the doctor/specialist visitors and 40% of hospital/rehabilitation patients in the last twelve months expressed specific criticism of the medical care and service they experienced.
With almost 50% of patients in hospital/rehabilitation, the main criticism is that they were not treated as human beings, but as a „case“ (see Figure 2).
The passivity of health insurance companies is particularly critical. Only 101 percent of patients with negative experiences with their doctor, specialist, hospital, or rehabilitation center received individual and coordinated support from their health insurance company.
Extrapolated to the entire statutory health insurance system, these facts show that around 10 million doctor/specialist patients and 4 million hospital/rehabilitation patients across Germany receive no or insufficient support from their health insurance company each year when they experience care problems (see Figure 3).
Based on the current expenditure structure of the statutory health insurance system – 60% of annual expenditure is caused by medical and hospital treatment; per capita expenditure for this is around 1,350 euros – this results in a theoretically positively controllable cost block of 14 billion euros per year for the entire statutory health insurance system.
The actual magnitude of the savings effects will be revealed by health care research in the coming years. It will be necessary to determine whether the effects require cost-saving or quality-enhancing measures.
Conclusion 1: It is therefore worthwhile for all health insurance companies to listen to the experiences of their insured members and to address their needs and human sensitivities in detail. Seemingly minor deficiencies in medical treatment can have a significant impact on the manageable cost volume in the statutory health insurance system.
Ways out of the sidelines
Within the framework of human-centered care management, health insurance companies actually have all the assets in their hands to truly put the patient at the center. The study clearly shows health insurance companies the most urgent decisions that have a significant impact on customer loyalty and satisfaction (see Figure 4):
Conclusion 2: If health insurance companies succeed in moving away from the „case-by-case mentality“ and their role as mediators and guides between doctors, hospitals, rehabilitation and nursing care becomes perceptible to the insured, then the first step towards humanity will have been taken.
Compatibility of modern medical technologies with human aspects
For certain medical conditions, modern medical technologies are essential for patients' quality of life. These include, for example, mobile-based remote monitoring for patients with heart disease (home monitoring), online coaching for patients with rheumatism or asthma, and the transfer of patient information between doctors and hospitals.
Regarding the impact of innovative medical technologies on human aspects and quality of life, the pros and cons of insured persons are almost evenly balanced (see Figure 5). On the one hand, more than ever before, 70 percent of insured persons fear a reduction in human attention and a helpless dependence on technology, and 54 percent see their privacy threatened by the virtual exchange of data between doctors and hospitals. On the other hand, 68 percent see opportunities in the mechanization of medical care to place the insured person at the center.
Conclusion 3: To reconcile technological development and human aspects, health insurance companies must focus much more intensively on individualized care and management of their insured members. If technical monitoring can be successfully integrated with intensive personal care, we expect better treatment outcomes.
Customer Excellence: The Growing Importance of CRM/HRM Solutions in Healthcare Management
The path to this goal lies in IT support for care management that is noticeably more convenient for customers. 40% of statutory health insurance (GKV) members are annoyed that their insurer does not have personal information on current therapies, preventive examinations, or vaccination status readily available for each customer contact, but instead requires a lengthy process of requesting it again.
Conclusion 4: Customers clearly express their expectations for a people-centered healthcare management system: Individualized CRM-based management of information, communication, and support with direct decision-making support.
New approaches to communication
Customers want a communication mix of traditional and modern tools. The member magazine remains the preferred information medium for all target groups.
However, ignoring social networks and the potential of mobile marketing as a customer-oriented statutory health insurance provider is grossly negligent, as they offer unique opportunities for human communication. More than 30% of statutory health insurance policyholders can imagine being active fans of their health insurance provider on social media, testing new products and services, or communicating with the insurer via a virtual office.
The interest of statutory health insurance (GKV) members in the health insurance fund's mobile services is surprisingly high. 60% of GKV members are interested in mobile health applications for their mobile phones.
Conclusion 5: Since social media offers special opportunities for human communication, they will establish a permanent place in communication with policyholders.
High expectations of the insured
Although the SHI market's 40% providers are completely interchangeable from a customer perspective and insured persons are indifferent to which health insurance company they are insured with, customers' expectations of health insurance providers remain consistently high.
Conclusion 6: In a changing society in which social aspects are becoming more important again, the cash register that noticeably puts people at the center wins!
The way out of the dilemma: „People at the center“ as an overarching management principle
We are aware that many health insurance funds are in the midst of the decision-making process regarding their future care management strategy. Against this backdrop and taking into account the study results presented, we would like to present a concept below that, in our experience, is suitable for facilitating complex strategic decision-making processes in healthcare and social care companies and for channeling them in the "right" direction for each company.
Put simply, this is the essence of two management concepts: the HealthCare Relationship Management concept, which has already been extensively presented in the literature (see, among others, Schaaf, 2005, 2008, 2010, 2011), and the "Employee First" model by Vineed Nayar (Harvard 2010). In both concepts, people play the decisive role as THE factor for successful companies. From this, hc:VISION has developed the "People-Centered" (MiM) principle for the healthcare sector. In summary, our goal is the following:
The „MiM principle“ complements the HRM concept with a concrete change framework for companies and systems that are convinced that people are the starting point for every successful change.
The MiM concept is based on the conviction that successful healthcare companies must strike a balance between the diverse interests of the people involved in an organization or system (e.g., a healthcare network). Communication, transparency, and comprehensive information are essential elements in this process, all of which simultaneously have high technical relevance.
Only satisfied employees who enjoy working conditions that allow them to fully concentrate on what matters most (the patient!) can delight customers. In the healthcare sector, this means, on the one hand, retaining (healthy) insured members through compelling service or even attracting new ones, and, on the other, having optimal opportunities to organize patient care in the best possible way and with the highest quality. But this is only possible if the partners in patient care work together in a truly win-win situation. This is also the operational core of every successful strategy in the healthcare industry, against which organization, processes, and IT must be measured!
The MiM principle thus offers, in particular, an intrinsic change framework in which the essential parameters of change are aligned with the people involved (employees, insured persons, patients, partners).
If one follows the logic of the MiM principle, i.e. one is convinced that the people acting in an organization or system must be the focus, then the strategic parameters of the future direction are fundamentally clear:
Incorporating the MiM parameters helps ensure that the entire company focuses on improving the core framework for the people working or affected in various areas. This results in a clear prioritization of the various strategic issues: All topics that contribute to improving working conditions, improving insured person satisfaction, improving the quality of care, and improving partner relationships must be given priority.
In this sense, IT, whose growing importance is clearly underscored by the current TCP study, must be defined in the same spirit as the future organization of the cash register and the new, overarching processes, for example. IT thus becomes a topic of strategic importance in a holistic change process!
With regard to the four perspectives of the MiM principle, the health insurance funds must answer the following questions in particular:
Employee perspective:
• Which IT, processes and organization best enable employees to provide optimal and user-friendly support to insured persons, patients and partners?
• How can it be ensured that employees have all the information about insured persons, patients and partners in a timely manner and at every contact channel in order to be able to provide them with optimal care?
• How can we ensure that the processes of all departments work hand in hand?
• How can administrative processes be changed most sustainably?
Insured person perspective:
• What structure, processes, and technology help achieve sustainable customer excellence? How do you get the best possible view of the customer?
• How can comprehensive policyholder campaigns, including retention management, be best and most sustainably supported?
• Which solution offers the best integration of analytics and targeted customer relationship management, e.g. through the option of cross-selling and up-selling?
Patient perspective:
• How can complex care processes be managed holistically?
• How can large populations of insured persons be managed?
• How can a unified customer view be achieved, taking care management into account?
• How can CRM be coordinated for both sales and supply management?
• How can thousands of individual contracts with patients and service providers be integrated? How is quality assurance implemented?
Partner perspective:
• How can all insured and patient-relevant information be integrated with partner references?
• How can cross-company processes, especially those related to service providers, be organized?
• How can supply networks be managed and controlled together with partners?
• How can all those involved in the care process „securely“ access all relevant data?
The questions reflect not only the essential requirements for achieving customer and cost excellence, but above all the requirements arising from the complex topic of supply management. At the same time, they provide a guideline that can be used to answer questions such as the "right" leading IT.
Summary
The MiM principle originally emerged because experiences from comprehensive care and change projects suggested that the "human" component is still very often underestimated as a success factor. The TCP study "The Patient on the Sidelines" has now empirically proven the validity of the assumptions underlying the MiM principle. It is now up to the responsible players in the healthcare system to draw the "right" conclusions from the available findings. The "right" concepts are certainly already available.
by: Michael Schaaf*
Dr. Evelyn Kade-Lamprecht**
