by Priya Stipe, John Guido

The Challenge

A national health insurance company sought to develop and expand its delegated Fee for Value Model, but in order to do so, it urgently needed to address recent member dissatisfaction. The organization was aware of their members’ discontent, but lacked the comprehensive view needed to establish an optimum member experience. Enter Point B. Our team provided the expertise, data-gathering and deliverables to create line of sight within key leadership roles. At the same time, we unified stakeholders by devising solutions and plans for improvements on processes across the organization.

Creating a Better Member Experience

With recent feedback from a member survey indicating dissatisfaction with their delegated Fee for Value model, our first course of action was to pinpoint the root causes of the issues.  

Additionally, directors and those with ownership over various verticals lacked inter-departmental visibility, and consequently, when confronting the member frustration issue, were unable to come to an agreement on how and what to do about it.

To assist our customer in creating a better member experience, the Point B team developed a phased, member-centric approach to the issue. We started with people, establishing corporate alignment and consensus-building across various functions to gain speed in overcoming challenges and priority of action items.  

Phase I: Discovery and Assessment

After an initial discovery period that examined every touchpoint of the member journey, we conducted in-depth, focused interviews across the organization to determine its overall health. Once the appropriate data was collected, Point B delivered a holistic assessment of the current state of the company, which included:

Member Journey: We mapped out a baseline of member sentiment and activity, creating a refined member journey that clearly illustrated member touchpoints and why frustrations arose across their experience.

Operational Assessment: Our comprehensive employee interviews, coupled with internal analyses of people, processes and technology, identified operational capability gaps within the organization.

Phase 2: Creating Alignment

One of our biggest learnings (and surprises) from the Phase 1 work was the lack of alignment from key leaders. In fact, during their interviews, many directors questioned whether there were any operational problems within the organization or legitimate member concerns in the first place.
We knew getting everyone on the same page – and quickly – was a critical factor for success and hosted a workshop to correct these misunderstandings.

During our workshop, we walked the group through both the member journey and operational assessment. Through a series of virtual whiteboarding sessions, we discussed each member challenge, gauging its likeliness and impact, while gaining alignment across all functions of the business.

We repeated the exercise to address the operational challenges and concluded with a facilitated discussion about solutions to remediate the issues.

Our human-centered approach to this workshop proved to be incredibly beneficial for our customer – creating lasting connections amongst organizational leaders. 

Phase 3: The Service Blueprint

To set our customer up for enduring success, we created a Service Blueprint, a document aimed to develop better methods of communication and decision making between company operations and member journeys by specifically illustrating how individual issues negatively impact member experience.

Additionally, we built a prioritization matrix – showing the impact of each challenge versus its frequency – based on the challenges uncovered and discussed during our workshop.

Furthermore, for each challenge, Point B documented the solutions and initiatives created by stakeholders. And for those challenges that the workshop couldn’t solve, Point B’ers drew from their extensive experience to supply potential solutions to help guide our customer on future projects.

The biggest win of all? Clarity and structure that has helped our customer simplify complex processes in the healthcare space.