• July 1, 2007
  • By Marshall Lager, founder and managing principal, Third Idea Consulting; contributor, CRM magazine

Market Focus: Healthcare: The Great Divide

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The healthcare industry continues to have issues defining itself and its approach to CRM--but that's because it's more than one industry. Within the vertical we call healthcare are life sciences and pharmaceuticals, insurance and payers, provider organizations, and patient management. Surprisingly, the lattermost area is the one that has received the least attention from software vendors. "In healthcare, when you're talking about CRM you're traditionally talking about payers--the provider side is nascent. There's some growth in government healthcare, though," says Valerie Kirk, director of healthcare strategy for Oracle. "Why not providers? It's financial. Often they have a lack of resources, and CRM is viewed as nice to have, but fluff. Also, providers typically operate in geographically defined markets, where there's limited competition." Hospital chains used to only care about relationships with physicians and hospitals, because that was how the business arrangement worked. But this is beginning to change. "Today, the patient--the individual customer--matters more. With consumer-directed health plans and health savings accounts, payers must engage consumers and give them more service in exchange for shifting more of the burden to them," says Matt Wallach, vice president of sales and marketing at Verticals onDemand. As healthcare becomes ever more commercialized--there are enough TV and radio ads for new drugs and specialist hospitals to prove this--CRM continues to be highly important on the side of the business that most individuals never see. "The time to get a product to market and adopted in life sciences and pharma is greatly affected by how you deal with key opinion leaders," says Jim Zuffoletti, cofounder and president of OpenQ, a vendor of key opinion leader (KOL) relationship management software. "KOL management's future is human network management--pharma and device companies are trying to study and understand how influence and information passes," Zuffoletti says, and the way in which it's done is becoming more complex. "Traditional CRM concerns 'What business do I do with Dr. Smith?' First-generation KOL [in CRM] is all about Dr. Smith's history and associations. With the network management approach, you communicate with Jill Jones, who has influence with Dr. Smith." The traditional roles of CRM go through some reshaping when it comes to patients and the provider side of healthcare, says Paul Smolke, director of healthcare strategy for Microsoft. "Sales and marketing in the healthcare provider field translates to outreach--patient education, health and human services updates, et cetera. Service automation, especially in chronic populations, is automating the management and assigning of personnel." However, there's been increasing focus on specialty care and consumers. "The individual market for healthcare purchasing is becoming more significant; there's increased privatization of care, especially public healthcare like Medicare; and national health plans are coming along," Kirk says. "It may be moving to an online model where consumers enter some personal information and get an estimate, like car insurance," Kirk says. Wallach sees a similar possibility: "The challenge is how aggressive we can be in marketing without breaking HIPAA regulations." Top 3 vendors in healthcare (pharmaceuticals): Oracle/Siebel Cegedim/Dendrite SAP Service on the Horizon
Horizon Healthcare Services provides coverage to more than 2.9 million people throughout the state of New Jersey. As healthcare has become more individualized and privatized, Horizon has had to change its marketing tactics to attract customers and to revamp its customer service to keep them well informed and content. After one such campaign that brought in close to 200,000 new members, the company found itself unable to meet one of its top priorities--continual improvement of customer service. Increased membership brought heavier call volumes and longer phone queues as new customers asked detailed questions about their new health policies. Doctors new to the plan also needed support, because Horizon's data infrastructure wasn't up to the task. "Often a physician's office would call about claims that were processed through multiple claim systems, and our phone representatives would have to navigate all five systems to answer their questions," says Pat Geraghty, senior vice president of service at Horizon. Horizon turned to Oracle's Siebel products (Siebel Call Center, Siebel Sales, and Siebel Service) to build a system that was easy for agents to learn and transparent for customers to use. The program has been successful: Phone representatives finish their training in four weeks versus the 20 that the old system required, and their productivity is up 15 percent. Call wait times and total call length are also down 20 percent each, despite serving 200,000 more customers. The customer self-service portal boasts 3,000 registered provider users and 26,000 member users. --M.L.
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