Will: Hello, Dave. Welcome to the show.
David: I’m very happy to be here, Will. Thanks a lot for having me.
Will: Dave, I want to hear on today’s show about what it means to be a chief experience officer. But before we get to your role, just give us a overview of what Centene Corporation does. Big company, Fortune 100 company, a lot of people not necessarily haven’t heard of it. Give us an overview of Centene.
David: Sure. You’re right, a lot of people have not heard of Centene Corporation, in part because we don’t go to market really under the Centene brand. The Centene brand is really designed for current employees, prospective employees, investors, and government regulators and legislatures where were partnering with states to conduct business on their behalf. Our business model is primarily as a managed care organization for government programs.
What are government healthcare programs? They include Medicaid, which is primarily for the underserved populations, Medicare, which in general is for the over 65 population, although there are other product categories where Medicare provides services. We’re also very active on the healthcare exchanges, the Obamacare plans inside of the country. We serve over 14 million members currently. We also have the TRICARE West region of the United States, so that’s healthcare services for Department of Defense, military personnel and their families.
Medicaid is a joint program that’s administered by each state government. They put in funds, and also receive funds from the federal government. Medicare is funded by the federal government. The exchanges is a combination of some government subsidies, and then private citizens who sign up for the exchanges are also paying all or portions of their premiums associated with that product.
Will: With Medicaid, just being a naive person, I always just assumed that, okay, it’s the government program. I mean, the government would have all these government employees processing claims and doing all that stuff. Is that not how it works? The government actually would contract with a company like Centene to manage it at a given state level?
David: Yes. Many state governments choose to contract with private managed care organizations or insurers to run the program on their behalf. Probably 20 years ago, the majority of state Medicaid programs were run by the state governments in what’s called a fee-for-service model where there’s basically a publicly available fee scheduled published for a variety of services. And then, physicians and other medical personnel will bill on a transactional basis for providing those services.
What many of the States have found over the past couple of decades though is that there are more efficient ways to run the program and to hold the providers to a common standard. As a managed care organization, we help to provide additional assistance to the portion of the population that is really using the majority of the services. In those cases, think about somebody that’s got multiple medical conditions. I might have heart disease and be overweight and have diabetes. What we do is we work with the providers in each of those specialty areas to help coordinate care, and to ensure compliance on the part of the member with that regimen of care.
When you provide that extra high touch service via nurses or social workers that make up a large portion of our employee base, then you find out that you actually get better health outcomes and you can lower costs. If you think about driving a car, you probably take it in for an oil change every once in awhile. If you don’t do that, eventually the car will have very serious problems. The same is true in healthcare. As long as we’re doing the little things right along the way, we can potentially preemptively solve bigger problems that could otherwise come later on.
Will: Does the state government contract with Centene to manage the entire Medicaid program in the state of X, or are they just carving out specific populations like, “Okay, all of the diabetes patients will have you care”?
David: Yeah, that’s another great question. In general, the state government will contract with more than one managed care organization inside their state. For instance, in a smaller state like New Hampshire, they might contract with two or three providers across the entire state population. In a larger state like Florida, they might divide the state into 11 regions and then bid the contracts out for multiple bidders and multiple winners in each of those regions. Some states do have separate programs with smaller populations that they might award to a single carrier statewide. In general, states really enjoy having a couple of players inside of the state to ensure competition, and we think that breeds more innovation in the space as well as we compete for business.
Will: And then, within a given geography, like in those 11 regions of Florida, if you live in Tampa, are you assigned to one of those providers or do individuals actually have to choose between multiple ones?
David: Individuals will be given a choice. If they don’t choose, there are some algorithms used to assign members to one plan or the other. Generally speaking, states don’t like having a single health plan that has monopoly power in any specific region, and so they have ways of divvying up the populations to ensure that it’s fair and that there’s good competition.
Will: Okay. Then, for a patient then that has selected one of the Centene brands, so they might… It might not be called Centene. It’d be, have some, a brand for that local plan. Your company would do all of the billing, but then also if it’s a patient that has some complications, you would provide some extra nursing or extra services to make sure that patient stays more healthy, and that therefore can reduce the total costs over time?
David: Yes, that’s approximately correct. We do handle assigning members to a primary care physician. We handle making payments and adjudicating claims. And then, for those populations that are receiving higher touch, then we’ve got folks that help do that as well.
Will: Okay, great. Now I have a bit better understanding of the company. Let’s talk about your role. Chief experience officer, what does that mean?
David: Anything I want, Will. I was hired a little over seven years ago as the first chief marketing officer for Centene. At that time, we were a little over $5 billion in total revenue. I was hired in 2012. The Affordable Care Act was passed in 2010, not yet implemented, but our CEO, Michael Neidorff, knew that more consumerism was coming to the healthcare space then currently existed. He was interested in having somebody with a consumer packaged goods background come in and bring some outside industry thinking into the company. I’d spent 12 years at Proctor & Gamble doing traditional brand management stuff on really super exciting and sexy brands like Charmin bath tissue and Eukanuba dog food. Charmin is poop coming out and dog food is poop going in, so I can talk about that whole cycle, maybe later on or for your outtakes, which is fascinating.
In general, what I did for the first couple of years here as the CMO was understand why does the company exist, what’s our purpose, and help to articulate that. We exist to transform the health of the community one person at a time. Our mission is to improve health outcomes and lower costs, and we do that in partnership with the state and federal governments. We did a lot of work to understand how do our brands in each state show up and is there a more efficient way to go to market. We decided that, yes, yes there was.
Even though we operate as Sunshine State in Florida and Peach State Health Plan in Georgia, there are still things about these populations that are very similar from one state to the next, and we should probably apply those sets of understanding from one state to the other. We worked for about three years to put a process and discipline in place that we felt really good about. And then, we started doing some a consumer segmentation and journey mapping. We realized what most people who have a high degree of interaction with the healthcare system realize, which is the healthcare experiences a lot of times not super awesome.
On Siegel+Gale’s Brand Simplicity Index, health insurance ranks at the bottom and on Temkin Experience Rating, health plans rank at or near the bottom, and in both cases were below the cable companies. I haven’t met anybody who’s really enthralled with their television service provider, so how is it that healthcare, which can actually save people’s lives, do worse than the cable companies? I think the answer is a pretty simple, which is no matter how many Pay-per-view programs you order from your cable company, you still only get 12 bills a year. Will, I’d like to ask you. How many pieces of correspondence do you get throughout the course of the year from the healthcare system?
Will: Oh my God. It is, I mean, beyond just the bills. Every single time you go, it’s-
Will: I’ve posted a couple of times on LinkedIn about some of the crazy ones that you get that just don’t make any sense at all. For one thing, like sometimes I’ve gotten bills where it said, “Okay, the allowable is $50,” and whatever. And then, your plan allowed this and it says, “Okay,” but then you actually owe money, like owe more than the actual amount that they billed. Like, “Well, they billed you $50, but your plan allows like 200, and then you owe 200.” Like, “What? I owe more than they billed me? What?”
Will: And it just-
David: And then, we use this jargon that nobody understands because there’s insurance, there’s co-insurance, there’s deductible, there’s a copay, there’s a premium. The list goes on and on and no one really understands what any of that stuff means. As we got into the details of how frustrating the consumer journey can be in the healthcare space, we said, “Okay, you cannot market your way out of a mediocre product experience. We really need to work on the product experience.” At that time, we changed my title from chief marketing officer to chief experience officer. Although my sphere of control did not expand all that much, my sphere of influence did. We do a lot of work now with HR and with IT and with operations to really understand what are the points of friction that we as a company are delivering to our members and to our providers, and what are the things that we can do to address those challenges and get these friction points at least to neutral.
Will: Let’s talk about a few. How do you measure the customer experience?
David: We use an internal satisfaction measurement. We have in the past used net promoter score as well. We think that customer satisfaction, which we are moving to assess after every interaction that a member has with us when they call in or use the website, and you have probably seen these automatic surveys that pop up after you shop for something online. It gives you the opportunity to opt in or opt out of a quick survey. We’re using tools like that to make assessments. We also do a variety of live member research throughout the year to get a feeling for how we’re doing through that mechanism as well.
Will: Tell me about any work that you do to map out the customer journey across different types of transactions. If a customer needs to call in to dispute a bill or to get some special thing approved, do you have any work where you map that out and see the end-to-end time and the number of touches it takes, and then work to do some lean ops type things around those processes?
David: Yes. For anybody who’s done consumer journey mapping work, whether it’s through some human-centered design workshop or through a marketing workshop, we do that work every couple years on each of our product lines. We’re in rotation between Medicaid, the exchanges, Medicare, and our complex care business on how we assess those journeys. In general, for each segment of the population, we know that there are between 80 and 150 different types of touch points that a member could have with us throughout the course of the year. We’ve identified where there’s the most friction and have put programs in place to address those things.
The four broad umbrella areas that we’ve really identified on how to activate are on communication, access to care, respect and education. Really, respect is the most important one, because as we’re dealing with underserved populations and as we’re dealing with people who are experiencing healthcare issues, it’s really important that we move forward in all aspects of our touchpoints with a degree of empathy and respect and empowerment that we think is important. Otherwise, we’re just adding stress to what’s already a stressful situation.
Will: How do you manifest that part, that piece around respect? How do you measure how respectful are we being, and how do you work to train your employees to be more empathetic or respectful?
David: Yeah, so we have a variety of training available to call center staff and other employees. We’ve got a very robust annual employee training program that we undertake here at Centene. And then, there’s also most of our calls are recorded, that typical “Your call is being recorded for training purposes” message that you hear when you call into a lot of call centers. We do that as well. We’re always trying to educate our employees and help them to manifest that empathy that we think is important that our members and providers receive.
Will: What have you found are some of the areas that are the most important around improving the experience that are the biggest pain points for people? I’m curious to hear the story of what you’ve done to improve those pain points.
David: Well, I mean, it all starts with joining the plan. I can either send you out an 8.5×11 piece of paper with 12 point font that’s folded in thirds and put into a business envelope, or I can do something else. We’ve worked really from that initial new member package all the way through other aspects of the journey that we know 100% of our members receive and are working our way through that. Would you rather read the box score of your baseball team or read the Sports Illustrated version of an in depth report on the star pitcher, or would you like to watch a 30 for 30 expose on how the team has done?
Really, what we’re trying to do is understand how do we take what is a required transaction and elevate that into an engagement that’s valued by the member and not likely just to be thrown into the recycling bin the way I do with my explanation of benefit documents that I receive that says “This is not a bill” across the top. Any way that we can stop frustrating people and wasting their time, but instead of using black and white, we use color. Instead of using words, if we can provide diagrams or informatics, then we do that as well. It starts with the things as basic as welcome to the plan, and how do we make people feel welcome as opposed to feel like they’re a burden.
Will: Yeah. How have you done that rather than just the, like you said, the 8.5×11 folded up? What sorts of things have you done to, on that very first touch point, the welcome piece?
David: Yeah. We basically, I don’t know, maybe six years ago said, “Hey, what we think is one of the best in class pieces of communication across any industry is the airline safety card,” right? When you get into an airplane, you can pull that thing out of the back of the seat in front of you and take a look at it. It uses either very few or no words what to do if the oxygen mask comes down or how to get out of the plane in the case of an emergency. We’ve really taken this design philosophy to heart. Our welcome packets are just that. They are packets of easy to digest information with a member identification card and some other materials that is something that you can hang on to and not misplace. We’ve really made the use of a very specific color palette. Our brand colors are raspberry, orange, lime, and, grape. We specifically chose those colors because they’re warm and welcoming and as I like to say, they are sorbet flavors. How can anybody get mad at being treated to a sorbet?
Will: One thing… This is a little off topic, but one thing that I always wonder about every time I pay a medical bill is how they send me the bill, and then you pull off the slip at the bottom to write in your credit card number, and the place for your credit card number is super small. I mean, and I’m able bodied and I can just barely fit in the 16 digit number there. I think, “Wow, 30 years from now when I’m elderly and I have like tougher time writing, that would be really tough.” And then, you look at the back of that piece of paper, and there’s just all this space. Like why don’t they give you more space to write in your credit card number and sign your name? Have you looked at the forms at all, and [inaudible 00:21:47]
David: We have. Yeah, we actually have looked at our forms, and there’s always work underway to improve the forms. What you’re talking about is a billing statement from a hospital system or a provider. That’s not something that we send out. We do send out the explanation of benefit documents, and we have worked very hard to make sure that they don’t look like something that should just be discarded. This idea of human-centered design is really becoming more important to our company, and I think it’s becoming more important to industry as a whole.
Our members have expectations of how they interact with us, not because they have had other interaction with Humana or United Healthcare, but because they’ve had interaction with McDonald’s and Panera and Patagonia and Walmart and Amazon, right? Our competitive set has to be how do we deliver really best of the best experience as opposed to best in class. Because even if we can get above average in healthcare, we’re still at the bottom of the barrel relative to other consumer interactions. We’re keeping our eye on the prize at how do we get better overall and not just relative to where we are right now and what our peer set is doing.
Will: Tell me about what you’re doing in terms of working to improve the experience for the providers.
David: That’s a great question. We are farther ahead on our consumer journey than we are on our provider journey, but we are working on provider as well. A lot of this is getting operational data correct. Do we have the right address in the system and the right hours for our providers? Are we paying claims accurately and on time? Is the provider’s ability to interact with us easier or harder than how they interact with other payers in the system? We do have a group that focuses on contracting with providers, moving away from the fee-for-service model that I talked about at the beginning and into a value-based contracting model, which allows for a additional performance payments for providers that are providing the best quality of care. There’s a lot of work underway there, too.
Will: What do you think for a consumer is the best way to give feedback to a managed care company or a health insurance company? I’ve in some cases with my own health insurance, when I just couldn’t get satisfaction by calling customer service, I resorted to mailing a letter to the CEO of the company. I looked up the headquarters address. Actually then, there’s some kind of ombud squad that looks at that mail and they managed to take care of this issue, That probably wasn’t… I don’t know if that’s the best approach. What do you, from your role, what should consumers do if they’re not getting satisfaction by just calling customer service?
David: Yeah. If they’re not getting satisfaction just through calling in, I think reaching out electronically is helpful. Obviously, we monitor our social media channels, and that’s, for a consumer in any industry, that’s always a route to take. I hope that folks would receive satisfaction before having to send a letter to the CEO. If you’re having trouble with Centene, I’d rather have you send the letter to me than to our CEO. I guess that would be an option, too.
Will: Yeah. The problem that I had was not with Centene. I want to make that clear. What about with states? As Centene competes for contracts at the different state level, to what degree are states looking at the experience that managed care plans provide to patients beyond just the fee for it? To what degree are you seeing them evaluating the experience that you provide?
David: Yeah. States are super interested in the level of care that their citizens are receiving and the quality of care. Both access can members get to providers the way they need to, as well as what are the outcomes. There are several nationally recognized and mandated sets of data that come out that are measuring quality. We’re always looking at making improvements on both the HEIS and the CAPs set of measurements. Those are the two primary sets of measurements that the government mandates, gets evaluated.
Will: Do you see the idea of having a chief experience officer, is that spreading? Do you talk to other chief experience officers to swap notes?
David: Yeah. The chief experience officer title is starting to grow in popularity. It probably first started 10 or 15 years ago, primarily in hospitality businesses. Hotels and hospital systems have both really been thinking about this idea of experience more broadly than other industries have, although I suspect it’s going to grow in importance across other industries as well. I think as a marketer, I’ve seen a progression in the way marketers think about their craft. I mean, obviously there’s an art and science to marketing. I think many decades ago we thought that advertising was the be all and end all of marketing activity. They said, “No, we can’t just advertise our brand. We have to build the market.” This idea of marketing just beyond a single offering started to come up and then say, “Well, now we have to do brand management. People have to buy into the brands, not just by the product that the brand offers.”
Big consumer packaged goods companies have figured that out. Obviously, other industries have as well. I think this idea of experience and thinking about a continuum of touch points across that experience spectrum is important. We use the language of transaction engagement and relationship, and how do we move transactions into engagement realm? If you have enough engagement, can you actually have a relationship with your member or your consumer?
I think this idea of having an experience officer is going to become more prominent just like companies have both a CTO, chief technology officer, as well as a CIO, chief information officer. We’re going to see chief marketing officers in concert with the chief digital officer paired up, versus the CIO and CTO. I think depending on the organization, you’ll see a growth of CXOs who are trying to synthesize what the brand experience should be, as well as what the product is offering, as well as what are the additional touchpoints that consumers are experiencing with regards to that broad brand proposition. How does that all come together?
Will: Let’s dial the clock back a little bit. You talked about you worked at Proctor & Gamble. Before that, you went to Naval Academy and you were a Marine for what, about six years.
David: That’s correct.
Will: I’d love to hear about how your Marine experience, your military life, has impacted your professional career after that, either leadership lessons that you’ve used in your professional career or habits that you gained in the Marines. Love to hear a little bit about how the Marine experience has stayed with you.
David: Sure. The Naval Academy and the us Marine Corps are both leadership organizations. Yes, I have a bachelor of science degree in English. Officially, I have an English BS degree, which I think is a little bit amusing. That school, just like the other service academies, are really designed to enhance people’s ability to lead, which a basic definition of leadership I think is getting people to do things that they wouldn’t just do on their own.
The Marine Corp is certainly a leadership organization. The Marine Corps is an up or out organization. No one gets hired as a general. You have to start off as a Lieutenant and work your way up. I think there are similarities in corporate America to the way the hierarchy in the military service works. Procter & Gamble certainly was a hierarchical organization in many ways more bureaucratic than the Marine Corps was. I think the Marine Corps tended to be more decentralized.
But I think three of the last six CEOs for P&G had military experience in their background. We see a lot of similarities in hierarchal goal organizations, but also in organizations that require empathy to get things done, which is pretty much every single one of them. I think the common misconception about the military is that people have to follow orders because it’s the law. That’s not really a manifestation of good leadership. Authority can be given, but respect must be earned.
I think as we think about our place in our organizations in our communities, it’s human nature to want to work with people that you enjoy working with and that you respect, as opposed to somebody who’s bullying you. I think that general military experience has certainly helped me demonstrate a point of difference versus some of my peers who, especially early in my career who didn’t have a similar set of experiences. I was, I think, 25 years old and I had 65 people in my organization. There are not a lot of 25 year olds that get that level of experience, and it certainly helps as you transition to corporate America to know how to get things done.
Will: Something I’ve heard from other military folks is also a little bit of a sense of calm under stressful situations where sometimes in corporate life it’s like, “Oh my God, the document. We had a mistake in the model. We have to redo all the pages.” And like, “Well, we’re not being shot at right now, so.”
David: Well, exactly. Well, I’ve been… I was with Proctor & Gamble about three months. I had a newborn at home. There was a lot of stuff going on. We were, on our brand teams, we were going through our annual business review, which is a very stressful time. People were really freaking out. I went over to another assistant brand manager who had been there a little bit longer than than I had been, but who had served in the Navy. I said, “Chris, I don’t get it.” He’s like, “What? What are you talking about?” Like, “Everybody’s so stressed out, but no one’s shooting at us.” He laughed and pushed his chair back, and said, “You know? You’re right. That’s good perspective to have. When you’re trying to sell toilet paper, in general lives are not in danger. That’s always a good perspective to have.”
Will: As just parting thoughts, Dave, what would you say are things… If someone was interested in eventually getting promoted to a chief experience officer role on what are some preparations or some important background someone should have for that?
David: Yeah. Number one is know what you do well and do that. A lot of people are trying to figure out what the magic bullet is, and I’ve found that there’s two schools of thought. There’s the Tony Robbins, the motivational speaker who likes to tell people to find their passion and go do that. Mike Rowe, the host of Dirty Jobs likes to say, “Well, find something that needs to be done and just love doing that.” I think those are both good points of view. Wherever you are and whatever your job you’re in, makes sure that that’s the best job you’ve ever had. If it’s not, then find something else to do. But know what your strengths are and play to those strengths I think is item number one.
Item number two is for people aspiring to any sort of executive leadership or organizational leadership is being infinitely curious. Consume as much information as possible on as many different planes as possible. I mean, probably the most successful marketing program that I ran as an ABM when I was working on the Charmin brand, the idea came to me as I was reading Outside Magazine. Well, paper manufacturing and the great outdoors don’t have a ton in common, but you never know how your brain is going to connect the ideas that will deliver a breakthrough. Read as much as possible or listen to podcast, however you consume information. Gain access to information as widely as you can, and make sure that your brain is engaged and your curiosity is never stated. Learn more.
Will: Fantastic. Dave, thank you so much for being on the show.
David: My pleasure, Will. Thanks for having me. We should do it again sometime.
Will: Sounds good.