The healthcare market has changed dramatically over the last five years with the introduction of insurance exchanges and reform efforts that are rewarding health quality over quantity. These changes have accelerated a shift toward healthcare consumerism and increasing demands among consumers for experiences that are tailored to their needs. Healthcare organizations that are responsive to these changes and adjust the way they interact with their members have gained market share.

For one Colorado-based healthcare provider, company leaders were particularly challenged by low member satisfaction and net promoter scores along with declining member retention. Efforts to improve member satisfaction were not having the impact they needed and the ongoing loss of members was financially unsustainable.

To understand the problem, the client first turned to the tools they have always used – annual patient satisfaction surveys and call center complaint data. The challenge was that the survey results and call center complaints were fairly similar to years past. Nothing stood out as a significant change.

Archetype approached the problem differently. Our team started with a behavioral and quantitative approach and identified every customer who left in the past 4 years – then worked backwards to assemble their ‘journey.’ This journey included every touchpoint from the moment they first became a customer until they left. Archetype then assembled a baseline of successful journeys to contrast the two.

The healthcare journey is complex and there is a tremendous number of touchpoints including scheduling appointments, physician encounters, receiving bills, getting referrals, filling prescriptions – as well as life events like switching jobs, getting married, having children.

In all, a dataset was created consisting of nearly four billion data points – and it’s the first time the client ever assembled such a comprehensive view of their members.

After the journeys were assembled, sophisticated machine learning algorithms and data mining techniques were applied to search for patterns in the customer journeys that lead to people leaving. Archetype was able to identify the factors that contributed to customer loss.

The results were surprising—and they pointed the client in a very different direction from previous efforts.

Archetype identified the retention problem was costing the organization $162M annually and that the majority of members who left were new, young, and healthy members (people who haven’t yet chosen a doctor or made their first appointment.) These customers were invisible to the client’s earlier analytics because they hadn’t been to a clinic and therefore weren’t represented in the data being used to analyze member satisfaction. The problem set of customers were completely off the client’s radar.

Initial hypotheses are that the registration and process of choosing a doctor are difficult and confusing to this group of members, leading people to get frustrated and switch providers at their next opportunity. Archetype recommended the client focus on efforts to reach out to this cohort of members and make sure they understand how they can benefit from the services available to them.

This work has prompted the organization to look differently at their member population and is changing the direction of their analytic investigations.  Archetype continues to support their efforts in other projects that are helping gain a deeper understanding of their members and will identify necessary investments to meet member expectations.