If you receive errors when attempting to view this white paper, please install the latest version of
"Through an innovative approach and revolutionary technology, Online Insight
has established a solid reputation in the marketplace with several well-known industry leaders in healthcare
, life insurance, financial services and real estate."
Source: Online Insight, Inc.
NextGen Health Care: How Technology can Help Make Consumer-directed Health Care a Reality
Health Care is also known as :
Health Care Info,
Health & Wellness,
Health Care Cost,
Health Care Issues,
Health Care Planning,
Health Care Investments,
Healthcare Talent Management,
Health Care Guide,
Healthcare Industry Solutions,
Health Care Systems.
The primary goal of every health benefits company is to develop, market, sell, service and retain the "right" health plans for
the "right" clients at the "right" times - for the lifetime of each policy. An admirable goal that presents several challenges:
- "Right" always changes, especially when it comes to the individual needs and preferences of humans who are
constantly inluenced by media, past experience, their peers, and even governments.
- The "right" health plan is dificult to evaluate.
a) First, each health plan consists of multiple facets, which can be mutually defeating. For example, a "benefit-rich"
plan that may sell well and have high retention rates would likely be expensive to service/maintain unless only the
healthiest individuals were approved at underwriting.
b) Second, perception - as inluenced by marketing messaging - comes heavily into play. For example, a plan's
preventative health features might reduce claims expenses but unless the marketing/advertising messaging is highly
effective, many prospects might not perceive the value of these preventative measures clearly enough to pay the higher
premium typically associated with such plans. Therefore, sales could be weak.
- The "right" clients are strongly dependent on the plans that are currently being offered. They are also dependent on
the needs and preferences each prospect perceives at the precise moment they evaluate coverage options. In short, the
"right" client cannot be understood independent of the other two items: the perceptions of the individual and the products
available at an exact moment in time.
Untangling the Healthcare Knot
Many of you will recognize the picture to the right - the Gordian Knot, an appropriate
image for this twisted mass of inter-dependent issues creating the daunting set of challenges
that is the focus of this paper. How can a health plan provider begin to coherently
pull on the strands within this knot in order to harness its potential to achieve:
- Higher sales?
- Better margins?
- Longer client retention?
- More effective plan development?
It is the goal of this paper to communicate the value of a new suite of software technologies that provide a single point of
entry for prospects and health plan providers (including agents) to educate a new or renewing insured on the full value proposition
of each plan offering. The software then recommends the best plans, highlighting the it between plan features and
prospect needs, to enhance the overall sales process and close rates. Behind the scenes, the same technology suite measures
and records all prospect preferences to allow sales, marketing, advertising, and product development to beneit through the
production of more targeted offerings and personalized messaging at greatly reduced costs.
Guided Selling : Channel-independent technology solution that allows a prospect, in a self-service or agent-assisted mode, to
determine what product features are important to them, create a feature preference proile, and match that proile to products
within a speciic catalog in a best it continuum.
Sales and Marketing Effectiveness : Technology solution that measures and records each prospect's preferences toward plan
features and offerings and allows users to leverage this information to develop more effective market messaging, advertising and
product development resulting in greater cross-sell and up-sell opportunities through more targeted offerings at a lower cost.
Prospect : Potential customer.
Representative : This encompasses Sales Representatives, Sales Executives, Account Executives, Account Advisors, Independent
Agents, and outside brokers for all health plan provider sales channels and product lines including Medical, Dental,
Vision, Life and more.
Most health plan providers use a variety of systems and processes to support prospects, and representatives working with
prospects, in their efforts to buy/sell insurance and related products. However, none of the present systems and processes
meet the business need of the organization to provide consistent "best-selling" practices to every prospect at every touch
point. They also do not mathematically measure and record each individual's responses in order to optimally respond at the
point of sale and to improve the overall marketing, advertising and product development efforts of the enterprise.
Because existing systems and processes do not consistently support and enforce best-selling practices through all channels
(Internet, call center, in-person...) at every prospect/customer interaction, we ind:
- Representatives do not have access to all the data they need to make timely and insightful plan recommendations. A signiicant
amount of critical data from prospects/customers has not been stored and does not exist to support sales efforts.
In addition, data that does exist must be accessed from multiple systems, reformatted, and interpreted. This increases
costs to the business through: longer and more dificult sales cycles; multiple data retrieval and entry; and opportunity
cost from lost opportunities when "best-sales" practices cannot be executed.
- Prospects and representatives tend to commoditize products, e.g. buying/selling the least expensive premiums, instead
of engaging prospects in a dialogue that educates each individual on the value associated with other features that match
their speciic needs. Thus, they miss the win-win of maximizing the premium earned as well as prospect satisfaction.
- The lack of shared knowledge and a closed cycle between product development, marketing/advertising, and sales makes
higher close rates more dificult to achieve and hinders continual optimization of the sales process. It also increases
the likelihood a sale will be lost and reduces the opportunity to learn from each prospect what messaging and products
he/she would ind more effective.
- Higher margins, better retention rates and the continual optimization of margin and retention are limited. This also
decreases revenues through lost renewals and lost opportunities to up-sell and cross-sell higher margin and ancillary
products as well as the lost opportunities to learn from prospect reactions to these up-sells and cross-sells.
Because existing systems and processes do not precisely measure, record, and consistently respond to each prospect's reaction
to plans, features, the Brand, and other key differentiators presented at the point of sale, we ind:
- Representatives and prospects can fail to identify "hot button" issues that compel individual prospects to buy certain
- At the critical point of sale, representatives are unassisted in their efforts to follow "best-selling" practices and therefore
are likely to stray from those guidelines.
- There is little capability for the organization to provide "best-selling" interactions to a prospect in self-service channels
such as a website because automated decision assistance a prospect can trust is inadequate or altogether absent.
- There is not a complete record of the entire sales interaction including all questions asked, responses given, and measurements
of prospect reactions to plans and plan features regardless of the time, location, and selling channel (representative-
assisted or self-service)
- Many current sales systems and processes are not easily accessible outside the ofice. This situation severely limits their
value by not ensuring "best practices" are always available to the prospect and representative whenever and wherever
they are needed.
- Management Reporting is inadequate: not all the data that management needs is tracked; the data entered is inconsistent;
some data is not entered by representatives at all or not entered in a timely manner due to amount of work required; and,
some reports needed are not supported.
Breaking the Knot
Coniguring and deploying a 360' Guided Selling and Sales & Marketing Effectiveness solution that allows Representatives
and Prospects to access its functionality through multiple channels and points of entry is the tool necessary to defeat the
Gordian Knot of healthcare. First and foremost, this tool provides the beneits of closing more sales at a higher margin with
greater long-term persistence. However, the secondary beneits can be even more enriching to the top and bottom lines.
This solution allows sales, marketing, advertising, and product development management as well as higher-level corporate
management to access pertinent information about prospect/customer preferences, "best-sales" strategies, the quality of
marketing messaging/advertisements, and even the market pull for new products that are "on the drawing board." Finally,
the proper deployment of a robust platform for 360' Guided Selling and Sales & Marketing Effectiveness results - almost
immediately - in improved relationships between the health plan provider's associates and prospects, as well as its external
business partners driving business.
Likely Motivations for Your Company to Act Now
Gain a Competitive Advantage
The current sales tools used by your captive and independent sales teams offer limited capability to eficiently and effectively
counter competitors. This motivation is made more pressing given that Guided Selling's higher close rates, retention,
margins, and cross-selling of ancillary products are already being realized by some of your competitors - across their entire
Close More Sales
Each day without a centralized system for selling that ensures the consistent application of "best sales" practices, retention of
critical customer preferences/responses, and continual optimization of sales and marketing effectiveness, results in lost sales
opportunities that should be won.
Implement a Scalable Sales Platform
The costs of managing your various sales segments, channels, technologies, representatives, and so forth are growing with
each new addition. Taking advantage of this opportunity can inally provide a fully integrated selling platform that instead of
costing more as you grow your selling network, actually beneits from that growth. It takes advantage of economies of scale
by learning real-time and irst-hand from the needs and preferences of even more of your clients.
Obtain Real-Time Customer Insight
Every day that Executives, Product Development, Marketing, Advertising, and Sales are not completely synchronized, company
money is being used less eficiently. Various parts of your sales forces are not fully engaged in selling every product offering,
especially newly launched products. Marketing and Product Development may have different views of why products
exist or why prospects buy them. Executives steer strategy based on incomplete views of customer needs and their broader
organization. This situation is avoidable; it is avoidable because one type of information drives all of these typical business
silos - the real-time and irst-hand needs and preferences of prospects and customers. A single system that measures, tracks,
and stays synchronized with this heartbeat of the business ensures that sales strategy and tactics, market messaging, advertising,
and product development and reinement are aligned with each other at every point in time.
In summary, business needs and activities are constantly changing (e.g. the addition of the online sales channel) and existing
systems and processes have become less and less effective at continually optimizing sales performance in light of this constant
change. This creates the opportunity to take a signiicant step forward in your company's executive, sales, marketing,
advertising, and product development performance and integration.
The Business Opportunity
Your organization has a unique opportunity to signiicantly increase sales of both core products and ancillary products while
simultaneously unlocking new synergies across the executive (strategic), sales, marketing, advertising, and product development
organizations through the deployment of a 360' Guided Selling and Sales & Marketing Effectiveness solution.
This project can ensure that every prospect and customer receives a "best of breed" sales interaction every time and through
every channel. This interaction will deliver the right value-added sales messages at the right times and increase each representative's
ability to sell or present your company and its partners. Similarly, this "best of breed" interaction will reach to
Implementation of this project will reduce the number of steps needed by representatives to collect and synthesize data about
their prospects and partners, consequently increasing the number of sales a representative can make through increased eficiency.
This project also provides functionality that ensures this continuity even after a representative, who has built long term
relationships, leaves your company or after a new representative joins the organization and is required to make sales contacts
from a more nave and inexperienced position.
Implementation of this system will also provide critical information that management can use to evaluate business status,
strategies, tactics, and overall optimization and integration.
The Business Rewards
Many business beneits can be accredited to a complete and effective deployment of a 360 Guided Selling and Sales & Marketing
Effectiveness solution. They include, but are not limited to:
- Increased top-line revenues
- Widening margins as the emphasis on price decreases with a deeper appreciation of the full value of other plan features
- Increased prospect conidence by providing a proven method that identiies personalized product recommendations the
prospect perceives will best meet his/her needs, helping to validate his/her decision
- Higher conversion rates
- Improved retention rates; stronger, more loyal customer relationships
- Interactive, engaging sales process that educates consumers on which plan features are most important based on theirspeciic
personal and inancial needs
- Consistent sales experience across multiple channels: web, call center, kiosk and agent ofices
- Ability to generate rich leads complete with buying motivators and individualized, "best-it" product recommendations,
enabling representatives to execute insightful and timely recommendations to maintain buyer interest and conidence
- Enhanced analysis of historical transactions and demographic data in concert with psychographic data on buyer motivations
- Creation of a 1:1 virtual focus group with 24x7 accessibility for new product simulation and evaluation
- Ability to leverage preference data to validate segmentations and simulate market share
- Implementation of targeted marketing campaigns focused on individual motivations
- Integrated sales, marketing, advertising, product development, and executive decisions, both tactically and strategically
- Consistently up-to-date 360? view of all client/prospect needs and preferences accessible by each operational area
- Ability to provide the right product(s), to the right market(s) at the right time(s) and price(s)
Business Risk Analysis
Risks of Taking This Action
- This project will not eliminate the need to proactively advertise, market, and sell your products. This project simply
ampliies the effectiveness and overall returns on these efforts.
- Your organization will have to overcome some resistance from those who are too comfortable with the "old ways" of
selling, including the old systems and procedures.
- Some training will be necessary to ensure that your organization extracts maximal beneit from this 360' Guided Selling
and Sales & Marketing Effectiveness platform.
Risks of Not Taking This Action
- Increasing dificulty achieving maximum effectiveness from new sales, marketing, advertising, and product development
associates that lack training and years of experience.
- Associate dissatisfaction due to increasingly complex systems and manual processes.
- Inability to lower cost per sale because of continuing product development, sales, and marketing ineficiencies.
- Loss of associates to other companies, especially direct competitors that offer more robust technology platforms to their
- No assurance that "best selling" practices are employed in every sale through every channel to increase sales rates, margins,
and client retention.
- Up-selling and cross-selling initiatives will be more dificult to introduce and sustain across all channels, products, and
- Representatives and Account Executives will continue to use a variety of home-grown solutions to partially address
sales and marketing effectiveness needs and the information from these mixed solutions will never be able to be shared
across the enterprise.
- The enterprise will not have a consistently up-to-date 360' view of all client/prospect needs and preferences around
which executive decisions, sales, marketing, advertising, and product development tactics and strategies can be integrated
- As a sales organization, you will not be on par with many competitors. The lack of this system impedes effective competition
today and even more so as time progresses and your competitors - who have already moved in this direction
- become more sophisticated at leveraging these tools and techniques.
Overview of the Solution
Through an interactive conversation with prospects at the point of inluence - either assisted by an agent or in a "self-service"
mode (e.g. through a website) - this solution elicits and captures valuable information that it uses to identify "best-it" product
recommendations. This system can then explain and educate the prospect/agent on the direct connections between each
recommended product and the individual prospect's needs and preferences. This allows the prospect/agent to visualize the
true alignment between each product's value propositions and to provide the conidence needed to complete the call to action,
immediately. This allows the organization to sell more, in less time, at lower costs. By implementing a truly multi-channel
guided selling suite, your enterprise provides a consistent sales process that allows consumers to purchase products that meet
their personal and inancial needs - when they want, where they want, and how they want. Additionally, this high-touch sales
process reassures customers that the plans they ind and purchase, in fact, do align with their needs and budgets, resulting in
stronger and longer-lasting customer relationships.
This solution goes beyond product recommendations and increased sales. It gathers comprehensive buying motivation and
preference knowledge that is:
- Real-time : captured at the point of interaction
- First-hand : direct from the customer, avoiding subjective interpretations
- Detailed : measuring precise motivation levels
- Automated : obtained and analyzed at computer speeds and scale
With access to this business-critical information, your company can develop more effective strategic decisions, product
development actions, and sales and marketing campaigns tailored to individual and segment-level preferences that provide
measurable results. This alignment with customers' buying motivations is not just a one-time advantage; by being an integral
part of the ongoing business processes, the solution ensures this alignment endures as the market constantly changes.
This solution contains four, fully integrated components:
- eMpower Motivations : embodies "best selling" practices to engage consumers in an interactive conversation to uncover
underlying buying motivators and "hot buttons" that lead a customer to purchase your products.
- eMpower Sales : delivers critical components involved in the buying process - perceived knowledge, perceived choice
and perceived individual it - at their highest level to provide the conidence consumers need in your product recommendations,
so that they execute the call to action.
- eMpower Distribution : helps transform information seekers into customers by providing all distribution channels
- including agency/agent forces - with the capability and knowledge needed to close more sales.
- eMpower Enterprise : delivers business-critical intelligence on buyer needs, preferences, demographics, transactional
behavior, and psychology consistently across the entire enterprise, empowering everyone involved in the value chain
with the information necessary to deliver the right product, to the right market, at the right time and price.
This leap forward takes your company beyond recommending "what" your customers should buy to helping your agents and
customers understand precisely "WHY" they should buy before the call to action and precisely WHY they did or did not buy
each product after the call to action was presented. This critical WHY factor enables you to close more business in less time
at a lower cost with sales, marketing, advertising, and product development working together at peak eficiency by sharing a
complete understanding of market motivators, segment-by-segment and individual-by-individual.
- All "best selling" processes deployed to this system will be accessible to all channels that your company sells through
today and may anticipate selling through in the future.
- The sales conversations support deep product education to prospects in a wide variety of forms, including:
a) Glossaries of key terms
b) Access to product and related literature
c) Multi-media content
- Natural Language Generation (NLG) can be used to describe the alignment between product features and prospect needs
in simple textual form.
- The system collects any demographic information required to facilitate the sale.
- Through support for rules-driven, dynamic-behaviors the sales conversations are tailored intelligently based on all
known aspects of a prospect (e.g. avoid discussing maternity coverage for single male applicants).
- The initial reaction of each prospect to the product features available is elicited and permanently recorded from each
prospect at every point of sale.
- Sophisticated mathematical modeling is employed to test prospects initial reactions to product features and featurevalues
and reine them before recommendations are made.
- Each sales conversation encourages prospects to holistically consider the products being offered, thereby reducing commoditization
that occurs when prospects simplify down to price. For example, avoid the prospect scanning down to the
lowest monthly premium by making him/her fully aware of the value of lower deductibles, better health network coverage,
out-of-network beneits, etc.
- The system has the ability to create visual representations of the it between each product feature and each prospect need
and preference to reinforce the recommendations and drive the call to action.
- Emotional considerations, such as the desire to protect one's family and to protect one's self in catastrophic situations
can be presented by the system.
- The sales conversation provides the ability to support any combination of the following activities:
a) Opening the sales conversation
b) Deep, mathematically-measured, prospect needs assessment
c) Education on the Brand, products, features, etc.
d) Cross-selling of ancillary products
e) Up-selling to higher priced or higher margin products
f) Answering objections
g) Making completely customized product recommendations
h) Providing a wide variety of calls to action (enroll, apply, chat, schedule a call/visit, contact an agent, etc.)
i) Fully support agent-based selling
- These guided selling conversations are Comprehensive (across marketing campaigns and sales calls), Multi-Channel (faceto-
face, web, call center, kiosk), Real-Time (adapting to customers' constantly changing perceptions), First-Hand (direct
from each customer without the error of statistical guesstimates), and Detailed (measuring precise levels of preference).
- An ability to get "quick" product recommendations is provided at every point in the process.
- An ability to reine the "quick" product recommendations by re-engaging the full needs assessment process is provided.
- When products are recommended, the system offers signiicant lexibility, including:
a) Recommending all products, or just an intelligently selected subset.
b) Can "page" the products to allow the prospects/agents to move rapidly through the recommendations.
c) Supports differences in products, legal disclosures, and more determined by the state in which the sale is being made
or other aspects of the prospect, product, and transactional context such as the applicant being "male" or "female."
d) Supports dynamic product features, such as monthly premium, that must be retrieved or calculated in real-time from
the available data.
e) Provides mathematically accurate rankings of the products being recommended based on all known demographics,
needs, and/or preferences of the individual prospect.
f) Allows for a much more detailed view into each recommended product.
- Side-by-side comparisons of products can be provided where not only features can be compared/contrasted but also all
information about how well each product meets this unique prospect's circumstances.
- The system allows agents to leverage it by directing clients/prospects to it either with or without their presence (as they
desire/choose) and yet always being sure that they can be credited for the sale.
- The sales conversations support agent follow-up in the cases that a prospect does not want to execute the call-to-action
immediately, instead preferring to have a follow-on conversation. In this case, the system provides the agent a complete
record of all information gathered including preferences and product alignments with prospect needs and wants.
- The system allows straightforward integration with other systems as required or requested.
- The system allows your company to recommend and sell "bundled" products as might be required over time.
- Every sales conversation is recorded at suficient detail to allow it to double as a market research event to ensure that
market knowledge remains up to date without additional research expenses.
- An executive dashboard is provided to allow management to see the progress of prospects (with and without agents
involved) through the "best practice" sales processes.
- Robust reporting over the market research collected from sales prospects is provided. Some key functionality includes:
a) Report on the importance prospects are placing on each product feature.
b) Report on the relative preference between all values for each product feature (e.g. preference for a $500 deductible
versus a $1,000 deductible)
c) Report against the demographics and other information collected from prospects at the point of sale.
d) Simulate the market appeal for a new or revised plan design against the stored needs/preferences from real prospects.
This means that the system can tell you how prospects would have reacted to this new or changed plan had it
been available when they were at the point of sale.
e) Report on sales volumes and engagement levels through each part of every sales conversation.
f) Run statistical analyses - average, minimum, maximum, standard deviation - on the information collected.
g) Perform estimations on the relative value of each upgrade and downgrade to the richness of a plan to see precisely
where the intersection points are between value points and prospects' willingness to pay for them (increased premiums,
h) Detect perceptual correlations in how prospects think about plan offerings (e.g. how much willingness to pay increased
premiums does a client correlate with your brand).
- The reporting expressed here runs against all individuals interacted with to-date or speciied segments of the individuals as
deined by your speciied criteria (e.g. all males, all people with certain needs/preferences, or all people in a given zip code).
- Segmentations can be combined for a look at more complex sub-segments of the full prospect pool.
- The system can report within speciied time windows to allow analysis of more recent or broader collections of individuals.
- This system supports "pure research" as well, so that your company can also freely test "blue-sky" ideas - that should
not be exposed to all prospects - with selected respondents.
System Properties and Environment
- Representatives and prospects can access this system anytime through any sales channels that your company is currently
- Portability gives the representatives the ability to access the system using laptops or PDA and other wireless devices
over the Internet.
- Connectivity between external applications and systems to pass information is provided.
- The reporting and analytics features are accessed from a single point of entry.
- The solution makes multiple preference-rich prospect leads available to agents at any time.
- The need for duplicate data entry is minimized.
- Prospect preferences collected at the point of sale are kept in synchrony with the information being analyzed for advertising,
marketing, and product development.
- This solution supports the entire enterprise from a single deployment, i.e. your enterprise does not have to support more
than one logical instance of this solution no matter how many products, channels, sales agents... will be served now or
in the future.
- This solution is platform-independent so that you may change hardware vendors, operating systems, database vendors,
etc. without having to replace this Guided Selling and Sales and Marketing Effectiveness platform.
This project will deploy a new system throughout your company that will perform Guided Selling and Sales & Marketing Effectiveness.
Initially, it can be deployed in a "stand-alone" mode with minimal integration to your other systems. Over time,
however, it may be desirable to integrate the information in this system with other systems for Sales Force Automation, Data
Assumptions & Dependencies
- Existing cold calling and prospecting systems used today will remain unchanged.
- This system provides its own reporting system and does not require integration with current reporting applications and
- All ield representatives and agents can have laptops with web browsers for one point of access.
- Email can be used to deliver preference-rich sales leads to agents.
Review of typical off-the-shelf sales force automation, contact management, and other sales systems that are marketed and
available for purchase clearly demonstrates they do not have the depth and breadth of functionality required to support the
full range of Guided Selling and Sales & Marketing Effectiveness requirements. Similarly, the depth and breadth of functionality
provides signiicant barriers to "in-house" development. More importantly, when time-to-market and opportunity costs
are fully considered, the deployment and customization of another sales system becomes unacceptably costly.
There are many different ways to measure the success of a strategic and tactical initiative such as the one described in this
paper. For illustrative purposes, some that can be applied to this project include:
- Representatives, agents, and prospects utilize the system each time they come to your sales channels to shop for and/or
purchase your products and ind value in the functionality and information provided
- Better enforcement of "best sales" practices across channels, agents, and prospect interactions to improve results
- Increased productivity from newer and less experienced sales associates, call center representatives, and outside agents
- Longer-lasting, more loyal customer relationships
- Increased close rates both in self-service and in agent-assisted sales interactions
- More effective and valuable lead generation program
- Increased effectiveness of marketing and advertisement messaging and placement
- Reduction in product development expenses
- Practical elimination of ill-fated product launches
- Execution of more effective business strategies across the enterprise as a result of sales, marketing, advertising, and
product development being on the same page and working together
Table of Contents
- Table of Contents
- Executive Summary
- Breaking the Knot
- Likely Motivations for your Company to Act Now
- The Business Opportunity
- The Business Rewards
- Business Risk Analysis
- Risks of Taking this Action
- Risks of Not Taking This Action
- Overview of the Solution
- Major Features
- System Properties and Environment
- Resulting Processes
- Assumptions & Dependencies
- Alternatives Considered
- Success Measures
NextGen Heathcare : How Technology Can Help Make Consumer-Directed Healthcare Reality
Published : February 1, 2006
Author : Bradley S. Fordham, PhD, Executive Vice President & CTO, Online Insight
Copyright ' 2001-2006 Online Insight, Inc.
All Rights Reserved, Printed in the U.S.A.
This document is provided for informational purposes only and the information herein is subject to change without notice. Please
report any errors herein to Online Insight. Online Insight, Inc. does not provide any warranties covering and specifically disclaims
any liability in connection with this document.
Online Insight is a registered trademark and "eMpower Motivations", "eMpower Sales", "eMpower Distribution",
"eMpower Enterprise", "Insight Intelligence", "Know WHY. Know NOW", "Collaborative Customer Conversation", and
"engage.educate.eMpower" are trademarks of Online Insight, Inc.
Online Insight, Inc.
7000 Central Parkway, Suite 500
Atlanta, Georgia 30328