PegaWorld iNspire 2023: Bupa is Transforming Healthcare as We Know It

COVID has changed the way we think about healthcare. Digital-first options remain at the center of member preferences – across demographics. It has also made people more conscious of their healthcare and insurance options driving higher product engagement. Further, private healthcare must remain accessible to a broad spectrum as recession fears loom – all driving an awareness of cost management across industries. Discover how Bupa is tackling these challenges through lean customer service management, not just healthcare options.

Transcript:

- Hi, everyone. Susan Taylor here from the Healthcare and Life Sciences team at Pega. I'm delighted to welcome you to the second day of PegaWorld and an amazing session from our clients at Bupa. So for those who haven't met our speaker, she's come all the way from Australia. And what's most amazing is we first met her on the coldest day of the year in Boston and now she is here with us in the desert in the summer. So truly a leader in the Pega Healthcare and Life Sciences community. I'd like to welcome to the stage Lisa Dickson from Bupa.

- Thank you, Susan. That was a very generous introduction. Okay. Let's wait till we get my slides up. Great. Okay, so let me maybe just start telling you a little bit about me. My name is Lisa Dickson. I'm the head of personalization at Bupa in Australia. This is my third organization now working with Pega CDH. So I've had experience across the telco industry. I then moved to utilities, and now, obviously, have moved into the health sector. So hopefully, three times round says something a little in itself about the tool. I would describe I was once a very frustrated marketer. So that's me on the screen, in case that's not clear. My background before I kind of moved into this space was really marketing, and I really wanted the opportunity to affect more of the delivery end and the outcomes. I wanted to understand what was actually hitting the market, and I wanted to get more real-time feedback about what our customers were thinking. So the attraction of moving into, at the time, an analytics team was a bit too strong. And I must admit, I did it hesitantly. I did it thinking that I'll jump back to the other side of the events eventually and never did, 'cause obviously, I've loved it. So obviously, now at Bupa Australia, Bupa, however, is a global healthcare organization. We are a payer and a provider. So our core offering is health insurance, private health insurance. But we also have our own branded offerings, which I'll show you in a minute. Our motto is to help our customers live longer, healthier, happier lives, which is quite a nice thing to be striving for. It's a bit of a win-win. We're not trying to encourage people to do anything bad, just to look after themselves, which obviously costs us less. So fairly mutually beneficial outcome. Some of the services that we offer outside of private health insurance are things like aged care, dental, optical services, stuff like that. And I probably should pause here as well. For anyone that's used to the American healthcare system, I think most of your private health is actually provided by your employer. That is not the case in the Australian market. I think it's between sort of 5 to 8% of Australians, pardon me, get their private health provided by their employer. And usually, they're American companies. So in Australia, it's very much a retail product. We have very similar industry challenges to the rest of the world. COVID, obviously, came along and shook things up fairly dramatically. And in Australia, same as everywhere else, the system became very stretched very quickly. But for anyone that doesn't know our market very well, we are an island and so we do rely on immigration population to actually prop up a lot of our industry. So with our borders being closed, it's kind of taken a little bit of time to recover from that position. And we're starting to see a little bit of bounce back there now, which is good. However, maybe more on the positive side of the COVID days is we've had a lot of feedback from our members to say, "Actually, the digital services that were available during that time were actually pretty cool. Why can't I see my GP online? Why can't I talk to them on the phone instead of waiting in a waiting room for 40 minutes when they're always running behind and people coughing and sneezing all over me? Actually, I'd really like that service to continue." So we've seen a massive uplift in the demand for digital services, and that part of our business is definitely expanding. One of the things I get asked a lot, I guess, is why personalize at all? Like why are we even doing this in the first place? My team and I talk a lot about the fact that it probably doesn't get much more personal than health. It's a very personal topic. But aside from that, I might share a little story from when I first started. So I've only been in the health industry for about 18 months myself. And on my first day, I still remember my MD sent me down. He said, "Right, here's where we're at. We are performing pretty well as a business. We run a good book. Problem is, our customer sentiment doesn't always match how well we think we are performing. So unless we do something about that, we're probably gonna have pretty short-lived strategy." And that doesn't mean comparing how we're performing just to other players in health. The health industry as a whole, I think the marketing maturity in this space is probably a lot further behind from where some other industries are set. So this is like we're being compared to Google and Spotify and other really digital-first organizations, and so we need to do something about that. So where do we start? So our very clever UK-based CEO decided he would commission some research, and that research was looking at what are our members telling us in terms of the things we just have to get right as basic hygiene. What are the things we have to make sure are working so that we've actually even got permission to play in more exciting spaces? And that research was laddered down into the Australian market as well. And we identified 22 micro moments, which were further refined to 11. But it's things like when I make a payment, please tell me if it doesn't work. Rather than, "That doesn't work. Someone doesn't tell me I'm gonna make a claim, and then all of a sudden, I'm stuck with a bill." But it's also more exciting, things like I've been a member since I was born. So if you've been a member for 21 years or 40, if you've been a member for 40 years versus my neighbor who joined last week, what am I getting versus what my neighbor's getting, and how am I being recognized for that? So this is where we started. Problem is the more hyper-personalized you get, the harder that is to control, right? How does a human brain possibly wrap itself around all those permutations and all those different customer expectations and all those different life stages. So we needed a tool to come and help us scale our ambition, and that's where Interstage left, Pega CDH came in. Now, I should mention that we started the journey in outbound. So I wasn't at Bupa when it was first implemented, so I can't tell you about all the corridor conversations of why this was the best choice. But one of the things I do hear repeatedly and I heard in my previous two organizations, it's just one of those tools that says, does what it says it's gonna do on the box. So we like it. But outside of the outbound space, it didn't take very long for the conversation to evolve to more of a 360 view. And so we are on a digital implementation journey right now. We're due to go live on our bupa.com implementation in the next couple of weeks. But even from what we are doing already, in the first six months of working with Pega CDH, some of the benefits that we've seen operationally, we've seen a delivery efficiency uplift of more than 50%. So these slides were pulled together a couple of months ago so I can guarantee you it's more than that now. We've seen at least an incremental savings of working with partners of over a million dollars. So what I mean by that is working with marketing partners where we used to actually outsource a lot of the delivery of our communications with customers. And we've seen a response uplift of more than 30%. So this is like 30% more are engaging with the types of conversations that we're trying to have with them. So despite doing all of that, we're also lowering our opt out, our unsubscribe rates, which is really promising as well. And just to give you an idea, I should have mentioned where we started was a world of, you know, we weren't even talking to all of our members. We were talking to policy holders. So if you paid the bill, we talked to you. But if you had a family of four, we probably didn't even have their contact details. It was starting from a pretty lean spot. And there were probably three primary conversations we were having with you every year. The first primary conversation in Australia, if you have private health, you get a tax break. So tick, we would send you a receipt for paying for your private health every year. We operate on a calendar year. So around kind of November, December every year, you'd get a note from us saying, "Better use your extras 'cause they'll reset in January." So if you want two pairs of glasses from your optical store, get one now, get another one in January. And then about April, we'd set your premium for the year. That was kind of about it. We're starting from a pretty low base. We now have more than 127 propositions live in Pega CDH. And from previous experiences, without a tool like this, that's at least a couple years worth of work. So yeah, we are really pleased with where we've landed there. But in terms of actual bottom line benefit, I thought I'd share three use cases and the success of those with you today. So the first use case is our abandoned car activity. So this is people who are visiting our website. There's quite a long a research period that occurs in purchasing health products. And so we know that our customers are coming and having a look or our potential customers are coming and having a look at what our offering is, and they're often saving those quotes or they're making their own notes and they're coming back later on when they have more information. And that information could be coming from competitors. It's probably also coming from places like family and friends, doctors, trusted people who might also have say private health or other experiences with Bupa. So what we've done is we've personalized that journey. So we now know if you are someone who is new to us, we've not had a relationship with you before, so you're probably new to the industry or switching from somewhere else. We know that if you're coming back, so you used to have a relationship with us, you might be coming back. We also know that if you're an existing customer, and that's probably showing signs of potentially shopping around or churn risk. So we've been able to tailor our messages accordingly based on other behaviors that we can see that you're showing in other channels or in the online space as well. So we've seen a response rate to our banner cart personalization of 16%. That's against an industry standard of about 10%. So we're very pleased with that. Keeping in mind it's a three phase program, I've only delivered phase one. So yeah, really happy with that. And that's delivering us around about 5.2 incremental revenue annualized each year. So not a bad place to start. The second use case I was gonna talk to you about is our optical referrals case study. So this was actually our first real time data use case. So this is looking at people who go into store, and they might have their eyes checked. And then we want them to make a referral for someone else to come along. But we were throwing buckets of money away at certain offers to get kind of people to come and be enticed to that offering. So we were doing what we tend to call batch and blast activities, so we are sending emails out to lots and lots of people, just hoping to see what sticks. We took a different approach with this where we started to actually look at micro segments of different types of customers, and we looked at different types of offers. And what we found is we not only doubled the response rates for those referrals, but we were able to demonstrate that the cheaper proposition was more effective. And so the reason why we think this is is because we've been able to really simplify the message, strip back what we have to say, kind of keep it simple stupid. So again, that's been something that we've been able to, hopefully, take into other areas of our business as well. And then the third one, particular favorite of mine, we've been looking at how we can support our members recovering at home after they've had a surgery. So we started with hip and knee surgeries, thinking that was probably lower risk compared to some other types of experiences. And for every person that we can assist recovering at home, we're obviously not paying for a hospital bed, and then we can provide other services to help support that recovery. So you've got access to doctors and nurses over the phone. And obviously, if there's issues, we can make sure that they're resolved, but just means you're not in a hospital bed. So the way that this initiative has been designed, we can see engagement rates with our members at over 80%. I've never seen that before. And the thing that probably stands out for me, more than anything in this space, is not a single member has changed their contact preferences out of this. And probably, the only time in my 20 years of marketing history I've seen that is when I worked for an airline. We're giving away free business class upgrades. So that was a fairly significant find for us, but this particular initiative has only been live for us for a couple of months now. We can already see we're gonna get near to $5 million incremental revenue of this cost-saving, should I say, in you. So we're now looking at what other surgeries might this translate to. So we obviously don't have answer to that yet, but we are looking at some more sensitive journeys around things like chemo treatment at home, dialysis at home, and even things like disease management with diabetes and that kind of stuff. So as I mentioned, we started our journey in outbound. We're continuing our integration journey, as we speak, into the inbound channels. The thing that I guess I wanted to speak, just pause on, is it can be really tempting, I guess, looking at our omnichannel journey, particularly one where we're on some fairly aggressive timelines to just lift and shift what we're already doing into a tool that actually fundamentally works quite differently. And so I'm really proud to say that we're taking the opportunity to kind of reimagine a lot of those experiences. And a really good example I like to use is, in the contact center, you send lists and say, "Right, this group of agents, you can call people about welcome to do that. This group of agents, you can cross sell to new products." That would be kind of how things roll. But now, what we do is we look at who are the most important people to speak to today. And so any particular group of agents could be speaking about a range of topics. And so you can imagine that's driving a whole culture shift in terms of like cross skilling and those kinds of opportunities in the contact center as well. And then on the inbound space, very similar. And what that's helping us with, I don't know if others have experienced the same trends, but certainly pre-COVID, we had pretty predictable contact center. On Tuesdays at five o'clock, you knew what you were getting. And just before the weekend tapped out, like you knew what you were getting. But since COVID, and people's working arrangements have changed and been more flexible, we see very picky demands. And so we need to be able to scale up and scale down really quickly, both for our outbound and our inbound contact. Outbound because it drives inbound contact anyway, but certainly from an inbound contact perspective, if we don't have the bums on seats to support the calls coming in, we need to have a framework that can flexibly scale up and scale down. So some of the other journeys that we're starting to look at, welcome journey. So what we're really interested in this space, obviously, we already have a welcome journey. There's certain things that we have to tell you when you join about the products that you purchase, certain things that government likes us to tell you as well. But we often don't know why you join. So you might join because you wanna get a tax break, and that's pretty much all the level of interest that you have in having private healthcare. You might join because you're starting a family. Other people might join because, I don't know, they accidentally fell off their parents' policy 'cause they're not studying anymore and they're out in their own. They kind of accidentally landed here and know nothing about private health at all. So as you can see, that's three very different journeys that we wanna take someone on after joining. So that's something we're really interested in building out our omnichannel experiences for as well. Being rewarded, we launched our loyalty program at the end of last year, so that's in its infancy. We're obviously looking to activate that through all that we do, but we're also really interested in understanding what our customers are telling us that they wanna be rewarded with and what resonates. So we've been able to respond really quickly to some of the feedback that we're getting in this space. And some of the stuff's been really simple. There was a lot of feedback about the fact that we're trying to reward people with discounting, stuff like that. But then we charge 'em credit card fees. So easy, we fixed that. But we wouldn't have had that feedback without that instantaneous response. And then the health experiences, which I touched on a little earlier as well. I think, generally, there's a trend in the health space where we're moving to sort of more proactive preventative care. So yeah, I'm really excited to explore what's to come here as well. So some of the more surprising learnings I was interested in sharing with you today, and I might have to refer to my notes here because I can't remember what I was gonna say, but I guess with the introduction of automation, we've freed up a lot of human time. So what that means is that the brains of our staff members are freed up to think about things differently. So I've actually seen the rise of more ambitious marketing plans. So I find that really exciting. Actually having the time and space to think more effectively around what strategies people have wanted to deliver. And probably have been thinking about those things for a long time but just haven't had the bandwidth. We've had I think more opportunities to learn about our customers from a 360 perspective, rather than learning about our policy numbers. And so quite often, in fact, I won't give it away 'cause I've got a little example coming up after this. We've found some data skeletons. So the minute that we start looking at our data from a customer lens, we've found some problems, and they've probably been there for 20 years. We just didn't know about them. So now we're in a position to kind of really surface those problems and actually do something about it. And then lastly, and this is the one I think, this probably sounds really cheesy, but we've kind of been forced to work more as a team. So I've been a Bupa member since I was born, right? And so from the outside in, it's just a healthcare company. But inside, it can feel a little bit like there's health insurance and then there's dental and then there's optical, and we all have slightly different relationships with the customer. It's kind of forced us to bring a lot of that more closely together. So here's the example I was going to share. It probably brings to life one of the examples of our data skeletons. So you've got Auntie Betty. Auntie Betty likes knitting. She's a little bit deaf though. And we've been calling her. So if we're healthcare company, we should probably know she'd be deaf, right? Knew something else. Turns out, her daughter Deb makes most of her health decisions for her anyway. So actually, one of the things we've been exploring is how we can extend our customer preferences and contact permissions to broader ecosystems. So where you do have people looking after elderly parents or children or whatever, it makes it really clear who gets to make which decision. And then we also learned about Auntie Bea. Now, Auntie Bea has been going to Bupa Dental for about 20 years. Turns out she's the same person. Whoops. So again, it's kind of bringing those relationships together across the silos and really starting to understand that we've got one customer base and we've got one Auntie Betty and we need to do better. I wanted to touch a little bit on some of the technical benefits that we've seen. Obviously, we're working with the Pega cloud solution. My previous organization, we had a cloud solution but it was not owned, it was not the Pega one. And then prior to that was on-prem. And the thing that I've really noticed in this space is it just takes a lot of problems off my plate. Makes life really easy. One of the other things I've noticed is it's really easy to get an engineer on the phone. And so for anyone that's not already working with Pega, that's just something that I would consider and I think really sort of sets the platform apart. Oh, and that's what I was gonna mention. The range of connectors that are available for speeding up some of the integration deployments. So I remember, I went on a trip in February this year, and I think I was gone for two and a half weeks, and by the time I came back, our Tealium CDP was already integrated. And I thought they were joking. I was waiting for the next meeting to say, "All right, we're here to talk about this again." But it was already done. So I think given I've only been with the health industry for 18 months, yes, I've got some history in CDH, but for me, it was really good to be able to learn about across the industry silos, different I guess plugins, adapters, accelerators that Pega have available as well. I think that there are probably three primary conversations that we've been forced into as a business that probably sit a little bit more peripheral than CDH. So I thought it was worth sharing those with you today as well. And the first one is, I guess, the importance of learning how to use real-time data integration. So I know that feels kind of obvious, but I think we've been forced to have conversations about where do we need real time and where do we not, and therefore, to have really deliberate conversations around how we support each of our platforms. Things aren't falling over, but we're still getting the real time triggers where we need them. And the other thing, obviously, when you're building or bringing different data systems together, we've got lots different data models. So where are we reconciling all of that and where are we making sense of where you've got five different sources with different structures so that actually, the data shows up in a system in a meaningful way. So this is something that I'm really excited has happened really quickly. The other area is content. I know there was a bit of discussion around content and AI this morning. Personal opinion is that content is ripe for disruption. And we tend to talk about content like it's one bucket, but you've got everything from kind of research to strategy to planning to development to like the list goes on really. And so I guess we're starting to explore what in that ecosystem can we automate and think more dynamically about. I don't have all the answers yet, but very interested to see where we land 12 months from now around large language models and stuff like that. And then the third area is really looking at how our delivery system comes together. If you're gonna have a tool like Pega that is a central brain, and you are able to do business with all corners of your business, you have to make sure you're equipped to do business with all corners of your business. And so we've had to take a bit of a hard look ourselves and look at how do we remove some of the red tape in our delivery system and how do we bring end-to-end resources together. But how do we bring those end-to-end resources together in a less linear fashion? 'Cause I'm confident we've got people in our customer experience department who saw things be spat out at the other end and go, "That wasn't our idea. That's not what the problem was that we were trying to solve." And I think through all the business casing and Chinese whispers and prioritization conversations that organically have to happen in any business, that loss of confidence that actually, the problem you thought you were solving is not popping out at the other end. So we've moved from siloed delivery systems that come together once a quarter to persistent teams that include end-to-end resources, all the way from planning to customer experience to research, to development, to testing, to product management, deployment, et cetera. All in the one spot, specifically for the purpose of personalizing more effectively. And then the last thing I wanted to share is that, again, another cheesy moment, but I think the reason that this has worked so well at Bupa is we have worked in very tight partnership with Pega. I was very lucky to be invited to the Boston headquarters. Susan mentioned freezing cold temperatures at the beginning of this year. And I guarantee the week spent with so many clever people in one room is six months worth of problem solved. So I think that's something we've really appreciated. Again, really applying what we know about the tool into the health industry, but also like I've got fairly in depth experience now in CDH, but it's kind of learning what other applications are gonna be critical to our journey as we evolve and mature as well. So I don't see a world where we won't have customer service. We need that single pane of glass in our contact centers, in our retail stores to make sure that the conversation is pulled succinctly together for our agents. And it's not kind of, I think I've heard the expression "swivel chair" lots of times in the last two days. So yes, we are no different. Our agents have to navigate a lot around lots of different systems and lots of different sources of data and probably case management. I mean, if we're looking to expand the way that we look at healthcare more holistically, I don't see a world where we wouldn't end up there as well. So that's all I had to share today. But I'm happy to take any questions from people.

- [Speaker] It sounds like the decision or the implementation of CDH at Bupa was before your time. But having come from the other organizations, how do you convince a spray and pray marketer that this is the right approach to customer engagement?

- Yeah. It's funny isn't it? I don't think that that's not a conversation at Bupa still, and it's probably still a conversation in other organizations I've worked at, but as a ex-marketer, you almost have to unlearn everything you've been taught at university. And so that's like, you kinda think, "Really? What are you on about here?" But I like to think about it as you don't necessarily have to give up volume, 'cause there's lots of volume debates. What you have to think about is that not everyone gets the same message at the same time in the same channel. And when you start going, "Oh, I still get my volume," but some of it might be on the web, some of it might be in the app, some of it might be via email, some of it might be in the contact center, you think, "Oh, okay, well, that doesn't feel like such a departure from where I've been." And I think, I mean, theoretically, that sounds logical, right? But I think what really brings that to life is making sure that you've got real time dashboard reporting. So it's not good enough to be saying, "We'll let you know how it went in three months." They wanna know in two days like how's this activity performing? And I think having that instantaneous feedback from a tool like Pega allows you to reconcile the fact that your in-market state is not necessarily the final state and you've got opportunities to start small scale, quickly tweak as you go. It just feels like less of a commitment.

- [Speaker] And how do you do 100 treatments in six months? That sounds fantastic.

- Honestly, that's probably one thing I've been really impressed with Bupa is there's a belief in content being the game changer. And so we are, yes, at the bottom of the maturity curve, but culturally, everyone's kinda like, "Come in and help. We don't know what we're doing here." We know we wanna do great customer experiences. We know how to come up with great content. We don't know how to do the analytics and we don't know how to do the automation, so help us with that part. And so culturally, I think that's definitely really helped.

- [Speaker] And who are your partners? How'd you get all this done?

- We have many. One of the challenges of being in the Australian market, again, on an island is like we don't have the U.S. population, which means we don't have resources sitting on the bench. So often, you've got a couple of quality partners and you're upskilling. And so you've gotta learn to chunk down the role of a decisioning architect and you've gotta learn to chunk down the role of even testing all type. And in product management, we've gotta learn to kind of chunk that down into different roles as well. I think one of the things that's really helped Bupa compared to the previous organizations is that we've now migrated to the next best action designer. It's such a friendly interface that there are different roles that can now come to the table and have more confidence in at least doing the early stages of building a proposition. And so it just means you've got a bigger workforce than having to rely discreetly on a decisioning architect. That feels like a bit of a scary role or a bit of a foreign concept.

- [Speaker] Any other questions?

- Hi, thank you for the great presentation. You talked about implementation and delivery. I'm just interested in knowing a little bit more about the discovery process and who were the key stakeholders who actually drove and led that process and if there are any key learning that you can share from that?

- Who led the discovery process?

- [Speaker] Yeah, like who were the actual roles, like key stakeholders who drove it and then got to the solution that were most suitable?

- Yeah, great question. We tend to think about our delivery in three streams. So one stream being, what are all the use cases that we wanna design? So that's where you get your value, right? Like are we cross-selling, are we upselling, are we retaining, are we like servicing? Like what are we doing? And that is led by product management and business stakeholder inputs, obviously, from product expertise perspective. And then we also think about expand. And so the second stream is really around the integration. So again, being towards, we're still building while we're flying the plane. And so a lot of the integration work is led through our architects. And so actually, that's the other thing I probably should touch on is I'm really impressed with the architect culture at Bupa. And so there is a blueprint and a roadmap. And so I feel like maybe compared to previous experiences, I'm stuck in less debates. Is that this solution or that solution? Well, we know because we've got an architecture roadmap that's really clear. And then the other stream is more about, how do we build intelligence on the platforms? And so this is where we've got expertise around Pega specifically that builds a lot of the intelligence around the frameworks. So things like your contact models or your comms frameworks, the analytics, or the data science models that brought into the tool, the adaptive model learning, et cetera. So it just depends probably what stream, but you've got everything there from product management to architecture to domain expertise. So I hope that answers your question.

- Thank you. Thank you, Lisa, for a very insightful presentation. I loved when you mentioned that the teams came together in a more collaborative way to break down the silos. I know in the U.S., that's often a huge challenge. This department needs to send out this message, this department needs to send out that message. I'm wondering what you did to inspire the teams to better collaborate together.

- Yeah, I was pretty lucky, honestly. I think that there are some significant streams of work that we're lining up all at the same time. So I've obviously come along to talk about personalization. I think marketing maturity is building, and I think that there's been a focus on how do we deliver more efficiently. Now interestingly, that delivery conversation started with a focus on how do we strip money out of tech. But actually, I was lucky enough to be brought into, I don't consider myself a tech person. I think I'm a business person, but obviously, people in my team are both technically and product-minded. And so I was sitting in a lot of these workshops and I kept hearing language around things that happen upstream and conversations that happen upstream. And I'm sitting there going, those conversations don't happen. So how can you have a delivery improvement conversation around only half the problem? And so I think there was, like I guess, more and more kind of business owners came into that discussion, probably heard similar feedback to myself. And it started a bit of a groundswell of can we maybe start thinking about our end-to-end delivery ecosystem a bit differently? So we actually relaunched our personalization program in beginning of April this year, Personalization Reimagined. And that was the shift from, I think I mentioned earlier in the presentation, from quarterly planning where all the different business units came together. Instead of doing that, what we did was we said, "Well, we need these people from digital, we need those people from analytics, we need those people from the contact center, we need those people from CRM design." And they all came and sat in one team permanently. And so rather than bringing the people to the work, the flip was you're bringing the work to the people. And so we set out to support five use cases over a two-year journey. I think we're already supporting 15, and we're only nine months through that journey. So it just shows, I think that just the small tweaks around that mindset can make a difference. But it's that containerized persistent model where you've got expertise and IP being retained in one spot that I think has really moved the needle for us.