Episode #77: How to Solve Customer Experience Problems, Before They Happen

If you’re in the healthcare industry you’re familiar with H-CAHPS. If you’re not in the healthcare industry, you should be familiar with H-CAHPS. It’s one of the first, large-scale customer experience measurement systems. And it’s something we can all learn from. In today’s episode, we look at measuring customer experiences, and how to improve ratings before they come back to haunt you.

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CXM Experience. Hi, I’m Grad, your host, CXO, chief experience officer at Sprinklr. And today we are going to talk about something that comes from my background. But it’s going to be part of our future. I want to get you excited about something that you may not think about very often.

So, a super quick thing about me, which, you know, I would say we spend very little time talking about. But in my career, I have done a number of very interesting things. And one of the favorite times in my career was actually when I started at Microsoft. I was hired into Microsoft Research into the Health Solutions Group, working for Peter Neupert, who was the CVP for the HSG. And I was partnered with Sean Nolan, who I know advocated very heavily for my hire, because I was super weird and super strange and super eccentric. And he kind of likes that kind of pirate.

And if it wasn’t for Sean and Peter, I don’t even know. My whole life would be completely different. And not nearly as rich, not nearly as wonderful as it has been. So, I owe a massive debt of gratitude to Peter and Sean. I’ve said this before in blog posts and other places. And I try to say it as often as I can. I’m sure they’re drumming their fingers on the table and they’re saying, I hear you got this debt, but where’s the cash? So, we’ll figure that out one day. But they’ve been amazing parts of my life.

And one of the things that we did together was we launched the world’s first online PHR, Health Vault. Microsoft Health Vault. It was also Microsoft’s first cloud product, which was very cool. And we worked very closely with a lot of hospitals to integrate something called Amalga, which was a SQL system that allowed us to aggregate health data into a single patient discharge record. So, they could then be shared to their Health Vault record, and then with their primary care physician and other health institutions.

And there are millions and millions of people that got signed up to Health Vault. It was recently turned off by the company — don’t get me started. But for a decade it had a great run and did some important things and saved thousands and thousands of lives.

So, why am I talking about this? Part of it is there’s this entire outcome-based psychology and philosophy around the way that hospitals run. And because of the importance of CMS, which is the Center for Medicare and Medicaid Services. This is the government agency that pays for health care in Medicare and Medicaid, which is a massive percentage of health care payments and the health care system.

It is interesting to me… I originally come from Canada, where 100% of health care is paid by the government. And Americans tend to be somewhat politically inspired by discussions around healthcare. But in fact, quite a bit of the American system is actually public already because of CMS. So, if you go to CMS.gov, a whole bunch of stuff there. But they talk about what they’re trying to do to create the very best healthcare system they can. And because so many patients are on either Medicare and Medicaid… if you think about it, it’s actually a massive percentage of the population, because classically, you don’t really get sick and you don’t really access a lot of health care until you’re of the age where you’re on Medicare or tend to be in situations where you may be on Medicaid anyway. So, this is a very significant percentage of the patient population. And no hospital can run or expect to be able to financially succeed without having a great relationship with CMS. gov.

So, the CMS team, about a decade ago, introduced something called hospital CAHPS. And CAHPS is spelled C-A-H-P-S. And it’s usually termed HCAHPS. Hospital CAHPS. Most people say HCAHPS. So HCAHPS is the very first national standardized, publicly reported survey of patient perspectives on hospital care. And so, the HCAHPS survey is actually a 29-item instrument. And there’s a data collection methodology around it. And it measures patients’ perceptions of the hospital experience.

We talk a lot about CXM Experience in the CXM Experience, and we talk a lot about experience. Well, HCAHPS is actually one of the very first and one of the earliest measures of experience, specifically around patients. And I’ll go into a little bit more detail on it. But the quick shortcut on this is that your HCAHPS score is a measure of the patient experience that you’re delivering as a hospital. And if your score is very low, your payments are penalized by CMS. And when I say penalized, I’m talking millions, if not tens of millions of dollars in penalties that are exercised with poor HCAHPS scores.

So, for hospital administrators, they live and die by these HCAHPS scores. Their nightmares are nightmares around poor scores, I’m going to come back to that in a couple of minutes in terms of how we can manage that better.

So, the general idea of HCAHPS is it allows a valid comparison to be made across hospitals, both locally, regionally, and nationally. It was implemented originally in 2006, just as I started in health care. And public reporting began in 2008, about 11 years ago. So, since 2012, HCAHPS scores have played a role in hospital payment through the hospital value-based purchasing program. So, 2012 was when HCAHPS went from being an interesting idea to something that had economic impact on the hospitals.

So, the HCAHPS survey captures the patient’s experience of communication, responsiveness, things related to medicines, cleanliness, quietness, how did the discharge go, how was the transition to post-hospital care, what’s the overall rating of the hospital. And it’s administered as a survey between two and 42 days after discharge to a random sample. It can be done via mail, telephone, mail, and telephone, or IVR. It’s interesting that they’re not using modern channels yet. And they’re not using channels that people prefer. So, I think there’s a bias in the survey to people who are older. They don’t have a WhatsApp connection, for example. But we’ll come to that later. But I think all these things come in due time.

The survey is available in multiple languages. And there are about 4,000 hospitals who participate in HCAHPS, and about 3 million patients complete the survey each year, which is a pretty significant number.

The great thing about HCAHPS is that it’s publicly reported. They actually publish the results on the Hospital Compare website. So, if you’re going to a hospital, or if you’ve got some kind of procedure booked, it’s worthwhile checking it out. You can go to medicare.gov/HospitalCompare, and then it’ll show you the different HCAHPS scores for the hospitals.

It’s also employed, as I mentioned a few minutes ago in the hospital value-based purchasing program, and that affects the amount of money that hospitals get from CMS. You can see it online. There’s an HCAHPSonline.org site that allows you to see all current, historical, state, and national results. And you can see who the top hospitals are as well.

So, why are we talking about this? Do you want to know what the acronym means? Maybe, okay, so let’s do the acronym. So, hospital CAHPS, or HCAHPS. The H is Hospital. And CAHPS is C-A-H-P-S. And that stands for Consumer Assessment of Healthcare Providers and Systems. HCAHPS. Consumer Assessment of Healthcare Providers and Systems. And repeating myself again for a moment here, but it’s pretty amazing, pretty innovative, and pretty forward looking. That this is one of the very first detailed experience trackers. Think about when they launched this, right? They launched it in 2006. They started publishing in 2008. And they started penalizing in 2012. They gave everyone lots of time to get their scores up.

I would submit that most private sector companies weren’t even thinking about experience scores in 2012. I always love it. I love it when the public sector can do something like this and show the way. It’s very interesting. And healthcare generally, one of the reasons I’m such a big fan of healthcare, we’ll probably talk about it a bit more in the next few weeks, is that is an amazingly innovative category. And they do some incredible things in it. And it’s been deeply influential on my own view on martech and other systems.

So, why else are we talking about this? It’s cool. They did experience scoring. Yeah, that is cool. Now you know the acronym. There’ll be a test at the end of the class. Any other ideas?

I’ve mentioned a few times that the HCAHPS score is used to penalize hospitals financially, or reward them, depending on how you want to look at it. But I think for most hospitals it’s a downward payment, not an upward payment. A good HCAHPS score maintains your payments. A bad HCAHPS score decreases them. So, it’s mostly a stick-based incentive system.

How much do you think a hospital would pay, or care, to know what their HCAHPS score would be in advance? How much time do you think administrators of the hospital spend worrying about their HCAHPS score? I’ll give you a preview, they spend a lot of time worrying about it. It is a very significant, worrying issue for them. So, what are they going to do about it?

Well, there does happen to be an application called Sprinklr. What does Sprinklr do? Sprinklr collects data from people who are talking across all the modern channels, from Reddit, to blogs, to review sites — there’s a lot of interesting private sector hospital review sites now as well. And of course, all the social platforms, etc. And what’s interesting about HCAHPS is as innovative as it was, and as forward thinking as it was, it is still a relatively antiquated survey mechanism, relying primarily on mail, or telephone, or IVR.

Imagine if you could collect all the data from modern channels, which is immediate. And see when people are unhappy, horrified by cleanliness, disappointed in food, not particularly pleased with the discharge process, which they tend to post. And imagine if you could get back to those people immediately. Really disappointed with a discharge today, didn’t even get a pair of crutches. By the way, that’ll be my post tomorrow.

So, tomorrow, I am going in for surgery. And I’m going into a hospital that I’m not going to name right now, because I don’t want to make them angry at me. But part of the discharge is that… I’m having knee surgery. I’m super scared, by the way. But they don’t provide crutches. They said order crutches off Amazon. So, I did. They haven’t arrived yet. I don’t know if I’m going to have crutches tomorrow, right? So, I might have a bad review for Amazon and a bad review for the hospital at the same time. It’s called a twofer.

But I’ll post that right away. I’ll post that before the HCAHPS survey comes to me. The hospital could get back to me, deal with the issue and fix it, and make me feel better. And when I get that HCAHPS survey, I’ll have a way different response. Or the hospital may decide to bad, so sad. We’re not giving you any damn crutches because they’re 20 bucks. And I’m only paying 20 grand for the surgery. They can brace themselves for potentially lower HCAHPS score.

It’s a really interesting idea. And one thing, I’m surprised that we don’t see more HCAHPS-focused implementations in Sprinklr. And that’s something that we’re going to be spending a lot more time talking about with our customers over the next few weeks, months, and years. And if you’re in the healthcare industry, and if you’re worried about HCAHPS, Sprinklr is a great way to get a preview of a potentially damaging score, or more importantly, to see what people are saying and fix it.

Because this whole idea of listen, learn from that, and love them back. That is customer experience management. It measures the customer experience. And it manages it. Fixes it. Makes people feel better. HCAHPS, again, nothing but kudos. Super innovative. But they’re just measuring the experience. It’s just CX. It’s really customer feedback. Customers will say, in this case, consumers of the hospital will say, I had a terrible time. The cafeteria was dirty. The food was terrible. Discharge process was ridiculous. That’s just simply noted, and the hospital is penalized.

What’s better, is I say those things, and someone fixes them for me. Oh my gosh, your discharge process wasn’t good. I’m going to call you right now. Send me a DM and let’s have a call, I need you to know what your discharge should be, I need you to understand what drugs you should be on. I need you to understand what you should be doing to care for that. When you need to book PT. That can be fixed quickly. Bad food, dirty, that can be fixed. The way you fix it is you go clean the place, and you get the food better. And what you say to the person who’s complained is, I am really sorry. Here’s a coupon for Mickey D’s, or Chick-Fil-A, or whatever you like. Have that on us. We’re horrified. And we have implemented these cleanliness procedures. And we’ve implemented these food improvement procedures.

When someone gets that HCAHPS survey, they’re gonna be like, you know what, I didn’t have a great experience, but they’re pretty responsive. They got back to me right away, and I’m not going to ding them as hard as I might have.

So, if you’re in healthcare, think about this. Think about how you can be way more connected to the modern channels and get ahead of, and on top of these HCAHPS surveys, and optimize your payments from cms.gov. For the CXM Experience, I’m Grad Conn, CXO at Sprinklr. And I will talk to you, next time.