John Ounjian, Chief Information Officer, Blue Cross & Blue Shield of Minnesota

The healthcare industry is in flux and CIOs like John Ounjian of Blue Cross & Blue Shield Minnesota (BCBS MN) are playing a central role in developing a new healthcare delivery system. The customer care system in use at BCBS MN includes Aspect Communications' Customer Self-Service, which provides Interactive Voice Response (IVR) functionality by integrating advance speech recognition from partners like SpeechWorks, and also Aspect Call Center and Aspect Enterprise Contact Server, all integrated to work as one application. With this system, BCBS MN customers are offered multiple channels into their healthcare plans, including: self-service elements via voice and online systems, the ability to manage their own portfolio with voice recognition or a secure Web site, and also having a live person to talk to when needed. Recently, STM sat down with Ounjian who provided at look into his vision for the future of customer service in the healthcare industry and how he thinks we can "shatter the granite" that currently surrounds the customer experience. STM: From what I understand, you are trying to impact not only the insurance side of healthcare, but the entire healthcare delivery system. Do you think that what you are trying to do at BCBS MN can do that? OUNJIAN: That's right. This is not just about BCBS MN or even about BCBS on a national level. It is about the healthcare industry. I believe that as part of the healthcare industry we make a difference and that difference starts to translate itself back to our millions of members. Then that difference begins to make our members more productive, and healthier, which will in-turn translate into the real workplace and then into the communities. So at the very end, the real joy of what we are talking about isn't making healthcare a better industry, but raising the standard of living of America. In which case healthy, productive individuals will translate their benefits in many forms—from social life, to business life. The impact that healthcare can have on the individual is far greater than the business of healthcare. STM: You spoke in your presentation at SpeechTEK 2002 about "shattering the granite". Can you explain this? OUNJIAN: Part of the "shattering the granite" is an industry challenge that we need to do collectively. We need to understand the uniqueness of each individual that we are connecting to. Market segmentation: the young, the old. To give you an example: It is not just the uniqueness in terms of your like and dislikes. What about personal disabilities? Assume you are color blind. Now instead of wanting to see beautiful graphics, you are only concerned with fonts that are readable. Those are things that technology can bring. The uniqueness of not only your likes and dislikes, but also how communication is going to much more conducive. So the whole intent that I was trying to drive by "shattering the granite" was, "How do we improve our effectiveness in connecting to individuals?" STM: What do you mean by improving our effectiveness in connecting with individuals? OUNJIAN: People who have poor eyesight want bigger fonts on the screen, versus seeing lots of pretty colors. We need to find means of communication that is more conducive to speaking to particular individuals, such as physicians or brokers. What are the elements that help to better connect with their logic and approach of how they do business. Technology can bring uniqueness. That is what the automobile manufacturers have learned. They have many varying types of vehicles to suit each market segment. We must understand this as the auto industry has done. How do we provide our communications vehicle so that it meets different segments and markets. STM: You're dealing with millions of people, so how can you possibly do this? OUNJIAN: Millions of people drive cars and the auto industry has dealt with it. We must understand what are the experiences that people are looking for, and what is comfortable for them. There are some individuals that will never be able to use particular technologies. So they will decide to continue to use the mail, or the telephone. We must give them multiple options to see how the consumer world will aggregate. In the healthcare industry we have not understood segmentation well enough to say what are the likes and dislikes and where are the market segments. So what we normally do is bring a one-size-fits-all attitude and see who uses it. STM: Doesn't that get expensive? How can BCBS pay for all of this individualism? OUNJIAN: The individualness is built from ground-up. In our business, we have source data. Why should there be different data depending on who is using it. The database for the member and the provider are very similar. How do you bring databases to be more common sources of information? That is going to save money, because companies have too many databases and too many customer information files anyway. So if we streamline our databases in terms of consolidation and improve the accuracy, it is going to save money. The other part is that our databases are limited—There is no personalization. How do we know what you like and don't like? So what if when we are doing the enrollment, we ask you: "Do you like voice recognition? Do you like the Web? Would you like us to be communicating with you proactively? Do you want us to do nothing?" We can begin to profile our customers during enrollment. If you are not interested in learning about diabetes or chronic heart disease, why am I sending you information on these items? And if you are, maybe I could spend little more money and do a better job of getting you that information. STM: How does speech recognition (SR) fit into all this? OUNJIAN: SR is a powerful technology, but SR technology by itself is only one component. By itself SR cannot make a difference. For instance, you could bring SR to the transaction of name and address changes, but have you leveraged SR in a strategic way? I believe that once you integrate SR into the structure of your delivery system it becomes much more natural. The system comes to recognize what kind of service you need. SR is a technology that needs to be shaped into your overall design rather than standing by itself as a singular channel. It needs to be brought more horizontally and made more seamless. It also has to connect better to my own way of thinking and interacting in the experience that I am in that moment. STM: Do you see speech companies starting to provide that for you? OUNJIAN: I think speech companies right now are still very siloed. They have the technology and have tried to channel that technology with some specified applications. Basically, speech companies have brought the product to the customer and asked, "What do you want to do with it." The customer then picks the slot and SR is dropped into it. But SR is not yet a part of the overall system of communication. It is used more as a technology of transaction and has not entered the world of interaction. SR, I think, will become a rich technology when it finds how to bridge interaction and transaction. STM: How important is speech technology in the vision you have, and could you meet that vision if speech wasn't a part of it? OUNJIAN: I think SR is vital. SR is going to bring the whole element of natural experience with the customer. Pushing a key on a keyboard is not natural, but what is natural to a human is speaking. So speech recognition technology brings the greatest communication power of an individual—speech. For example, the power of a transaction is very precise. Which means if I have a dialog box that says, "Pick option one, two, or three", and I pick option two, that action is very precise. But how do I really know that you wanted option two; how do I really know what you are trying to ask me? In the world of transactions, you lose that whole element of trying to understand the customer and what it is they are trying to do. But if you have enough power in the technology to understand the spoken commands, you then analyze those commands, and play it back as a form of confirmation, acompanied by, "Did I understand you correctly?" Then the customer is in a position of saying, "Yes, that is what I am trying to ask." Now the customer is getting what he really wants rather than just the closest option. That is the gap that SR is going to fill. STM: In five years, what do you think BCBS will look like in its customer care? OUNJIAN: I think what we are going to find out is that our customers are going to be interacting with us in multiple channels. What we are going to be providing to our customers will be efficiency and effectiveness, in terms of our accuracy and timeliness. But more importantly, our customer service will transform from being a contact center to being defined as the whole enterprise. The new BCBS of Minnesotta service model is going to be built on, "How do we give you convenience, but yet when you need a representative, who is the best live expert for your question?" I do believe that in the end we are going to find out that we are not talking about the different technology that we have implemented. We are going to be talking about how we are advancing the ease of doing business with the healthcare payer, and that BCBS is an easy company to do business with. STM: In one sense, many of your customers may not have a choice of healthcare provider because it is provided by a corporate plan. Why go though this added expense when you already have captive customers? OUNJIAN: Yes, that is true for now. However, what's happening is that purchasers are beginning to shift decision power and risk to their own employees. So now individual choice is beginning to open up. Products that are going to begin to emerge are consumer directed health products. In which case the employer will say to you, "Here is the money I am depositing into your account. Now you go pick and choose your plan." At that point it may not have to be BCBS. You can opt for other plans. However, at that point we need to provide you the tools whereby we can help you make your choices. We provide tools for you to make decisions and put the various options side-by-side, so now you have a choice not to do business with me. Then comes the selection process of the individual. And yes, the deductibles are going to rise, but you will have much more direct responsibility of your financials. So healthcare is going to become a portfolio for you to manage, and financial decisions will have to be made. Therefore we need to expand our tools to move beyond just the healthcare options, but also into the financial aspects of your healthcare portfolio. Healthcare is really built on three words: Quality, Access, Price. The element of choice will be built on affordability. Affordability is going to drive the level of quality and the level of network access. That is where the power of technology comes in. It helps define how we are going to interact with you to be able to understand your needs so that you can make the right choice. The power of SR lies in our ability to give you options that are more meaningful, by understanding your spoken word. STM: The cost in healthcare is not really with you providing customer service, but instead paying for services that are provided to your customers in the hospital or doctor's office. Is there anything that SR can do on the healthcare provider side that can help to lower costs or at least maintain costs? OUNJIAN: Any one of us in the healthcare world is only one component of the value supply chain. So, in essence, it doesn't matter if you are an insurer, a hospital or a physician, you are part of a larger supply chain. If we are able to bring the richness of communication and interaction and we begin to connect it into our individual supply chain, we can energize the entire healthcare supply chain. We also need to energize the value we are creating inside of it. As a member of a healthcare plan, and you go into a physician's office, one of the things they have to do is eligibility for you. If I have improved the hassle of how you get admitted into a hospital, I have improved your life and the life of the hospital. And at the end of the day the whole industry has won. So today, as an example, so much cost is incurred because so much wrong information gets pushed around. SR can help to streamline and consolidate these efforts.

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