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Bupa Australia adopts Pega to build more authentic relationships with its members

Derek du Preez Profile picture for user ddpreez June 13, 2023
Healthcare requires a sensitive approach, where relationships require developing trust. Bupa Australia is using Pega’s platform to do exactly that.

healthcare, people, technology and medicine concept - close up of doctor in white coat with stethoscope and tablet pc computer over blue background with charts © Syda Productions - Shutterstock
(© Syda Productions - Shutterstock)

Bupa is one of the world’s leading health insurance and private healthcare providers, with its Australian organization having close to 4 million members. And whilst the company has a solid financial foundation, it is rethinking how it interacts with its ‘customers’ and is hoping to build a closer, more authentic relationship with them. Bupa sees this as critical to its future success and is using the Pega platform to establish a more nuanced understanding of its members’ needs. 

Lisa Dickson, Head of Personalization at Bupa Australia, spoke with diginomica at Pega’s annual user conference in Las Vegas this week, where she said that much of the ‘relationship building’ agenda is being driven by senior leadership. Bupa’s CEO has a keen interest in personalization, Dickson said, and Australia is being used as a test for further rollouts globally. 

Dickson is honest about the organization’s current understanding of its members (or to put it another way, its incomplete data view of its customers). She said: 

We run a good ship, the books are strong - but our customer sentiment doesn't always align with how well we think we're doing. So unless we do something about that, it's gonna be a fairly short lived strategy. 

We needed to get to know our customers better. How do we do that? We need to build relationships with them - and we didn't have a relationship with all of our members. 

Traditionally, Bupa had a relationship with the person that paid the bill. Even if that bill included a number of people with varying needs on the same household policy. Bupa wasn’t talking to everyone involved and often engagements would be transactional in nature. For instance, Bupa would reach out when the member needed a receipt to claim against tax, or to flag that a member’s benefits would be reset at the end of the year. 

This predictable pattern of limited engagements meant that Bupa’s marketing practice wasn’t particularly mature, said Dickson. However, working with Pega, this is now changing - but it’s a long-term strategy. She added: 

We were starting right back from: how do we get people’s contact details? How do we get their preferences to actually use those contact details? And then what channels do we have to work with? 

Bupa Australia has, at present, integrated all of its outbound channels through Pega and is on the path to integrating its inbound channels. It is also launching its first digital channels next month and then will move to assisted channels later this year, such as the contact center and retail stores. 

In terms of how Bupa is collecting member data, it is exploring how it can gamify engagement and update details that way. Or, for instance, when members log into the Bupa website, they may be delivered a prompt that asks them if they could update their email address and if they’d like it to be updated to include marketing engagement. Dickson said: 

It's all about having that connected 360 ecosystem and then looking for ways to keep that engagement alive.

Building the foundation

Dickson explained that Bupa’s CEO has been terrific in terms of executive support, including publishing some research that looked at what she described as ‘hygiene factors’ for engagement - essentially the basics that an organization has to get right before it can move on to more meaningful experiences. She said: 

There were 22 micro moments identified that were narrowed down to 11 when that laddered down to the Australian market. And it's things like ‘get my payment right’, ‘don't make claims the most memorable experiences when I go to hospital’, ‘reward me if I've been a member for 60 years’.  

We spent a lot of time over the last 12 to 18 months looking at those hygiene factors. Whereas now we're kind of hitting that exciting sweet spot where we can look at step changes. 

What are the signature experiences they're going to set us apart? So for example, everybody's talking about cost of living at the moment, particularly in the Australian market where private health is discretionary. That’s of concern and so we want to make sure that people are prioritizing their health. 

It’s not enough for us to talk about the cost of health care. We have to talk about other benefits, like waiting periods, like proactive health care management. We need to look at other ways that we can offer value to our customers. 

In terms of the valuable data that Bupa is aiming to collect in order to understand their members better, Dickson provided an example of the welcome experience. There’s a lot of things, as an insurance and healthcare provider, that Bupa has to tell new members when they join the company - including information about the product and any government requirements that are involved. However, Bupa often doesn’t understand ‘why’ someone may be joining. Dickson said: 

You might be joining, because you just don't want to pay more tax. Someone might be joining because they want to start a family, which is a whole different conversation. And then someone else might join because they’ve fallen off their parent’s policy, as they’re not a student anymore. 

So you can see already, other than ‘Welcome to Bupa’, there's all these tailored opportunities that we can address if we understand that. But part of that is building that relationship, so we're not freaking you out when we say ‘what are you here for?’. Often there is a gentler way to have that conversation, such as ‘Is there anything else we can help you with today?’. And quite often people will divulge that information, but unless we've got a way to systematically capture that information and do something productive with it, what's the point?

An empathetic approach 

Bupa is using Pega to do just that - systematically collect the desired information and then use the vendor’s decision engine to try and engage with members in a more authentic way. Key to all of this, Dickson said, is engaging in a way that doesn’t feel too intrusive - healthcare is a sensitive area for many people and sending a deluge of information requests often wouldn’t be appropriate. Dickson added: 

There’s a lot of test and learn. It's not a black and white science. But I'll give you an example: in the welcome programme I was describing, where you might be joining for different reasons, we’re probably not going to send you a survey asking you to tick the box that applies to you. That feels to me like, what the hell do you want to know that for? 

But I might say to you during a welcome call, is there anything else I can help you with today? And you might tell me you’ve got diabetes and you'd like to learn more about that. And then I've got somewhere to capture that information and help you in your next steps. So I think you've just got to be a little bit creative and a little bit sensitive about getting that information and come across in a genuine way. 

This test and learn approach has been key to Bupa’s journey with Pega, but Dickson acknowledges that this can become pretty complex, pretty quickly. In essence, all this information is too much for a human brain to process, which is why it has found Pega’s adaptive model and machine learning capabilities so valuable. She said: 

It means that there's a lot that we can push into the system with the right frameworks, and it moves things and moves our thinking from touch point experiences to framework thinking. And we can adapt.

One of my favorite things to talk about is, I can't just push information at you all the time. That's not how you have a conversation. I might start a conversation, but then you might want to say something and then I should respond to that respectfully, rather than pushing information at you. 

I think that's one of the things that Pega has helped us with the most - it's helped us to have that always on mentality. And then across our touchpoints and our experiences, we think it might be a good thing to cross sell to you today, but based on everything we're seeing…is it?  

Like many other vendors in the market, since the release of ChatGPT, Pega is looking at how it can make use of generative AI and large language models. End user organizations are too thinking this through - Bupa being no different. Dickson is excited about the opportunity here and sees content as a valuable use case. She said: 

I don't see a world where we don't have large language models helping us generate content. Because in the world of decisioning, often content becomes the bottleneck. You're driving more and more variations of how to have a different conversation - and I can't send my agency a brief every time I want to do something new, I've got to be able to have a way that that content can be automatically evolved.

Finally, Dickson said that one thing she’s learned during this time at Bupa, and at previous organizations, is that it’s easy to get stuck in ‘analysis paralysis’. But her advice is to start small and realize that the tooling can help you scale, when you find success. She added: 

Doing one thing better than yesterday is better than waiting two years to do something amazing. So it's just kind of that incremental mindset. 

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