My Health Insurance Company Tries to Keep me Healthy

I am grateful to have the health insurance I have, and grateful for the payments they've made to resolve problems I've had. Nonetheless, I can't help but be astounded at the never-ending flow of expensive, incompetent, annoying and utterly useless interaction I have had with the company's computer systems. It's small potatoes in the overall scheme of things. It's also simple stuff. Why can't they (and others like them) get it right?

The answer is simple: the company's leaders, like most enterprise companies, want to be leaders in technology. Today, that means funding big, publicized  initiatives in AI and ML. Initiatives that will, of course, transform healthcare. Soon. Getting email right? Getting paper mail right? Trivial stuff. Wins no awards, gets no attention. It's unworthy of attention, like the way the rich owners of a grand house with a dozen servants wouldn't stoop to paying attention to the brand of cleaning products they used.

The email

An email from Anthem showed up in my inbox with the subject "Schedule your checkup now -- at no extra cost." Naturally I open it. Right away there's a graphic, demonstrating that it wasn't just the software team on this job:

The message with the graphic repeats the message in the subject line, strengthening it -- don't just schedule a checkup, schedule it early. Why should I do this? "It's a good way to stay on top of current health issues and take care of any new ones early, before they become more serious."

Sounds good! Except that the very next thing in this email urging me to "schedule [my] checkup early this year. There's no extra cost." is this:

My plan "usually" covers it?? WTF?? Right after telling me "There's no extra cost," as in There IS no extra cost??

Then comes "You may pay a copay, percentage of the cost, or deductible if you've already had your physical for the year or if the visit is to diagnose an issue and set a plan for treatment or more tests."

I'm supposed to schedule it "early." I last had an annual physical six months ago.  Is a physical I schedule now, in March, free or not? At the bottom of the email there is a nice big box that says in big type "Schedule your checkup today." It then says "To find a doctor or check what your plan covers, please use the Sydney Health mobile app or visit Anthem.com."

I've already done the Sydney trip, describing it here. Not going there again. I'll go to the main site. I'll spare you the details. They don't know who my primary care doctor is and don't let me tell them. They give me a big list of doctors I could visit, most of whom are pediatric -- oh, yeah, good suggestions, Anthem! They must think I'm young for my age ... or something.

Then I try to find out what my plan covers, as they suggest. Nothing about annual checkups being free of charge; it's all about co-pays. Maybe it's there somewhere, but I can't find it. As usual, the link Anthem provides is to the front door of the site, not a cool new twenty-year-old technology called "deep linking," which brings me right to the relevant place. Maybe next year. Or decade. Or century.

What could have happened

There's a concept that's been around in the industry for a couple decades called "personalization." It includes things like

• when you send an email, address it to the person, instead of making the email be like a brochure.
  
• reflect basic knowledge of the person, like whether they had an annual checkup last year -- if they did, maybe they already think it's a good thing, and the message should be to be sure to do it again
  
  • They've got my history -- they could praise me for getting checkups for the last X years, and reminding me to keep up the good work.
    
• Is the checkup "no cost" or not? Anthem has my account information, name, address and the rest. They have my plan. They know whether it's free or not. They just don't bother to check.
  • Taking my history into account, they could say that, just as last year's checkup was 100% free, this one will be too.
• As it happens, a week before getting the email I saw my primary care physician and then a specialist who submitted pre-auths for tests. Anthem has the visit claims and pre-auths. I'm doing exactly what they want me to do, as they said in the email, "take care of any new ones early, before they become more serious." Instead, what I hear from Anthem is 100% clueless -- exhorting me to do something that the slightest bit of effort on their part would tell them I'm already doing! Blanketty-blank it!

This is customer interaction 1.01. It's also common sense. It's standard practice for companies whose tech and marketing teams have progressed past the year 2000 into the current century.

The Postcard in the mail

You might think it couldn't get worse. You'd be wrong.

After I got the email, a postcard showed up in the regular US mail. A full-color postcard from my friends at Anthem! Here's the front of it, showing a person who looks just like me having a virtual doctor visit.

Anthem cares about my health and really wants me to get that checkup -- today! They care about it so much that they appear to have two whole departments, one for email and one for postal paper mail, each charged with getting me to get that checkup.

So what do they tell me on the back? Take a look:

Here's what the email said:

It's a good way to stay on top of current health issues and take care of any new ones early, before they become more serious.

Here's what the postcard said:

Having a checkup is one of the best ways to stay on top of current health issues and take care of any new ones early, before they become more serious.

Notice the similarities and the subtle differences -- it's clear that each department wanted to assert its independence and word the exhortation in the way it thought best. The email modestly said "it's a good way," while the postcard went all the way, saying it's "one of the best ways." How much time in meetings was spent getting the wording exactly right, do you think?

Last but not least is the issue of cost. Like with the email, the postcard strongly asserted that the cost is completely covered. But then there's that little asterix, hinting that you might want to look at the tiny little print at the bottom of the page, where you find maybe it's not free after all. At least there was no mention of Sydney. I guess the paper mail department is jealous, and wants to avoid promoting the thing those snotty folks in IT keep yammering on about.

Anthem Leads the way

You might think from this that Anthem is incapable of going beyond the 1-2 punch of emails AND mass paper mailing. Incapable of doing basic software of the kind I was writing in high school, software that is little but common sense. I will let the evidence speak for itself.

Whatever Anthem may or may not be doing in terms of keeping up with paper mail and adding an electronic version, a little searching reveals that Anthem is spending huge amounts of time and money on "advanced digital" whatever, fashionable things like AI, ML and the rest of the lah-de-lah.

To discover Anthem's strategy, you have to find and sift through an array of websites that aren't the Anthem.com one you would think.

Here is part of what the Anthem CEO says in the most recent annual report: "The traditional insurance company we were has given way to the digitally-enabled platform for health we are becoming. This platform strategy is grounded in data and deploys predictive analytics, artificial intelligence, machine-learning and collaboration across the value chain to produce proactive, personalized solutions for our consumers, care providers, employers, and communities." I guess that means they're working on getting AI and ML to send me an email that's "personalized" sometime soon. Maybe.

Anthem has a Chief Digital Officer. Here's what he said in that same annual report: "At Anthem, we have built the industry’s largest platform, integrating our immense data assets, proprietary AI, and machine-learning algorithms." Is this just a lab project? No! "It’s through this platform that we are able to digitize knowledge and create a more agile and seamless experience for our consumers, customers ..." I guess digitizing my name and slipping it into an "agile and seamless" email to me is right around the corner!

In May 2020 Anthem signed a major "digital transformation" deal with IBM. According to Anthem's CIO Tim Skeen, "We are seeing a dynamic change in the healthcare industry, requiring us to be more agile and responsive, utilizing advanced technology like Artificial Intelligence (AI) to drive better quality and outcomes for consumers." Sounds good! If IBM's Watson AI can beat the world champion Ken Jennings at Jeopardy, I guess it's just a matter of time until it figures out how to personalize emails.

A glowing article last year quoting the Anthem Chief Technology Officer described how Deloitte and AWS are helping Anthem deliver "measurable benefits" such as "capabilities that use AI/ML, cognitive, analytics, and data science" to implement their strategic vision, one of whose key tenets is " 'n=1' personalization through consumer-driven whole-health products and services." Is it possible that the strategic vision of "n=1" personalization will enable them to send me an email that's to me, instead of a brochure? We'll see.

At yet another website of Anthem's I discovered that they have a Product Management and Strategy Lead who talks about how Anthem is "using predictive models and machine learning to provide consumers with the unique information, programs, and services they need ..." There's a VP of AI Technology who is "harnessing machine learning and AI ..." There's a VP of Innovation who is "... implementing innovative solutions ..."

What a wealth of important people and efforts, all bringing digital transformation to Anthem! With all this industry-leading technology, it's only a matter of time before I receive something from Anthem that isn't a postcard with the added bonus of a digital brochure, do you think?

Conclusion

See this post and the summary at the end for links to other amazing achievements of the Anthem software team -- which extends from bad communications to it's-really-bad cyber-security involving massive losses of customer personal information.

It's clear that Anthem, like most companies of its kind, pays huge amounts of attention to the current "thing," whatever that is, making sure everyone knows they're leading the way. Meanwhile, they largely ignore trivial things that are "beneath" them, things like treating customers moderately well. It starts with avoiding paying attention to the foundation of everything, which is data. Then it's compounded by the perverse status hierarchy in software in general and data science in particular; the hierarchy is simple: the farther you are away from real human customers, the higher your status. I hope this will change, but I'm not betting on it. Meanwhile, I remain grateful for the payments they make for the health care services I receive.