Comparing NPS for Telehealth and In-Home Assessments

July 21, 2020

What is NPS?

Net Promoter Score (NPS) is a management tool used to measure member loyalty or affinity. Data has shown when used properly, it’s a strong predictor of future revenue and profit. 

Fred Reichheld pioneered the Net Promoter Score system in 2003. Fred Reichheld is an expert on customer loyalty and is a Harvard MBA, Bain Fellow, business strategist, author, and speaker¹. 

NPS is widely used—in fact by two-thirds of the Fortune 1000 companies².  It’s used across every industry from airlines to healthcare to solid waste. Traditional customer satisfaction surveys are long, have low response rates and do not provide actionable feedback.  NPS is starkly different from other customer satisfaction surveys in that it asks two simple questions:

• Likelihood to recommend us to a friend on an 11 point scale (0-10)
• Why did you give that score? (freeform verbatim)

The simplicity of the metric, the rich data it provides, and the results that firms see when implementing the learnings are what makes it so popular worldwide.  It’s also open source and free, which helps.

How Does it Work?

Members are sorted into three groups based on their survey response:  0 to 6 are Detractors, 7 or 8 are Neutral, and 9 or 10 are Promoters.   The math is simply the percentage of Promoters minus the percentage of Detractors.  The range is from 100 to -100.  It’s one number, and you don’t have to know how many people chose a number or take weighted averages or anything.

Matrix Medical Network has been measuring NPS for the Medicare in-home comprehensive health assessment via a paper mail in survey since 2012.  Our response rate is ~10% of completed assessments.  While our NPS has some seasonality to it, it remains in the 70s throughout the year, which is amazingly high for any industry, and high for health care.  NPS is our best way to have a pulse on our Member experience and preferences.  By fixing the key Detractor issues, we are able to improve our business.  All of our Health Plan partners are extremely focused on NPS as well because high Member satisfaction means Member retention for health plans.  According to the oft-used rubric, acquiring a new Member can cost health plans 5x more than retaining existing ones.  Thus, investing in the Member experience is a wise bet.

For context on what a good NPS looks like, it is helpful to review a cross-industry perspective.

Why does it Matter?

When we began offering telehealth services in March due to the COVID-19 pandemic, I wondered how members would score our virtual assessments.  I was interested in comparing the NPS of our virtual visit to our in-home visit results.  My hypothesis was that telehealth would score considerably lower, primarily because the experience is not as intimate as having a nurse in your home, and consequently the bond might not be as strong.  Further, there is the inability to perform some services virtually, like blood pressure and BMI (Body Mass Index).  Lastly, there is always some risk of technology challenges. 

With our telehealth members, a paper mail in survey was not practical.  We are doing a follow up phone call NPS survey for a percentage of completed visits. This is done within 48 hours of the visit to ensure an accurate recollection of the visit. Here is what we found on a sample size of 2,219 completed surveys:

We do many more video visits than audio-only visits.  It’s remarkable that video telehealth scores are on par with in-home visits.  When we synthesized the member verbatims from the telehealth Promoters, we learned they liked their visit for the following reasons:

• Convenience
• Didn’t take much time
• Helpful, face to face over technology
• Liked being able to ask questions

Gratitude for our virtual wellness visit was a big theme from many of our members.  They have been experiencing isolation, difficulty getting medications refilled and in desperate need of COVID education.

How is the Data Actionable?

Interestingly, the top two Detractor verbatims are the same as In Home visits – I already have a doctor and I am healthy and do not need this.  The other complaint themes were Prefers an in person visit for vitals and testing and Call quality issues like interference, poor connection, and dropped calls. Matrix is investing in improving our telehealth offering, and we will be rolling out a new platform shortly.  This will minimize the technology challenges, make connecting with our Nurse Practitioners that much easier, and ensure a robust experience.  We are consistently listening to our members and refining our offering to improve the member experience.

Given that video visits perform the same as in-home, we learned that looking a member in the eye is really important to the member experience.  We always try to book a video visit first if the member has a smart phone or other device.  I am confident that health plans who receive assessments via our video telehealth platform can rest assured that the member experience will be just as strong as if we had visited the member in their own home sweet home. 

You can read more about the Net Promoter Score in the Fortune article, The simple metric that’s taking over big business.

¹ Fred Reichheld, Wikipedia
² Geoff Colvin, The Simple Metric that’s Taking Over Big Business, Fortune: May 18, 2020.