TriCare and Kaiser Permanente Lead Health Plans in 2013 Temkin Experience Ratings

We recently released the 2013 Temkin Experience Ratings that ranks the customer experience of 246 companies across 19 industries based on a survey of 10,000 U.S. consumers. Here are highlights from the health insurance industry:

• The health plan industry has the second-lowest average rating. The average score was 55%, tied with Internet service providers. (The lowest-ranked industry was TV service providers.)
• The industry has been steadily improving over the last three years, from an average rating of 50.3% in 2011 to 54.8% this year.
• The highest-ranked health plan, TriCare, is #78 across all industries in the ratings.  The plan’s rating of 71% is six percentage points ahead of the second-highest-ranked health plan, Kaiser Permanente.
• TriCare earned the top marks for functional and emotional experience while Kaiser Permanente earned the top accessible rating.
• TriCare earned the largest improvement over 2012, 12 points, followed by Anthem (BSBS) with an eight point gain and Highpoint (BCBS) with a seven point gain.
• Coventry Health Care has an unusual profile, somewhat below average functional rating with a strong accessible and emotional ratings.
• Thirteen of the 15 health insurance companies surveyed have scores considered “poor” or “very poor.”
• Three plans tied for the lowest functional component: CareFirst (BCBS), Health Net, and Empire (BCBS).
• Medicaid earned the lowest score for the accessible component.
• CIGNA and CareFirst (BCBS) earned the lowest emotional ratings.
• The lowest-ranked health plan, #242 Empire (BCBS), was the only plan with a “very poor” rating.
• Here’s a link to industry results from the 2012 ratings.

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Report: 2013 Temkin Experience Ratings

We published the 2013 Temkin Experience Ratings. The report analyzes feedback from 10,000 U.S. consumers to rate 246 organizations across 19 industries. Congratulations to the top firms in this year’s ratings: Publix, Trader Joe’s, Aldi, Chick-fil-A, Amazon.com, and Sam’s Club.

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You can also download the data for $395.

The Temkin Experience Ratings are based on evaluating three elements of experience:

1. Functional: How well do experiences meet customers’ needs?
2. Accessible: How easy is it for customers to do what they want to do?
3. Emotional: How do customers feel about the experiences?

Here are the top and bottom companies in the ratings:

Here’s how the industries compare with each other:

(NOTE: We have published posts on the detailed results for all 19 industries)

Here are the companies that are leaders and laggards across the 19 industries:

In this year’s ratings, 37% of companies earned “good” or “excellent” scores, while 28% are rated as “poor” or ”very poor.” Companies with at least a “good” rating grew by nine-percentage points since 2012 and by 21-points since 2011. Of the 203 companies that are included in both the 2012 and 2013 Temkin Experience Ratings, 57% firms had at least a modest increase. The companies that made the largest improvement over 2012 are Citibank, TriCare, TD Ameritrade, Office Depot, EarthLink, Hardees, and Regions Bank.

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Get the Data

Do you want to see all of the data? You can purchase an excel spreadsheet for $395…

To view all of our ratings (experience, loyalty, trust, forgiveness, customer service, and web experience), visit the Temkin Ratings website…

The bottom line: Customer experience is improving, but there’s still a long way to go

Companies Don’t Earn The Loyalty Their CX Deserves

Our report The ROI of Customer Experience shows that customer experience is highly correlated to loyalty. The research analyzed the relationship between Temkin Loyalty Ratings and Temkin Experience Ratings (TER) for 206 U.S. companies.

After analyzing the connection between these ratings, we found that some companies seem to have higher loyalty levels than they seem to deserve based on their customer experience while others have lower loyalty levels.

Using that dataset, I compared actual loyalty levels with projected loyalty levels. How? By plugging each company’s experience rating into our regression model to identify what their loyalty rating should be (normalized to their industry average) based on its TER and compared that projected rating with its actual loyalty rating. In the chart below you can see the companies with the largest positive and negative variances from the model’s projections.

The companies with loyalty levels the most above the projections are USAA, Highmark, Medicaid, credit unions, and TriCare. The companies that fall the most below the projections are T-Mobile, BMW, Bosch, AT&T, and Alamo.

Let’s examine USAA as an example. Since it has very high experience ratings compared with its industry peers, our model projects that its loyalty ratings should be at the high end of banks, credit card issuers, and insurance carriers. This analysis shows that USAA’s actual loyalty levels are higher than expected, even after factoring in its wonderful customer experience.

So what?!? There’s nothing inherently good or bad with being above or below the projected loyalty level. There’s no reason to expect companies to fall directly on their projected loyalty levels.

What’s interesting about this analysis is not what’s good or bad, but WHY are some companies so far away from the projected levels. This is where I’ll leave the data behind and offer my interpretation about WHY some companies have higher than projected loyalty while others have lower than projected loyalty:

• Product fit. CX is not the only component of customer value. Companies that have tailored their products and services to better meet customers’needs (like USAA and TriCare) have an even better loyalty level than their CX would suggest. If companies have a poor product offering, then their loyalty may be lower than projected (this may explain Sears and DHL).
• Product quality. If companies have quality problems with their offerings, then they would have lower loyalty levels than their CX deserve (this may explain AT&T, T-Mobile, and Alamo).
• Service expectations. Companies that have premium status (BMW cars and Bosch appliances) often elicit higher expectations from customers, so they don’t earn the loyalty that their CX would suggest and have to work harder.
• Trapped customers. In industries where customers have a hard time switching, a bad experience may not lead to the loyalty decline anticipated by the model; the same type of situation would occur if a company is harder to move away from than it’s competitors (this may explain Medicaid, Medicare, MSN, and EarthLink).
• Commoditization. In industries that have a lot of pricing comparisons, customers may overly focus on price and not award good customer experience with the level of loyalty that the model projects (this may explain Alamo). It can also push consumers that have poor experience to more quickly leave a company for its competitor (this may explain DHL).
• Substitutions. In sitations where customers don’t have a lot of clear alternatives, they will be more loyal to a company than the model suggests (this may explain eBay). A company that relies on self-service may be seen as easier to move from than a company that forms more personal connections with customers (this may explain E*TRADE).
• Emotionality. Sometimes customers develop a strong affinity for a brand that increases loyalty and dampens the negative effect of any poor experiences (this may explain Southwest Airlines and Apple).

These items cover three broad topics: offerings, competitive environment and customer expectations. What do you think causes companies to earn more or less loyalty than their customer experience seems to deserve?

The bottom line: CX is correlated to loyalty, but other things matter as well

Report: Net Promoter Score Benchmark Study, 2012

We just published a Temkin Group report, Net Promoter Score Benchmark Study, 2012. It provides NPS data on 180 U.S. companies across 19 industries. Here’s the executive summary:

USAA took the top two spots for its banking and insurance businesses while HSBC came in at the bottom for banking and credit cards. Our analysis of differences across consumer demographic segments showed that NPS tends to go up with age, doesn’t vary much by income levels, and is often highest with Asians. We also asked consumers what would make them more likely to recommend the companies and found that promoters are more likely to select lower prices and detractors are more likely to select better customer service. While there is some debate about the efficacy of NPS, our analysis shows that promoters are much more likely than detractors to purchase more in the future across all industries. To help you implement a successful NPS program, we’ve included eight tips such as don’t believe in an “ultimate question” and use control charts, not pinpointed goals.

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(includes the data)

The industries included in this report are airlines, auto dealers, banks, computer makers, credit card issuers, fast food chains, grocery chains, health plans, hotel chains, insurance carriers, Internet service providers, investment firms, major appliance makers, parcel delivery services, rental car agencies, retailers, software firms, TV service providers, and wireless carriers.

The report contains the following components:

• NPS for 180 companies across 19 industries
• NPS differences based on age, income, and ethnicity of consumers
• Improvement areas selected by promoters and detractors by industry
• Connection between NPS and future purchases by industry
• Eight tips for implementing a successful NPS program

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(Includes the data)

The bottom line:  Companies need to give customers a reason to recommend them

2012 Temkin Web Experience Ratings

Temkin Group has just released the 2012
We introduced the Temkin Web Experience Ratings last year. The 2012 Web Experience Ratings include 159 companies from 18 industries and is based on a survey of 10,000 U.S. consumers.

Congratulations to the top firms in this year’s ratings: Amazon, credit unions, USAA, PNC, Southwest Airlines, eBay, Sam’s Club, ShopRite, JCPenney, and ING Direct. Of course, not every company has earned good web experience, especially the companies at the bottom of the 2012 ratings:  Charter Communications, Humana, Qwest, Cigna, Time Warner Cable, Anthem, Road Runner, Medicare, Blue Shield of CA, and TracFone.

We also  examined industry averages and found that banks and investment firms have earned the highest Temkin Web Experience Ratings followed by hotel chains and retailers. But consumers gave very low ratings to Internet service providers, health plans, and TV service providers.

The research also examines how individual companies are rated relative to their industry peers. The following 11 firms outscored their industry average Temkin Web Experience Ratings by 10 percentage points or more: Kaiser Permanente, Amazon, ShopRite, Southwest Airlines, USAA, Starbucks, H.E.B., Publix, credit unions, Marriott, and Apple.

The following 15 companies fell 10 percentage points or more below their industry averages: Wells Fargo Advisors, AAA, Charter Communications, Delta Airlines, Citibank, Bank of America, Humana, TracFone, Qwest, Old Navy, U.S. Airways, Rite Aid, Kohl’s, Kmart, and Charter Communications.

Temkin Group also analyzed changes from the 2011 Temkin Web Experience Ratings. Led by TV service providers and insurance carriers 11 of the 12 industries that were in both the 2011 and 2012 ratings improved since last year.

Seventy-two percent of companies that were in the 2011 and 2012 Temkin Web Experience Ratings showed improvement. Led by Comcast (Internet and TV service), Allstate, AOL, Charter Communications, Toshiba, and Sam’s Club, 20 companies improved by 10 percentage points or more between 2011 and 2012. Only three companies­— Kohl’s, TracFone, and Rite Aid—declined by 10 percentage points or more during that timeframe.

Do you want to see the data? Go to the Temkin Ratings website where you can sort through all of the results for free. You can even purchase the underlying data if you want to get more access.

The bottom line: Web experience is not good enough for how important it is

2012 Temkin Trust Ratings

Temkin Group has just released the 2012

We introduced the Temkin Trust Ratings last year to gauge which companies are earning this important element of loyalty. The 2012 Temkin Trust Ratings include 206 companies from 18 industries and is based on a survey of 10,000 U.S. consumers.

Congratulations to the top firms in this year’s ratings: USAA, credit unions, H.E.B., Publix, Chick-fil-A, Sam’s Club, Hy-Vee and BMW. Of course, not every company has earned such a high degree of trust with their customers, especially the companies at the bottom of the 2012 ratings: Charter Communications, Citigroup, Bank of America, HSBC, Time Warner Cable, Comcast, and Qwest.

We also examined industry averages and found that grocery chains have earned the most trust from consumers followed by investment firms, retailers, and parcel delivery services. But consumers do not trust TV service providers, Internet service providers, or credit card issuers.

We examined how individual companies are rated relative to their industry peers. Twenty-one companies are 10 or more percentage points above their industry averages. The ones that are farthest out in front: USAA (34 above credit cards), credit unions (30 above banks), USAA (28 above banks), USAA (22 above insurers), and PNC (21 above banks).

Twenty-nine companies are at least 10 percentage points behind their industry averages. Here are the ones that fall the farthest behind: Bank of America (23 behind banks), Citibank (22 behind banks), Super 8 (19 behind hotels), Charter Communications (18 behind TV service providers),  Days Inn (18 behind hotels), and Citigroup (18 behind credit card issuers).

We also analyzed changes from the 2011 Temkin Trust Ratings. The research shows that consumers are more trusting this year than they were last year. Led by computer makers and insurance carriers, all 12 industries that were in both the 2011 and 2012 Temkin Trust Ratings showed improvement.

Fifty-two of the 139 companies that were in the 2011 and 2012 Temkin Trust Ratings earned double-digit improvements and six companies improved by more than 20 percentage points: USAA, PNC, Lenovo, credit unions, U.S. Bank, and HSBC. Seventeen companies lost ground over the last year with the biggest drops coming for Cox Communications, Bank of America, Citigroup, Edward Jones, TriCare, and Costco.

Do you want to see the data? Go to the Temkin Ratings website where you can sort through all of the results for free. You can even purchase the underlying data if you want to get more access.

The bottom line: It’s hard to succeed without your customers’ trust

2012 Temkin Forgiveness Ratings

Temkin Group has just released the 2012
Every company makes mistakes now and then, but how willing are customers to forgive the company when it happens? Forgiveness is a valuable asset that companies earn by consistently meeting customers’ needs.

We introduced the Temkin Forgiveness Ratings last year to gauge which companies are earning this important element of loyalty. The 2012 Temkin Forgiveness Ratings include 206 companies from 18 industries and is based on a survey of 10,000 U.S. consumers.

Congratulations to the top firms in this year’s ratings: USAA, Hyatt, credit unions, H.E.B., Hy-Vee, Dollar Rent A Car, Chick-fil-A, Publix, Costco, and Amazon.com. Of course, not every company enjoys such a high degree of forgiveness from their customers, especially the companies at the bottom of the 2012 ratings: Citigroup, Charter Communications, HSBC, Chrysler dealers, EarthLink, Bank of America, Comcast, Quest, and US Airways.

We also examined industry averages and found that grocery chains have earned the most forgiveness from consumers followed by retailers, appliance makers, and parcel delivery services. But consumers are not very likely to forgive mistakes by credit card issuers, Internet service providers, and TV service providers.

We examined how individual companies are rated relative to their industry peers. USAA holds the top two spots, outpacing its credit card and banking peers by more than 30 percentage points. USAA also outpaces the insurance industry by more than 20 percentage points. Credit unions, Hyatt, US Cellular, Dollar Rent A Car, Chick-fil-A, and Bright House Networks are also more than 15 percentage points above their industry averages. Five companies fall 15 or more percentage points below their industry’s average Temkin Forgiveness Ratings: Chrysler dealers, Citigroup, Travelers, Charter Communications, and RadioShack.

We also analyzed changes from the 2011 Temkin Forgiveness Ratings. The research shows that consumers are more forgiving this year than they were last year. Led by banks and insurance carriers, all 12 industries that were in both the 2011 and 2012 Temkin Forgiveness Ratings showed improvement.
Sixty-eight of the 139 companies that were in the 2011 and 2012 Temkin Forgiveness Ratings earned double-digit improvements and four companies improved by more than 25 percentage points: TD Ameritrade, Lenovo, USAA, and credit unions. Ten companies lost ground over the last year with the biggest drops coming for Citigroup, Continental Airlines, Travelers, Sears, Holiday Inn Express, and The Hartford.

Do you want to see the data? Go to the Temkin Ratings website where you can sort through all of the results for free. You can even purchase the underlying data if you want to get more access.

The bottom line: To err is possible, to earn forgiveness is divine

Health Plans Deliver The Worst Customer Experience

This post examines the 13 health plans included in the 2012 Temkin Experience Ratings.

Kaiser Permanente was the top rated health plan, the only plan to receive an “okay” rating, but it is only ranked 87th overall. TriCare, Medicare, Aetna, United Healthcare, Humana, Empire BCBS, Blue Shield of CA, and CIGNA all received “poor” ratings. Four plans received “very poor” ratings and are ranked in the bottom seven across all 18 industries: Highmark BCBS, Health Net, Medicaid, and Anthem BCBS.

Health plans represented the lowest rated industry, and only one of three industries to receive an average rating of “poor.”

The industry, however, experienced a modest two percentage point improvement between 2011 and 2012. Ten health plans were included in both the 2011 and 2012 Temkin Experience Ratings. Kaiser Permanente had a double-digit improvement in its score while five other plans increased their score by five or more points: Anthem BCBS, Aetna, United Healthcare, CIGNA, and Humana.

Do you want to see the data? Go to the Temkin Ratings website where you can sort through all of the results for free. You can even purchase the underlying data if you want to get more access.

The bottom line: Health plans have a chronic case of poor customer experience

Report: 2011 Temkin Trust Ratings

We just published a new Temkin Group report, 2011 Temkin Trust Ratings. Here’s the executive summary:

We asked 6,000 U.S. consumers how much they trust different companies. The data allowed us to rate 143 companies across 12 industries. USAA and Amazon.com earned the top spots in the 2011 Temkin Trust Ratings while Comcast and Charter Communications dominate the bottom of the list. Only eight companies earned a “very strong” rating. Retailers, investment firms, and hotel chains have the highest average rating, while Internet service provider and TV service providers have the lowest.

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First of all, kudos to the top 10 firms in the ratings:

(1) USAA (insurance)
(2) Amazon.com (retail)
(3) Costco (retail)
(4) Edward Jones (investment firm)
(4) Hyatt (hotel chain)
(4) Sam’s Club (retail)
(4) TriCare (health plan)
(8) Kohl’s (retail)
(9) Walgreens (retail)
(10) Vanguard (investments)

Here are the results across industries:

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If you want to get access to all of the data in this ratings, check out the Temkin Ratings website

The bottom line: It’s time for more companies to earn their customers’ trust

Health Plans Deliver Poor Customer Experience

In the 2011 Temkin Experience Ratings, we examined the customer experience across 12 industries. For this post, we will take a closer look at the 10 health plans  in the ratings.

Health plans have an average rating of “Poor” and was the next to lowest ranked industry…

Let’s take closer look at the results for all of the individual health plans…

As you can see, TriCare leads the health plans and is the only plan to cross over into the “okay” rating. Medicare and Kaiser Peermanente are the only two in the “poor” rating. The remaining seven firms firms earned a “very poor” ratings.

Let’s take a look at the three components of the Temkin Experience Ratings…

TriCare  is the top-performing health plan when it comes to all three experience components and is the only firm to pass the line of goodness for its functional experience. The remaining health plans drop off rapidly; especially when it comes to the accessible component. Anthem falls well below the other health plans across all experience components.

The bottom line: Health plans, like TV service providers, need a customer experience overhaul

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Report: 2011 Temkin Loyalty Ratings

We just published a new Temkin Group report, 2011 Temkin Loyalty Ratings.

The report identifies the level of loyalty that US consumers have for 143 organizations across 12 industries.

Here’s the executive summary:

Amazon.com, Kohl’s, and Costco took the top spots in the 2011 Temkin Loyalty Ratings. We asked 6,000 US consumers to rate their level of loyalty to companies across three components: purchasing additional products and services, reluctance to switch business away, and likelihood to recommend the company to friends and relatives. This data allowed us to rate 143 companies across 12 industries. Only 17% of those companies received a “strong” or “very strong” loyalty rating. The results show that retailers have the highest level of loyalty while TV service providers and health plans have the lowest.

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First of all, let me give a shoutout to the five companies with the highest ratings, indicating that they have the most loyal customers:

• 1. Amazon.com
• 2. Kohl’s
• 3. Costco
• 4. (tie) Lowe’s
• 4. (tie) Sam’s Club

Here’s a list of the top 20 companies in the ratings. Click on the graphic below or click right here if you want to see the results for all 143 companies.

The Temkin Loyalty Ratings are calculated by examining three levels of loyalty that companies have earned from consumers: willingness to buy more products, reluctance to switch business away from, and likelihood to recommend those companies.

Overall, consumers don’t have a strong degree of loyalty across many industries. Retailers, by far, earn the highest levels of loyalty. TV Service providers and Internet Service providers, on the other hand, have earned woefully little loyalty with consumers.

Here are some of the other findings from the research:

• Results versus industry averages. Led by USAA (insurance and credit cards), TriCare (health plans), credit unions (banks), and Southwest Airlines, 12 companies had double-digit advantages in loyalty over their industry. At the other end of the spectrum, Radio Shack (retailers), Super 8 (hotel chains), and Gap (retailers) led 18 companies with loyalty scores at least 10 points below their industry averages.
• “Recommending” leaders and laggards. Led by Costco and Amazon.com, 36 companies have “very strong” ratings for consumers that are likely to recommend them to friends and colleagues. At the other end of the spectrum, Charter Communications, Anthem, and Comcast are the only firms with a “very weak” rating in this area.
• “Switching” leaders and laggards. While no companies have very strong ratings for customers that are reluctant to switch, TriCare and USAA lead the five companies that have a “strong” rating in this area. Blue Shield Of California and Lenovo are at the low-end of the spectrum along with 12 other companies that have negative ratings in this area.
• “Repurchasing” leaders and laggards. When it comes to having customers who are likely to purchase something else from them, Amazon.com and Old Navy lead 21 companies with “very strong” loyalty ratings in this area. HSBC and Charter Communications are two of the seven companies that didn’t even cross the 20% mark in this area.

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For access to more data, you can visit Temkin Ratings Website.

Now that we’ve published the Temkin Loyalty Ratings and the Temkin Experience Ratings, we’re analyzing the correlation between the two datasets. Look for out upcoming report: Customer Experience And Loyalty: Connecting The Dots

The bottom line: Loyalty is up for grabs!

Customer Experience Industry Leaders

In my previous post, I introduced the 2011 Temkin Experience Ratings and showed the top 20 firms. While that is the best way to identify overall leaders, I also want to give a shout-out to firms that are leading in their industries.

USAA, for instance, is the tops in two categories: credit card and insurance.  And Cox Communications may only be #82 on the list and have a “poor” rating, but at least it’s better than all of the other TV Service providers.

The bottom line: It’s better to be the best of the worst than the worst of the worst

The 2011 Temkin Experience Ratings

We just published a new Temkin Group report, 2011 Temkin Experience Ratings. Congratulations to the top five companies (out of 143 in the ratings):

1) Amazon.com
2) Kohl’s
3) Costco
4) Lowe’s
4) Sam’s Club

The ratings evaluate 143 large organizations across 12 industries based on feedback from 6,000 US consumers.

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The Temkin Experience Ratings are based on evaluating three elements of experience:

1. Functional: How well do experiences meet consumers’ needs?
2. Accessible: How easy is it for consumers to do what they want to do?
3. Emotional: How do consumers feel about the experiences?

Here are the top 20 companies in the ratings:

Here are the results for the 12 industries:

Here are some interesting findings from the report:

• 15 of the top 20 firms are retailers. The exceptions are three hotel chains (Marriot, Hyatt, and Courtyard By Marriott), one bank (Regions), and an insurance company (USAA).
• Anthem is at the bottom of the list along with six other health plans that are in the bottom 13. Comcast and Charter Communications each show-up twice in the bottom six spots.
• Only 24 companies ended up with “excellent” or “good” ratings.
• When we compare company ratings with their industry averages, three companies outperformed their peers by at least 10 points: TriCare (health plan), USAA (insurance and credit cards), and Regions (bank).

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Are you interested in getting a deeper look at the data? Or do you want to see the differences across age, ethnicity, education, and income segments? Then you should visit Temkin Ratings at www.temkinratings.com.

The bottom line: Customer experience excellence is in short supply.

20 Companies Most Susceptible To Negative Comments Via Facebook

In the recent Temkin Group Insight report, How Consumers Give Feedback, we analyzed what US consumers did after they had a very bad or a very good experience. One of the areas we examined was the use of social media outlets like Facebook and Twitter.

As a part of the analysis, we examined the difference in social media use across 141 companies. Our analysis looked at how often people that had interacted with those companies had also used social media to talk about a very bad experience in the previous 60 days. We then compared that data to the overall US average.

This chart shows the 20 companies that interact with consumers who are most likely to post a very bad experience on Facebook.

As you can see, Days Inn, E*TRADE, and Apple are twice as susceptible to having a bad experience show up on Facebook.

The bottom line: These firms need to think a bit more about Facebook than the average company

 

Health Plans Deliver The WORST Experience

In Forrester’s 2008 Customer Experience Index (CxPi), we ranked 113 companies across 12 industries. I recently published a snapshot of the health plan industry looking at the results from the eight plans on the list (Aetna, Anthem (BCBS), CIGNA, Kaiser, Medicaid, Medicare, TriCare, and United Healthcare). Here’s some of what we found:

• Experiences are “very poor” and getting worse. As a group, the eight health plans ended up with a “very poor” rating of 51%; the lowest score of any of the 12 industries we examined. Making matters worse, the industry dropped three percentage points from the 2007 CxPi results. 
• Kaiser led the pack. With an “okay” score of 70%, Kaiser led all health plans. All of the other plans ended up with ratings of either “poor” or “very poor.”
• Medicaid is as bad as it gets. With a terrible rating of 38%, Medicaid was the lowest scoring plan. It also ended up in next to last place across all 113 organizations in our rankings.
• Only Kaiser improved. When we compared the 2008 results with those from 2007, only Kaiser showed an improvement. CIGNA and Medicaid, on the other hand, declined the most.
• Some big shifts in CxPi components. There were five double-digit changes in the scores for the three underlying elements of the CxPi: Kaiser’s improvement in being easy to work with and enjoyability, Anthem’s decline in enjoyability, and both CIGNA’s and Medicaid’s drop in being easy to work with.

The bottom line: Put customer experience on the health care reform agenda