Improving Member Perception: How Health Plans Can More Effectively Move the Needle


Elevating customer services isn’t enough to raise Star ratings and quality. Payers and their provider partners also need to meet patients at their level.

If there’s one term health plans are fixated on in early 2022 when it comes to improving member relationships and ratings, it’s experience.

The CMS has made it clear that quality bonus payments tied to its Medicare Star ratings will be indefinitely aligned with member experience, and health plans and their provider partners will need to do everything possible to raise the bar and elevate performance on the Consumer Assessment of Healthcare Providers and Systems (CAHPS)® assessment. This is no easy feat.

As many health plans have noted, it’s often the patients with the highest-needs, such as the 66% of non-dual-eligible Medicare beneficiaries living with two or more chronic conditions, who are the least engaged in their healthcare, and possibly have fewer positive experiences with their health plan and healthcare providers.

Anne Davis

Anne Davis

Traditionally, many health plans have invested in improving customer services as a means to improve the member experience. This is true, to a certain extent. There’s only so much most health plans can do to improve customer service, for example, by eliminating language barriers and coaching member liaisons on web-chat courtesy or the ins-and-outs of program benefits. A payer can’t raise its Star ratings from 3.5 to 5 simply by overhauling its customer service approach.

To elevate member perception of care and services in a significant way requires more attuned, personalized solutions that demonstrate that a health plan cares about its members.

What do health plan members really want?

So what’s driving the least engaged, highest-need health plan members to rate their plans and providers well or poorly on CAHPS and other quality surveys? While there are many possible answers to these questions, it’s clear that a positive experience is key.

A 2020 J.D. Power study based on responses from 31,283 commercial health plan members showed that health plans who performed lower than average were widely perceived as lacking a customer-centric mindset and not putting the best interests of their members first.

Yet the study also noted that proactive efforts by health plans to engage with their members by, for example, providing guidance on how to control costs drove improvements in satisfaction higher.For health plans that made efforts to keep out-of-pocket costs down, satisfaction scores were 819/1,000, or 152 points higher than when a plan didn’t make such efforts.

Another online study of 3,000 health plan members ages 26 and older noted that payers that offer a consistent digital member experience across multiple channels are more likely to see high member satisfaction scores.

Understanding members’ needs is crucial for health plans and providers. While national surveys provide insights into relevant themes and trends, a more localized understanding of populations can garner insights for action. Many Medicare Advantage plans review regular experience and satisfaction surveys of their members in order to keep an eye on how members are experiencing the plan and providers in the network.

Elevating experience ratings the right way

While providers’ office wait times are not always something that health plans have information on (or control over), there are other aspects of a members’ experience with the plan that can be seen in the “overall rating of health plan” questions that are posed to members - where satisfaction can blur with experience. The subject of healthcare costs is a top concern among health plan members regardless of which plan they’re enrolled in, and cost can impact one’s satisfaction with the plan.

Given these realities, there are ways that health plans can reinvest in their membership, potentially boosting members’ satisfaction with their plan. Many health plans utilize rewards programs for positive behavior changes like measuring their blood pressure or blood sugar levels. If members are incentivized in the right way to engage with their health and meet health-related goals, they’re more likely to see their health plan as a stakeholder in their life. Rewards from these types of programs are used for basic needs like food and transportation. As a recent American Academy of Family Physicians report noted, poverty restricts the resources used to adopt healthy behaviors. Additional dollars each month can support members’ access to nutritional food and other tools for healthy living.

Incorporating programs and tools that leverage the principles of behavioral economics to encourage and incentivize members to take charge of their health through daily check-ins can build healthy habits. The financial motivation to change habits is a great way to start, and utilizing behavioral economics principles, intrinsic motivation builds over time as small goals are met.

The benefits of building better habits through frequent interventions (such as daily check-ins) ultimately lead to a vastly improved experience with health care and services, and greater individual health confidence.

One recent study by a small physician practice that sought to improve health confidence among its patients illustrates this point. For the study, practice leaders explored the use of “intense interventions” such as motivational interviewing — a communications technique that emphasizes encouragement and empathy — for several months for select patients. The at-risk patients who received more intense and frequent interactions with healthcare providers had higher levels of health confidence three to 12 months later than those who received less intensive intervention and saw improved health confidence that led to lower use of hospital care.

By offering the right member incentives, health plans can do a better job of meeting patients where they’re at — and potentially giving the much-needed extra push to meet a health goal and improve overall health. Member perception, in turn, will also improve. And all of this bodes well for boosting member experience, the holy grail in 2022 and beyond.

Anne Davis is the vice president of government markets and strategy at Wellth.

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