Healthcare Member Experience

Transforming Medicare Advantage: A Holistic Approach to Improve CAHPS Scores and Member Satisfaction & Experience

Focusing on the Root Causes of Negative Member Experiences for Sustainable Improvement in Satisfaction and Retention

Healthcare member experience is a critical focus for Medicare Advantage health plans.  A research study reveals that 86% of customers stop doing business with a company due to negative experiences, while positive experiences lead to 42% of them remaining loyal. In the context of Medicare Advantage, Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores are crucial quality measures. Many health plans primarily concentrate on “mock surveys” to improve these scores, which may not be the most effective approach. To make a real difference, it’s time to shift focus towards understanding the underlying reasons for member dissatisfaction and churn, and to address those issues to create a positive experience for members.

Section 1: Identifying the Leading Indicators of Negative Member Experiences

To effectively address member dissatisfaction, it is essential to identify the root causes of negative experiences. Health plans should:

1. Conduct thorough data analysis: Analyze member feedback, complaints, and other relevant data to identify patterns and trends in dissatisfaction.
2. Engage in open communication: Encourage members to voice their concerns and provide feedback through multiple channels, such as surveys, focus groups, and one-on-one interviews.
3. Monitor and assess internal processes: Evaluate the effectiveness of current workflows, policies, and procedures that may contribute to member dissatisfaction.

Section 2: Addressing the Issues and Creating Positive Experiences

After identifying the leading indicators of negative member experiences, health plans must take proactive steps to address these issues and enhance member satisfaction:

1. Streamline workflows: Optimize internal processes to ensure efficient and timely delivery of services, reducing wait times and administrative burdens on members.
2. Enhance customer service: Invest in training and support for customer service representatives, enabling them to provide empathetic, knowledgeable, and efficient assistance to members.
3. Personalize member interactions: Implement strategies to tailor communications and services to individual member needs and preferences, fostering a more personalized and satisfying experience.
4. Promote transparency: Be open and clear about coverage, costs, and expectations to help members make informed decisions and reduce confusion.

Section 3: The Win-Win of a Holistic Approach

By taking a holistic approach to improve member satisfaction, health plans can enjoy multiple benefits:

1. Improved CAHPS scores: Addressing the root causes of member dissatisfaction can lead to a significant and sustainable improvement in CAHPS scores.
2. Enhanced member retention: Satisfied members are more likely to remain loyal, resulting in higher retention rates and increased profitability.
3. Positive word-of-mouth: Happy members are more likely to recommend their health plan to others, promoting organic growth through referrals.
4. Competitive advantage: A strong reputation for member satisfaction can set a health plan apart from competitors, attracting new members and boosting market share.

To make a meaningful impact on CAHPS scores and member satisfaction, health plans must look beyond “mock surveys” and focus on addressing the root causes of member dissatisfaction. By taking a holistic approach, health plans can create memorable experiences for their members, leading to increased satisfaction, retention, and overall success. It’s time to think broader and make a real difference in the lives of Medicare Advantage members.

Healthcare member engagement platform inGAGE™ is a cloud based software as a service (SaaS) technology that utilizes artificial intelligence (AI) to connect the healthcare data ecosystem. The simple three step process starts by (1) gathering healthcare data (claims, demographic, HIE, SDOH, surveys etc.) both structured and un-structured, (2) then utilizes AI to create a real-time member insights, to (3) activate the Next Best Action (NBA) network through a huge list of omni-channel engagements.  By leveraging inGAGE™ health plans to deliver lifetime member value, driving growth and increasing overall plan profitability.