Avoiding Common Pitfalls of Performance Guarantee Surveys

Updated on November 22, 2020

By Suzanne Cogan

Many health plans and pharmacy benefit managers (PBMs) have contractual commitments with their large clients to meet certain performance guarantees (“PGs”), including meeting minimum levels of satisfaction with the services provided among the employer clients’ employees.  Member surveys are the gatekeepers for determining satisfaction scores but can hinder a health plan’s or PBM’s ability to demonstrate the exceptional service it provides if not conducted strategically. And with the pandemic at play, plans may find it harder to meet their employer clients’ PG thresholds for 2021 based on current findings.

According to an online poll of more than 2,000 consumers conducted in May by SPH Analytics, fewer than 4 in 10 (37%) said that their health plan had reached out to them with information regarding COVID-19. Of those diagnosed with COVID-19, 80% said that their plan had done something to make them question remaining a member, while 70% of them would switch right now if they could. 

These sentiments could negatively impact member experience surveys — and the ability for health plans to either avoid financial penalties or realize incentives tied to contractual PG member experience survey scores.

But it’s not too late to change. Health plans and PBMs need to take control of their survey process in the final quarter of 2020 by working closely with their third-party survey vendors to ensure optimal results.  

Understanding Survey Pitfalls 

Meeting minimum thresholds within contracts can often be challenging but too often, the problem lies not only in what these surveys gauge, but also in how they gauge it. 

Some common pitfalls include: 

  • Surveys that aren’t timely. A third-party survey vendor doesn’t meet key deadlines, either because it can’t accommodate the capacity of surveys required to assess member experience, or garner enough statistically significant data within a given timeframe.
  • Surveys that use inappropriate methodologies. If members are burdened to answer text-based surveys at odd hours when they are busy, their annoyance may contribute to poor ratings that don’t accurately reflect the high-quality plan benefits they receive.
  • Surveys that aren’t asking the right questions. Survey questions must strike the right balance:  they can’t be too broad and must be designed to elicit optimal feedback for the health plan. For example, surveys that simply ask a member if they’re ‘satisfied’ or ‘dissatisfied’ are too vague and won’t help a health plan isolate a problem area. 

There are many different causes of these survey pitfalls, but a common problem is that health plans often lose control of the survey process: They let their third party survey partner dictate the size, scope, methodology and timing of surveys, with little data, input or feedback from the health plan. Or, they don’t explain their objectives and goals for the surveys and assume their survey partners have sufficient insight and expertise. 

Optimizing Surveys and Satisfaction Ratings

While health plans can’t completely control the actual experience that physicians, customer service reps or others render, there is a lot they can control. 

Here are five factors that health plans should consider when evaluating third-party survey vendors to gauge member satisfaction of large employer clients and meet their contractual obligations.

1.  Process. Health plans should not simply stand by and let a third-party surveyor determine the right approach for measuring satisfaction. They should have full insight and control of the survey process, from the development of questions to analyzing data that will drive changes.  They should tie the surveys back to their contractual performance guarantees, ensuring that they are adequately measuring what they are being financially rewarded or penalized for in their contracts.

2. “What” is measured. The best surveys are tailored to measure specific quality indicators, such as customer service waiting times during peak hours. For 2021, health plans should talk to their survey partners about their specific goals, such as a 90% influenza vaccination rate among health plan members, and tailor questions accordingly. If this were the quality goal, a health plan would want to talk to its survey partners about including questions such as, “did my provider send reminders about the flu shot?” to identify any gaps in outreach.   

3. Questionnaire design. As many physicians will say, how you ask something is as important, if not more so, than what you ask. In the same way, the survey language a health plan uses is key: Is the plan asking members about the most important aspects of their healthcare experience, such as ease of making appointments? Surveys should be worded to elicit feedback on specific issues, within predesignated cohorts (e.g., individuals enrolled in Health Plan A) to accurately identify improvement opportunities. 

3. Sample size. A health plan’s sample size must be large enough to provide health plans with meaningful insights. A health plan’s third-party vendor partner should be flexible enough to make adjustments in order to obtain the correct sample size and statistical validity (e.g., 90% or 95% confidence) and be flexible about making adjustments. 

4.  Survey methodology. The way data is collected – such as by digital and non-digital methodologies – can influence results. The right survey partner analyzes information, follows trends, understands the benefits of one approach versus another – and can develop the right methodology based on a combination of the health plan’s needs, budget and goals.  

5. Timeliness. When it comes to surveys, timing is everything: Surveys need to be developed, reviewed, administered, collected and analyzed within a pre-designated timeframe. But if a third-party vendor doesn’t have the capacity to handle an employer’s needs (e.g., 600 distinct surveys, delivered over 12 months), the health plan could experience major delays in getting the data it needs to uphold its performance guarantees. On the flip side, health plans that work with smaller employers may need help obtaining enough data in a tight time period to yield significant results.  Health plans should communicate their needs for back-end support early on.  

While the current pandemic is creating a lot of uncertainties in healthcare and business, taking control of the 2021 survey process can ensure health plans are on track with their goals. Leveraging the right surveys in the right way is essential to maintaining high satisfaction scores and ensuring that a plan can stay competitive and financially solvent.

Suzanne Cogan is Chief Commercial Officer of SPH Analytics.

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The Editorial Team at Healthcare Business Today is made up of skilled healthcare writers and experts, led by our managing editor, Daniel Casciato, who has over 25 years of experience in healthcare writing. Since 1998, we have produced compelling and informative content for numerous publications, establishing ourselves as a trusted resource for health and wellness information. We offer readers access to fresh health, medicine, science, and technology developments and the latest in patient news, emphasizing how these developments affect our lives.