Elevating the Member Experience in 2024: Expert Advice for Health Plan Executives

Updated on December 26, 2023
Mature Doctor Involved In Serious Discussion With His Patients

For the second year in a row, Medicare Advantage and Part D plans’ Star ratings fell in 2024, potentially giving dissatisfied members an additional incentive to explore their options. As a new wave of members are onboarded following annual and open enrollment season, MA-PDs — and all other health plans — must critically assess their member experience strategies to address some of the common miscalculations that can leave them vulnerable to lackluster re-enrollment amid intense competition.

Below, we outline five member-centric approaches that plan executives can utilize to elevate their member experience in the coming months.

Prioritize Member-Centric Metrics

Many health plans make the miscalculation of concentrating on average handle time (AHT) and other process metrics when they should instead prioritize first call resolution (FCR) and other member-centric metrics. FCR, which measures member issues resolved on the first contact, is one of the gold standards to gauge member satisfaction. Another essential member-centric metric is net promoter score (NPS), which measures the likelihood that members would recommend the plan to others.

Focusing on NPS provides plans with the insights required to develop actionable strategies to elevate the member experience. When substandard call quality and inaccurate information from agents were triggering member frustration and lowering NPS at one national health plan, executives utilized an analytical approach to identifying and targeting root causes of the issue — including overly complex systems and rigid scripting that restricted agents’ “politeness.” This data-led approach helped the plan increase its overall NPS from 25% to 37%.

In addition to NPS, another valuable member-centric metric is transactional net promoter score (tNPS), which measures satisfaction related to specific member-plan interactions, such as enrolling in a plan, filing a claim or inquiring about benefits. By adding this newer metric to their KPIs, health plans can ensure they are measuring factors directly correlated to member satisfaction.

Utilize Technology to Personalize the Member Experience

Payers must replace outmoded systems that undercut their member experience goals and embrace updated technology such as personalization engines that leverage member data to craft messages that resonate with members. With AI-powered “bots,” this personalization can extend to self-service interactions, providing members with relevant information tailored to their preferences.

For instance, one innovative Medicare Advantage plan saw its Star ratings soar from three to five stars after implementing several best practices to personalize the member experience, including using self-service bots to guide members to resources and support in their preferred format. Members can choose from a wide range of easy-to-navigate videos, tutorials, interactive guides and adaptive FAQs to help resolve their issues more quickly and seamlessly. With its coveted five-Star rating, the health plan can now augment its revenue by selling year-round, not solely during open enrollment.

Connect Key Data on the Cloud

Another strategic error that health plans make is not harmonizing their platforms, which creates situations in which agents must routinely locate member data from multiple sources. Not only does this create inefficiencies, but it also contributes to a dissatisfying member experience marked by “dead air,” long holds and annoying transfers.

To ameliorate this issue, plans should harness the benefit of a single platform on the cloud, which ensures that member information is accessible in real time, in one place. Maintaining this single source of truth for member information also allows agents to leverage opportunities to upsell or connect members to other benefits that may improve clinical outcomes and contain costs. In addition, a single platform helps plans keep pace with the digital innovation happening across the industry, so they may continue to deliver a more personalized, engaging member experience in the future.

Embrace the Advantages of Omnichannel Campaigns

Plan leaders are making a misstep if they think omnichannel marketing strategies are not appropriate for healthcare. In fact, today’s digital-savvy members expect the same seamless member experience they receive from e-commerce interactions from their healthcare as well.

Additionally, creating targeted omnichannel campaigns for members can provide payers with a previously untapped approach to reach their strategic goals. For example, one Medicare Advantage plan was concerned that its members with chronic conditions failed to take full advantage of their benefits, which could contribute to poor clinical outcomes and tarnish its Star rating. The plan leveraged omnichannel to contact 535,000 members with pre-existing conditions via phone and text, encouraging them to schedule care appointments. Members initiated more than 105,000 inbound calls, and the plan realized a 300% increase in the rate of appointments scheduled. In addition to closing care gaps and supporting members’ wellbeing, health plan executives also protected their Star rating.

Optimize Complementary Technological and Human Resources

Another common miscalculation for health plans is not outsourcing to optimize their workforce and technology assets. One such asset, AI, serves a critical role in helping plans successfully pair people-centered technology with empathy-based human interaction. For instance, one health plan equipped its newly hired agents with AI-driven agent assist tools during open enrollment season. The tools gave new hires the confidence they needed to achieve 15% higher accuracy and 12% higher member satisfaction in the first month, compared with agents who lacked added support from the tools. In addition, the AI tools decreased the new hires’ AHT by one minute during the plan’s peak season.

Aiming for an Elevated Member Experience in 2024

For regional and national health plans, growing brand loyalty will be an imperative to drive renewals and protect revenue streams in 2024. By strategically employing these member-centric approaches, plans can eradicate sources of friction that generate member dissatisfaction while reducing costly inefficiencies.

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Rajesh Subramaniam

Rajesh Subramaniam is MD & CEO of ResultsCX, leading a team of 23,000+ people across 25+ global locations. As the highest-ranking executive, he sets the strategic direction of the company and focuses on driving sustainable growth for the business and its stakeholders. Part of the Firstsource co-founding team, Rajesh believes in investing in people development and building a culture of high performance to achieve employee and customer excellence.