Re-Engaging Health Plan Members: 5 Foolproof Strategies

Why putting the patient’s experience first is more important than ever.

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By Suzanne Cogan, Chief Commercial Officer, SPH Analytics

It’s no secret 2020 felt overwhelming for health plans and their members, from shifting regulatory and clinical guidance, to changes in benefits. As a result, many consumers were left wanting more out of their healthcare experience.

A May 2020 poll conducted by SPH Analytics at the beginning of the pandemic revealed that as many as 70% of consumers would switch plans if they could.

While it is easy to blame the bulk of these sentiments on the effects of COVID-19, the reality is that the pandemic may have exacerbated some issues that already existed, casting a spotlight on the importance of refining and prioritizing strategies related to member experience improvement.

The good news is that it’s not too late to re-engage these consumers. In fact, national movements suggest that it’s more important than ever to engage them. 

CMS, starting in 2021, is increasing the weight of patient experience measures used to calculate Star Ratings. As such, scores from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey — the main tool that gauges health plan member experience — now represents a bigger portion of the Star Rating weighting for contract year 2021. In shifting some of the emphasis off outcomes, organizations will need to pay closer attention to the quality of service they provide or risk the loss of monetary incentives.   

Under the Microscope

Before plans can embark on making changes, it’s helpful to understand some of the more common and recent issues, or member grievances. One consistently cited issue is benefits. 

Case in point: The SPH survey showed that two-thirds of health plan members surveyed were unclear about their coverage and benefits, such as whether their plan covered telehealth. 

While this may not have mattered much pre-COVID, when telehealth utilization was relatively low, it has mattered a lot since March 2020, when the most populous parts of the country started shifting in-person care to virtual environments. Because CMS traditionally limited Medicare telehealth coverage to rural areas, many consumers wondered if their primary care physician would be covered for appointments conducted virtually.  

Health plan members have also expressed grievances over other issues tied to experience. For example, the lack of transparency over costs, and slow or lackluster customer service were common complaints in 2020.

Bottom line: Health plans may believe they are on the right track, but member perception doesn’t always line up.

Ready to Engage

There’s an art to engaging and retaining members, and in doing so, elevating experience and outcomes. We’ve found that these five best practices for member engagement are common among health plans that score high in experience-related STAR measures: 

1. Baselining consumer sentiment.The sooner healthplans understand what areas need improvement (e.g., customer service, benefits transparency), the sooner they can address problems before they escalate. In fact, by the time consumers receive CAHPS surveys, it may be too late to make any impactful changes. By using off cycle member experience surveys prior to the official CAHPS survey, an organization may be less likely to face surprises.

2. Deep data analysis.It might look like a health plan is doing everything right, but their data often tells a different story. For example, if 80 percent of health plan members are satisfied with member services, that’s great — unless the national average is 90 percent. If a plan is underperforming, it would want to dig deeper — for example, by looking at staff retention among member services staff to see if turnover has increased (and members are interacting with less-experienced member services personnel more frequently).  Digging deeper should also incorporate comparisons to other health plans via national benchmarks, given the fact that Star ratings are calculated in relation to other plans.

3.Personalized communications. It’s often said that we’ve gotten away from seeing patients as individuals with their own healthcare and communication needs.Health plans pour millions into broad messaging campaigns, dispatched through traditional media and digital marketing programs. But the messages are often too generic to cause the consumer to take a healthy action. To better engage consumers in their healthcare, health plans must personalize communications. For example, when trying to reach consumers to schedule their flu shot, leveraging predictive analytics that assigns scores to each member (such as, engage-ability in their own healthcare, likelihood to react to a certain communication modality) allows the plan to tailor outreach in the most impactful way to different segments of the member population.

4. Frequent assessments.Health plans that achieve higher Star ratings tend to take ongoing and real-time measurements of member experience to keep a finger on the pulse, mitigate any potential problems, and identify the areas where progress is being made. 

5. Transparency. Clear communication is the cornerstone of satisfaction in the healthcare world, especially for health plans. For example, patients want to know the extent of their coverage and what tests and procedures will cost. Having coverage information easily accessible, clearly worded in a variety of languages, and pointed out to members by customer service representatives during calls is an easy way to boost satisfaction without heavy lifting and policy shifts.   

Improving member experience will be key to improving engagement, on the heels of a tumultuous year. While navigating the healthcare system can be challenging, health plans that are effectively engaged with their members today will be the Star Ratings success stories in 2022 and beyond.

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