Health Plan Satisfaction Shows Room for Improvement

Five Best Practices for Optimal Member Engagement

By Dan McDonald, CEO, 86Borders
LinkedIn: Dan McDonald
X: @86Borders

I recently had the pleasure of sitting down with Beth Friedman, Senior Partner at FINN Partners, for the FINN Voices radio show on Healthcare NOW Radio. We explored the critical issue of member satisfaction within health plans.

Our conversation was extremely timely given that a recent HealthEdge study cites less than half of a health plan’s members are satisfied. It is also important to note that health plans recently launched the 2024 member enrollment and recruitment season; a time when member satisfaction with health plans is most crucial. Here are five key take aways from our conversation.

1. Member satisfaction drives Star ratings

Health plans are evaluated based on CMS’s Star rating program to measure the experiences Medicare beneficiaries have with their health plan and health care system. A higher Star rating increases health plan reimbursement and expands the time frame under which plans are permitted to recruit for new members. One of the foundational components of the Star rating system is health plan member satisfaction. Hence the importance of this metric.

2. Overlapping member outreach causes confusion

A key challenge arises when health plans engage multiple vendors to engage members across different initiatives. While each vendor independently reaches out to members, there is a lack of cohesion, resulting in multiple communications that may not convey a member-centric approach. This disconnect can lead to member abrasion and, consequently, a less pleasing member experience.

3. Member-centric approach considers personal needs

Instead of merely reaching out to members to close specific gaps in care and ensure screenings occur, savvy plans take a more member-centric approach. This involves genuinely inquiring about how members are doing and, particularly, addressing the needs of vulnerable and hard-to-reach populations. To bridge this gap, we must recognize the importance of engaging with members on a personal level, uncovering their social determinant needs, and aiding them to address these needs.

4. Accurate member data becomes essential

Addressing data challenges in aggregating information on these members is another critical aspect that Beth and I discussed. Data is king and health plans face numerous hurdles in capturing accurate member data. Many members may not complete forms as expected, and language barriers can further complicate data entry. 86Borders aggregates data from diverse sources and provides it back to health plans. In this way, progress is quickly made to connect with and engage members more effectively.

5. Not all member populations are the same

We also delved into the complexities that health plans face in fine-tuning policies and procedures for diverse member populations. Policies designed for one group may not suit another. The challenge for health plans is to implement multiple sets of policies within a large organization. Here, health plans collaborate with vendors to supplement their efforts and provide tailored solutions for specific member groups.

Post-pandemic changes could drop Star Ratings

As CMS lifts COVID-19 guardrails, Medicare Advantage plans could see a decline in Star Ratings. This is especially relevant for health plans bonus payment, which could drop if plans fall below three stars.

Ensuring Star Ratings starts with member satisfaction and experience, which is improved through a holistic, member-first approach. Below is a checklist for health plans to ensure member engagement program readiness for 2024 shifts in Star calculations.

• Engage with members on a personal level. Take a personalized approach to member outreach, especially with vulnerable populations. Many members struggle to meet basic needs, which gives way for care gaps. Get to know vulnerable members and help address SDOH such as housing insecurity, food insecurity, transportation issues, etc. Taking a personalized approach closes care gaps on a member-level and helps reach those who were previously believed to be unreachable.
• Improve data collection and accuracy. Health plans struggle with inaccurate member data. This discrepancy creates pitfalls in the way health plans are able to reach and understand members. Being sensitive, empathetic and aware of their needs is critical for building relationships. Accurate data collection is paramount as a first step in this process.
• Build trust. Becoming familiar with members on an individual level is one of the most valuable keys for success of members and health plans. Identify local partners that can support with providing much-needed services such as transportation, pharmacy, housing, etc.
• Educate. Health plans can be confusing and difficult to navigate. Often, members are unaware of the benefits available. Take time to educate them on their benefits to make sure they are receiving the best care. Additionally, be patient with members who may not understand certain healthcare jargon. Rather than saying it’s time for their “colorectal screening,” break down the term so that everyone is aware of the procedure.

Following these steps helps health plans ensure positive member experiences and improve overall members satisfaction.

More member engagement best practices ahead

In the world of healthcare, if you can engage a member, nothing else matters. If you can’t engage a member, nothing else matters either. Listen to the full interview below and view more valuable tips for better member engagement.