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How to identify and retain at-risk members

What's the real impact of losing a member? For all health plans, especially those with larger Medicare Advantage membership, it can be a very costly proposition. Acquiring new members in a saturated, highly competitive market requires a substantial financial investment. And disenrollments not only impact Star Ratings, but net promoter scores (NPS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys can also take a hit, as longer-retained members tend to rate health plans more favorably.

Addressing member churn, curbing disenrollment, and improving retention are common challenges health plans face—and must tackle head-on.

Identifying the root causes of member disenrollment

Member disenrollment isn't spontaneous. It's usually the result of a suboptimal product or a series of poor member experiences, which cumulate, undermine loyalty, and lead to attrition. But what are these experiences, and how can we understand them?

Members' experiences are made up of the many different interactions they have with your health plan—direct and indirect. These may include customer service, product usage, and digital touchpoints. Frictions introduced anywhere along this journey can cause member satisfaction to wane and increase the chance of churn during the next enrollment cycle. Understanding the role of member experiences in causing disenrollments is the first step to developing the strategies to prevent it.

Some bad experiences are clear, such as an unexpected prior authorization denial. Others are much subtler—and may go unnoticed until it's too late. Member disenrollment can result from a major member issue but is often a combination of many smaller frustrations and suboptimal experiences that occur over time.

In today’s world, with every company vying for customers, consumers’ expectations are much higher. Asking for something to be faxed just doesn’t cut it anymore. Having to call three times to solve an issue is simply unacceptable. Not having a user-friendly app to access common functions (like an ID card or submitting an appeal) is just plain frustrating.

Health plans need strong feedback systems that proactively encourage members to share their experiences and insights. This will help you identify problems and take strategic steps to improve.

The sooner you can spot members at risk of churning, the sooner you can intervene, and the better your chances of holding onto them. Sometimes, fixing a problem through amazing service recovery can turn a negative experience into a positive one—and a detractor into a promoter—overnight.

Predicting member churn among those most at risk

Predicting member disenrollments isn't about making educated guesses. Health plans need predictive analytical models to understand which member experiences have the biggest impact by looking at member characteristics and their past experiences. Using this member data to identify at-risk members can prevent churn before it happens.

Data analytics can provide valuable insights into member behavior and attrition attributes. You should look for this data across multiple sources—like member interactions, transaction history, plan attributes, and feedback.

Vital data points to consider include:

  • Out-of-pocket costs
  • Repeat call patterns
  • Number of open cases
  • Denials of any kind

Proactive and personalized member experience strategies

Proactive member experience strategies aim to see and address member needs before they escalate into bigger issues. This is critical, as unresolved health plan problems can impact and further stress people at their most vulnerable moments.

Key elements of these strategies include:

  • Regular communication with members
  • Personalized experiences based on member preferences
  • Proactive, early intervention to handle potential issues

By being proactive and crafting personalized experiences, you can build better relationships with members and even create the kind of behavior changes needed to drive the triple aim (i.e., improving the patient experience, bettering the health of populations overall, and reducing cost). This will help you meet their needs and exceed their expectations, boosting NPS in the process. A few successful member experience strategies include:

  • Seeking member feedback and acting on it
  • Personalizing member experiences based on their preferences and needs
  • Using data analytics to predict and fix problems before they cause issues

The role of continuous listening in preventing member disenrollment

Continuous listening has proven to be a powerful tool in combating member disenrollment. This strategy, and the technology that enables it, involves maintaining a steady dialogue with members as they traverse the healthcare landscape. You ask for their feedback often, look for it wherever it might exist, and respond with understanding and compassion.

Continuous listening goes beyond occasional surveys or feedback requests. This strategy encourages consistent engagement with members to fully understand their experiences and perceptions, as well as measure their behavior and engagement along the member journey.

Listening to your members and responding to their feedback shows that you value their experiences and opinions, so you can address specific member concerns. This is the inner loop of the closed-loop action system. Listening also lets you focus on the outer loop, or the larger systemic issues that must be addressed, creating initiatives and programs to tackle pain points that affect many or all members.

Taking action to improve the member experience

Understanding why members leave and fixing these issues early is crucial to improving member retention. Continuous listening supports proactive member experience strategies, and can address challenges before they become larger enterprise-wide issues. The key to success lies in asking for and acting on feedback. It lies in personalizing member experiences. And it lies in using data to predict members that may disenroll. Doing so will let health plans always stay a step ahead, and build stronger, longer relationships with their members—resulting in improved NPS, growth, Star Ratings, and even reducing costs.

Join Press Ganey's webinar on April 30 for an in-depth discussion on improving the member experience. Our experts will explore how health plans can move beyond traditional surveys to harness real-time member insights and proactively address the root causes negatively impacting member experience. Register here. 

To learn more about strategies for improving member experience and reducing disenrollments, reach out to an expert on our health plan team

About the author

David Shapiro is the Senior Vice President and General Manager of Member Experience, where he leads a team dedicated to advancing solutions, analytics, and insights aimed at enhancing the quality, experience, and retention of health plan members. With a 25-year career marked by a focus on health plan member experience, David’s successful track record includes significantly improving consumer and provider satisfaction, net promoter scores (NPS), and Star Ratings during his leadership at UnitedHealthcare as Chief Experience Officer. His broad skillset spans consumer and provider experience, managed care experience strategy, engagement marketing, consumer data, and customer relationship management.

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