Skip to main content
Request a demo

5 strategies to improve the member experience

Consumers’ expectations for their health plans are changing. They want greater clarity on what services are authorized by their plan, better alignment and coordination between their providers and plan, and clear communication around billing practices.

While many Americans get health insurance through their employers, the Affordable Care Act’s marketplaces give consumers without job-based coverage more options than ever before for health insurance.

That means health plans must focus on retaining members who enroll with them—and that starts with a high-quality experience. Here are five ways that health plans can achieve a 5-star rating from members.

  1. Ensure your onboarding and welcoming process is up to par. Research shows that new health plan members (less than 12 months’ enrollment) generally rate their overall satisfaction with their health plan lower than members who have been with the plan for at least a year. Health plans must ensure their onboarding process involves education on how to access information, locate in-network physicians and other providers, and contact customer support. Plans should also work to make sure that new members are aware of the plan’s specific benefits and features. Surveying members within the first year of membership can help health plans identify pain points and areas to improve.

  2. Be proactive. Health plans have oodles of data at their fingertips—and they can use that data to identify patients at risk of having a bad experience. For example, if a plan notices that a member with diabetes hasn’t been refilling prescriptions or seeing their doctor, the plan can take steps to close those gaps in care. The key is to be proactive, rather than waiting until members experience a health crisis.

  3. Reframe experience in the context of diversity, equity, and inclusion (DEI). Every member is different, which is why health plans must look at experience through a DEI lens. Many member surveys don’t include questions that consider socioeconomic status, race, ethnic background, and other important factors.

    But health plans “need to cast their nets wider, utilizing broader data-mapping tools to understand behaviors and trends,” according to Tejal Gandhi, MD, Press Ganey’s Chief Safety and Transformation Officer, in Healthcare Business Today. “To get the best information, member surveys must be designed to be more inclusive—or, with more than one type of member in mind. Working to develop new survey questions for members and patients that assess a variety of topics—such as the presence of social determinants, or access to technology—ultimately helps health plan leaders do a better job of identifying gaps.”

  4. Support provider networks. Medicare Advantage plans are rated on a 5-star scale—and plans that achieve at least 4 stars are rewarded with quality bonus payments. But a portion of a plan’s rating is dependent on the performance of its network providers. “A patient’s interactions with both the provider and the payer inform the overall experience,” my colleague Aaron Fausz wrote in a recent blog post. And payers have a massive opportunity to shape that experience.

    Providers are generally focused on outcomes and quality of care. Payers can help their network providers improve the patient experience through partnerships that provide training and coaching, share data that identifies key drivers of negative scores, and streamline processes that lead to delays in care.

  5. Eliminate barriers to healthcare access. Access to care can play a significant role in members’ overall satisfaction—as well as their loyalty. For starters, it’s important for payers to maintain accurate provider directories for members. Press Ganey’s Data Enrichment solution transforms provider directories into one-stop shops with accurate data, care experience transparency, and digital appointment scheduling. Other barriers, such as transportation, mobility impairment, financial obstacles, and long wait times at physician offices, can be reduced or eliminated through services such as telehealth—but health plans must make that an option.

Understanding the unique needs and challenges of each member is indispensable to a positive member experience. Health plans must also make the extra effort to ensure members of all backgrounds understand their plan coverage, options, and limitations.

Press Ganey’s acquisition of SPH Analytics fuels our ability to help health plans understand and improve the member experience. We have unique data assets and expertise to help you stay ahead of the competition. Reach out to a Press Ganey expert today.


About the author

Bonnie leads the Clinical Improvement solutions team in Strategic Consulting. She partners with clients, including health systems and payer organizations, to improve delivery of patient-centered care and coordinate high reliability tactics with existing initiatives using data-driven strategies. Before joining Press Ganey, Bonnie served as Director of Health System Improvements at Greater Oregon Behavioral Health, where she provided organizational oversight for services aimed to ensure exceptional member experience (quality, accreditation, credentialing, provider relations, utilization management, network management, and member services).

Profile Photo of Bonnie Thompson, MSN, MBA, PMP