Positive Member Engagement Crucial to Stars Success for Health Plans

With the shift in the Consumer Assessment of Healthcare Providers and Systems Survey (CAHPS) and other operational measures weighted from 2x to 4x, a positive Member Experience with the plan is now critical to succeed in Stars. Understanding member’s journey with the plan, end to end, is paramount. In our experience, health plans that listen to the member and proactively react to their feedback often will achieve their performance goals and reach 4.0+ Stars for their contract.

Creating a Culture of Positive Member Engagement – Strategic Approach

Individuals are most dissatisfied when their expectations are not met. The Medicare Program and the Medicare Stars team need to work collaboratively across the organization to ensure that members' expectations are clearly set, defined, and ultimately exceeded. Mature Health Plans have strong alignment between the management of their products and the management of the Member Experience. From the pre-sales process to acquisition to onboarding and throughout the life cycle of the membership, health plans need to be cognizant of every member interaction to make each touch meaningful and impactful.

Below we discuss four key themes outlining a successful member engagement strategy.

Predictive Analytics and Centralized Data

• You cannot fix what you don’t understand and measure. Health plans need to think more creatively about the ways they understand Member Experience at the health plan. Centralizing Member Experience metrics in a database will go a long way to help enable better, more informed decision making.
• Understanding your membership – Plans need to consider deployment of micro-surveys, pulse checks, and off-cycle surveys in order to gather key member insights which will inevitably inform your ongoing strategy.
• Predictive Analytics – predicting future member dissatisfaction will help mitigate downstream risk. Analysis of member-level predictions can identify opportunities for targeted messaging.

Alignment of Messaging and Synergy Identification

• Plans typically have the internal capabilities, tools, and resources necessary to optimize member communications. Internalizing multichannel engagement strategies and leveraging those capabilities and expertise reduce reliance on external solutions and ensure greater governance, data management, and program management.
• In heavily siloed organizations, members are often victims of ‘information overload’ due to numerous member outreach campaigns throughout the year. Within these campaigns, there are several opportunities to combine efforts among plan operations that should be considered to reduce member abrasion.

Enhance the Payer – Provider Relationship Potential

• Providers are typically a member’s primary point of care, not the plan. Plans should optimize their provider relationships as it can have deep downstream impacts on CAHPS and satisfaction. This includes understanding a member’s care journey, medication history and other relevant experience information.
• Positive Feedback Loop – keeping providers informed and engaged is key. Plans need to educate providers about what you are asking your members to do in addition to the incentive opportunities they may have. Lastly, plan product design changes can impact providers, and proactively informing providers of changes and their impacts can improve engagement.

Benefit and Resource Optimization

• In a highly competitive Medicare landscape, optimized benefit design and reward or incentive programs can significantly impact Member Experience while also impacting other domains (i.e., HEDIS, HOS, PDE, etc.). Plans can also empower their supplemental benefit providers to bolster the member experience across existing touchpoints (and therefore avoid the need for additional outreach).
• Health plans invest a lot of money into programs and resources that members either are not aware of, or not capable of connecting with. It is the health plan’s job to proactively form those connections, to improve satisfaction and engagement.

At ProspHire, we continue to partner with Health Plans, to offer insights, analysis, and execution strategies to improve Star ratings. Have you considered your own health plan’s member engagement strategy? We would love to have a conversation. Feel free to reach out to me, Andrew Bell, at [email protected]. Let’s prosper together.