3 ways health plans can improve member experience

May 24, 2022

Health plans that prioritize individuals and their unique health experiences can become the plan of choice by meeting members where they are. Time and time again, health plans retain members and achieve high ratings when they work to understand the needs of members and enable a positive member experience.

Ratings and surveys increasingly focus on member experience

Ratings and surveys are widely leveraged within healthcare to help members and other stakeholders make informed decisions. The Centers for Medicare and Medicaid Services (CMS) provides Star Ratings that compare the quality of various Medicare Advantage plans and ranks them accordingly. Among the attributes tested, customer experience has proven notoriously hard to improve. CMS has indicated it will likely place more emphasis on the customer experience metric in ratings moving forward, putting pressure on payers to provide a more individualized experience for patients.

Healthcare.gov also runs a health insurance plan quality rating system to help shoppers in the marketplace compare plans. The ratings incorporate three categories, including member experience, and give an overall score of one to five stars.

Members also look for reports when evaluating the quality of their care. The Consumer Assessment of Health Plans Survey (CAHPS) is an invaluable tool for evaluating the experience of individual patients receiving care. CAHPS asks patients to report everything from how quickly they received care to the efficacy of their communication with their providers.

Member experience and plan competitiveness are becoming increasingly connected — payers that do not make member experience a strategic priority will find it challenging to attract and retain members. But, according to a 2021 Forrester poll, payers are moving in the right direction: there was a three-point increase in member experience scores (on a 100-point scale) from 2021 to 2022.

3 ways payers can improve member experience by making it easier for members to engage with their care journeys

Members often can feel like they are lost in the shuffle and left behind when seeking care and as a result, are asking for more individualized and custom experiences. Here are three ways payers can enable members to play a greater role in their managing and delivering their care.

1. Prioritize digital communication

In an increasingly digital world, healthcare consumers want more digital communication from their care teams — especially following the pandemic. Patients have indicated a high interest in digital communications from providers, and it follows that they expect the same from their health plan.

Digital communication can range from incorporating text reminders about preventative care and appointments to messaging directly with providers online. Offering communication with providers and payers alike across channels can help re-engage patients and improve their experience with their health plan.

2. Improve health literacy

Navigating our complex healthcare system can be very difficult, even to those most familiar with the industry. Often, members struggle to understand health plan premiums, identify in-network providers, or dissect costs they are responsible for. Americans surveyed for a report published in 2019 indicated they had inadequate health insurance literacy.

Accenture said it best, “It’s not Americans who are failing in healthcare system literacy. It’s the complexity of the system that’s failing them.” Improving healthcare literacy can significantly enhance the experience members have with their health plan.

3. Ease access to care

Prior authorization can be a pain point for health plan members. Manual processes can lead to delays in members receiving the care they need — sometimes requiring they wait up to two weeks when authorizations need a more thorough review. These delays to critical care can impact a member’s health and how they view their health plan.

“No one in healthcare sits there and says, ‘I love the fax machine. This is my favorite way of transmitting clinical documents,’” says Dr. YiDing Yu, a practicing physician and the chief medical officer at Olive, of the outdated prior authorization process. “[Prior authorization] is stuck in this very manual process. We can’t tolerate this inefficiency for our patients — they deserve a lot better.”

Integrating AI and automation into prior authorization workflows can enable faster submissions, decisions and care for members. Olive’s UM solution streamlines the process by automating antiquated prior authorization programs and providing AI-assisted clinical reviews to enable real-time decisions that lead to more efficiency on both sides of the fax machine and in turn, more timely care for members.

Learn more about Olive’s Utilization Management solution.

When health plans improve the member experience, it’s a win-win — they attract and retain members and give members the access to the care they need.