Health Plan Member Engagement and CAHPS Elevated to a Year-Round Priority

December 8, 2023

Member satisfaction isn’t just a metric; it’s a crucial determinant of a health plan’s success. Beyond inherent value in bolstering quality scores such as Stars and Consumer Assessment of Healthcare Providers and Systems (CAHPS), member satisfaction directly influences the financial returns from government agencies like CMS especially in the years ahead. Here’s why.

The 2023 CMS ruling marked a seismic shift in Star calculations compared to 2020. The change elevated the weight of customer experience and member satisfaction measures from a weight of 1.5 to 4 in 2023. McKinsey and Company further accentuate the tangible benefits of customer experience and member satisfaction revealing that a one-star increase due to exceptional member experience can result in a remarkable 45% increase in CMS rebates.

To harness these rewards and fortify quality measures, health plans must shift their most common and cemented practices. Rather than viewing member satisfaction as a checkbox during enrollment season, it should be embraced as a year-round initiative with its enduring impact on member contentment and subsequent financial rewards.

Pitfalls of seasonal pushes for member satisfaction

Despite the well-intentioned efforts of health plans to boost member engagement, many are trapped in unproductive strategies. Common errors arise when health plans adopt a brief focus on seasonal member satisfaction initiatives during times such as Q4 pushes, member enrollment season, or attempts to align with organizational growth trajectories.

Mistakes include relying on gifts as solutions to member grievances, needs, or concerns. The following sheds light on the common errors made in these approaches and amplifies the inadequacies of such strategies:

  • Inadequate member data: If health plans restrict their focus on member satisfaction to specific and brief time frames, they risk lacking comprehensive data to reach a substantial portion of their members. Presently, some health plans lack reliable data for approximately 20% of their current members, rendering it impossible to ensure their satisfaction without sustained year-round engagement efforts.
  • Misguided technology investments: Allocating substantial amounts of annual budgets to contract outreach efforts and individualized gifts during seasonal initiatives represents a costly investment in often ineffective technologies. Redirecting these financial resources towards infrastructure and staffing experienced care coordinators with continuous longitudinal training throughout the year proves more sustainable and impactful.
  • Accessibility challenges for vulnerable populations: Seasonal initiatives often involve sending technology-based gifts, an approach intended to contrast with perishable gifting items. However, this strategy falls short for vulnerable or senior members who lack interest in such technology or the means to download related apps. Consequently, health plans face an increase in customer service calls, necessitating additional IT training to address the challenges posed by gifted products.
  • Logistical issues with perishable items: Initiatives involving the delivery of perishable items, such as food, commonly result in logistical challenges and errors. These include returned items, deliveries to incorrect addresses, and various other issues. The absence of accurate member data and continued communication with members contributes to these problems, leading to incorrect addresses, a lack of knowledge about a member’s health concerns, and the potential delivery of food during inconvenient times, resulting in spoiled or compromised items upon the member’s arrival.

New member engagement strategies to consider

A more effective strategy necessitates identifying member preferences through feedback mechanisms like polls or focus groups. Members prioritize greater support, care services, shorter wait times, and effective care coordination over superficial incentives. 86Borders exemplifies a member-centric approach to year-round care coordination, engaging with plans’ most vulnerable populations to address their nuanced needs. Here are six new strategies to consider. 

  1. Identify member preferences: Prioritize understanding member preferences through incentives, rewards, or gifts by seeking feedback. Comprehensive knowledge of member needs is essential to tailor engagement strategies effectively.
  2. Prioritize member needs: While gifts may have their initial appeal, members place higher value on health plans addressing their core needs and concerns. A member-centric approach involves actively prioritizing the resolution of healthcare obstacles standing in the way of individual members.
  3. Act upon expressed needs: Listening is crucial, but meaningful member engagement requires action. A care coordinator should not merely serve as a sounding board. Rather, they must proactively address and quickly resolve the member’s needs.
  4. Understand individual member dynamics: A member-centric approach to care coordination necessitates a nuanced understanding of each member’s comfort level in voicing concerns and preferences for outreach. Building trusted relationships is key to overcoming barriers to healthcare access.
  5. Prioritizing CAHPS: Health plans must embrace the significance of Consumer Assessment of Healthcare Providers and Systems (CAHPS) scoring, as it plays a pivotal role in a plan’s Star ratings. Achieving high member satisfaction necessitates a complementary high CAHPS score.
  6. Personalized communication: Simple but effective tactics include using preferred member names and pronouns, repeating the member’s name during interactions, and adopting a personal conversational approach. Avoid the potential drawbacks of scripted outreach, which can come across as impersonal. Scripts are most effective when they are personalized and tailored to individual member situations.

Health plans must pivot their efforts towards a sustained commitment to year-round member engagement and a heightened focus on CAHPS scoring. This transformative approach not only aligns with regulatory shifts but ensures that health plans are not merely reactive but proactive in delivering superior member experiences. In prioritizing member satisfaction as an all-year initiative, health plans better navigate the intricacies of modern member satisfaction and secure long-term success.