Health Plan Member Satisfaction Shows Room for Improvement: Five Take Aways from FINN Voices

September 7, 2023

I recently had the pleasure of sitting down with Beth Friedman, Senior Partner at FINN Partners, for the FINN Voices radio show on Healthcare NOW Radio. We explored the critical issue of member satisfaction within health plans.

Our conversation was extremely timely given that a recent HealthEdge study cites less than half of a health plan’s members are satisfied. It is also important to note that health plans are entering member recruitment season; a time when member satisfaction with health plans is most crucial. Here are five key take aways from our conversation.

1. Member satisfaction drives Star ratings

Health plans are evaluated based on CMS’s Star rating program to measure the experiences Medicare beneficiaries have with their health plan and health care system. A higher Star rating increases health plan reimbursement and expands the time frame under which plans are permitted to recruit for new members. One of the foundational components of the Star rating system is health plan member satisfaction. Hence the importance of this metric.

2. Overlapping member outreach causes confusion

A key challenge arises when health plans engage multiple vendors to engage members across different initiatives. While each vendor independently reaches out to members, there is a lack of cohesion, resulting in multiple communications that may not convey a member-centric approach. This disconnect can lead to member abrasion and, consequently, a less pleasing member experience.

3. Member-centric approach considers personal needs

Instead of merely reaching out to members to close specific gaps in care and ensure screenings occur, savvy plans take a more member-centric approach. This involves genuinely inquiring about how members are doing and, particularly, addressing the needs of vulnerable and hard-to-reach populations. To bridge this gap, we must recognize the importance of engaging with members on a personal level, uncovering their social determinant needs, and aiding them to address these needs.

4. Accurate member data becomes essential

Addressing data challenges in aggregating information on these members is another critical aspect that Beth and I discussed. Data is king and health plans face numerous hurdles in capturing accurate member data. Many members may not complete forms as expected, and language barriers can further complicate data entry. 86Borders aggregates data from diverse sources and provides it back to health plans. In this way, progress is quickly made to connect with and engage members more effectively.

5. Not all member populations are the same

We also delved into the complexities that health plans face in fine-tuning policies and procedures for diverse member populations. Policies designed for one group may not suit another. The challenge for health plans is to implement multiple sets of policies within a large organization. Here, health plans collaborate with vendors to supplement their efforts and provide tailored solutions for specific member groups.

More member engagement best practices ahead

86Borders doesn’t do one aspect of member engagement differently; we do a thousand little things differently. This aggregation of differences provides effective engagement with difficult-to-reach members. Listen to the full interview for more insights into how health plans can improve engagement and Star ratings through a member-centric approach.

In the world of healthcare, if you can engage a member, nothing else matters. If you can’t engage a member, nothing else matters either.