The report draws from a database of 5.5 billion patient encounters to offer a comprehensive look at member experience. It identifies the most critical drivers of member satisfaction and loyalty, including access, safety, privacy and care coordination. Among the key findings:

Member experience and Star Ratings are linked. Member experience and Star Ratings are more closely linked than many health plans may realize. Health plans traditionally have focused on customer service, benefit design and engagement, but emerging data reveal that patient safety and privacy now are critical drivers of satisfaction and align closely with Medicare Consumer Assessment of Healthcare Providers and Systems questions.
Specialist engagement is the differentiator. Access to primary care is expected, but specialist engagement and care coordination between primary care providers and specialists are what set high-performing health plans apart. Members with a PCP give significantly higher Star Ratings, but specialist engagement remains the key differentiator for leading plans.
Meaning of access is broadened. Access involves more than availability. Ease and speed of access, as well as support from office staff, are critical factors that shape the member experience. Despite best efforts, access to care has shown minimal improvement across all health plan types over the past five years.
Improvement strategies should be tailored. Net Promoter Scores, which gauge member loyalty and satisfaction, vary significantly across health plans. Medicare plans achieve an NPS score 47 points higher than commercial plans, highlighting the fact that improvement strategies are not one size fits all. By focusing on the specific needs of Medicaid, Medicare and commercial lines of business, plans can drive meaningful improvement in high-impact areas.
Drug coverage and availability are important. Although prescription drug coverage is central to member experience, access to medications is just part of the equation. Data reveal that the availability of mail-order services can significantly improve satisfaction and affect overall drug plan ratings.
Disparities in care need to be addressed. Nearly 1 in 20 Medicare members have experienced unfair treatment by a health care provider. Historically disadvantaged populations are more than twice as likely to report mistreatment.

Instant Insights /

Health plans urged to improve member experience, address disparities

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