5 Ways To Evaluate Your MA Member Experience

The term “member experience” means many things to many people in a Medicare Advantage (MA) plan.  When the Stars team hears the term, they immediately think of the Consumer Assessment of Healthcare Providers & Systems (CAHPS) and administrative Star measures. When the Sales or Marketing teams hear the term, they immediately think of new enrollments and retention rates. The truth is that both definitions are right!  And for many plans, defining the term “member experience” is easier than actually improving the member experience. 

Improving member experience is not a “quick fix” project, and no single tactic is likely to dramatically change the way your members interact with your staff and/or use your benefits in the community. But in our many years of working intimately with MA plans to create seamless, positive experiences that accomplish the many inter-related experiential needs, there are some common themes to focus on. 

If you are searching for ways to improve your member experience, here’s a checklist of things to look for:

  • What is your value proposition in the market?  Every plan has a slightly different market differentiator. Knowing the angle your sales agents focus on with prospects as the foundation for your marketing, messaging and member support help create positive experiences where the plan’s operations and messaging aligns with what the member believes they are purchasing when they enroll with you.
  • How well are new members supported while they adjust to your benefits and networks?  New insurance coverage is always filled with “hassle factor.” From finding new doctors to changing medications, the process is often confusing, challenging, and frustrating – even for young, healthy members! Add in the extra confusion with preferred pharmacy networks, the need for new prescriptions, dental networks, vision networks, supplemental benefit vendors, and then combine these very normal experiences with the heavier illness burden in MA, declining cognitive abilities among seniors, and decreasing independence, the struggle is very real! Embracing quality improvement initiatives with the actual experiences of your customers in mind is key to success.
  • Do your benefits actually meet your members’ needs?  All too often, and sometimes against our best intentions, consumers select MA plans that are misaligned with their needs. Consistently reviewing your members’ experiences and medical loss ratio (MLR) can help you identify where enhancements are needed to benefits, services, and supports, to ensure your benefits continue to meet the actual needs of the members enrolling in your plan.
  • How easy is it for members to use your benefits?  Tools like utilization management, prior authorizations/approvals, step therapies, etc. are commonly used to help manage medical spend. However, sometimes we use these tools more frequently and pervasively than actually needed – and often in ways where our older and aging, or younger and disabled members, struggle to use the benefits they’ve purchased. Periodically reviewing the return on investment (ROI) of these activities can help ensure they are accretive to your bottom line without unduly inconveniencing members.
  • How well are your vendors supporting your members’ experiences?  The continued proliferation of vendors entering the MA space is almost astonishing. Carefully and consistently evaluating (and re-evaluating) the adequacy and effectiveness of vended services and activities from your members’ perspective is a healthy way to validate the reasonableness of outsourcing. In cases where vendors are not adequately accretive to your overall Star Rating or not seamlessly providing services and support to members which endears them to you, it can be important to surface the issues and resolve through insourcing.

Whether you need help identifying opportunities to improve your member experience or you need assistance implementing change, we can help. For additional questions and inquiries about how GHG can support your needs, please contact me at msmith@gormanhealthgroup.com

Melissa Smith
Melissa Smith

Melissa Smith is Senior Vice President of Stars & Strategy at Gorman Health Group, LLC (GHG). Melissa’s team helps clients improve performance within quality ratings systems such as Star Ratings, improve health outcomes and the member experience, evaluate market dynamics and opportunities, optimize distribution channels, and supports our clients’ strategic planning needs.

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