Why Member Experience? And Why Now?

Recently, I was having a drink with a friend in the industry, and I started talking about our member experience roadmap. My friend made the mistake of asking me why I was bringing this up now – weren’t there more important things to be worrying about, such as developing the right product or Star Ratings? This upcoming Annual Election Period (AEP) is projected to be a strong one – why is member experience top of mind? Unfortunately for my friend, she had to hear a very long-winded version of why member experience is important, especially since this is a passion of mine! I’ll spare you the same diatribe, and instead provide the highlights of my conversation.

Member Experience Starts with the Sales Process – Strong member onboarding during the sale kicks off the member experience process. With strong onboarding, an understanding of what to expect from the plan, and when to expect communications, the new member is likely to start off feeling confident in his or her purchasing decision. In addition, giving the member certain tasks of what he or she should do as a new member, such as making a doctor or eye doctor appointment, helps to engage them as a member.

Member Experience Affects OEP and Retention – In a recent webinar with Deft Research (Deft) and I, Deft stated the majority of all Open Enrollment Period (OEP) switchers were AEP switchers. This is a powerful reason to ensure plans have a strong member experience process in place for new members. Switching Medicare Advantage plans is a big deal. Not treating your members like it is a big deal or not providing the proper information timely and properly sets off buyer’s remorse. Before this past OEP, a plan had nearly 9 months to make a good first impression – this is no longer the case. Look at the cost of each new sale – when you lose these members during OEP, it is a real lost financial opportunity.

Member Experience Is Critical to Star Ratings – Recently, a Gorman Health Group client who went from 4 stars to a 3.5 stars asked us to figure out how much the lost half star cost them. It was over $30 million – that’s A LOT of benefit dollars! Consumer Assessment of Healthcare Providers and Systems (CAHPS®) scores help drive Star Ratings, and plans have been doing this for years. Why are plans still struggling? Because they don’t understand what is driving member frustration and fixing the root cause(s) of member dissatisfaction, and creating a positive membership experience. Developing “journey maps” and really understanding how/when to best engage your members will help areas beyond just your CAHPS®.

Member Experience Is Becoming an Important Part of Product Development – Member experience in the product development process has recently started to become a real issue – but, it is a good problem to have to solve. With the addition of multiple new mandatory supplemental benefits such as over the counter (OTC), transportation, meals, and other benefits, we are seeing growing frustration related to access to benefits. Plans today are now contracting with multiple vendors to offer these great new benefits, and the number and types of benefits are going to continue to grow. How does the member access these benefits, and what is the engagement process? Does the plan have multiple vendors sending materials to members? Are there five different phone numbers to call or websites to access? Developing the rules of member experience and a process to make it both easy and efficient for members to access benefits is really important. Plus, setting customer expectations for vendors is important in making your member experience seamless.

Strong Member Experience Programs Generate Revenue – Do the math and you will see the revenue. When you look at the lost opportunity of revenue for members switching to other plans – and the cost to enroll another member to make up the revenue – the cost of member experience programs is, in reality, a strong investment.

Enough of my rant! Back to work! But we would really appreciate the opportunity to share our passion for member experience with you. Contact us today to find out how we can help!


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Diane Hollie
Diane Hollie

Diane Hollie is Associate Vice President of Sales, Marketing & Strategy at Gorman Health Group (GHG). In this role, she provides strategic consulting services to ensure organizations maximize their sales distribution and marketing mix. Diane brings GHG clients more than 20 years of experience in marketing, sales, and product development for Government programs. Her strong marketing, sales and compliance background has extended to providing compliance guidance for marketing, sales and customer service communications.

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