Getting Health Plan Member Satisfaction Right is Tough: Here are Five Things You Can Do About It

We’ve all been there. You’re running late to your 9 am meeting on a Tuesday, coffee in hand, when you realize you still haven’t found a specialty physician that is able to see you in the next 2 weeks before you leave for vacation. Frustrated, you spend the rest of the morning on the phone getting additional in-network providers and calling offices—wondering if you’ll ever get that appointment that your family doctor recommended you schedule weeks ago.

This highly relatable situation boils down to a few factors – one of the largest is the complexity and disconnectedness across the healthcare ecosystem. Healthcare payors (health plans) have historically struggled to crack the code on achieving member satisfaction, in part because they can only do so much to affect the relationship and interactions between a health plan member and his or her provider(s).

While there are only so many factors that a health plan can control, all is not lost. By shifting their focus from back-office transactional thinking to end-to-end care and service thinking, payors have an opportunity to move the needle on member satisfaction, but it takes more than a single department, function, or team to lead the charge.

In member-centric payor organizations, sponsorship begins at the C-level, where executive support cascades to all levels of the organization. Further, leaders instill an appreciation in employees of how vital their role is in the life of the member. Teams focus on building awareness around all the influences that affect a member’s healthcare journey – beyond merely his or her direct interactions with the health plan. This is especially important for non-member facing capabilities such as IT, where employees may feel disconnected from the value their efforts provide to members.

With this member-centered foundation, what are the actionable mechanisms that payors can put into place to facilitate a shift from transactional to total care thinking for their members?

1. Play a role in busting the silo between payors and providers. Through increased information sharing, both players in the healthcare ecosystem can play a role in driving faster times to resolutions and outcomes. The mobile app Pager is a great example of what’s possible through payor-provider integration. Users can easily schedule doctor’s appointments, chat directly with a nurse, and find physicians within their network in a single, streamlined tool. Large health plans, such as Blue Cross Blue Shield of New Jersey, have forged partnerships that bring these seamless services to members.

2. Empathy is a critical component of the human experience and should be embedded into interactions with members by designing services that appeal directly to an individual’s lifestyle. Direct and personalized member interactions promote loyalty. This empathy is especially important in crucial discussions—whether that be helping a member understand his options for care or explanation of claims. Payors can also consider immersion training, where an employee shadows a member for a period (e.g. during his or her trip to the doctor), giving that employee an opportunity to observe the member’s challenges firsthand—ultimately instilling a greater appreciation for those he or she serves.

3. Redefine the metrics that matter. Most payor organizations today, prioritize regulatory and reimbursement drivers; instead, human-centered measures that result in member satisfaction should come first. Think beyond static metrics such as Net Promoter Score—one that is commonly used in retail—as it does not account for the discrepancies in healthcare relationships among unique member populations. Rather, health plans should incorporate socioeconomic and biological factors, along with a member’s experience, as barometers for success. While there are some universal drivers of member satisfaction, perceived value can vary and the way we measure that value should shift as well. For example, the urban member seeks location and proximity to care. The rural member seeks unique access to care where a provider isn’t an Uber ride away. Both groups, however, value timeliness and quality of care.

4. Focus on the financial experience. Aside from a member’s experience with a physician, the financial experience is a driving factor in his or her retention. Empower employees with the information and authority to provide simple explanations of billing issues, to take actions needed for first-time resolution, along with realistic resolution time expectations. Also, focus on building the capacity for these employees to provide more proactive recommendations that position them as trusted advisors. For example, those interacting directly with members should be readily available to discuss procedure costs, recommended payment plans, etc. To do this, a key step is redefining the teams that handle financial information– shaping a financial experience team with representation across departments that are working to achieve the same outcome.

5. Adopt value stream thinking. Successful payor organizations focus on value and outcomes, as opposed to de-centralized functions that focus on vertically focused activities. This often drives “passing off” of responsibilities. By reducing the number of procedural restriction points, organizations will be more holistically accountable to the needs of the payor, in turn driving retention and reducing internal costs by improving efficiency.

Health plan member satisfaction challenges boil down to legacy mindsets, current procedures, and ways of working across the disconnected healthcare landscape. While these challenges are not insurmountable, payor organizations must reorient their purpose around the member—a purpose that should play out in every aspect of the organization, from redefined metrics to increased collaboration with key players in the healthcare ecosystem.