Engaging Members With Their Personal Doctors

May 18, 2023


The Centers for Medicare & Medicaid Services (CMS) is transitioning both Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and Operational measures from 4x-weighted to 2x-weighted in the 2024 measurement year. Despite the reduction in measure weight, plans should not lose focus on the importance of improving member experience. All plans should continuously focus on increasing engagement by strengthening the relationship their members have with their personal doctor.

Member-provider engagement should be viewed as two-fold. First, every member within a health plan should have an assigned personal doctor. Second, plans should ensure members are seeing their providers at least once per year through annual care visits. These two elements improve the likelihood that members will receive appropriate preventive screenings, which enforces stronger measure performance and positive member experiences.

Engagement can be enhanced by encouraging all members to have a conversation with their doctor about issues they do not understand, the reason they are prescribed medications and any screenings they receive. Plan should work to empower their members to have these discussions at all appointments. By having these conversations with their provider, members can build their health literacy, gain a deeper understanding of their treatment and improve medication adherence.

Improving Health Literacy to Empower Members

Education should always be the primary goal when increasing member-provider engagement. Members should walk into an appointment with their personal doctor and know that their doctor has their best interests in mind and be seen as the quarterback of their care. Limited health literacy and other barriers older adults face can make this challenging. Members may have cultural or religious beliefs that may impact their willingness to follow the clinical guidance of their doctor. Plans should advocate for all members and provide the necessary education to enable members to take charge of their healthcare and see every touchpoint with their doctor as valuable.

Advocating for Member Self-Efficiency

The first step to ensuring each member gets the most out of each visit is to enable members to improve their self-efficiency. This not only increases their ability to communicate with their doctor, but also improves their quality of life and empowers members to achieve their health goals. These goals can be as simple as engaging with their personal doctor and having at least one meaningful conversation about their care.

Benefits of Stronger Member-Provider Relationships

Improving member-provider engagement has several benefits to members, providers and health plans. Members who are more engaged with their doctors report higher levels of satisfaction with their care. Doctors are also more likely to interact with patients who are more highly engaged in their care and self-sufficient, contributing to better clinical outcomes.

Through increased engagement, plans experience stronger performance by ensuring members get needed care, increasing member satisfaction, and improving other Star Rating domains, such as Healthcare Effectiveness Data and Information Set measures and pharmacy outcomes.

Continued success in member experience requires constant education in all initiatives and strategies. By empowering your members to address the topics that are meaningful to them, their relationship with their personal doctor will improve and their satisfaction with their overall healthcare becomes the lasting result.

Our Expert Advisory Services team has decades of experience helping plans address Star Ratings challenges through improvements in member-provider engagement. If you need assistance improving health education and member self-sufficiency within your plans, reach out to Healthmine. Contact me at for more information.

John Willis is a quality improvement expert with over 20 years of experience guiding managed care plans to success. Having worked in Stars since its inception, he has a proven track record of building out turn-key strategies that enable Medicare Advantage plans to boost Star Ratings. He has significant experience working with Medicare Advantage, Dual-Eligible Special Needs Plans, Individual Special Needs Plans to improve member experiences and quality scores.
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