Expediting Member Experience Improvements With a Targeted Survey Tool

Since the start of the pandemic, the steady adoption of consumerism within the healthcare industry challenged health plans to design more holistic member experiences. Advancements in online interactions between consumers and businesses have driven members to expect better experiences from their plans, whether it involves customer service, access to care or interactions with providers.

Plans that have adapted to the demand for digital experiences have done so by evaluating member experiences at every stage of the healthcare journey. To reach this level of interoperability, plans need to develop an in-depth understanding of the relationship between member experiences, financial success and operational efficiency. Surfacing real-time feedback on member experiences, continuously monitoring quality score performance and responding with targeted interventions is the key to navigating the new, consumer-centric landscape.

How Do Member Experiences Affect Plan Performance?

Member experience is a broad method of measuring the level of trust members have in their health plans and directly correlates to long-term financial success. Without trust, members are unlikely to respond to outreach or follow-up on recommended care. A lack of trust can stall efforts to engage members in their healthcare, resulting in plans wasting resources, staff and funding due to poor response rates.

This lack of trust and engagement flows into quality improvement programs. Both federal and state health agencies monitor member experiences through standardized surveys. The results of these surveys are quantified into quality scores that impact the amount of funding plans receive through bonus programs, pay-for-performance rewards and capitation withholding payments.

As seen with the Medicare Advantage Star Ratings program, improving member experiences drives performance in these high-value measures and allows plans to increase government funding through quality bonus payments. Re-enrollment also relies on positive interactions with members, especially in competitive marketplaces like Medicare Advantage, Medicaid and the Affordable Care Act where members can take their care elsewhere if a plan does not meet their standards.

How are Member Experiences Measured?

The primary method of tracking member experiences is through the Consumers Assessment of Healthcare Providers and Systems (CAHPS®) survey. The Centers for Medicare & Medicaid Services (CMS) administers this survey in partnership with the Agency for Healthcare Research and Quality (AHRQ) across multiple areas of the health industry, including government-sponsored health plans, hospitals, emergency rooms, hospice care and outpatient services.

Based on the results of these surveys, CMS and AHRQ can quantify member experiences within Medicare Advantage, Medicaid and Children’s Health Insurance Programs through CAHPS measures. These measures play an important role in determining performance in quality improvement programs at both a federal and state level.

CMS conducts the CAHPS survey annually for Medicare, Medicaid and Commercial populations, but how this survey impacts plan performance varies. CAHPS measures are double weighted in the Star Ratings program, making strong performance vital for Medicare Advantage plans. State agencies may ignore measure performance when determining quality incentives for Medicaid plans, but when CAHPS measures are used in quality improvement programs, member experience can have a direct impact on financial success in Medicaid.

While not as intricately tied to quality scores, Commercial health plans are publicly ranked in the National Committee of Quality Assurance (NCQA) Report Card based on their CAHPS scores. These rankings can impact an employer or patient's decision to select a plan for health coverage. The NCQA also uses CAHPS measures to determine Health Plan Accreditation.

Alongside the CAHPS survey, Affordable Care Act plans and Small Business Health Options Programs are evaluated through the Quality Health Plan (QHP) Enrollee Survey, which affects performance in the Quality Rating System. Like the Star Ratings program, the Quality Rating Systems ranks plans on a scale from one to five stars, which is publicly reported in the Health Insurance Marketplace®. Enrollees and small businesses can review these rankings when selecting healthcare coverage.

Plans that perform well on the QHP Enrollee Survey can improve their rankings in the Marketplace, increase enrollment rates and maintain accreditation with CMS. In turn, low scores can signal a drop in rankings and significant financial fallout.

The Benefits and Limits of Mock Surveys for Quality Improvement

One of the biggest challenges of patient experience surveys is that plans have few options for rectifying CAHPS scores and QHP Enrollee responses after they’ve been completed. These national surveys are conducted over several months, and long processing times means plans do not see the results until even later. By this point, plans have few options for improving member experiences and quality scores within the next performance period outside of high-cost, high-touch initiatives.

Mock surveys, such as mock-CAHPS, are an invaluable tool for getting ahead of these pain points. Routinely evaluating member experiences with mock surveys gives stakeholders better access to member feedback. When captured in real-time through digital surveys, this data can be funneled into meaningful quality improvement initiatives that proactively improve quality scores throughout the year.

The traditional approach to mock surveys is to conduct them once or twice a year. With the mock-CAHPS survey, health plans may only conduct surveys outside of the official blackout period from March to June. While these surveys still capture useful information, there is still a three-month data gap that must be accounted for.

These surveys are also designed to capture the full breadth of a member’s experience, but a plan may only need answers to specific questions. For example, previous official or mock-CAHPS results may highlight difficulties in getting needed care, but there is still the question of why a member could not get care. Getting answers to these specific pain points in real-time is the key to activating meaningful improvements in plan performance.

A Leaner, Faster Method of Improving Member Experiences

Healthmine’s Pulse Surveys enable health plans to field member feedback to specific questions about their experiences and identify opportunities to foster positive sentiments. Designed to maximize response rates, our solution supports the ability to use member preferred formats, including email and text messages. Plans can select a handful of questions from our expansive survey library or field their own questions to members to get answers to their most pressing questions.

Time and speed are vital for having a positive impact on member experiences. Pulse Surveys actively ingest responses into a member engagement tool that allows plans to review feedback in real time and action follow-up outreach to address pain points. From improving enrollment in reward programs or educating members about plan benefits, our digital suite equips plans with all-in-one member engagement solution for improving member experiences.

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