Market trends and regulatory changes make this a critical period for the health plan member experience.
With the end of the open enrollment season and the start of a new year, the healthcare payer landscape continues to shift. Across every line of business, health insurers are facing fiercer competition for member growth and retention than ever, threats from new market entrants, and regulatory shifts. This makes the opportunity for differentiation on member experience especially important to payers. 2022 is shaping up to be the most important year for member experience that payers have seen. Here are three key reasons why:
1. Medicare Advantage quality ratings now rely heavily on member experience scores.
The clearest view of the shift toward member experience is in Medicare Advantage (MA). Starting in earnest this spring with the annual consumer assessment of healthcare providers and systems (CAHPS) surveys to random samples of MA plan members, the measures used by CMS to score member experience and complaints, including customer service, getting needed care, and getting appointments and care quickly will be weighted 4 times more in the calculations of the overall plan scores. That means the vitally important Star Ratings, which determine MA plan reimbursement and can greatly impact membership growth and retention, depend more on member experience than any other factor.
Regulators show no signs of stopping their major emphasis on member experience in quality ratings. Last month, CMS issued their advance notice that indicated the agency is not currently considering anything that would diminish the impact of the CAHPS-driven measures. Indeed, CMS does seem to be pushing for new ways of evaluating MA plans on the basis of health equity and social determinants. If adopted, it’s likely these measures will have a member experience component, as plans more closely audit how different communities access information, services, and care.
Regardless of what CMS may do in the future, the present reality is that member experiences have the potential to directly impact key sources of MA revenue—making experience an absolutely vital priority in the competitive MA space.
Creating a better way for health plan member experience
2. Competition, the fiercest it has ever been for plans, will extend beyond enrollment periods.
That competition is itself a major reason why member experience has become a focus for so many payers. MA has understandably dominated health insurance headlines, as more Americans age into Medicare than ever before, and more payers offer more MA plans than ever as membership soars.
In addition to the major emphasis on marketing to beneficiaries, supporting sales efforts, empowering broker networks, and strategically designing plan products, payers also have to ensure they keep the members they are able to capture.
Health plan switch rates tend to be low, but payers know that the cost to replace a lost member is significantly greater than the cost to retain them. Traditionally, members are more likely to switch after key negative moments—a denied claim, a formulary change, or a provider leaving the plan’s network. But our latest research on health plan member experience shows that the most common source of member frustration today is poor customer service.
While its impact on retention will never reach those other key events, it’s a good reminder to payers that there are more “moments that matter” with members than ever before, as more consumers engage with their healthcare between in-person provider visits. This leaves plans with poor member experience more vulnerable than before—when members were more likely to go longer without interacting directly with the payer’s tools or staff.
3. Healthcare consumer expectations are higher than ever.
“Consumerization” in healthcare has been a buzzword for years. It’s now taken for granted that the entire care landscape is adapting to shifting expectations. But a number of key trends have given more direct meaning to “consumerism” for payers specifically.
Employer health plan members are twice as likely to be in a high-deductible plan than they were a decade ago. Price transparency is now the law for providers and is becoming more common in disruptive pharmacy offerings. Care options using new delivery models— including many owned directly by payers—are spreading rapidly and drawing more and more patients. The rise in MA continues with no signs of slowing under the new administration.
People are pushing back against the traditional care delivery and payment system. Consumers are not satisfied with black box pricing and payments, and they expect to shop for important healthcare services with the same ease and access to information that they experience in less-critical aspects of their lives.
That also means delivering service with expertise on the plan, the care, and the member. It includes giving members the convenient, connected, and tailored experience they are used to elsewhere. Payers who deliver exceptional support have the opportunity to build a deeper and better consumer relationship than before in this era of member experience.
Talkdesk works with some of the most innovative payers in the industry to deliver a differentiated experience, in the moments that matter to their members. Learn more about our Healthcare Experience Cloud™, or see our latest research on health plan member experience.