Enhancing Health Plan Experience: Key Insights for Providers
Enhancing Health Plan Experience: Key Insights for Providers
In a world that's rapidly evolving, understanding the member experience in health plans is more critical than ever. Recent research from Press Ganey, recognized as a leading provider of experience measurement and data analytics for health systems, sheds light on this pressing issue. The latest report titled “Health Plan Member Experience in 2024” emphasizes the urgent need for health plans to focus on key areas that can boost member satisfaction.
Insights from a Comprehensive Study
The report is the result of extensive analysis, surveying 450,000 members across more than 200 health plans, leveraging data from Press Ganey’s vast database of 5.5 billion patient encounters. This research provides a detailed look at what really matters to members. It identifies critical drivers of satisfaction, which encompass access, safety, privacy, and care coordination. By focusing on these areas, health plans can create a seamless, connected, and personalized experience for their members.
The Empowerment of Health Plan Members
According to David Shapiro, Senior Vice President and General Manager of Member Experience at Press Ganey, health plan members are increasingly informed and empowered. Utilizing data-driven insights, health plans can uncover opportunities to enhance their services, streamline workflows, and tackle various pain points. Promoting a culture of continuous improvement, supported by real-time feedback, is essential for achieving a superior member experience and lasting success.
Key Findings from the Study
The findings in the report provide valuable insights for health care providers and planners.
- Connecting Member Experience with Star Ratings: There's a more substantial correlation between member experience and Star Ratings than previously thought. Health plans often concentrate on customer service and benefit design, but new data indicate that safety and privacy are increasingly essential factors of satisfaction.
- Importance of Specialist Engagement: While access to primary care is essential, engagement with specialists and coordinated care between primary care providers (PCPs) and specialists are critical differentiators for successful health plans. Members with dedicated PCPs tend to rate their plans higher, yet specialist interaction remains a key component.
- Reconsidering Access: Access to care is more than just availability; the ease and speed of access along with support from office staff play vital roles in shaping member experiences. Unfortunately, improvements in this area have been minimal across various health plans over recent years.
- Tailoring Strategies for Improvement: Net Promoter Scores (NPS) indicate a clear difference in member loyalty and satisfaction across health plans. Remarkably, Medicare plans report significantly higher NPS scores than commercial plans. This suggests that effective improvement strategies should be tailored to the distinct needs of different health plan types.
- Prescription Drug Coverage Impact: Coverage for prescription drugs is central to member experience. However, available mail-order services significantly contribute to satisfaction and influence overall ratings of drug plans.
- Addressing Care Disparities: Alarmingly, about 1 in 20 Medicare members report experiencing unfair treatment from healthcare providers. Vulnerable populations such as low-income individuals, LGBTQIA+ members, disabled persons, and dual-eligibles report mistreatment at more than twice the rate.
Strategies for Improvement
By implementing actionable strategies derived from the report, health plans can make significant strides toward improving key metrics related to member experiences. This involves pinpointing real-time issues and segmenting feedback based on demographics and health conditions, thereby allowing tailored actions that enhance access, streamline communication, and reduce financial burdens on members.
About Press Ganey
Press Ganey collaborates with healthcare providers and health plans to elevate patient and workforce experiences through a unique combination of data and technology. Their platform enables clients to gather and analyze critical insights to retain employees and ensure equitable and patient-centered care journeys. Recognized as a trusted partner to over 41,000 healthcare organizations and 85% of health plans in the United States, Press Ganey continues to lead the way in enhancing healthcare experiences. They are part of PG Forsta.
About PG Forsta
As a premier provider of experience measurement and data analytics, PG Forsta offers healthcare solutions that are widely adopted across various provider and payer organizations. Their Human Experience platform focuses on the voice of the customer, providing insights for leading global brands and supporting nine out of ten market research agencies worldwide.
Frequently Asked Questions
What is the focus of Press Ganey's recent report?
The report highlights critical areas for improvement in health plan member experience, offering insights from comprehensive data analysis.
How can health plans enhance member satisfaction according to the findings?
Health plans can enhance member satisfaction by addressing key drivers such as access, safety, privacy, and care coordination.
Why is specialist engagement important for health plans?
Specialist engagement is vital as it differentiates high-performing health plans and contributes to higher member satisfaction ratings.
What role does prescription drug coverage play in member experience?
Prescription drug coverage is central to member satisfaction, with effective services like mail-order increasing overall satisfaction ratings.
How does Press Ganey assist healthcare organizations?
Press Ganey partners with healthcare providers and payers to improve experiences through data analysis and strategic insights, promoting patient-centered care.
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