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5 key drivers of Member Experience

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Experience management is of great importance for any organization, irrespective of the industry they are operating in. For health plan providers this requires a commitment to better member experiences, quality and cost.

A focus on member customer experience is a key aspect in preventing customer churn and easier acquisition of customers for your health plans. Customer Experience is also a major contributor to a health plan’s star ratings, which in turn impacts revenue.

Better CX also translates into better patient and member engagement as well as improved member satisfaction, which can play an important role in executing care management initiatives more effectively. Metrics such as NPS® (Net Promoter Score®), CSAT (Customer Satisfaction) and CES (Customer Effort Score) are excellent indicators of a person’s experience at various touchpoints. All of these metrics can uncover unique insights depending on the context and timing of their use.

There are 5 critical drivers of customer experience for healthcare plan providers:

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This might seem straightforward, and it’s easy to understand why most providers assume that would be the case but customers generally don’t have a lot of clarity about the coverage offered by their healthcare plans. This can negatively impact member experience and hamper engagement. Plans need to ensure that their customers are fully aware of what is covered in the typical member journey with their organization.

Easy access to info

Members who have more information about their plan’s coverage have an NPS® higher than those who do not have a clear understanding of the benefits offered by their plan. This is especially important for information relating to drug coverage.

Research shows that 31% of dissatisfied customers rely on pharmacies to provide information relating to drug coverage. Compare this to rates of dissatisfied customers who got the same information via the providers’ website (19%) or at their Doctor’s office (21%).

Most providers provide this information online, but there needs to be an effort in making it more accessible to even the least tech-savvy customers. Healthcare plan providers can also make this information more accessible through mobile apps.


Typically the first point of direct contact with your members. Enrollment is a key touchpoint as it is often the only touchpoint where your brand gets to interact with less frequent users. Traditionally, less frequent users tend to be those who are least satisfied with services as well. health plan providers must get the enrollment experience just right, as it helps define the overall member experience.

Ease of enrollment is key to improving member experience

68% of members tend to complete the enrollment process inside one hour and are highly satisfied with their experience. Members who exceed this time are typically those who have trouble finding information and face challenges in selecting a plan that suits their needs.

Information clarity

Members with more clarity about their plan’s benefits during the enrollment process tend to be more satisfied. Many people are not aware of what is available and the true extent of the benefits covered by their plan. In-person support can help ease this process which improves overall member experience.

Customer Service

Support and service is an important driver of customer satisfaction for any industry and it’s especially important for those in the healthcare sector. Studies show that healthcare plan providers need to improve in 2 main areas:

How easy is it to talk to a person?

Healthcare in general has a learning curve and a majority of members, especially those belonging to an older demographic would prefer talking to a real person. Only 44% of plan members surveyed find it easy to reach a person for help.

Waiting times greatly impact how easy customers find it to reach your support team, and are a major contributor to member dissatisfaction.

How knowledgeable is your customer-facing staff?

Your employees are the face of your organization, and customer-facing staff often get to bear the brunt of customer displeasure. While it is impossible for your entire staff to provide clinical advice without in-depth medical training, you must equip your staff with relevant customer data and metadata. This ensures that your staff always has member data on hand and can guide them whenever needed.

Provider's network

Members who are happy with their plan’s provider network have an NPS® of 52%, versus -32% for members who are dissatisfied with their provider network. By conducting regular healthcare surveys, plans can figure out gaps in their provider network.

Transparency about network

Your website is typically the most used resource for members to get information about your network. Improving your website will directly lead to an improvement in your overall member experience as well. This includes improvements to the user interface, availability of up-to-date information and relevant recommendations based on your members’ ailments and requirements.

Cost to members

Cost to members is a critical factor for customers when considering health plans. It also shows how much value customers place on your overall member experience along with what’s included in your plan.

Customers’ perception of your plans’ value for money is a key factor in determining customer experience for employer- provided plans. For the rest, saving on out of pocket costs determines customer satisfaction with their plan.

Factors that influence customer perceptions of a plan’s value:

How much does it cost out of pocket?

Every demographic which subscribes to health plans considers out of pocket costs a key factor in their perception of a plan’s customer experience. Out of pocket costs plays an even bigger role in determining customer experience for Medicare Advantage plan subscribers, as they are more frequent users of health services. Research shows that Medicare Advantage plan members who were satisfied with their provider’s ability to supply out of pocket savings had an NPS® Survey Score of 80% versus 26% for those who were dissatisfied with their savings.

Price competitiveness: Is your member experience worth it?

As the frequency of members’ usage of healthcare services increases, their perception and their interest in value for money increases as well. This is why health plan providers need to plan their interactions carefully. Members should be reminded to make regular visits to their physicians or take their flu shots on time. These interactions greatly impact your member experience.

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