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5 tips for improving and sustaining member satisfaction

With the HEDIS® season over and bids having been submitted for calendar 12 months (CY) 2022, Medicare Benefit plans have a breather earlier than summer time enrollment schooling classes, official Well being Outcomes Surveys (HOS), and plan Annual Discover of Modifications (ANOCs) are due.

As normal, the “respiratory time” is brief. In June, J.D. Energy launched its newest U.S. Medicare Benefit Examine, noting that “general satisfaction scores are 54 factors greater (on a 1,000-point scale) when members efficiently have interaction with their plan to ask a query or clear up an issue than after they don’t have any engagement in any respect.”

Engaged members are loyal to their well being plan and expertise improved well being outcomes. The Facilities for Medicare & Medicaid Companies (CMS) and the Nationwide Committee on High quality Assurance (NCQA) agree that client satisfaction is paramount to high quality care. The CMS Star Scores system has elevated Shopper Evaluation of Healthcare Suppliers and Methods (CAHPS®) measure weights from 2 to 4 for Star Scores 2023, growing the mix of HOS/CAHPS influence to greater than half of a plan’s general score.

Shopper satisfaction is a year-round effort and is impacted by a member’s full expertise with the well being care ecosystem, together with moments within the physician’s workplace, discussions with the well being plan’s customer support, and expertise in securing prescription medicines. However year-over-year HOS and CAHPS nationwide averages have been comparatively flat for practically a decade. How can payers enhance these measures—and maintain that enchancment in subsequent years? Listed here are 5 tricks to get you began.

  1. Evaluate your 2022 bid and analyze inhabitants cohorts to grasp which members of your plan inhabitants are most definitely to be impacted by plan adjustments. Proactively attain out prematurely of the Annual Discover of Change (ANOC) mailing.
  2. Conduct off-cycle satisfaction and outcomes surveys to grasp the place any ache factors may exist in the present day and handle them earlier than the top of the 12 months. There may be nonetheless time for customer support trainings, fine-tuning processes, and implementing tips for first name decision.
  3. Ask for suggestions with each member touchpoint. Ask, “How can we make your expertise wonderful?” Conduct sponsor disenrollment surveys to finest perceive why enrollees are making the swap, if they’re. Use the outcomes at the side of off-cycle surveys and complaints and grievances knowledge to maintain enhancing.
  4. Be proactive and private. Gathering ongoing suggestions is crucial, as is knowing your members’ preferences and activation factors. One-size-fits all is not going to be efficient in creating your engagement technique. Lean on specialists and measure what works and what doesn’t.
  5. Keep in mind: it is a marathon, not a dash. There isn’t a such factor as enhancing satisfaction “as soon as and for all.” One off-cycle survey gained’t be efficient. Create a steady enchancment program for satisfaction and engagement—following the member by way of their well being care journey for so long as you’ll be able to be part of it.

Cotiviti’s client well being engagement platform, Eliza®, can help your client satisfaction program and allow you to enhance Star Scores. Learn the way Eliza leverages behavioral science, expertise, demographics and third-party knowledge to create tailor-made messages for people.

HEDIS® is a registered trademark of the Nationwide Committee for High quality Assurance (NCQA).

CAHPS® is a registered trademark of the Company for Healthcare Analysis and High quality (AHRQ).

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