Notable gaps in health plan member experience outlined in 2024 report

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A new report from Press Ganey sheds light on critical gaps in health plan member experience, offering insights into areas where improvements are urgently needed. The report, titled, “Health Plan Member Experience in 2024,” draws on data from 450,000 members across more than 200 health plans, in addition to Press Ganey’s database of 5.5 billion patient encounters. The report reveals significant drivers of patient satisfaction and loyalty, including access to care, safety, privacy and care coordination.

“Health plan members are more informed and empowered than ever before,” David Shapiro, senior vice president and general manager of member experience at Press Ganey said in a news release. “Leveraging data-driven insights can help health plans identify opportunities to enhance their services, streamline processes and address pain points. A culture of continuous improvement, fueled by real-time feedback, is essential for delivering a superior member experience and achieving long-term success.”

The connection between member experience and star ratings

Member experience is more closely tied to star ratings than many health plans may realize. Although traditional focuses on customer service and benefit design remain important, emerging data highlights the growing role of patient safety and privacy. These factors align closely with Medicare Consumer Assessment of Health care Providers and Systems (CAHPS) questions, an indication of their critical influence on patient satisfaction. For primary care physicians (PCPs), maintaining a focus on safety and privacy can positively impact patient perceptions and health plan ratings.

Specialist engagement as a differentiator

Although access to primary care remains a foundational expectation for patients, the report identifies specialist engagement and coordination of care as key drivers of patient loyalty. Health plan members who have dedicated PCPs report higher overall satisfaction, but leading health plans excel by ensuring seamless interactions between PCPs and specialized health care. PCPs can play a pinitol role in continued patient satisfaction by facilitating effective referrals and ensuring continuity of care.

Expanding the definition of access

Access to care encompasses more than just availability. Ease and speed of access, in addition to the quality of support provided by office staff, significantly shape patient experiences. Despite efforts, the report notes minimal improvement in access to care metrics across all health plan types over the past five years.

Tailored improvement strategies

The report highlights the variability of Net Promoter Scores (NPS) among health plan types. Medicare plans achieve NPS scores 47 points higher than commercial plans, illustrating the need for tailored improvement strategies. The report explains that plans can drive meaningful improvements in high-impact areas by understanding the unique needs of Medicaid, Medicare and commercial lines of business.

Prescription drug coverage and satisfaction

Prescription drug coverage is critical to member satisfaction. The report reveals that, although access to medications is crucial, additional factors, including mail-order pharmacy options, significantly influence overall satisfaction and drug plan ratings.

Disparities in care

The findings of the report also underscore disparities in member experience. Nearly 5% of Medicare members reported unfair treatment by health care provider. Historically disadvantaged populations—including low-income, LGBTQIA+, disabled and dual-eligible individuals—were more than twice as likely (10.1%) to report mistreatment.

Recommendations from the report

Health plan members are becoming more selective, making it essential to deliver excellent member experiences. According to the report, continuous feedback collection allows health plans and providers to adjust quickly to evolving needs. Integrating member feedback with provider performance data can reveal patterns that impact satisfaction and enable targeted improvements in care delivery. Tools like AI-powered text analytics help uncover hidden challenges, including issues with benefit design or access gaps, enabling health plans to address them effectively.

To stay competitive, health plans should benchmark themselves against similar organizations to identify relevant areas for improvement. Grouping feedback by demographics or health conditions provides a clearer understanding of specific issues impacting certain populations. Focusing on safety and privacy initiatives further builds trust and satisfaction, enhancing both star ratings and patient outcomes.