The Quest for Member Satisfaction Marketing...5 steps plans should 14 take to improve member experience NovuHealth's proactive 15 approach to CAHPS and satisfaction References 16 20%

The Quest for Member Satisfaction:WHY MEMBER SATISFACTION IS BOTH A PRIORITY AND A PUZZLE FOR HEALTH PLANS

eBOOK

Executive SummaryIt’s been more than 20 years since the Centers for Medicare & Medicaid Services (CMS) first began measuring member satisfaction among Medicare Advantage (MA) plans. For nearly a decade since that time, the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) has been an integral part of a plan’s Star rating.

And even though CMS announced in early 2020 that plans don’t have to submit CAHPS data for 2021 Stars in light of the COVID-19 pandemic, member satisfaction still matters for plans, perhaps now more than ever.

In mid-2020, CMS refined the Medicare Advantage Star Ratings system (and Part D Star Ratings) by giving CAHPS measures more weight in determining ratings. Specifically, CMS increased measure weights for CAHPS patient experience and access measures from 2 to 4. This change takes effect for the 2021 measurement year and will be reflected in the 2023 Star Ratings. As a result of this change, a plan's bonus and rankings will becoming increasingly dependent on the member experience; and improving member satisfaction and the overall experience has become a top priority for leading MA plans nationwide.

However, while member satisfaction is growing increasingly important for plans, all too often, the member experience is treated as an afterthought rather than seamlessly integrated into health plans’ DNA. To stay competitive, plans today need to prioritize the member experience and take a holistic approach to CAHPS and member satisfaction.

TABLE OF CONTENTS

Executive Summary 2

The high stakes of low 4 member satisfaction

When satisfaction drops, 5 retention follows

Happy members 7 = high HEDIS scores

Low CAHPS scores cost you 9

Why is member 11 satisfaction so elusive

What, exactly, do your 12

members want?

The link between 13 member satisfaction and engagement

5 steps plans should 14 take to improve member experience

NovuHealth's proactive 15 approach to CAHPS and satisfaction

References 16

20%25%

2019 2021+CAHPS as a percentage

of Star ratings

eBook: The Quest for Member Satisfaction / Executive Summary 2

https://www.novu.com

DID YOU KNOW? Market research from J.D. Power shows health plans falling far behind other industries in the area of customer experience and Net Promoter Scores—just above cable companies—with little improvement over the past few years in plans’ ability to improve the customer experience. 2

NET PROMOTER SCORES BY INDUSTRY

43

AutoDealers

36

Super-markets

31

Retailers

26

Banks

12

Utilities

3

Cable +Internet

18

HealthPlans

eBook: The Quest for Member Satisfaction / Executive Summary 3


The high stakes of low member satisfactionThese days, members are more discerning about the service they expect; more savvy about their ability to switch plans; and more likely to complain to others—including on the CAHPS survey—if they are unhappy. All of which can eventually impact a plan’s Star rating and bottom line. Today, plans that ignore their members’ satisfaction do so at their own peril.

What's more, during a pandemic, when members are feeling more stress and isolation, they may have higher expectations of their health plan and may be more critical of their plan if those expectations are not met. How plans engage and interact with their members can greatly impact member satisfaction, retention and overall health long term.

eBook: The Quest for Member Satisfaction / The High Stakes of Low Member Satisfaction 4


Members in plans rated in the bottom 10% were

4X more likely to disenroll

than members in plans rated in the top 10%.3

When satisfaction drops, retention followsResearch shows that CAHPS scores are a bellwether for voluntary disenrollment. One study found that members in plans rated in the bottom 10 percent were four times more likely to disenroll than members in plans rated in the top 10 percent.3

Another study painted an even more dire picture: plans with poor ratings were nearly 12 times more likely to see high disenrollment compared to those with high ratings, while those with poor customer service were about 4.5 times more likely to see high disenrollment than their peers.4

What's more, a health plan's Star Rating Measure: C29 (Members Choosing to Leave the Plan) is publicly available data. So it's not difficult for members and potential members to determine how a plan stacks up against its competition in the area of member satisfaction and retention.



18

2014

18

2015

19

2016

19

2017

21

2018

24

2019

28

2020

DID YOU KNOW?

Increased ease and choice make switching plans easySwitching health plans has become far easier for members in recent years. In a 2018 survey of 1,000 MA enrollees, nearly 60 percent said they would consider switching their plans in 2019.5

One contributing factor: MA members have a lot of choices. In fact, the average Medicare member now has access to 28 plans, a steady increase since 2014 and the most since 2010.6

Members also have two opportunities to switch: during the open enrollment period (OEP) and the annual enrollment period (AEP). And they’re getting savvier about using both.

In August 2018, just a quarter of MA members knew about OEP. Deft Research, the firm that conducted the survey, predicted a resulting switch rate of 3 percent. A short eight months later, the percentage of members who knew about OEP more than doubled to 66 percent, resulting in an estimated switch rate of 4.5 percent. Deft predicts an even higher percentage of MA members who understand OEP in 2020, leading to an even higher switch rate.7

AVERAGE NUMBER OF MEDICARE ADVANTAGE PLANS AVAILABLE TO BENEFICIARIES, 2010-2020

Jacobson G, Freed M, Damico A, Neuman T. A Dozen Facts About Medicare Advantage in 2019. Kaiser Family Foundation; 2019.8



Happy members = High HEDIS scoresAnother key reason for plans to focus on the customer experience: health plans that provide better access and customer service also provide better clinical care and receive higher HEDIS scores.9

The Healthcare Effectiveness Data and Information Set (HEDIS) is a set of measures designed to identify the healthcare services provided and how they impact member health. According to the National Committee for Quality Assurance (NCQA), 90 percent of health plans rely on HEDIS data to compare their performance with other plans.

HEDIS scores help a plan gauge the quality of the care it provides members. There are significant financial incentives for insurers if a score exceeds certain thresholds. One reason that health plans with better access and service receive higher HEDIS scores could be that engaged and satisfied members are more likely to engage in programs designed to improve health outcomes.



DID YOU KNOW?

About 72 percent of all MA members belong to a 4+ Star-rated plan.

The majority of the growth today is dominated by four national plans.

Source: Jacobson G, Freed M, Damico A, Neuman T. A Dozen Facts About Medicare Advantage in 2019. Kaiser Family Foundation; 2019.8

5 Stars

UHC26%

Humana18%

BCBS15%

CVS (Aetna)

10%

KaiserPermanente

7%

Wellcare2%

Cigna2%

All otherInsurers

19%62%

2015

68%

2016

67%

2017

74%

2018

72%

2019

4.5 Stars4 Stars3.5 Stars3 Stars2.5 StarsNo Rating

5 Stars

UHC26%

Humana18%

BCBS15%

CVS (Aetna)

10%

KaiserPermanente

7%

Wellcare2%

Cigna2%

All otherInsurers

19%62%

2015

68%

2016

67%

2017

74%

2018

72%

2019


5 Stars

UHC26%

Humana18%

BCBS15%

CVS (Aetna)

10%

KaiserPermanente

7%

Wellcare2%

Cigna2%

All otherInsurers

19%62%

2015

68%

2016

67%

2017

74%

2018

72%

2019


DISTRIBUTION OF MEDICARE ADVANTAGE ENROLLEES BY PLAN STAR RATING, 2015-2019

MEDICARE ADVANTAGE ENROLLMENT BY FIRM OR AFFILIATE, 2019



Low CAHPS scores cost youJust as higher HEDIS scores can benefit a health plan, low CAHPS scores can come at a high cost. You know that a poor CAHPS rating affects your overall Star rating which, in turn, affects your bonus and your ability to capture new members—it’s a continuous downward spiral. So of course there’s a cost to your plan at a macro level. But what about the individual cost of losing a member?

We worked with the actuarial and consulting firm Milliman to determine just that – the value of a retained member, and conversely, the cost of a lost member. Our work with Milliman and our internal research suggests that every member you lose is equivalent to a loss of about $6,782 in gross profit over four years. Can you afford that?

X

Every member you lose

= $6,782 in gross profit loss

over 4 years.



Why is member satisfaction so elusive?It’s not easy being a health plan in today’s environment. After 40 years of managed care, your customers have some entrenched perceptions of health insurance that you have to overcome.

In addition, too often the member’s only interaction with the health plan is when something goes wrong —a procedure, test, or medication is denied. Or they are hit with a deductible or co-insurance they weren’t expecting. Or they try to call member relations and have to work their way through five prompts before reaching a real person. There’s paperwork, confusing language, and the fact that health care is stressful enough these days.

A 2020 J.D. Power study of commercial health plans revealed a serious member engagement problem among plans. The study found that plans lack customer centricity overall, with only 36% of plan members reporting that their plan acts in their best interest "always" or "most of the time."11

eBook: The Quest for Member Satisfaction / Why is Member Satisfaction so Elusive? 10


73%

would stay with the plan

82%

would advocate for the brand

82%

would consider the brand for their

next plan

So what, exactly, do your members want?In a nutshell, they want to feel appreciated, respected, and valued. At least, that’s the finding from the 2019 Forrester Health Insurers Customer Experience Index, which surveyed nearly 13,000 US health plan members from 17 large health plans.

A whopping 73 percent of those who felt respected said they would stay with the plan; 82 percent would advocate for the brand; and 82 percent would consider the brand for their next plan. Yet less than half of those surveyed felt their plan “respected them as a customer.” 14

Of the members who said they felt respected by their plan,



The link between member satisfaction and engagementNumerous studies have tried to suss out why members leave health plans. One key reason that arises regularly is satisfaction with the level of engagement and communication members receive from their plan.

The 2020 J.D. Power study of commercial health plans found that proactive member engagement efforts by a plan can result in significant improvement in overall member satisfaction.11 But many plans fall short in this area. Another study found that fewer than 9 percent of Medicare Advantage plan members say they’ve experienced good information and communication from their plans.11

At NovuHealth, our own research from working with nearly 15 million members is that they are often unhappy with how their plan communicates with them. They are inundated with materials, some of which can be difficult to understand, and when they call their plan, they report that they often feel “talked down to” and that their concerns “weren’t heard.” Forrester’s 2018 survey of health plan consumers found that only half rated their plan’s communication skills as high.15



5 Steps plans should take to improve member experienceWith nearly a decade of experience working with health plans to improve the experience of their members (and impact their CAHPS scores), we identified 5 key steps to any successful effort:

OFFER CONVENIENCE Make sure you offer your members the same level of service and convenience they have come to expect from other companies, including online access to forms, short phone wait times, and a live agent during regular working hours.

COMMUNICATE CLEARLYExplain complex medical terms in plain language; avoid clichés, idioms and slang; and use design to help readability. Above all, don’t just tell members what to do—tell them why it matters.

EDUCATE YOUR MEMBERS Provide accurate information and access to resources that your members may not even be aware of, such as those you offer through community partnerships. This also means anticipating potential member dissatisfaction and informing them what to do if they have a bad experience.

TAKE ACTION TO ADDRESS THEIR CONCERNS Mock surveys to identify unhappy members are helpful but are a waste of time and money if you don’t follow up and address the issues they raise. Taking action based on the results of mock surveys helps you be proactive before the member receives that CAHPS survey to complete.

MAKE THE EXPERIENCE PERSONALYour members aren't "one-size-fits-all." Your member engagement strategy shouldn't be either. Amazon knows what kind of books they like; you should you know what kind of messaging and which communication channels they prefer. So be sure you’re using a multi-channel approach that includes email, SMS, phone calls, IVR, mail, social media, and in-person interactions. This also means offering services that meet members' individual needs.

1

3 4 5

2

eBook: The Quest for Member Satisfaction / 5 Steps Plans Should Take to Improve Member Experience 13


NovuHealth's proactive approach to CAHPS and satisfactionTo stay competitive in the marketplace today, health plans must make CAHPS and member satisfaction a priority.

NovuHealth’s Member Satisfaction Solution is designed to help health plans proactively address the most common sources of member dissatisfaction—and the Part C measures plans can address directly. We begin by applying proprietary predictive analytics to identify the members who are unhappy or unengaged. Then, we proactively connect with them to keep them informed and engaged. We remind them about the valuable benefits their plan offers. We connect them with vital community resources. And we let them know their plan cares about them.

THE RESULT? An improved member experience, enhanced member satisfaction, and a positive impact on CAHPS measures.

eBook: The Quest for Member Satisfaction / NovuHealth's Proactive Approach to CAHPS and Satisfaction 14


NovuHealth is the leading healthcare consumer engagement company, driven to improve consumer health and health plan performance. NovuHealth motivates consumers to complete high-value healthcare activities by leveraging its sophisticated engagement platform, proven loyalty and behavioral science strategies, and deep industry and regulatory expertise. Headquartered in Minneapolis, NovuHealth has worked with nearly 40 health plans and served nearly 15 million consumers across all 50 states.

© 2020 NovuHealth LLC. All rights reserved.

1. Harris Insights & Analytics L. Harris Poll: Only Nine Percent of U.S. Consumers Believe Pharma and Biotechnology Put Patients over Profits; Only 16 Percent Believe Health Insurers Do. 2016; https://theharrispoll.com/only-nine-percent-of-u-s-consumers-believe-pharmaceutical-and-biotechnology-companies-put-patients-over-profits-while-only-16-percent-believe-health-insurance-companies-do-according-to-a-harris-pol/.

2. Kuhn B, Zanotti A. Why Improving Customer Experience Is So Hard In Healthcare — Merchant Medicine. 2019; https://www.merchant medicine.com/marketreport/2019/7/15/why-improving-customer-experience-is-so-hard-in-healthcare. Accessed March 10, 2020.

3. Lied TR, Sheingold SH, Landon BE, et al. Beneficiary reported experience and voluntary disenrollment in Medicare managed care. Health Care Financ Rev. 2003;25(1):55-66.

4. DuGoff E, Chao S. What's Driving High Disenrollment in Medicare Advantage? Inquiry. 2019;56:46958019841506.

5. Welltok. Health for the New Senior Generation. 2019.Available at: https://cdn2.hubspot.net/hubfs/415877/Assets/welltok_medicare_survey_121818.pdf.

6. Jacobson G, Freed M, Damico A, et al. Medicare Advantage 2020 Spotlight: First Look. Kaiser Family Foundation;2019.Available at: https://www.kff.org/medicare/issue-brief/medicare-advantage-2020-spotlight-first-look/.

7. McDonald I. 7 lessons learned from the 2019 Medicare OEP. August 6, 2019; https://www.risehealth.org/insights-articles/medicare-market/7-lessons-learned-from-the-2019-medicare-oep/. Accessed March 10, 2020.

8. Jacobson G, Freed M, Damico A, et al. A Dozen Facts About Medicare Advantage in 2019. Kaiser Family Foundation;2019.Available at: https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage-in-2019/.

9. Schneider EC, Zaslavsky AM, Landon BE, et al. National quality monitoring of Medicare health plans: the relationship between enrollees' reports and the quality of clinical care. Med Care. 2001;39(12):1313-1325.

10. Landon BE, Zaslavsky AM, Beaulieu ND, et al. Health plan characteristics and consumers' assessments of quality. Health Aff (Millwood). 2001;20(2):274-286.

11. Power J. Health Plans Have a Customer Engagement Problem, J.D. Power Finds. May 14, 2020; https://www.jdpower.com/business/press-releases/2020-us-commercial-member-health-plan-study

12. Monet V. How health plan and provider interaction affect customer satisfaction for plans. Becker’s Hospital Review. January 30, 2017. https://www.beckershospitalreview.com/patient-experience/how-health-plan-and-provider-interaction-affect-customer-satisfaction-for-plans.html. Accessed March 10, 2020.

13. Merkle. Merkle Releases Customer Experience Impact Report. July 1, 2019; https://www.merkleinc.com/news-and-events/press-releases/2019/merkle-releases-customer-experience-impact-report. Accessed March 9, 2019.

14. Adams F. The US Health Insurers Customer Experience Index, 2019. Forrester;September 17, 2019.

15. Beaton T. Customer Service is Primary Driver of Health Plan Satisfaction. Health Payer Intelligence. June 20, 2018. https://

healthpayerintelligence.com/news/customer-service-is-primary-driver-of-health-plan-satisfaction. Accessed March 11, 2020.

16. Elliott C h. These Companies Have The Best Customer Service. Fortune. July 11, 2018. https://www.forbes.com/sites/christopherelliott/2018/07/11/these-companies-have-the-best-customer-service-heres-why/#a21b490b80a7.

17. Merkle. Merkle Releases 2020 Loyalty Barometer Report, Reveals Need to Create Human Connections is Top Priority. March 3, 2020; https://www.merkleinc.com/news-and-events/press-releases/2020/merkle-releases-2020-loyalty-barometer-report-reveals-need. Accessed March 10, 2020.

18. Humana. Humana’s Go365® Wellness and Rewards Program Announces Five-Year Impact Study Results August 6, 2019; https://press.humana.com/press-release/humanas-go365-wellness-and-rewards-program-announces-five-year-impact-study-results. Accessed March 11, 2020.


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The Quest for Member Satisfaction Marketing...5 steps plans should 14 take to improve member experience NovuHealth's proactive 15 approach to CAHPS and satisfaction References 16 20%