Recently SPH Analytics had the opportunity to assemble a group of ten Medicare Advantage members from the greater Nashville area to conduct a focus group about the members’ health plan experiences. This focus group was conducted in front of a live audience at the 11th Annual RISE Summit which was attended by health plan executives and management.

While the discussion among ten Nashville area Medicare Advantage members is not necessarily representative of other Medicare Advantage members, there were a number of interesting insights from the group.

Medicare Advantage Members and Star Ratings

These Medicare Advantage members seemed completely unaware of the Star Ratings program and have never tried to look up ratings of their plan from any source.  These members do not recall any government or health plan promotion of the Star Ratings program.  They learn about plans from the mailings they get and often from professional advisors, such as brokers or former employers.

Health Plan Satisfaction

Generally speaking, Medicare Advantage members give credit to their health plan for helping to keep them healthy.  Members comment that their plan covers annual exams, screenings, and immunizations which all contribute to their well-being.  A number also mentioned their participation in low or no-cost exercise and fitness programs, such as the Silver Sneakers program, which their plans make available to them.  Several members actually switched health plans because their former plan stopped offering the Silver Sneakers program.

These members don’t seem to feel their health plan overwhelms them with too much information or too many touchpoints.  They also made it clear that they don’t hesitate to call their plan’s Customer Service agents if they have questions or need information, and they report generally positive experiences when doing so.

All of these members are relatively satisfied with their current health plan.  A majority indicated their plan has always covered them for the services their doctor felt they needed, although a couple indicated situations where the plan imposed barriers to care and this caused dissatisfaction.  Several also acknowledged that they haven’t needed any major care and how a plan covers them when they are in serious need is the only true test of how good the plan is.

In the absence of problems, most have not been inclined to switch, though many indicated perusing changes to their plan at each open enrollment and skimming information from other plans or seeking professional input to be sure they aren’t missing anything better by staying with their plan.

Listening to Your Members

It’s important that health plans take the time to listen to their members talk about their experiences with the plan.  There truly is no substitute for hearing members’ own words as they evaluate various aspects of the medical care and service they obtain from their plan.

If you haven’t reached out to your members to hear about their experiences in dealing with your health plan, we suggest you consider doing so.  This “qualitative” assessment is a good complement to the larger-scale member surveys you conduct, such as CAHPS®, and can help you understand the why behind the ratings that members give you in surveys.

In addition to focus groups, there are a number of ways to hear the voice of your members.

  • Monitor calls that come into your call center; even an hour a month will provide insights
  • Review complaints and grievances to see what members are experiencing
  • Talk to experienced front-line agents to get their take on what your members are saying
  • Attend a meeting of your Member Advisory Group if your plan has one
  • If you have a health plan retail outlet, stop by and talk to members and potential members first-hand
  • Conduct a CAHPS Drill-Down Survey that includes open-ended questions to hear the words members use to explain their experiences

Whatever approach you take, if you care what your members think and what they are experiencing, there’s no better way to understand your members than to listen to their stories.

Learn More

Want to learn more about Improving CAHPS with Drill-Down and Simulation Surveys. Watch our recored webinarHealth plans that have employed CAHPS Drill-Down Surveys will discuss the process and how it helped them listen to their members.  Click here to View

Additionally, SPH Analytics offers Quality Improvement Consulting Services to help plans decipher member experiences and determine how to create and implement meaningful and lasting improvements. Click here to request additional information and/or to talk to someone about our consulting services and drill-down surveys.

Medicare Advantage members are usually happy to provide feedback, and the health plan can gain valuable understanding about their members’ experiences and needs when they listen.

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