Health plans that proactively engage members can realize significant member satisfaction (JD Power 2020). Health plans, however, fall short in this area for a number of reasons.  Health plans often fail to communicate: 1) Information that is valuable to the member, 2) In a way that is easy for the member to understand, and 3) In a manner the member finds respectful.

Health plans that don’t proactively engage members and effectively communicate with them are negatively impacted by a poor customer experience that is evident in their Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Stars Ratings scores. Members get enough information from their plans, but they don’t always understand it and often feel they are being talked down to. According to a Forrester Health Insurers Customer Experience Index, 73% of people who felt respected by their plan said they would stay with the plan and 82% of those would advocate for the brand.

For this reason and others, health plans have not been as successful in improving their customer experience as compared to other industries. (

Customer engagement and voluntary disenrollment

Health plans use CAPHS surveys to improve the quality of the healthcare services they deliver. CAPHS surveys are similar to patient satisfaction surveys, but they are different. CAPHS surveys can include health plan ratings but they go beyond ratings to ask consumers to report on their experiences with the healthcare services they received.

CAPHS scores also typically show voluntary disenrollment from a health plan. Members in plans in the bottom 10% of survey scores are 4x more likely to disenroll from plans than members in top 10%.

According to a GAO study on what drives MA disenrollment, beneficiaries who are in poorer health and have higher healthcare spending are more likely to disenroll from their plan. These plans also tend to be small for-profit plans that enroll more low-income and disabled individuals. Individuals are more likely to report poor member experiences than those in plans with lower levels of disenrollment.

Star Ratings measures pertain to the member’s experience with a plan. Poor ratings could be the result of misinformation at the time of enrollment, difficultly getting the right information or even finding out a provider is not in network. Member satisfaction is important before they enter the plan as well as after they enroll.

Proactively engage members to improve the customer experience

Health plans can better engage members by being more proactive with personalized communications that include the right data. One way is to proactively communicate information that is uniquely valuable to them.

Health plans can:

  • Show their health plan can do something about what’s important to members – High-cost drugs impact a member’s experience with their health plan. Health plans can proactively connect their members to lower-cost therapeutic options to improve medication adherence, leading to an improved customer experience, which can impact disenrollment and ultimately Star Ratings.
  • Educate members about drug options – Provide a tool, such as ConnectureDRX’s DrugCompare, that enables members to self-serve to find lower-cost drug options in addition to receiving information about alternatives directly from the health plan.
  • Communicate options clearly and succinctly – Use text, email, direct mail and call center operators to let people know about lower-cost drug alternatives.

Proactive member outreach focused on clearly communicating what’s important to health plan members can not only improve the customer experience but can help change behavior that will impact CAPHS survey scores and Star Ratings.

Read how DatabaseRX can help health plans connect members to the right information about lower-cost drug alternatives that can directly improve plan performance.