Medicare Advantage carriers typically focus their business development efforts on annual enrollment sales for growing new members. But while the annual enrollment period is certainly important, smart health insurers are beginning to provide proactive, knowledgeable, skillful member engagement tactics throughout the year to improve member satisfaction and retention, and ultimately, improve STAR ratings.
More specifically, there are five best practices your member engagement call center should follow to ensure customer satisfaction and retention all in a strategic effort to improve your STAR rating.
1. Employ a more thoughtful approach to onboarding
Too often the approach to onboarding is short-sighted, concentrating on getting the member signed up and mailing out the ID card and any other enrollment materials. But a more thoughtful, comprehensive approach to the initial onboarding process will pay dividends, not only in your STAR ratings, but also in establishing your organization as an interested partner in your member’s healthcare. How can you make the typical healthcare process a more thoughtful and engaging experience?
The first step, after mailing out membership cards and welcome packages, is to pick up the phone and be proactive in relationship building. Call the member to welcome and thank them for choosing your company and confirm that the member received the identification card and other materials, confirm that the plan has on record the primary care physician and make sure the member knows the member service phone number, understands co-pays and deductibles, and answer any other questions the member may have, all in an effort to properly set expectations.
Many complaints tend to arise in the first few months after enrollment, and most are avoidable through proper communication. By taking a proactive approach, you help eliminate most of the complaints members tend to report. Complaints of any type detract from STAR ratings, so early, proactive engagement is essential to eliminate confusion over the components of the plan.
2. Engage members at strategic touchpoints throughout the year
Businesses across all markets understand that nurturing members during those “in-between-moments” is critical to building member loyalty, retention and advocacy. The member-health provider relationship provides for many such interactions.
The CAHPS survey and annual notices of changes (ANOC) are known events that provide opportunities for member engagement to provide proactive service and to increase member satisfaction, improve survey performance and enhance member retention.
The CAHPS survey, conducted every spring, is a major calibration tool of STAR ratings. By the time the government takes the survey, it is too late to affect the outcome. Health insurers need to be proactive with members, and reach out early in the year to see if anyone is having issues using the plan or gaining access to care. Solving an issue for a member ahead of a CAHPS survey is a win/win.
Annual plan changes potentially involve price increases, changes in prescription drug coverage and other differences from the previous year. Price changes or any change in coverage will typically prompt a member to investigate other carriers, unless you are proactive. Once changes are announced, carriers should contact current members to alert them of changes and offer them explanations on how many can have little or no impact as well as their options. If a member has a drug becoming more expensive, there could be generic equivalents to prescription medicines that can save them money. Though the price for the current plan may be increasing, you may have another plan within your portfolio that will be a better fit based on the changes. By alerting the member to the changes and options within your family of plans, you show the member not only your continued interest in serving his or her needs, but also help put your company’s other options – rather than your competitor’s – at top of mind for plan selection.
Proactive member engagement touch-point campaigns will also help ensure that members are going for annual wellness visits, getting tests, receiving flu shots and following other recommended care advice to stay healthy and reduce the healthcare provider’s expenses. All of these conversations will positively impact your STAR ratings.
3. Mitigate your CTM occurrences
By following the above steps, you will help ensure any complaints are kept to a minimum. In addition to taking a more thoughtful approach to onboarding to eliminate complaints that tend to happen shortly after enrollment, you need to closely monitor any information provided to members.
Such monitoring enables your company to counter errant complaints, many times eliminating the complaint and any negative effect it would have on your STAR rating. With proper tracking, you can determine whether or not a member’s complaint is legitimate and address the matter appropriately.
4. Take a new approach to training
Member engagement agents need ongoing training on the nuances of the healthcare market, including the hard and soft skills necessary in counseling members from a wide variety of backgrounds on various aspects of their plans, how to have the best long-term outcomes and options and strategies for working with different personas within the senior marketplace.
It is essential that member engagement agents be fully prepared to communicate with seniors, and are aware of the differences in working with members of this age group. Seniors tend to need more types of care than other age groups, so deep product knowledge is essential, as is the ability to be patient because a higher percentage of seniors are hard of hearing, may not be aware of newer technology or may need additional explanations to grasp what a member care representative is attempting to communicate. Yet all seniors can’t be lumped together. While some are hard of hearing and forgetful, others continue to lead active lives and possess quick minds. Member engagement agents need to quickly recognize those differences and engage seniors based on their individual characteristics to ensure they understand their plans and answer all of their questions.
5. Employ the right people for your engagement center
Though ongoing training is essential, your advocate needs to have the right initial hard and soft skills when hired to produce the optimal outcomes. Your member engagement team must have the ability to find the right person for the right job, someone who has the right skills, interests, attitudes and motivator assessments to proactively engage members in ways that will enhance member satisfaction, your STAR ratings and contribute to your member retention efforts.
By using an outsourced provider with the right hiring tools, it is possible to predict the top performers for these jobs with an 80 percent accuracy rate, enabling your company to have a proficient healthcare advocate on the phone within a 60 to 90 day timeframe. Your member engagement partner needs to have a program that ensures they hire and train member engagement agents who have the right knowledge and personality to work in healthcare support – it’s not just a matter of taking an agent who has worked in other industries and putting them on healthcare accounts.
Your member engagement operations represent a critical resource for working with members throughout the year. Effectively incorporating these five tactics will improve member satisfaction, retention and loyalty – and ultimately increase your STAR ratings and profits.