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Member Experience: Your Achilles Heal?

Co-Author: Charro Knight-Lilly


In any industry, member, client, or customer experience and retention is a critical part of success. After all, it takes more time, money, and effort to “obtain” a customer than to “retain” a customer.

In Medicare Advantage, this criticality is compounded by the fact that member experience also makes up for over 30% of STARs measures; yet, we have found that member experience and member retention programs are often undervalued, underfunded, and unaligned.

With so much of an MAO’s success hinging on the beneficiary experience, beneficiary perception of the health plan, and health coverage – we’ve compiled a few tips that we believe are critical pieces of any member retention program:

1) You only get one chance to make a first impression – Sales and Enrollment Experience: It doesn’t start on the first day of coverage, or when the app is filed with CMS – it starts with the agent onboarding experience. It’s critical that your agents are excited about selling your products and can clearly and accurately relay product information to beneficiaries.


2) Member onboarding: Ensure that your onboarding process is smooth so that beneficiaries are provided with all information they need in a timely manner upon initial enrollment. Like any relationship, it takes time and consistency for the beneficiary to truly believe they are a part of your plan – create an onboarding process and communication strategy that ensures your beneficiaries feel valued and cared for.


3) Listen to your members: If you want to know what your members think of their health plan – look no further than your appeals, grievances, sales allegations, and CTMs. The fact is that your members have already told you where the MAO is failing – listen to them, perform root cause analysis, and take action!


4) Nothing is guaranteed: Don’t make the assumption that your members will remain your members during AEP or OEP. With so much uncertainty due to the COVID-19 pandemic and an election year, we can’t be certain that we know how beneficiaries will react. Be sure to go out this AEP with a strong campaign around “retention marketing”. Unsatisfied or disconnected members can easily be “wooed” by the competition.


5) Be forward thinking and innovative: If 2020 has taught us anything, it’s that nearly anything can happen, and we must be able to adapt quickly in order to succeed. The ability to be agile and innovative to address the market and the concerns of your membership is more critical now than ever before. For example, if you don’t know the Social Determinants of Health (SDoH) issues facing your membership and the Medicare beneficiaries in your local market, now is the time to find out. Data often tells us a story that we weren’t expecting, and there is no more appropriate time to challenge our ideas and look for new, innovative approaches to impact the satisfaction of our members by providing them with a best in class health plan experience.

Don’t know where to start? Contactus@rebellisgroup.com for more information or a proposal.

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