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Case Study - New Member Satisfaction

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Case Study: IndiGO Patient Predictive Modeling Copyright© 2015 SPH Analytics Page 1 New Member Case Study Educating New Health Plan Members to Improve CAHPS ® Scores Summary: New member welcome calls and survey outreach can be an effective method for educating new members to help ensure access to care and overall satisfaction with their health plan. A top health plan in the northeast United States and a large health plan in Hawaii were both challenged with implementing a program to ensure that new members understood plan benefits and to help develop positive member relationships to ensure long-term satisfaction and timely access to care. SPH Analytics developed a customized phone outreach program to welcome new members, evaluate the member's understanding of benefits, educate members, and alert health plans regarding any needed member follow up. Background: There is generally an overwhelming amount of information for which new members need education and understanding. New health plan members need to be aware of the plan's specific benefits, features, and expectations in order to receive optimal care while reducing out-of-pocket expenses. In addition, new members often need to proactively verify or select their Primary Care Physician (PCP) and ensure receipt of their health plan identification cards. Health plans need to educate new members on how to access information, locate in-network physicians/facilities, and contact customer support. Health plans should also make new members aware of wellness programs and additional services. Lack of knowledge and understanding among new health plan members can often impact the member's ability to effectively access care and impact the member's overall satisfaction with the health plan. Finally, it can be critical that health plans create a positive first impression for new members to ensure medical care and medication compliance and to begin building a trusting relationship and open communication between the health plan and the new member. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

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