Improving the health plan member experience by providing personalized assistance to customers considering a new plan.

Health Plan Member Experience: Improve Star Ratings

The health plan member experience consists of every contact the customer has with their health plan or healthcare provider. It’s essential to make the member experience as smooth and pleasant as possible to increase customer loyalty and prevent any interruptions in Medicare or Medicaid reimbursements. So today, we’ll discuss the impact of the member experience and how it affects CMS STAR ratings before offering guidance on improving the health plan member experience.

Impact of Health Plan Member Experience

For every health plan, the member experience plays a significant role in influencing an individual’s decision to stay with a plan or provider. Improving the member experience can help reduce churn, because satisfied customers generally want to continue with their existing health plans. In addition to contributing to high churn, poor member experience can affect a provider’s ability to receive Medicare and Medicaid reimbursements because of negative STAR ratings.

Health Plan Member Experience and STAR Ratings

The member experience has a dramatic influence on how the Centers for Medicare and Medicaid Services (CMS) awards STAR ratings to healthcare providers. For 2023, CMS retooled the rating system to increase the weight of member experience by about four times more than previous years.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey serves as an important source for member experience metrics. Because STAR ratings affect how CMS awards reimbursements, there are considerable financial consequences for providers who don’t perform well in these surveys. The CMS estimates a $3.65 billion reduction in reimbursements over the next decade because of the shift in STAR rating methodology.

Steps To Improving Health Plan Member Experience

Improving the health plan member experience can lead to higher STAR ratings and, as a result, in larger CMS reimbursements. Here are four steps to help improve the customer experience.

Steps to Improving the Health Plan Member Experience

icon-1Reduce phone and office wait times.

icon-2 Provide personalized assistance and member communications.

icon-3 Reduce out-of-pocket costs with discounts and telehealth.

icon-4 Make data-driven improvements for the best results.


  • Reduce Wait Times

Long wait times can have a pronounced negative effect on the patient experience, whether members are waiting for an appointment with a new physician, waiting to be seen once they’re in the office, or waiting on the phone for crucial healthcare information. The longer a member waits, the more likely they are to switch providers, and the less favorable they’ll be in reporting their experience in CAHPS surveys.

One way to identify the causes of long wait times is to survey staff and patients to see where and when delays occur and how big an impact they have. Reducing wait times may require additional staff training, retooling inefficient workflows, or implementing new technology. For example, a telehealth platform can help reduce the number of patients coming into the office daily, decreasing the burden on healthcare staff and ensuring faster access to care.

  • Provide Personalized Assistance

Another source of member dissatisfaction is confusion about plan and benefit details. Information presented on a website or in a brochure often leaves members without an easy way to ask questions, get advice on choosing a plan, or finding out what their existing plan covers. Simply contacting members with a personalized communication initiative to offer relevant tips and guidance can automatically improve the member experience. Many members also feel more satisfied with their plans when they have a dedicated representative to contact with questions.

  • Reduce Out-of-Pocket Costs

Overall, the health plan member experience will receive the most positive feedback when patients spend as little money as possible on treatment. One surefire way to improve STAR ratings is to provide savings on out-of-pocket costs. For example, offering discounts for telehealth, generic prescription drugs, and preventative care can help reduce patient costs and improve their plan satisfaction.

  • Make Data-Driven Improvements

Health plan providers collect a great deal of personal data from members, which can be leveraged to improve the member experience. Healthcare data analytics can help providers:

  • Identify service bottlenecks and other sources of delays.
  • Provide demographic information for more personalized communications.
  • Find opportunities to reduce costs for members without affecting the quality of care.

When used correctly, technology can help providers improve the health plan member experience. However, a poorly executed technology rollout could have the opposite result and increase patient frustration. To avoid potential hiccups, consider partnering with the technology implementation experts at Concord.

Getting Started

Concord USA is a consultancy that combines the depths of our technology and industry knowledge with a results-oriented culture to foster resiliency, efficiency, and innovation. Whether you are trying to improve customer satisfaction, update data strategies, strengthen security, or tighten up other technological issues, Concord can help.

Contact us today to learn more about how to improve your health plan member experience, our Technology Integration Services, and how we can help your business thrive.

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