RISE West 2017: Harvard Pilgrim executive explains why Medicare Advantage plans should survey their members

The 2017 RISE West conference is being held at the Fairmont Scottsdale Princess in Arizona from Sept. 17-19.(Leslie Small)

SCOTTSDALE, Ariz.—While there are many factors that determine star ratings for Medicare Advantage plans, consumer satisfaction is a major piece of the puzzle.

“You can’t really be successful if you’re not good at CAHPS,” Noreen Hurley, Harvard Pilgrim Health Care’s program manager of star quality and performance, said during a session at the RISE West conference.

CAHPS, or the Consumer Assessment of Healthcare Providers and Systems, along with the Health Outcomes Survey (HOS), both glean valuable data, but those data are heavily masked by the Centers for Medicare & Medicaid Services and tend to be old by the time insurers get them, Hurley explained.

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So to gain insight into its CAHPS and HOS performance, Harvard Pilgrim came up with a solution: It conducts a proxy survey of its members.

Hurley’s reasoning? “If you don’t ask your members about what drives satisfaction, you won’t know.”

Even the act of conducting the survey can improve satisfaction, Hurley noted, as Medicare members in particular like being asked what they think.

There are multiple ways that health plans can structure such surveys, depending on their needs, capabilities and populations. Important considerations include:

  • Timing. Harvard Pilgrim decided to conduct its survey in September, Hurley noted, as that allows it to include new membership from January and provides several months to impact the outcome of surveys conducted in the spring.
  • Which questions to include. Some plans may want to design questions that drill down into already identified areas of concern, Hurley said. Another option is to only ask questions that will produce answers that are actionable.
  • How to conduct the survey. Automated surveys can be costly to set up but then cheaper overall than surveys done by live agents, but members tend to prefer the latter. Harvard Pilgrim used live agents in 2016, Hurley said, then switched to interactive voice response surveys this year in order to cast a wider net.

Once the surveys are conducted, however, an insurer’s work isn’t over. The next step is to put the data to use.

First, health plans must come up with a near-term action plan for how to conduct outreach to members with immediate concerns that the survey uncovers, Hurley explained.

For Harvard Pilgrim, that meant triaging members to prioritize those who reported fair or poor physical and/or mental health, as well as those who answered "yes" to either falling problems or issues with balance/walking. It then went down the line to address less urgent concerns like problems with customer service. Notably, the insurer made sure to coordinate outreach so that it called each member only once.

Another key way to leverage information from member surveys is to combine it with other data sources and use the data to fuel predictive analytics, Hurley said. That can offer a more robust picture of a health plan’s membership, which it can then segment to engage members more effectively. Harvard Pilgrim, she noted, also built a dashboard to monitor its performance on customer satisfaction measures.

Finally, insurers can use member survey data to offer feedback to providers and encourage them to do their part to improve satisfaction. It’s particularly effective if insurers show providers how they compare to their peers, Hurley said, as it can ignite a friendly competition that results in improvement.

Ultimately, Hurley noted, it can be difficult to draw a straight line between addressing member concerns identified through internal surveys and better scores on official satisfaction surveys. “It’s more of a dotted, moving line,” as she put it.

Even so, Harvard Pilgrim seems to have seen its efforts pay off. “We did see an improvement in our CAHPS scores, and I really think this helps,” she said.

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