A new report from Press Ganey highlights the close relationship between patient experience and health plan star ratings.
Researchers polled 450,000 people across 200 plans and combined those survey results with its database of 5.5 million patient encounters. It found that people who gave poor scores for safety and privacy in surveys following a visit to their primary care providers also frequently awarded their health plan one star on quality and access to needed care on Medicare consumer services.
The report noted these are critical data for plans to consider, as they have traditionally focused on making improvements to customer service, benefit design and patient engagement. It suggests they should also be considering ways to address safety.
In addition, the survey found that patients expect easy access to primary care, but their ability to reach specialists is a key differentiator. Plans that earned four or more stars connected a higher proportion of their members with specialty care.
"Health plan members are more informed and empowered than ever before,” said David Shapiro, senior vice president and general manager of member experience at Press Ganey, said in a statement. “Leveraging data-driven insights can help health plans identify opportunities to enhance their services, streamline processes, and address pain points."
"A culture of continuous improvement, fueled by real-time feedback, is essential for delivering a superior member experience and achieving long-term success," Shapiro said.
Another key factor in high member experience, the study found, is prescription drug coverage. And, while that may seem obvious, it wasn't just availability of medications that drove improvement. For instance, members who were able to use mail-order services reported notably higher satisfaction.
The survey also noted that plans should be thinking more broadly about access to improve member experience. Availability of care on its own isn't the only challenge, according to the report, as ease of access, time to receiving care and experience with the front-office staff all play a role in how the member views access to care.
While the survey did identify clear wins that different types of plans could pursue, it also found that net promoter scores vary based on coverage. The net promoter score for Medicare plans was 47 points above that for commercial plans, the survey found, meaning plans should be looking to ways to tailor improvement strategies between Medicare, Medicaid and the commercial market.