A recent Press Ganey report raises pressing questions about the state of health plan member experiences, uncovering gaps that hinder satisfaction and loyalty. With data from 450,000 respondents across over 200 health plans, the findings uncover key areas such as safety, privacy, and care coordination that demand immediate attention.
According to the report, member satisfaction is closely tied to star ratings, with patient safety and privacy emerging as critical factors alongside traditional areas like customer service and benefit design.
Specialist engagement emerges as a crucial factor in member loyalty. While access to primary care is expected, a seamless collaboration between primary care providers (PCPs) and specialists sets high-performing plans apart. Health plans that excel in care coordination achieve significantly higher satisfaction scores, reflecting the demand for integrated and personalised healthcare experiences.
The report brings attention to significant disparities in care, revealing that nearly 1 in 20 Medicare members have experienced unfair treatment by healthcare providers. These issues disproportionately affect historically marginalised groups, including individuals who are low-income, LGBTQIA+, disabled, or dual-eligible, with these populations reporting instances of discrimination at more than twice the rate of other members.
Despite ongoing efforts, access to care remains a challenge. In fact, minimal improvements have been seen over the past five years, highlighting the need for innovative approaches that consider the role of office staff and digital tools in streamlining the member journey.
Tailored strategies also prove essential, as Medicare plans outperform commercial plans in Net Promoter Scores (NPS) by 47 points. This stark contrast reflects the importance of customising approaches to address the distinct needs of Medicaid, Medicare, and commercial members.
“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,” said David Shapiro, senior vice president and general manager of member experience at Press Ganey.
The report brings attention to significant disparities in care, revealing that nearly 1 in 20 Medicare members have experienced unfair treatment by healthcare providers. These issues disproportionately affect historically marginalised groups, including individuals who are low-income, LGBTQIA+, disabled, or dual-eligible, with these populations reporting instances of discrimination at more than twice the rate of other members.