Transforming health plan quality through improved experiences

Is your health plan’s quality ratings meeting your goals? Maybe you don't have access to current end-to-end experience data, which prevents you from improving quality in the way fully needed. Or you find it hard to prioritize quality efforts, because you don't have clear member insights to support needed changes. It's time for action. Today, taking a member-centric approach is essential for quality improvement. And that requires regularly listening to the member’s voice.

Traditional health plan quality improvement methods rely heavily on the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS). While these are critical for many reasons, health plans can’t stop there. They must dig deeper to assess members’ needs, experiences, and expectations as they navigate their unique care journey.

Because healthcare is just that: a journey—and a nonlinear one at that. It’s not confined to a single experience, and it often has many overlapping or intersecting paths. People don’t think of their experiences in silos—the patient experience vs. consumer experience vs. member experience—and health plans can’t either. Every experience is unique in itself, and it takes a deeper understanding of each to learn how to effect real change.

Taking a member-centric approach to quality improvement is about connecting the dots throughout their healthcare journey, including but not confined to each episode of care, as well as over their lifetime.

To do this effectively, health plans must invest in:

• Understanding the member’s experience as an individual and patient
• Delivering patient support services that improve those in-care experiences
• Crafting a health plan experience that meets members wherever they are in their journey

But beyond the philosophical exercise of reframing how we think about healthcare through a Human Experience lens, health plans must be using their member data and applying it against everyday feedback across a member’s journey.

In a member-centric model, continuous feedback is essential for quality improvement. It's the tool that can contextualize situations and provide direct insights into member expectations and experiences. But exactly how do we go about collecting that feedback?

Collecting member feedback through a clinical quality lens

Continuously listening throughout the entire healthcare journey unlocks a deeper-level understanding of pain points and wins.

Pre-visit

Capturing member feedback prior to a healthcare visit provides valuable insights into the member experience. This feedback can reveal potential barriers to care as well as any complexities in finding and accessing that care, which may lead to suboptimal quality outcomes or unmet member needs. Improving experiences leading up to a visit can have a tremendous impact on the long-term quality of care.

During the visit

Capturing member feedback about a specific healthcare visit, or across a care journey, identifies insights that requires immediate actions on the part of a health plan to improve their policies, network, or benefits—driving greater quality for members in the future. It may also help you address a specific member’s need where intervention in needed through a closed loop process.

Post-visit

Capturing member feedback days, weeks, and months after a visit helps a health plan quickly know when, where, and how to potentially support them in their care journey. It may help trigger health plan’s care and case management efforts to ensure the member is getting the needed post-visit care to improve quality outcomes.

While health plans invest a lot of their continuous listening programs focused on improving the experiences for net promoter scores (NPS), growth, and retention, these same measurement strategies can support improved outcomes while also supporting health plan affordability programs.

Final thoughts: The future of quality improvement

Continuous feedback powers a member-focused approach to quality improvement. It allows for health plans to see the entire healthcare experience through the lens of the member and patient—capturing a true Human Experience outlook. In the end, it’s a dynamic and responsive process, not a static one.

We need to move toward a future where every member feels supported and appreciated, and every health plan strives to help humans live healthier lives. After all, that's what quality improvement is all about.

To discuss capturing member feedback for quality improvement purposes, please reach out to Press Ganey’s team of health plan experts. They can discuss moving beyond traditional surveys to harness real-time member insights and proactively address the root causes negatively impacting experiences—and quality.