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The Relationship Between Member Satisfaction, Health Outcomes and Star Ratings

Matching members to the correct health plan for their individual needs has a long-standing impact on both members and health plans.

When a member is in the right plan for their needs, they are more likely to see a doctor regularly, take medications as prescribed, and adhere to treatment plans—all of which have significant impacts on health outcomes.

Many factors influence an individual’s choice of a health plan such as their overall health, acute and chronic conditions, and prescription medications. Additional considerations include income, geographical location, and the ability to remain with current providers.

When members experience satisfaction from their plan’s benefits, they are more likely to remain with the plan.

Members who choose the wrong plan are apt to spend more on healthcare costs or worse, not receive the care they need. For example, if a member visits their doctor and ends up paying more out of pocket than they anticipated, they leave with post-purchase dissonance, feeling unhappy and consequently, they lose affinity for the plan.

There is a health plan to suit every member and their unique situation. The challenge is connecting members to the plan that meets their needs.

Like many purchase decisions, selecting the wrong product can have a negative impact on the member’s perception of the health plan when in fact, the health plan isn’t bad, it was just the wrong product for that member.

“ We have the data that tells our member’s story,” said Andrea Wallace, Manager of Product Development. “When we tap into this information, we can better understand what our members want and need in a plan. We can help keep them healthy and happy.”

The impact on health outcomes and Star Ratings.

Health plans benefit from taking additional measures to ensure that they are targeting the correct people for each of their plan offerings. If a member is in a plan where the care they need is not covered, often they will avoid the care due to cost. Gaps in care result in lower Star Ratings and decreased member satisfaction leads to lower CAHPS performance. This adversely affects both the member and the plan.

Is there a way to influence these purchase decisions prior to open enrollment?

As health stewards of our members, we have a responsibility to use the data we have to guide members into the best plan for their individual needs. Using Advantasure’s highly sophisticated marketing technology, health plans can leverage member data such as demographic, health, claims, and provider data to nudge members into a plan that best matches their needs. For example, a member aging into retirement that has had the same physician for the past ten years is going to want to transition into a plan that specifically accommodates their continuum of care. Using Advantasure’s highly sophisticated platform, Smart Conductor can micro-segment this member, speak directly to their needs, and influence them to enroll in the right plan.

The next generation of health plan marketing is here.

The industry is evolving and demanding that health plans place greater emphasis on member experience. In order to stay ahead and provide best-in-class experiences, health plans must invest in understanding its members. The good news is that each health plan already has its member’s preferences—it’s in the data. Smart Conductor simply unlocks the insights.

Escalate your health plan’s marketing into the future with technology that works behind the scenes, uses your existing data, and produces a seamless enrollment experience. Every member deserves to find the best health plan for their needs.

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