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Health Plans Medicare

Unveiling the Hidden Insights: 4 Tips to Get Ahead of CAHPS 

Rant or rave? When your members share their experience about your plan, do you know which it will be? 

Before we can look forward, we need to look back. 
One year, medication adherence holds significant measurement weight and then the next HEDIS scores becomes the focus. So where do you focus your efforts now to make the greatest impact in the years to come?  

No matter how the CMS may modify Star Ratings, health plans should remember that the real secret to success lies in the ability to activate and engage members. So as you settle into 2024, you’ll want to focus on offering the kind of experience your members expect from companies like Amazon or Netflix: personalized to them and how they like it. 
Back to the question at hand: rant or rave? 

Official CAHPS results aren’t released until later in the year. The de-identified data provides vague insight, making it challenging for plans to address individual member pain points proactively. 

With the changes to Star Ratings, waiting to see what your members say poses a real risk.  

Thankfully, there’s no need to wait! You can do several things now to ensure positive outcomes for your plan and members.   

Here are 4 tips our member engagement experts recommend you do right now to promote strong Star Ratings for next year:  

1. Revisit your 2023 and 2024 data (so far)  

 Where did you shine? Where did you have pitfalls? Review your most recent results (especially those regarding member experience) to understand better where your members were and where you would like them to be.  

2. Clearly communicate members’ benefits.

In 2023, more than 9 in 10 Medicare Advantage enrollees had access to a variety of supplemental benefits like eye exams or dental and fitness benefits. Because most Medicare Advantage enrollees have access to benefits not traditionally covered by Medicare, it is important to communicate early and often about what benefits are available and at what scope—especially for those lesser-known benefits your plan offers.

A lack of understanding or confusion about coverage are just two proven pain points that lead to member churn, so make sure to address them from the start. Use an IVR welcome call and onboarding emails to help your members understand their benefit offerings early. Covering topics like in-network providers, prescription coverage and costs, and out-of-pocket costs, like copayments/coinsurance, will prepare members to use your benefits and boost satisfaction. 

Bonus! This proactive type of education will also minimize Q1 call center volume. 

3. Connect members with the resources they need and want.  

Once your members understand their benefits, do they know what other health and wellbeing resources you give them access to? Help by showing them what resources are also included (i.e., telehealth, wellbeing programs, coaching and mental health resources) and how they can access them. Use multiple communications channels like email, text, and direct mail to educate and invite members to engage with these resources. 

4. Don’t wait for CAHPS — you can launch a pre-CAHPS survey of your own! 

  • Cut to the chase. If you could only ask your members five questions to understand their experience, what would they be?  
  • Use multi-channel communications (automated voice (IVR) calls, email, text, and direct mail) to reach more of your population. Start with the most cost-effective channel and add follow-ups for non-responders through additional channels.
  •   Be creative with transfer capabilities to easily connect members with an IVR survey. A call center team member can help address key issues on the spot based on how they respond, a more personal and unique way to improve your member’s experience.
  • Respond to any negative feedback you get so that when the actual CAHPS survey is taken, you’ve already turned that pain point into an opportunity for growth & improvement.
  •  Evaluate if bilingual support for your communications makes sense to reach your Spanish-speaking population.

If you’re looking for a partner who can help you create a personalized road map for increasing your 2025/2026 Star Ratings, connect with a Virgin Pulse expert. We can help you quickly execute a CAHPS simulation survey to get a pulse check (no pun intended) on member satisfaction before the CMS blackout period arrives.  

Speak with a member engagement expert to get started.  

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