Reengineering the Member Experience: Why Now & How? (Part 1 of 3)

By Shobhit Saran - Asst. Vice President, Health Plans, Mamta Joshi - Sr. Healthcare Consultant & Sidharth Makhijani - Healthcare Consultant

Your consumers are diverse and their expectations are increasing. Health plans are in a unique position to influence health outcomes and care costs. Beyond a trend, reengineering the member experience is a fulcrum that, if done well, can build new levels of trust, loyalty, and brand positivity…not to mention NPS, online satisfaction scores, and community goodwill.

In this blog series, we explore three aspects of member experience:

  • What’s changed and why it’s time for a new approach to the member experience
  • Trends around member & data analytics that accelerate experience transformation
  • Digital tools and technologies that we use to elevate the member experience

Member Experience Trends: What’s changed?

Healthcare consumerization could be seen as a buzzword, but it’s no fad, reflecting the evolving expectations across all of your customers – individuals, employers, states, providers, partners. The ever-increasing demand for convenience and personalization, coupled with key trends, provides an opportunity for health plans to differentiate.

  • Experience matters more - CMS has raised the stakes now that Medicare Advantage scores more heavily weight consumer experience, increasing from 32% in 2020 to 57% in 2023
  • New data possibilities - Creating a longitudinal member record is possible now, integrating disparate and far-flung data like CAHPS survey scores, SDoH indicators, U.S. census data
  • Smarter engagement - Digital tools offer new technology and connectivity to engage members across preferred channels with push or pull messages, resources, and value
  • Maximize member relationships – Customized care and personalized wellness demonstrates how well the plan knows and understands member needs

Member Experience Reengineering: Where to focus first?

Robust omnichannel, member-centric experiences improve member retention, achieve higher renewals, and deliver on the promises made to new prospective members. Happier members who feel more in control of their health want more than online bill paying. That’s just the beginning.

Health plans that can orchestrate services, tools, products, and data seamlessly do so by reinventing conventional functions and putting members in the driver’s seat. Creating a technology-enabled member experience starts with understanding your members’ unmet needs and expectations. Do they rely heavily on health devices and mobile apps, how do they currently use your portal, and make health insurance and healthcare decisions? How do they want to take better control of their health and health coverage? Are they part of a special population? Do they require care management? Are they rising-risk for certain diseases? How can the health plan partner with them to realize their goals?

Transforming the member experience has a host of desired outcomes for the front-end. However, a well-constructed and executed member journey emerges from a powerful back-end approach. Ensuring that IT architecture, data access points, operations, and business operations synergistically align and support the member experience is just as important. Health plans can bridge current gaps in member experience through greater awareness, a thoughtful approach, and a workable roadmap.

Our next blog in this series will focus on modern data approaches that make reengineered member experiences possible.

Reference Links:

Customer experience in Medicare Advantage | McKinsey

2020 Health care consumer survey: consumer health trends | Deloitte Insights

Five drivers of a health plan's customer experience (

Industry Voices—3 member engagement pitfalls health plans should avoid | FierceHealthcare

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