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?
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