New Data Reveals Critical Gaps in Health Plan Member Experience

First of-its-kind Press Ganey Report Examines Member and Patient Experience Data to Highlight Pain Points and Areas for Improvement

CHICAGO--(BUSINESS WIRE)--Press Ganey, the leading provider of experience measurement, data analytics, and insights for health systems and health plans, has released its latest research report, “Health Plan Member Experience in 2024.” This report highlights critical areas for improvement in member experience, drawing on regulatory, voice-of-the-customer, and Press Ganey’s patient experience data. The findings underscore the pressing need for health plans to address barriers to higher member satisfaction.

Drawing on insights from 450,000 member respondents from over 200 health plans, and Press Ganey’s database of 5.5 billion patient encounters, the report offers a comprehensive look at member experience. It identifies the most critical drivers of member satisfaction and loyalty, including access, safety, privacy, and care coordination, and provides health plans with a roadmap to deliver seamless, connected, and personalized experiences.

"Health plan members are more informed and empowered than ever before," said David Shapiro, Senior Vice President and General Manager of Member Experience at Press Ganey. "Leveraging data-driven insights can help health plans identify opportunities to enhance their services, streamline processes, and address pain points. A culture of continuous improvement, fueled by real-time feedback, is essential for delivering a superior member experience and achieving long-term success."

Key Findings from the Report Include:

• Link Between Member Experience and Star Ratings: Member experience and Star Ratings are more closely linked than many health plans may think. Health plans have traditionally focused on customer service, benefit design, and engagement, but emerging data reveals that patient safety and privacy are now critical drivers of satisfaction and align closely with Medicare CAHPS questions.

• Specialist Engagement Is the Differentiator: Access to primary care is expected, but specialist engagement and care coordination between PCPs and specialists are what set high-performing health plans apart. Members with a dedicated primary care provider (PCP) award significantly higher Star Ratings, but specialist engagement remains the key differentiator for leading plans.

• Broadening the Meaning of Access: Access involves more than availability—ease and speed of access, as well as support from office staff, are critical factors that shape the member experience. Despite best efforts, access to care has shown minimal improvement across all health plan types over the past five years.

• Tailoring Improvement Strategies: Net Promoter Scores (NPS), which gauge member loyalty and satisfaction, vary significantly across health plans. Medicare plans achieve an NPS score 47 points higher than commercial plans, highlighting that improvement strategies are not one-size fit all. By focusing on the unique needs of Medicaid, Medicare, and Commercial lines of business, plans can drive meaningful improvement in high-impact areas.

• Prescription Drug Coverage and Member Experience: Prescription drug coverage is central to member experience, but access to medications is just one part of the equation. Data reveals the availability of mail-order services can significantly improve satisfaction, impacting overall drug plan ratings.

• Addressing Disparities in Care: Nearly 1 in 20 Medicare members have experienced unfair treatment by a healthcare provider. Historically disadvantaged populations—such as low-income, LGBTQIA+, disabled, and dual-eligible individuals—are more than twice as likely (10.1%) to report mistreatment.

The report provides actionable strategies that health plans can adapt to improve key metrics tied to member experience. By identifying root causes in real-time and segmenting feedback by demographics and health conditions, health plans can implement targeted actions to enhance access, streamline communication, and alleviate financial burdens for members.

For a detailed look at the findings and actionable insights, read the full “Health Plan Member Experience in 2024” report: pressganey.com/mx24

About Press Ganey

Press Ganey partners with healthcare providers and health plans to improve the experiences of their patients and workforce by marrying data with unparalleled technology and expertise. Our HX platform unites and enlivens disparate data, enabling clients to gather, analyze, visualize, and act on key insights to retain employees and ensure the care journey is accessible, safe, equitable, and patient-centered. We are the trusted partner to over 41,000 healthcare provider organizations globally and 85% of health plans in the United States. Press Ganey is a PG Forsta company.

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About PG Forsta

PG Forsta is a leading provider of experience measurement, data analytics and insights for healthcare and other complex industries. Our Press Ganey healthcare suite is the most widely adopted experience, clinical and safety solutions for providers, payers and life sciences organizations. Our Human Experience platform for enterprises, which includes an award-winning “voice of the customer” solution, powers the world’s leading brands and 9 out of 10 global market research agencies.