Health plan member experience in 2024

Health plans are facing increasing pressure to deliver exceptional member experiences while navigating a complex regulatory landscape. Fragmented experiences, operational silos, and rising member expectations are adding to these challenges. Our “Health plan member experience in 2024” report analyzes regulatory and member feedback to identify key drivers of satisfaction and loyalty—as well as opportunities for improvement and growth. It offers actionable strategies to improve access, safety, privacy, and care coordination, to help you elevate the member experience and boost Star Ratings.

Key member experience insights for 2024

• Patient experience and health plan quality ratings are closely linked. Patients who rate safety and privacy poorly in post-care PCP surveys typically award health plans 1 star for “rating of health care quality” and “getting needed care” in Medicare CAHPS surveys.
• Primary care engagement is essential, but specialist engagement is the differentiator. High-performing plans (4+ stars) engage a larger proportion of members with specialists.
• Access to care remains a challenge. Patients who have positive experiences with scheduling and contacting their provider tend to give higher ratings to health plans.
• Tailored strategies are key to improvement. Medicare plans significantly outperform commercial plans in NPS, with a 47-point difference.
• Prescription drug coverage is vital to member experience and quality of care, but it’s not the only factor. Simplifying processes like prior authorizations and mail-order can significantly improve member satisfaction.
• Addressing inequities in care is essential. Nearly 5% of Medicare members report experiencing insensitive or unfair treatment from healthcare providers—a figure that doubles for historically disadvantaged populations.

Download the report for more insights and key strategies around elevating the member experience.