Season 5 Episode 4 -Why access isn’t enough and what actually drives member experience
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In this episode of Rising Stars, presented by Press Ganey, Mick Twomey and Jessica Assefa sit down with David Shapiro to unpack new data shaping the future of Medicare Advantage and health plan performance.
At the center of the conversation is a critical insight: what looks like strong access on paper doesn’t always translate into real-world access for members. Coverage and network size may check the box—but when members can’t get care when they need it, the impact shows up quickly in experience, trust, and Stars performance.
Together, they explore:
- The growing gap between reported access and actual member experience
- Why provider interactions and appointment availability are shaping performance earlier in the journey
- The rise of member disruption, even when members don’t choose to switch
- How engagement signals can help predict outcomes and guide more targeted strategies
This episode highlights a fundamental shift: the drivers of performance are moving upstream. Plans that understand what members actually experience, and act on those insights, will be better positioned to improve outcomes and sustain performance over time.