Boosting member retention rates for health plans

Why should payers focus on member satisfaction?

Every commercial payer wants to attract and retain employers who will offer the payer’s health plans as a benefit to their employees. With these valuable contracts at stake, payer decision-makers are keenly focused on member satisfaction — and attuned to the factors that detract from it.

When employees are unhappy with their health plan choices, employers hear about it loud and clear. This can lead businesses to shop around for new payer options instead of renewing existing contracts.

Happy employees mean happy employers, so identifying and addressing the reasons for discontent is essential. The good news is that there are things you can do as a payer to promote member satisfaction. Transparency is a valuable step toward boosting your member retention rates. First, let’s look at the situation from their perspective.

Surprise, surprise: Why your members might be dissatisfied with their health plan

It’s not news that the cost of healthcare is rising. A survey of traditional Medicare beneficiaries found that, among those who opted to switch plans, 51% did so to lower their premiums or copayments.¹ But it’s not only the price that’s the issue; it’s the trepidation that comes with not knowing what those costs will ultimately be. According to a poll conducted by KFF, six out of 10 Americans (61%) are somewhat or very worried about affording the cost of unexpected medical bills.²

Health plan members frequently encounter unpleasant surprises related to the cost of care, including:

• Navigational challenges: The process of finding and selecting in-network providers can be cumbersome for members. Some may end up choosing a provider without seeing network affiliations, only to be hit with out-of-network expenses down the road.
• Surprise billing for out-of-network providers: An in-network provider may refer a patient to an out-of-network specialist, but they don’t always let the patient know. Out-of-network services often come with significantly higher out-of-pocket costs that members don’t anticipate.
• Lack of transparency around costs: Many members struggle to access clear information on their coverage, such as what their cost-sharing responsibilities will be. This lack of clarity upfront creates mistrust and dissatisfaction.

What do these challenges have in common? Without intending to, they all leave members in the dark about the ultimate cost of care — which patients might not find out until they receive the bill. Not being able to get a clear answer on the cost of care can motivate members to complain to their employers and demand alternatives to the health plans they’re offered.

What payers can do to improve member satisfaction — and employer retention rates

The key to improving satisfaction lies in boosting price transparency and providing supportive tools that empower both clinicians and members with actionable information at the point of care. Payers should invest in solutions that:

• Enhance provider network visibility: Make it simple for providers to identify in-network specialists and facilities for their patients.
• Deliver cost and efficiency insights: Share cost designations and quality indicators to help guide members towards lower-cost, higher-value care.
• Embed information seamlessly in clinical workflows: Ensure that relevant payer information is accessible to clinicians during patient encounters, so appropriate referrals can be made proactively in the moment of care.

By providing members and providers with the right cost and coverage information at the right time, payers can reduce out-of-network utilization and improve the member experience, thus promoting member satisfaction and supporting better member retention rates.

athenaPayer®’s Provider Network Directory: Improving member satisfaction through point-of-care transparency

One powerful tool being developed to address these challenges is the Provider Network Directory feature within athenaPayer. This solution will integrate payer network data directly into the clinical provider workflow in athenaOne®’s ordering system, surfacing real-time, in-network provider options and cost/efficiency designations at the point of care.

athenahealth’s deep integration of the Provider Network Directory within clinical workflows will create an efficient, transparent experience that benefits payers, providers, and members alike.

How the Provider Network Directory will work in athenaOne

• The Provider Network Directory will integrate detailed provider directory data from payers, including network status for specialists, imaging centers, and labs, updated regularly via bulk FHIR data exchange standards.
• While placing an order or referral in athenaOne’s electronic health record, the clinician will see a curated list of in-network providers aligned with the member’s insurance plan and coverage eligibility.
• Providers will be ranked by the payer’s cost efficiency and quality metrics, enabling smarter referral choices.
• When clinicians are empowered with this data, they will be better equipped to make in-network referrals, which can minimize surprise bills and elevate member satisfaction.

Potential business impact of the Provider Network Directory

• Reduces out-of-network referrals and associated member cost shocks
• Shortens care delays by improving access to appropriate in-network providers
• Improves payer-member trust through increased transparency and collaboration
• Improves provider-member relationships through shared information
• Supports payer goals to control costs while enhancing quality 

athenahealth’s deep integration of the Provider Network Directory within clinical workflows will create an efficient, transparent experience that benefits payers, providers, and members alike, turning technology into a driver for improved satisfaction and retention.

Open the door to member satisfaction — and employer retention 

Could greater transparency around in-network providers help payers retain members – and protect the valuable contracts they have with employers? Reach out today to learn more about the Provider Network Directory and other athenaPayer solutions. When payers can empower clinicians with the information that members need, everyone wins.