Closing the Performance Gap in Medicare Advantage Insurance: Case Study

One of the largest Medicare Advantage health plans in the U.S. wanted to improve their customer satisfaction performance.

BUSINESS CHALLENGE
One of the largest Medicare Advantage health plans in the U.S. wanted to improve their J.D. Power customer satisfaction performance. They asked J.D. Power for deeper insight into how they compared with best in class plans across the country. Due to high membership churn and targeted strategic growth, they sought a prioritized sequence of customer (member) super Key Performance Indicators (KPIs) on which to improve their performance and close their gap to core competitors.

J.D. POWER ENGAGEMENT
The health plan engaged J.D. Power for an advisory engagement focused on evaluation of performance gaps and recommended areas of focus for operational improvement and investment. J.D. Power completed the following steps:

1. Assessed the Current Situation: J.D. Power delivered an in-depth analysis of performance of the plan across both the Commercial Health Plan and Medicare Advantage Benchmarking Studies
2. Identified Areas of Focus: J.D. Power indexed overlapping internal support functions to the prioritized customer (member) facing aspects to invest and drive improvements within the organization 
3. Developed Prioritized Road Map: J.D. Power highlighted numerous near-term and long-term operational improvement recommendations including building Trust, improving Contact Center performance, Provider Networks, Care Coordination, Communication, and other critical factors 

THE RESULTS
The outcome of this engagement drove subsequent board-level discussions and investment in a transformation program as part of a multi-year project road map affecting member and provider-facing elements of the company.

Syndicated Improvements:

• Within a short period (trailing year), syndicated study satisfaction improved 40 points over two years on the "Info & Communication" Factor and 40 points on the "Provider Choice" Factor.
• The client further improved 34 points on the "Customer Service" Factor (33 point improvement on Phone and 40 point improvement on Website) as a result of changes made to operations.

These changes put the plan back into the top quartile on performance and by design in parallel increased CMS Star ratings results.

J.D. Power Benchmarking data drove critical enterprise changes, a shift to higher performance and a customer (member) oriented service platform.