Exceed Expectations: Making an action plan for improving member experience metrics
A deep dive into the importance of CAHPS, quality scores, and member satisfaction.
July 28, 2022

“It is all about the member experience.” 

These words resonate with many of us, especially those working at and with Medicare Advantage health plans, where experience measures have been elevated to a 4x weighting in 2023 Star Ratings.

Health plans have improved their member experience strategies, committees and organizational structures in response, taking into account Consumer Assessment of Healthcare & Provider Services® (CAHPS®) results, Net Promoter Scores (NPS) and other data elements that help understand the customer experience. 

But what exactly does “experience” mean? And how does it relate to satisfaction, loyalty and those all important CAHPS scores? Let’s dig in. 

What Constitutes ‘Experience’

Experience is both a noun and a verb, meaning: n. Encounter or undergo (an event or occurrence) and v. Practical contact with and observation of facts or events.

In short, experience is our perception of facts/events/an encounter. A person’s experience is a re-telling of how the event happened. The CAHPS survey is intended to address member perceptions and experience. 

CAHPS questions are truly centered around an individual’s experience of care - did you receive care, how easy was it to receive care - and the like. However, these questions do lend themselves to unspoken (and individualized) expectations: getting care “as soon as you needed”. 

The phrase “as soon as you needed” may mean different things to different people. Is the expectation that a person would be seen today or sometime this week?

 “In the last 6 months, how often did your personal doctor spend enough time with you?” What is “enough”?

Ask folks who have worked at a health plan and they will note that satisfaction/dissatisfaction is expressed in CAHPS (and mock-CAHPS) surveys because of this element of member expectation. When the plan or providers don’t meet those expectations, CAHPS responses demonstrate that dissatisfaction.


While experience is one’s perception of events; satisfaction is the measure of how an experience meets (or does not meet) one’s preconceived expectations.

Customer satisfaction can be measured by a myriad of data points including CAHPS, dis-enrollment reasons, complaint tracking and more. A key area of impact for health plans is to set and manage customer expectations. 

Are call volumes high? Thank your customers for their patience. And when you are able to see them/speak with them, go above and beyond; be sure you have made it easier, answered questions, perhaps even “delighted” the customer.

Programs, services and vendors that support and delight your customers is incredibly important. If expectations for fun, ease, and delight have been low, plans can hit a home run with programs that members love to be a part of. Additional resources, tools and support can be just what is needed to surpass member expectations and lead to higher satisfaction.


Satisfied customers do not necessarily mean loyal customers - nor does it mean that individuals will sing your praises. In looking at dis-enrollment data, many members switch plans due to provider network changes, benefits, and/or cost. In light of this decision making, plans must go above and beyond in order to create lasting relationships with their members.


“How likely are you to recommend/share this plan/company/product with friends and family?” This question is often asked at the supermarket check out, in a follow-up email after an online purchase, or even from one’s health plan.

The concept of “net promoters” was introduced in a 2003 Harvard Business Review article. Promoters, the article contended are “the customers with the highest rates of repurchase and referral, and gave ratings of nine or ten to the question. The “passively satisfied” logged a seven or an eight, and “detractors” scored from zero to six.”

Over the years, the Net Promoter Score (promoters over detractors) has been used increasingly by healthcare organizations to understand not just member experience but also loyalty of those members. Are members likely to remain if the benefit structure changes? Would they recommend their health plan to a friend or neighbor?

Voice of the Customer

All of the aforementioned data - CAHPS, pulse surveys, disenrollment data, complaint tracking, feedback lines, NPS - can be mined, and insights can be gathered for a more complete picture of the Voice of the Customer. No single data point will illustrate all issues, and therefore no single program or survey will address all issues.

Many plans have taken a cross-functional, matrix style approach to addressing Member Experience. Some have created cross-departmental Member Experience Committees tasked with sharing information, addressing concerns, and measuring success/improved experience. Ensuring senior leadership support of experience will enable committees and programs success.

Plans must understand the customer voice in all segments of plan operations and activity, measuring experience throughout the members’ touchpoints with the healthcare system. 

5 ways to address Experience, Satisfaction and Loyalty  

  1. Recognize that customer experience is shared across an organization - every department and unit has responsibility to serve and delight customers. Showcase that aligned responsibility through shared metrics and committees to keep a pulse on member experience.

  1. Utilize pulse experience surveys to understand what the experience is like for members with the plan and with the provider network. Mock surveys allow an understanding of details; which providers, which regions, which services require more assistance and focus. Partnering with daily engagement programs can also help increase member participation in these surveys to get more well-rounded data on member experience. Wellth’s in-app surveys have an over 80% response rate where typical surveys yield a 20-30% response rate. 

  1. Invest in customer service training, de-escalation and promoter programs. Highlight your wins and learn from your shortcomings. Create an action plan for survey responses.

  1. Clarify expectations with your members - what can they expect wait times to be, who will they meet with, how long is the visit, etc - give information in writing, orally, etc. Then make sure those expectations are being met. 

  1. Ask early and often how you are doing. Are there expectations you haven’t met or didn’t know existed? Your commitment to your members starts and ends with the relationship you create with them. 

Wellth creates custom member experiences that cater to each member's needs. Excellent member experience requires commitment; consider partnering with companies that are aligned with your mission to boost satisfaction, loyalty and experience while improving quality. 

Partner with companies that agree that “it’s all about the member experience.” 

CAHPS®, which stands for Consumer Assessment of Healthcare Providers and Systems, is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).