More Thinking and Insights

Member Experience and SDoH

April 15, 2021  |  Guidance


Yogin Shroff, Senior Partner and Chief Operating Officer

Member experience is rapidly becoming the measuring stick for success not only within CMS Stars but also towards attaining positive population health outcomes.

CMS Stars has been historically predicated around succeeding in closing crucial HEDIS measure care gaps, which require laser focus from all involved stakeholders -- providers, health plans, health systems, etc. Part of this strategic effort consists of fortifying strong member engagement with a robust provider engagement structure. Said differently, member satisfaction is centered around ensuring members are completing necessary screenings, tests, and check-ups annually. But just as important is building sustainable relationships with the network providers and incentivizing them to encourage necessary action from the member to complete critical healthcare activities.

As we turn the page to 2021, HEDIS has taken a slight backseat to member experience as the newly defined critical driving force behind obtaining the desired Star rating. With 56% of the overall CMS Stars rating attributed to CAHPS and Administration/Operations, the spotlight shines brighter on healthcare organizations and their ability to engage with their population, coordinate care more effectively, and induce greater positive health outcomes. A big piece of member experience and satisfaction is procuring strong access to care and dedicated focus on population health. And thus, mitigating member risk across the many existing social barriers must be a highly prioritized go-forward effort within the healthcare sector.

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