Resource
Center:
Strategies for Improving Health Plan Member Retention and Loyalty
Retaining members is an issue of increasing concern to managed health care organizations. Aggressive new member acquisition, common in the early stages of managed care, is giving way to an emphasis on winning members' loyalty. Loyal members are unlikely to switch to competing plans. To gain a member's loyalty, a plan must continually develop its connection with the member by providing high-quality information, assistance, problem-solving, and care. Member retention requires an ongoing commitment to nurture the relationship with each and every member.
Step #7: Improve Access to Medical Professionals
It is imperative to have a relatively stable and accessible provider network. The lack of availability of, or relatively convenient access to, chosen/preferred providers are primary reasons individuals (and plan sponsors) will defect. One of the most frequently cited reasons for member complaints is the inability to see a specialist without having to obtain a referral from a primary care physician (PCP). Like other issues that relate to access, referral processes continue to be a source of intense member dissatisfaction.
As a result, we are witnessing increasing experimentation with plan designs that minimize access barriers to specialists by members. Two examples include: direct access to a limited set of specialties (e.g., OB/GYN, ophthalmologist, pediatrician) and no prior authorization for all but a few specialty referrals requested by some (or all) PCPs. Early experience suggests that many (most) members see a PCP prior to a specialty visit but are highly satisfied with the additional freedom of choice that is offered.
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