3 Strategies to Elevate Member Experience Now

For healthcare companies that provide Medicare and Medicaid services, Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores are a key measure of patient experience. The survey results can significantly impact reputation, retention and reimbursements, so how can companies get ahead of delivering what matters most? 

Here are three strategies to enhance member experience scores quickly.

Build a skilled, empathetic member support team

A patient's first impression of their healthcare provider often begins with an interaction with a service advocate — whether scheduling an appointment, navigating insurance coverage, addressing a billing concern or resolving a claims issue. The quality of that experience shapes their trust and confidence in their care journey. 

But the reality is, only 57% of enrollees surveyed agreed that “customer service gave necessary information or help,” according to the 2024 CAHPS Health Plan Survey Database Chartbook.

To meet expectations, prioritize hiring skilled customer support — people with healthcare experience, strong problem-solving skills and the ability to communicate clearly and compassionately.

Go beyond basic training by immersing teams in hands-on learning programs that prioritize member satisfaction. Equip them with the skills to not only deliver exceptional experience but also to navigate complex call issues — such as prior authorizations, provider network and appeals.

Experiential learning might include:

• Role-playing and simulations to mimic real-world situations: This allows them to practice handling difficult conversations and navigate sensitive situations in a safe learning environment.

• Mentorship programs: Pairing experienced advocates with newer team members provides a valuable opportunity for knowledge transfer and allows newer advocates to learn from experienced professionals.

• Case study reviews: Regular review and discussion of real-life success stories provides concrete examples of how to apply learned concepts.

Regulations and offerings change constantly, so regular coaching and continuous skill development programs are important to fortify competency and confidence in managing more challenging situations.

Invest in team well-being to prevent compassion fatigue

The work of any service team is demanding — especially in healthcare where advocates manage sensitive patient interactions. Preventing burnout and compassion fatigue is crucial since exhausted advocates are more likely to rush conversations, leading to unresolved issues and poor patient experiences.

Repeated calls from patients whose concerns remain unaddressed erode trust and create frustration with their healthcare providers.

Burnout also leads to turnover, leading to institutional knowledge loss and increased costs to train new employees. The U.S. Bureau of Labor Statistics reports that about 2% of healthcare and social workers quit each month in 2024. 

To keep talent as well as preserve valuable expertise, organizations must take a more proactive approach to employee engagement and well-being. Providing flexible scheduling, career development opportunities and scientifically-based mental health support makes a measurable difference in morale, performance and retention. 

For example, integrating mindfulness programs can empower employees to self-manage stress, sharpen focus and build emotional resilience. Additionally, establishing peer support groups fosters a sense of community and mutual learning. 

Beyond well-being programs, community engagement activities also deepen support teams' understanding of the different populations they serve. Encouraging civic engagement cultivates empathy and cultural competency, leading to more compassionate service.

Apply AI to boost efficiency without losing the human touch

While AI is known for cost and scalability benefits, its true power lies in enhancing — not replacing — human interactions. About 70% of the healthcare executives are prioritizing investments in digital tools and services.

For example, chatbots automate routine tasks (eligibility checks and appointment scheduling), freeing frontline teams to focus on more complex cases. Knowledge mining tools provide quick access to a bank of answers and information, which speeds up representatives’ time to respond while enhancing accuracy and personalization. 

AI also helps reduce administrative burden from transcription and documentation work, allowing additional time for advocates to build rapport with members. 

Real-time insights from sentiment analysis and speech analytics tools also empower advocates to tailor their approach based on a caller’s tone and emotions as well as address recurring issues and anticipate future ones.

Better support, better outcomes

At the heart of every successful healthcare organization is a commitment to its members and patients. By investing in service team expertise, prioritizing advocate well-being and strategically leveraging AI support, organizations can create more meaningful patient interactions and lasting positive experiences. 

And while improving metrics is important, it’s not the true goal – it's about transforming healthcare interactions into empathetic, efficient experiences that put patients first and build enduring trust in the system.