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Member experience isn’t just a once-a-year sprint during CAHPS season—it’s a year-round strategy that drives satisfaction, trust and outcomes. While February through June brings the familiar flurry of survey collection—and when member experience may be most top-of-mind for plans—the reality is that lasting improvements happen well before and go far beyond the CAHPS survey window.
The smartest plans are already shifting their mindset. They know member experience isn’t just about a better Star Rating; it’s about building long-term trust, reducing churn and improving outcomes. And one of the most powerful tools to improve member experience? Behavioral science.
By understanding how people think, feel and act—and designing experiences around insights—plans will not only transform their relationship with members, but truly move the needle on member experience, satisfaction and retention all year long.
Why CAHPS Still Matters—Even with Changed Weighting
There’s been a lot of buzz about CMS’s decision to reduce CAHPS weighting from 4x to 2x starting with Stars 2026. While it’s true this change will affect how CAHPS measures contribute to overall Star Ratings, make no mistake—CAHPS still matters.
The CAHPS survey remains the gold standard for measuring the member experience. Scores reflect members’ ratings of their healthcare experience, access to services, the effectiveness of their health plan’s communications and their overall satisfaction with the plan.
Strong CAHPS scores reflect positive member experiences, the advantage of which extends far beyond Star Ratings, and can include:
- Word of mouth growth with members who are more likely to recommend the plan
- Lower member churn, allowing plans to improve retention and reduce costly disenrollments
- Fewer grievances and appeals, reducing internal administrative burden
- Stronger engagement, translating to better performance on other measures (e.g. medication adherence), improved outcomes and lower costs
Member experience is directly influenced by how satisfied members are with your plan, and this satisfaction is shaped by every interaction they have throughout the entire plan year.
Behavioral Science: The Key to Understanding—and Elevating—Member Experience
So, how do you improve something as complex and personal as experience? You start by understanding behavior.
Behavioral science is the study of how people think, make decisions and act. In healthcare, it offers a framework for designing interventions grounded in empathy, evidence and aligned with how people really behave.
At AdhereHealth, we use behavioral science to:
- Identify reasons for members’ nonadherence, such as competing life priorities, misinformation or distrust
- Build trust with members by using affirming language, active listening and a nonjudgmental discourse
- Use collaborative problem-solving conversations to guide members toward solutions
- Increase satisfaction by helping members feel seen, heard and supported throughout their journey
When we pair this approach with omnichannel outreach—by phone, SMS text, mail or email—we meet members “where they are,” in the ways they prefer. Engaging with members year-round, not just during CAHPS season, helps build consistency, which is crucial for earning their trust and improving their view of the plan.
Best Practices for MA Plans to Improve Member Experience
To achieve sustainable improvements in member experience, MA plans must adopt strategies that are both high-touch and high-tech. Here’s what that looks like:
1. Partner with tech-enabled vendors leveraging behavioral science
Scaling member experience requires a blend of smart technology and behavioral science expertise. It helps to work with a tech-enabled vendor that uses data insights (like missed refills or care gaps) to identify members’ needs early, and smart workflow technology that guides clinicians in their outreach and interventions, rather than reliance on a basic call list. Vendors that provide training in behavior change techniques empower clinicians to more effectively engage members. This recipe helps members overcome their barriers, resulting in members having better experiences with the plan.
2. Use omnichannel capabilities to meet members “where they are”
Not all members want a phone call. Others don’t check their email. The key is offering flexible communication modes—such as voice, SMS text and mail—and tailoring outreach based on preferences and engagement history. An omnichannel approach ensures your message uses the right channel for the right member and resonates.
3. Deliver personalized, actionable guidance
A generic message won’t cut it. Members need specific, relevant and achievable steps to move forward—whether it’s to refill a prescription, schedule a check-up or understand a health plan benefit. Personalized support shows members you’re listening, not just broadcasting.
4. Monitor engagement and adherence all year long
If you only measure satisfaction during CAHPS season, you’re missing the bigger picture. Plans have the opportunity to track member engagement, adherence and access challenges throughout the year to spot early signs of dissatisfaction and act before issues escalate.
5. Act early based on data signals
Behavioral signals—non-responsiveness, missed refills, missed appointments—can indicate initial challenges. With these data, plans can intervene early before minor issues become major problems. AdhereHealth’s healthcare data analytics platform and clinical team surface member-specific barriers—like cost concerns or transportation issues—enabling quick resolution to improve members’ experience and outcomes.
A Year-Round, Science-Backed Strategy for Better Experiences
Improving member experience isn’t about scrambling during CAHPS season—it’s about being present all year long.
Every interaction shapes how members feel about their plan. A consistent, behavioral science–driven approach ensures every touchpoint with a member builds trust, encourages engagement and leads to better outcomes. Plans that embrace this strategy will see higher CAHPS scores, stronger retention and lower costs.
As CAHPS season unfolds, it’s important to remember that member experience isn’t just a metric—it’s a mindset. It’s not about checking a box once a year. It’s about building relationships, showing up consistently and supporting members in ways that matter.
Looking to improve engagement while boosting adherence and experience with your plan? Check out AdhereHealth’s strategic adherence solutions. Contact us today to learn more!
Authored by:
Dr. Chandra Y. Osborn
Chief Experience Officer at AdhereHealth
