Customer Experience & Relationship Management

Customer Experience
and Relationship Management
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Our members are at the heart of everything we do. To stay true to our objective of providing the best possible care for individuals and communities, we continue to make improvements that simplify and enhance the member experience.

Empowering Medicare Members

We are committed to improving the well-being of our Medicare members through a combination of tools and touchpoints including:��

Providing more ways members can access quality care and their benefits:��We are making it easier for our Medicare members to access their digital plan health information, receive virtual care and compare drug costs. Our new Wellcare Spendables™ card provides members benefits on one, easy-to-use card to cover services and other costs.��

Supporting our members every step of the way:��From the moment they enroll, we provide members with the resources and support they need to manage their health and understand their health plan.

Inspiring members to take charge of their health:��We continue to invest in numerous self-directed tools which give members the ability to navigate their health plan, from reminders to schedule their annual wellness visit, to helping members set up mail-order pharmacy, to answering questions on a particular benefit, we make sure members have the information they need to use their benefits and receive the care they need.��

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Keeping Our Communities Covered

Across each of our Medicaid markets, we are continuously reviewing ways to enhance the member experience through new and ongoing initiatives. We are committed to ensuring the people in our communities have the appropriate health coverage, particularly as redeterminations began in 2023 after a three-year pause due to the COVID-19 pandemic.

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Targeted, direct to market engagement:
Proactive outreach efforts through multiple channels are being conducted to members who need to take action to maintain their coverage. In addition, when members contact our call center, our agents can proactively speak with the person about the need and next steps.��

Community organizations and provider partnerships:
We use our strong community and provider-based partnerships in each of our markets to ensure awareness and education is available in places such as food banks, YMCAs, Boys & Girls Clubs and schools.��

Member support:
We have enhanced our member satisfaction surveys to get more actionable feedback from our members and have invested in new technologies, enhanced call quality review, and streamlined internal structures allowing for better responsiveness to member comments and concerns.
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Programs to Make Marketplace Healthcare More Affordable

Ambetter Health has introduced a few ways to help our members limit their out-of-pocket costs.

Sempre��significantly reduces the financial burden on members by offering lower monthly copayments for timely medication refills.

The Paytient program offers Ambetter Health members in Mississippi, Indiana and Tennessee access to a credit line with no fees or interest, specifically designed for covering medical, dental and vision care expense.

MEASURING CUSTOMER EXPERIENCE

We are dedicated to being a healthcare partner that is reliable, ensuring a positive and convenient experience for our stakeholders. ��о�� uses several metrics and means to measure customer experience and satisfaction such as anonymous and random monthly pulse surveys, HEDIS and Consumer Assessment of Healthcare Providers and Systems (CAHPS). Additionally, Ambetter Health uses metrics such as Customer Satisfaction Score and Net Promoter Score across self-service channels and human-supported transactions.

PROVIDER EXPERIENCE

��о��’s Provider Engagement Operating Model was launched in 2021 to better align our provider-facing teams in the field to the providers they support. The model ensures that every provider has a dedicated Provider Engagement representative serving as the first point of contact for any issue the provider may encounter.

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