Three strategies for actionable member journey mapping

To create effective journey maps, plans must focus holistically on the right member experience using the following three strategies:

• Narrow in on a member goal by selecting specific care episodes and customer segments.


• Identify all potential pitfalls by engaging multiple plan departments.


• Gather a comprehensive list of pathways from provider and non-provider stakeholders.

Read below for case studies reviewing how health plans have deployed each of these three strategies.

Narrow in on a member goal by selecting specific care episodes and customer segments.

While plans may be tempted to map all possible journeys for all types of members, this will prove to be overwhelming. Plans must narrow their scope to focus on costly, high-volume care episodes and customer segments that are highly impactable.

WASHCA’s Joint Replacement Bundle
Washington State Health Care Authority (WASHCA) worked with Premera and Virginia Mason (VM) to create a journey map and accompanying joint replacement bundle for members. WASHCA identified total knee joint replacement as one of the most frequent procedures with high cost and quality variation—costing between $23,659 and $66,647 across 23 hospitals around the state.


Learn more about WASHCA’s Joint Replacement Bundle 

Identify all potential pitfalls by engaging multiple plan departments.

Different plan departments view member needs differently and each makes member experience improvements in isolation. Since nobody owns the end-to-end care experience, some consumer frictions are missed and improvement efforts are fragmented.

Horizon’s Customer Experience Champion Certification
Horizon involves staff across different departments to identify member frictions and embed customer experience improvements into its journey maps. The plan trained a select group of mid-level employees across the organization to identify and highlight member experience frictions throughout their daily work. The employees get certified as “C-Experts” after an all-day immersion training, during which they are asked to map out and think about how their department or function ultimately impacts members’ experience.

Learn more about Horizon’s Customer Experience Champion Certification 

Gather a comprehensive list of pathways from provider stakeholders.

Successful journey maps must gather information from all provider stakeholders. This guarantees an understanding of member pain points from multiple interactions in a care journey.

Bright Health’s Partner Capability Assessment
As part of its tightly integrated and aligned Clinical Model, Bright Health conducts assessments of its provider partners to identify improvement opportunities. For instance, Bright worked with a provider to understand why they had a high out-of-network ER utilization rate for their members. They mapped the patient journey from when they present at the out-of-network ER facility to their next follow-up appointment. Bright Health’s assessments included expert interviews with ER physicians, EMTs, and nurses, demos and process mapping, and quantitative analysis to identify gaps in awareness and effectiveness. Plan staff even tested services at the ER facilities themselves.


Learn more about Bright Health’s Partner Capability Assessment