Complaints received March 2026
Case per 1K YOY Volume
1705
Members
1846
Cases
2116
Complaints
Case Rate per 1,000 Members
March: 3.86
2026 Goal: 3.5
2027 Goal: 2.18
Month over Month
Top Issues
Health Plan
Category % of change MOM
Volume
Enrollment & Premium Billing /KP Individual & Family
2%
465
Billing
13%
193
Prescription Related- Pharmacy and Provider
27%
104
Service Area
Category % of change MOM
Volume
Appointments
15%
189
Referral
31%
55
Delay/Failure in contacting
5%
58
Spotlight
Most Improved
Kaiser Permanente Georgia
Cases per 1,000 Members 3.9 MoM
(1777 to 1846)
Drivers: The top 3 Complaint Categories driving the volume are: Clinical Service, Access, and the Health Plan. The complaints focus on Communication, behavior, and delay in contacting patients. The MoM complaint volume decreased for February. Access continues to be in the top category, and the Health plan with the Enrollment Ancillary & Supplemental Benefit.”The dissatisfaction with covered benefits, out-of-pocket costs, network access, or services related to Medicare Supplemental benefits.
Actions: More awareness of member frustrations through Regional Leaders sharing member comments at huddles and team meetings. Attend operational meetings with MOB Leaders to review quarterly month-over-month complaint performance. By sharing actionable data insights, increasing awareness of key drivers, and fostering cross-functional collaboration with departments, leaders are equipped to identify targeted improvement opportunities.
Service Area
Clinical Quality
Volume 12% MoM
(156 to 175)
Drivers:
- The increase in volume is primarily driven by the Diagnosis and Treatment Care, Advice given and Referral sub‑category, which increased 35% month‑over‑month
- Key issues include concerns about treatment quality and dissatisfaction with the advice provided.
Actions:
- Prioritize improvements in Care Coordination
- Use member‑reported abrasion data from multiple VoC channels to inform decisions and action planning.
- Leverage CXi3 and JAM sessions to support cross‑functional collaboration.
Shared Services
Health Plan
Volumes -42% MoM
(973 to 567)
Drivers:
All subcategories in this area saw a decrease, except for the Enrollment & Premium billing-KP Individual & Family, which increased by 2% month over month. Ancillary & Supplemental benefit concerns decreased by –36%.
Actions: The efforts of the Medicare improvement strategies are showing slightly in the month-over-month complaints. The efforts are in place to ensure all KPIF members have a smooth transition into the network.
Voice of the Member
”"Everyone was very kind and professional. They explained everything and gave me what I needed.
”"I am a new patient at Kaiser. Upon arriving to my appointment, a doctor welcomed me and walked me into the facility showing me where I needed to go and what I needed to do regarding my appointment. After seeing the doctor, I was escorted to the lab department where I had blood drawn. Thereafter, I visited the pharmacy to have a prescription filled. " Thank You.
A message from:
Leslie M. Blair, Vice President, Marketing, Communications, Community Relations, Community Health and Care Experience
Christina Martin MBA, MHA, CPXP Director, Care Experience Strategy
Christopher Jones, M.D., AMD, Access, Care Transformation, and Outside Medical, The Southeast Permanente Medical Group
Alan F. Johnson, MHA, LSSBB, Director, Access, Strategy, and Care Experience, The Southeast Permanente Medical Group
Chaundrissa M.O. Smith PhD, ABPP, Clinician Program Director, Care Experience Enculturation, Licensed Clinical Psychologist, Kaiser Permanente, Department of Behavioral Health