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Health plan customer satisfaction challenged by new era of empowered healthcare consumers

A big challenge for health plans is addressing member expectations based on their experiences in other industries.

Jeff Lagasse, Associate Editor

Customer satisfaction among commercial health plan members has improved nationwide, but health insurers are still confronting challenges when it comes to delivering on the financial and personal health expectations of their members.

According to the J.D. Power 2019 Commercial Member Health Plan Study, the key challenges health plans must address are higher co-pays for physician visits and coordination of care between different providers and care settings.

While health plans generally are adept at managing the operational aspects of their business, a bigger challenge is addressing member expectations based on their experiences in other industries. Those industries, such as retail, tend to address service needs more effectively through top-of-the-line technology.

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Health plan members are largely satisfied with their coverage and benefits, but when it comes to factors such as navigating cost issues or choosing between urgent and primary care, a lot of health plans are dropping the ball, the report finds.


Among the key findings is that increased health plan satisfaction is driven by coverage and benefits. Overall, health plan member satisfaction is 713 (on a 1,000-point scale), up 7 points over the previous three years.

The increase, in part, is driven by improved satisfaction with the coverage and benefits offered. Coverage and benefits -- not cost -- is the most important driver of customer satisfaction, now accounting for 25 percent of total health plan member satisfaction.

High copays and lackluster mobile apps are a drag on customer satisfaction, the findings showed. Since 2017, satisfaction increased across nearly all factors in the study, except for cost and mobile app. The decline in cost satisfaction is directly related to high co-pays for physician office visits.

Overall satisfaction scores are 254 points higher when members perceive their plan actively keeps out-of-pocket costs low, help to coordinate care and that there is enough coverage. Yet 54 percent or fewer of health plan members say their plan delivers on each of these criteria.

Meanwhile, alternative treatment channels represent an opportunity for health plans. Growing customer interest in telehealth, urgent care and retail clinics could help alleviate challenges posed by high co-pays.

Among all health plan members, 48 percent say they are either very or somewhat likely to consider telehealth options. That number jumps to 51 percent among Generation Y members. Additionally, 32 percent of all health plan members visited urgent care facilities. Digital access to personal health data and improved coordination of care could encourage further use of these lower-cost treatment channels.


There are promising benefit and cost trends among 28 association health plans, or AHPs, recently launched in 13 states, data released this year by shows.

The analysis, which offers insights about how the market is responding to a new Department of Labor regulation finalized in June 2018, shows a trend toward comprehensive benefits and double-digit cost savings -- although controversy remains surrounding AHPs, particularly when it comes to consumer protections.

The Department of Labor regulation, which is being implemented in stages, makes it easier for small employers to band together to offer lower-cost "large company" health insurance. The breadth of benefits had been one of the biggest concerns among detractors of association-based insurance.

Yet according to the analysis, no evidence of narrow benefit designs was observed in the new AHP benefit descriptions. And advanced features such as health savings accounts also have a strong presence among the new plans.

Twitter: @JELagasse

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