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Health plans have a consumer engagement problem, J.D. Power finds

The overall satisfaction score for commercial health plans was 719 out of 1,000, among the lowest of all industries evaluated by J.D. Power.

Susan Morse, Managing Editor

Sixty percent of privately insured U.S. health plan members said they had not been contacted by their health plan with guidance or information related to COVID-19, and nearly half (48%) said their health plan has not shown concern for their health since the pandemic began, according to the J.D. Power 2020 U.S. Commercial Member Health Plan Study.

The findings show that health plans have not gained customer centricity, as just 36% of commercial health plan members said their health plan acts in their best interest "always" or "most of the time," and just 25% said they view their health plan as a trusted partner in their health and wellness.

This lack of a customer-centric positioning results in an overall satisfaction score this year for commercial health plans of 719 on a 1,000-point scale, among the lowest of all industries evaluated, J.D. Power said.

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Proactive efforts by health plans to engage with members – by providing advice on how to control costs or helping to coordinate care – drive significant improvement in overall customer satisfaction. For example, when a health plan helps members keep out-of-pocket costs low, the average overall satisfaction score is 819, which is 152 points higher than when no such effort is made.

Expanding telehealth usage is associated with a 39-point increase in overall customer satisfaction.

The study was done largely before the COVID-19 pandemic hit the United States, but based on additional J.D. Power research conducted from March 15 to May 1, 75% of U.S. health insurance members are aware of telehealth, yet 54% do not understand if telehealth services are offered as part of their healthcare benefits.

The study measured customer satisfaction with commercial member health plans in 21 geographic regions. Highest-ranking health plans with scores of over 750 were:

  • California: Kaiser Foundation Health Plan (784)
  • East South Central: Blue Cross and Blue Shield of Alabama (761)
  • Florida: Humana (783)
  • Maryland: Kaiser Foundation Health Plan (802)
  • New York: Independent Health Association (783)
  • South Atlantic: Kaiser Foundation Health Plan (791)
  • Texas: Humana (797)

WHY THIS MATTERS

The results send a pretty big warning to traditional health insurers, J.D. Power said, and makes the industry ripe for disruption from a growing crop of alternative health insurance providers.

THE LARGER TREND

The U.S. Commercial Member Health Plan Study, now in its 14th year, measures satisfaction among members of 149 health plans in 21 regions throughout the United States by examining six key factors: billing and payment, cost, coverage and benefits, customer service, information and communication, and provider choice.

The study also measures several other key aspects of the experience and member engagement.

The study is based on responses from 31,283 commercial health plan members from January through March 2020.

ON THE RECORD

"Health plans are widely perceived as lacking a customer-centric mindset and not putting the best interests of their members first," said James Beem, managing director for global healthcare intelligence at J.D. Power. "The COVID-19 pandemic has amplified these shortcomings, but they are not new. If traditional health insurance plans want to resist the threat from disruptors, they need to demonstrate partnership with members – and on behalf of employers – to improve member health, reduce costs and help members navigate the healthcare system."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com