More on Strategic Planning

Payers rank member satisfaction as top priority, value-based care as last

New research suggests an evolution in the way health plans think about patients increasingly as consumers.

Susan Morse, Managing Editor

While member satisfaction is the first priority for insurers, the shift to value-based care surprisingly came in last among six possible answers in a new HealthEdge survey. 

In partnership with independent research firm Survata, Boston-based HealthEdge collected responses from 73 health plan executives in a survey that set out to determine their top goals, challenges, and strategies.

The most important organizational goal for the C-Suite? Member satisfaction. 

This was a bit unexpected, especially as it far surpassed the number two response: to lower costs, according to Harry Merkin, vice president of marketing at HealthEdge.

"That indicates an evolution in thinking on the part of health plans," Merkin said. "It seems to me the thinking is, members are not just members, they are consumers and they have needs beyond being covered by health insurance."

Customer service ratings for health plans have traditionally ranked below that of other industries such as retail, travel and financial services. 

As their third organizational goal, executives chose to improve provider relationships, followed by increasing membership,  regulatory compliance and in dead last, a shift to value-based models.

This is in stark contrast to a recent Amazon, Berkshire Hathaway and JPMorgan Chase development in which JPMorgan Chase CEO Jamie Dimon laid out in his his annual letter to shareholders the top tenets that will guide the new healthcare consortium. At the top is embracing value-based care models.

The HealthEdge survey next asked about the top three challenges facing organizations.

The top answer given by 62 percent, close to two-thirds of respondents, was the cost structures standing in the way of innovation. Second was lack of alignment among key external stakeholders such as provider networks and community resources. Third was the need to update processes for businesses.

This was followed by keeping up with constantly changing regulations, the skill sets of people, technology and the lack of alignment among internal IT and business teams.

"Their thinking was about how to reallocate resources," Merkin said.

A pretty significant margin of 59 percent said they would modernize technology as the first step towards improvement, in answer to the last question, what steps they were planning on taking to achieve these goals.

Secondly, they would upgrade workforce skills and the number three answer was to update processes.

"We feel strongly and positively this is the voice of the market," Merkin said. "This in our view is an evolution. Health plans are thinking about evolution, change, that they have customers in the form of consumers, have partners in providers and want to make upgrades in the company. This is a great framework." 

HealthEdge works with payers on core administration systems such as claims processing and in a care coordination software that gives  health plan medical management the analytics to put together a care plan for improved outcomes and lower costs.

Clients include Aetna, community health plans and most recently, Blue Cross and Blue Shield of Nebraska.

Twitter: @SusanJMorse
Email the writer: