Health plan members not satisfied

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Published: April 5,2010

Tags: health insurance, healthcare

After improving slightly in 2009, overall health plan member satisfaction has declined significantly in 2010, according to the J.D. Power and Associates 2010 U.S. Member Health Insurance Plan Study released today.

Now in its fourth year, the study measures satisfaction among members who purchased their coverage individually or through their employer from 133 health plans in 17 regions throughout the U.S. The study examines seven key factors: coverage and benefits; provider choice; information and communication; claims processing; statements; customer service; and approval processes.

Overall member satisfaction averages 701 on a 1,000-point scale, declining from 712 in 2009 and falling below 2008 levels. Member satisfaction has declined in all factors except customer service, where satisfaction has remained flat, with notable decreases in coverage and benefits and information and communication.

“This significant decline in overall satisfaction is partially driven by a lack of members’ understanding of their plan’s coverage and benefits and how to successfully access them,” said Jim Dougherty, director of the healthcare practice at J.D. Power and Associates. “Understanding alone does not explain member satisfaction, although it may help to mitigate other problems with the member experience. While satisfaction with many plans has declined this year, satisfaction decreases are less severe for those plans able to substantially increase member understanding.”

According to Dougherty, health plans can create a foundation for a more satisfying member experience by providing new and existing members with a better understanding of their coverage, and by proactively communicating with subscribers about impending changes in benefits, physician or hospital networks or costs. Overall, members with higher levels of understanding tend to be more loyal and are better advocates for the health plan. However, only four in 10 members say they fully understand their plans.

Health plan members in Pennsylvania, Michigan and New England remain the most satisfied with their health plan experience overall, although the average satisfaction score in each region has decreased significantly in 2010, compared with 2009. Member satisfaction in the Illinois-Indiana region remains constant, compared with 2009, moving the region to rank among the regions with the highest satisfaction scores in 2010.

Health plans ranking highest in their respective regions are (in alphabetical order): BlueCross BlueShield of Alabama; BlueCross BlueShield of Illinois; BlueCross BlueShield of Nebraska; Capital BlueCross; CIGNA (which ties to rank highest in Florida); Dean Health Plan; Group Health Cooperative; Harvard Pilgrim Health Care; Health Alliance Plan (HAP); Humana (which ranks highest in the Ohio and Texas regions); Independent Health Association; Kaiser Foundation Health Plan (which ranks highest in the California, Colorado, South Atlantic and Virginia-Maryland-Washington D.C. regions); SelectHealth; and UnitedHealthcare (which ties to rank highest in Florida).

The study also finds the following regarding member perceptions of healthcare reform(1):

• Only 10 percent of health plan members say they completely understand the healthcare reforms, while 57 percent say they partially understand them. More than one-fourth of members say they don’t understand the reforms at all.

• Eleven percent of health plan members say the changes to the healthcare system introduced by healthcare reform laws will result in the loss of their current coverage, while 56 percent say they don’t know whether their coverage will be affected.

• Forty percent of health plan members say their healthcare coverage will be worse as a result of the changes to the healthcare system, while just 9 percent say it will be better.

“The recent healthcare debate has demonstrated just how complicated the health insurance market can be,” said Dougherty. “While the full implications of the recent healthcare reforms will not take effect for a number of years, it is likely that individual consumers will have more choices than they have had in the past due to new exchanges and portability. Different segments of the population may have widely divergent expectations about the benefits and costs of reform, but one key constant in elevating satisfaction for all members is for health plans to proactively communicate to help subscribers avoid any unpleasant surprises.”

According to Dougherty, plans that focus on building relationships through member education, communication and reliable, consistent delivery of health insurance services and that effectively manage member expectations during periods of change; will likely have a competitive edge.

Among members who are able to choose their carrier, those with the highest satisfaction levels (901 points or higher) are seven times more likely to remain with their carrier in the future and 13 times more likely to recommend their carrier to others, compared to those with the lowest satisfaction levels (550 points or less).

The 2010 U.S. Member Health Insurance Plan Study is based on responses from nearly 34,000 members of commercial health plans. Members were surveyed online in Nov. and Dec. 2009.

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