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Integrated Delivery Systems Outperform Traditional Health Insurance Models

COSTA MESA, Calif.: 25 May 2017 — Coordination of care among healthcare providers is the single most important criteria influencing member satisfaction with their health plan, according to the J.D. Power 2017 Member Health Plan Study,SM released today.

 “Amidst sweeping changes in healthcare delivery and payment models, our data is showing that the one thing consumers value most is clear-cut, easy access to doctors and other healthcare providers,” said Valerie Monet, senior director of U.S. insurance operations at J.D. Power. “This puts health insurers in a unique positon because so much of their perceived value is reliant upon positive interactions with providers. These findings set the stage for the future of healthcare in which close coordination among health plans and providers that reduces friction points for members will be the key to success.”

 Key Findings

  • Close coordination is lacking among health plans and providers: The single most effective lever of health plan member satisfaction is helpful coordination of care among doctors and other healthcare providers. The ability to help members successfully navigate among providers is associated with a 136-index point (on a 1,000-point scale) increase in overall customer satisfaction.  Yet, just 25% of health plan members report receiving this service from their health plan.
  • Integrated delivery systems dominate rankings: Health plans that utilize an integrated delivery system (IDS)—a network of healthcare and health insurance organizations presented to members as a single delivery organization—outperform traditional health plans on every factor measured in the study.
  • Presenting low-cost narrow network options improves satisfaction: Although having access to a limited network of care providers can potentially become a friction point for members, health plans that have a narrow or tiered network also have the potential to reduce costs for commercial health plan members. Regardless of product choice, members who were presented with lower-cost narrow network options were significantly more satisfied with their health plan versus those who were not offered such an option or did not know whether it was offered. However, just 33% of respondents say they were offered a narrow network option.
  • The effect of payer-provider alliances is mixed: Aetna, Cigna, Anthem, and many other providers have begun to offer commercial products in collaboration with specific providers in the past few years. Partnerships vary from less integrated contractual agreements to highly integrated health system purchases. J.D. Power found mixed results when it examined member satisfaction with the plans in instances when members are being served by providers that are a part of a collaborative care model. Expected improvements in satisfaction related to relationship with the physician were seen in some areas but not in others. Regardless of the satisfaction associated with the plans/products at a high level, there is significant opportunity to improve member understanding of how a plan works and what is covered in advance of enrollment.

Study Rankings

Satisfaction is highest among health plan members in the five regions: Maryland (723); East South Central (722); California (716); Michigan (716); and Ohio (714). Satisfaction is lowest among members in the Colorado (676) and Northeast (682) regions.

Kaiser Foundation Health Plan ranks highest in six regions: Maryland, South Atlantic, California, Virginia, Northwest and Colorado. The following plans rank highest in at least one region: Highmark BlueCross BlueShield of Delaware; BlueCross BlueShield of Tennessee; AvMed; Wellmark BlueCross BlueShield of Iowa; Health Alliance Medical Plans; BlueCross BlueShield of Massachusetts; Health Alliance Plan of Michigan; Unity Health Plans; SelectHealth; Horizon BlueCross BlueShield; Capital District Physicians Health Plan; BlueCross BlueShield of Vermont; Medical Mutual of Ohio; UPMC Health Plan; BlueCross BlueShield of Arizona; and Humana.

The Member Health Plan Study, now in its 11th year, measures satisfaction among members of 168 health plans in 22 regions throughout the United States by examining six key factors: coverage and benefits; provider network; communication; claims processing; premiums; and customer service. The study also touches on several other key aspects of the experience including plan enrollment and member engagement.

The study is based on responses from 33,624 commercial health plan members and was fielded in January-March 2017. To see comprehensive health plan rankings for all 22 U.S. regions, visit www.jdpower.com.

For more on the study, visit http://www.jdpower.com/resource/us-member-health-plan-study.

See the online press release at http://www.jdpower.com/pr-id/2017065.

J.D. Power is a global leader in consumer insights, advisory services and data and analytics. These capabilities enable J.D. Power to help its clients drive customer satisfaction, growth and profitability. Established in 1968, J.D. Power is headquartered in Costa Mesa, Calif., and has offices serving North/South America, Asia Pacific and Europe.

Media Relations Contacts
Geno Effler; Costa Mesa, Calif.; 714-621-6224; media.relations@jdpa.com
John Roderick; St. James, N.Y.; 631-584-2200; john@jroderick.com

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Media Contacts:

Geno Effler

Costa Mesa, California

(714) 621-6224

media.relations@jdpa.com