COSTA MESA, Calif.: 9 May 2019 — 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,SM released today, the key challenges health plans must address are higher co-pays for physician visits and coordination of care between different providers and care settings.
“Health plans are doing a good job managing the operational aspects of their businesses, but they are having a harder time addressing the expectations members have based on their experiences in other industries where their service needs are more effectively addressed with better technology,” said James Beem, Managing Director, Global Healthcare Intelligence at J.D. Power. “Across the board, health plan members are satisfied with the coverage and benefits they have, but once they start looking to their health plans for guidance in areas like navigating issues related to cost or when to use primary care versus urgent care, many plans miss the mark on customer expectations.”
Following are some of the key findings of the 2019 study:
- Increased health plan satisfaction 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% of total health plan member satisfaction.
- High co-pays and lackluster mobile apps drag on customer satisfaction: Since 2017, satisfaction increases across nearly all factors in the study, except 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, helped coordinate care and that there was enough coverage, yet 54% or fewer of health plan members say their plan delivers on each of these criteria.
- Alternative treatment channels pose 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% say they are either very or somewhat likely to consider telehealth options. That number jumps to 51% among Gen Y1 members. Additionally, 32% 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.
Regional Study Rankings
Overall satisfaction is highest among health plan members in these six regions: Maryland (734); California (725); East South Central (725); Michigan (725); Illinois/Indiana (723); and Virginia (722).
Following are the top performers in each of the 22 regions included in the study:
- California: Kaiser Foundation Health Plan (792)
- Colorado: Kaiser Foundation Health Plan (741)
- Delaware/West Virginia/Washington, D.C.: Aetna (721)
- East South Central: Cigna (742)
- Florida: AvMed (774)
- Heartland: BlueCross BlueShield of Oklahoma (723)
- Illinois/Indiana: Health Alliance Medical Plans (734)
- Maryland: Kaiser Foundation Health Plan (799)
- Massachusetts: BlueCross BlueShield of Massachusetts (708)
- Michigan: Health Alliance Plan of Michigan (734)
- Minnesota/Wisconsin: HealthPartners (727)
- Mountain: SelectHealth (726)
- New Jersey: Cigna (714)
- New York: Capital District Physicians Health Plan (774)
- Northeast: Anthem BlueCross BlueShield of Connecticut (721)
- Northwest: Kaiser Foundation Health Plan (739)
- Ohio: Aetna (732)
- Pennsylvania: Capital BlueCross (722)
- South Atlantic: Kaiser Foundation Health Plan (805)
- Southwest: BlueCross BlueShield of New Mexico (708)
- Texas: BlueCross BlueShield of Texas (710)
- Virginia: Aetna (726)
The Commercial Member Health Plan Study, now in its 13th year, measures satisfaction among members of 146 health plans in 22 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 28,809 commercial health plan members and was fielded from January through March 2019.
For more information about the Commercial Member Health Plan Study, visit https://www.jdpower.com/business/resource/commercial-member-health-plan-study.
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 has offices serving North America, South America, Asia Pacific and Europe.
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