Health Plan Care Coordination Key as Beneficiary Satisfaction Climbs

May 17, 2019 - While beneficiary satisfaction with commercial health plans continues to climb, there are still key areas for improvement to drive an overall better consumer experience, according to a recent survey conducted by JD Power.

The JD Power 2019 Member Health Plan Survey, which interviewed just shy of 30,000 commercial health plan members, looked at six key factors influencing health plan member experience. Specifically, the survey asked respondents about billing and payment, cost, coverage and benefits, customer service, information and communication, and provider choice.

Health plans have improved beneficiary satisfaction nearly across the board, earning 713 points on a 1,000-point scale. This is a seven-point increase from surveys conducted three years previously, the report authors said.

Plan coverage and benefits are currently the biggest drivers for beneficiary satisfaction, accounting for nearly 25 percent of satisfaction scores, the report noted.

But there are key areas for improvement, the survey revealed. While members are generally satisfied with their plans across the board, they are looking for better coordination of care between different providers within their networks and more efforts to address their out-of-pocket costs and copays.

READ MORE: Humana Tops List for Member Satisfaction, Net Promoter Score

“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, the managing director of Global Healthcare Intelligence at JD Power.

Consumer satisfaction rose by 254 points when members perceived their plans as actively trying to contain their out-of-pocket costs, coordinating patient care and having enough coverage options. Despite that, fewer than half of health plan members said their payers delivered on these areas, revealing significant room for growth, Beem noted.

“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,” he said.

Emerging care delivery options could be key to improving beneficiary satisfaction, specifically as it relates to tamping down member healthcare spending. As more members express interest in telehealth, retail health, and urgent care centers, they may be able to circumvent the copay challenges.

These care options are often less expensive, and health plans should create supports to help patients navigate them, the report suggested.

READ MORE: Customer Satisfaction with Medicare Advantage Health Plans Remain Low

Overall, 48 percent of all plan members said they are likely to consider a telehealth visit, the survey showed, revealing a proving ground for innovative care delivery models. That number jumps to 51 percent when looking at Generation Y plan members.

There is also room for more retail health or urgent care clinic utilization, with 32 percent of members already saying they have visited these facilities.

While health plans promote use of these less costly options, it will be essential that they help patients select the most appropriate facility for their needs as well as coordinate care between these providers and members’ primary care providers.

Driving patient access to health data could help overcome care coordination challenges. As members become the arbiters of their own medical records they may share that data with different providers within their networks.

Additional survey findings included regional trends in beneficiary satisfaction. Maryland, California, East South Central, Michigan, Illinois/Indiana, and Virginia had the highest ratings among health plan members.

READ MORE: Narrow Networks, Customer Satisfaction Contain Payer Spending

The survey likewise identified the top-performing commercial payers in each of the 22 studied regions. Larger health plans such as Aetna, Cigna, the Kaiser Foundation Health Plan, and regional BlueCross BlueShield organizations came out as plans leading in beneficiary engagement and satisfaction.

This year’s survey tells a similar story to last year’s, noting that beneficiary satisfaction remains steady save for some hiccups related to member engagement and education.

Only 47 percent of last year’s survey respondents said they understood how their health plans worked, while several others noted challenges understanding pre-approvals and other administrative tasks.

“Amidst the consolidation activity this past year, the one area where top-performing health plans can really set themselves apart in the eyes of their members is to help them better understand how to navigate the healthcare system, including how their plan works and cost-effective access points for care,” Valerie Monet, Senior Director of US Insurance Operations at JD Power, said of last year’s survey results. “The key is effective communication.”

As health plans continue that work to drive patient navigation and health plan literacy, they must also tap the key tools to tackle patient costs and care coordination.