Health Plan Customer Satisfaction Improved, but Era of Consumerism Proves Challenging

May 9, 2019
Nearly half of health plan members said they are at least somewhat likely to consider telehealth options

Customer satisfaction among commercial health plan members has improved nationwide, but payers are still confronting challenges with delivering on the financial and personal health expectations of their members, according to a new study from market researcher J.D. Power.

The firm’s “2019 Commercial Member Health Plan Study” measured satisfaction among members of 146 health plans in 22 regions throughout the U.S.  by examining six key factors: billing and payment; cost; coverage and benefits; customer service; information and communication; and provider choice. It revealed that the key challenges health plans must address are higher co-pays for physician visits and coordination of care between different providers and care settings. Some key healthcare and health IT-related findings of the study include:

  • 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 percent of total health plan member satisfaction, according to the research.
  • 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 percent 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 percent say they are either very or somewhat likely to consider telehealth options. Additionally, 32 percent 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, the researchers stated.

“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,” James Beem, managing director, global healthcare intelligence at J.D. Power, said in a statement “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.”