J.D. Power and Associates is reporting overall health plan member satisfaction has declined "significantly," according to the company's 2010 U.S. Member Health Insurance Plan Study released this week.
The study - now in its fourth year - 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.
According to J.D. Power and Associates, overall member satisfaction averaged 701 on a 1,000-point scale. This is a slide from 712 in 2009 and falls 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 health care 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."
However, health plans can create a foundation for a more satisfying member experience, Dougherty says, 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, according to the study, 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.
Member perceptions of health care reform:
Only 10 percent of health plan members say they completely understand the health care 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 health care system introduced by health care 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 health care coverage will be worse as a result of the changes to the health care system, while just 9 percent say it will be better.
"The recent health care debate has demonstrated just how complicated the health insurance market can be," said Dougherty. "While the full implications of the recent health care 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."
Dougherty says 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.
Top Three Plans in Overall Member Satisfaction by Region
*No other plan in this region performs above the region average.
Arizona-Utah
Highest: SelectHealth
BlueCross BlueShield of Arizona
UnitedHealthcare
California*
Highest: Kaiser Foundation Health Plan
Colorado
Highest: Kaiser Foundation Health Plan
Great-West Healthcare
CIGNA
East South Central
Highest: BlueCross Blue Shield of Alabama
CIGNA
Humana
Florida
Highest: CIGNA (tie)
Highest: UnitedHealthcare (tie)
Blue Cross and Blue Shield of Florida
Heartland
Highest: BlueCross BlueShield of Nebraska
Wellmark BlueCross Blue Shield
BlueCross BlueShield of Kansas City
Illinois-Indiana*
Highest: BlueCross BlueShield of Illinois
Michigan*
Highest: Health Alliance Plan (HAP)
Priority Health
Minnesota-Wisconsin
Highest: Dean Health Plan
HealthPartners
BlueCross BlueShield of Minnesota
New England
Highest: Harvard Pilgrim Health Care
Tufts Associated Health Plans
Blue Cross Blue Shield of Rhode Island
New York-New Jersey
Highest: Independent Health Association
Aetna
BlueCross BlueShield of Western New York and BlueShield of Northeastern New York
Northwest
Highest: Group Health Cooperative
Providence Health Plan
Kaiser Foundation Health Plan
Ohio
Highest: Humana
Medical Mutual of Ohio
CIGNA
Pennsylvania
Highest: Capital BlueCross
Highmark Blue Cross Blue Shield
Geisinger Health Plan
South Atlantic
Highest: Kaiser Foundation Health Plan
BlueCross BlueShield of North Carolina
UnitedHealthcare
Texas
Highest: Humana
BlueCross BlueShield of Texas
UnitedHealthcare
Virginia-Maryland-D.C.
Highest: Kaiser Foundation Health Plan
Anthem Blue Cross and Blue Shield of Virginia
CareFirst BlueCross BlueShield
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