More than half of health plan members less than happy with coverage, survey finds

More people are “extremely satisfied” with their Medicaid and Medicare health plans than are those covered by an employer sponsored plan.

That’s one striking takeaway from a recent survey by HealthEdge, a SaaS solutions provider for core administration, payment integrity, care management, and member experience clients. HealthEdge’s results are based on responses from 2,800 plan members representing a spectrum of plan types.

Respondents were asked a series of questions designed to elicit their satisfaction level with their plans, and to learn what actions might improve their experience.

Overall, the survey found that 38% of employer sponsored plan members were “extremely satisfied” with their plan. That compares to a 44% satisfaction response from Medicaid and Medicare plan members, and a 52% satisfaction return for those with dual eligible plans.

Medicare plan members have access to as many as 39 plan options, and Medicaid plans are also increasing in number. That range of choices was cited as increasing satisfaction among those respondents.

None of those satisfaction levels was considered particularly laudable by HealthEdge, however. When respondents were asked what health plans could do to increase satisfaction, their top five responses were:

• Incentives and rewards for healthy behaviors
• Easy access to health records
• Access to providers who offer care based on member preferences and personal traits
• Good customer service
• Tools or information to help members find less costly care

Two focus areas emerged from the survey that, taken together, addressed most of these responses: Personalized care coordination, and personalized communications between the plan sponsor and its members.

Plans that included some type of care coordinator registered a higher level of happiness. Overall, 56% of those with an assigned navigator were very satisfied with their plans, representing an opportunity for sponsors that do not currently offer such services to members.

“Modern care management platforms enable care managers and providers to tailor care plans to member needs,” the survey reported. “Care teams with access to data on social determinants of health — such as housing instability, food insecurities and transportation barriers — can identify risks and connect members to the support they need to follow care plans and live healthier lives.”

Satisfaction levels also responded positively “when payers communicate with members in their preferred ways.” When that happens, 85% of respondents were more satisfied with their benefits package.

“According to the survey results, consumers want health plans to use different modalities for different types of interactions, thus requiring payers to take an omni-channel approach to member engagement and communication,” the survey said. “For example, when it comes to information about benefits and coverage or educational information, the survey says that most consumers want payers to use email and phone calls. But when it comes to appointment reminders with providers, consumers want communication via text/mobile apps.”

The survey also revealed important generational communications preferences. “The younger generation (18-24) is four times more likely to want digital communications. … The older generation (65+) opts for more traditional communication channels, such as phone calls and emails.”

HealthEdge offered six actions plan sponsors could take to immediately improve member satisfaction:

• Implement modern technology platforms that help turn regulatory requirements into competitive advantages.
• Deploy digital member engagement platforms that facilitate omni-channel communication strategies and enable health plans to meet members where they are through their preferred channels.
• Implement modern consumer assistance programs that enable agility and speed-to-market with innovative benefit plans and programs based on insights gathered from all different types of systems and data sources from across the ecosystem.
• Empower care management teams with powerful care management platforms that deliver data and knowledge that not only allow care managers to be more informed about individual member needs but also facilitate the design of more relevant care plans targeted at smaller populations with unique needs.
• Take a fresh approach to payment integrity with modern systems that improve the accuracy of claims, which can minimize provider abrasion and lead to stronger provider networks.
• Automate manual business processes and workflows to create efficiencies that enable staff members to be more productive and reduce the IT burden.

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“Market dynamics are creating a perfect storm for payers — one that requires a renewed focus on personalizing member experiences and improving member satisfaction. Forward-thinking health plans are adopting modern technology solutions that enable greater access to meaningful data, omni-channel engagement capabilities and more personalized care management strategies to meet the onslaught of challenges in today’s health care landscape,” said Christine Davis, senior vice president of Marketing at HealthEdge.