While many variables shape a member’s experience with their health plan, there are clear, consistent patterns among those who report higher satisfaction. In addition to being significantly more likely to say they “completely understand” their coverage—including benefits, services, and out-of-pocket costs—highly satisfied members are also far more likely to recall receiving proactive communication from their health plan. This includes reminders about preventive services, health summary statements, and notifications about changes to benefits or coverage. For example, members who say they receive preventive service reminders at their preferred frequency report satisfaction scores 125 points higher than those who do not (647 vs. 522). The same holds true for health-related education: members who receive timely information average a satisfaction score of 660, compared to just 546 among those who do not.

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Conversely, members who report significantly lower satisfaction are much more likely to say they struggle to access care when and how they need it, lack trust in their health plan, and feel unsupported in navigating care across multiple providers. One of the most striking differentiators is care coordination. Among members who said their health plan proactively reached out to coordinate care with health care providers, the average satisfaction score was 662. For those who reported no such outreach, satisfaction dropped by 162 points. Perhaps even more telling are the gaps in trust associated with care coordination: members whose plans support coordination reported satisfaction scores as high as 682, compared to just 510 among those who experienced no coordination—a 172-point difference that underscores the critical role of active, engaged support in building member confidence.

Health plans are consumer brands

Some of these challenges are bigger than health plans can fix on their own. The United States is in the midst of a nationwide physician shortage that is projected to reach 86,000 physicians by 2036. Drug prices have reached record highs. Health care price transparency continues to be a challenge for providers, health plans and consumers. And, navigating between complex networks of primary care providers, specialists, retail health clinics and other care settings is not getting any easier. While health plans cannot control all of these variables, they need to recognize that they do provide a critical link in the chain of communication between patients and their overall experience with the health care system. For some, that’s an opportunity to adopt a more consumer-facing role and help to proactively guide members through the process through regular reminders, clear explanations of coverage and treatment options and even consults with care managers. For others, it is merely a complex administrative process they must follow to get paid.

Increasingly, the public perception of the entire industry has been adversely affected by health plans that have taken a decidedly operational approach to health plan administration. Unfortunately, health plans will not score points—figuratively or literally—with consumers for being more operationally efficient. What the data shows us, and what the top-performing plans are proving, is that health insurance is a consumer business—and the effectiveness of health plan communication with customers is only becoming more critical as the healthcare landscape grows more complicated.

Plans that understand and embrace this ongoing consumerization of health insurance will continue to set themselves apart with higher customer satisfaction scores and better overall health outcomes. Until the lowest-performing plans catch up, however, the stigma of poor customer support, ineffective communication and widespread confusion among members will outweigh the good experiences and continue to strain the industry’s reputation.

Caitlin Moling is senior director of healthcare intelligence at J.D. Power.