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Member experience has direct correlation to plan satisfaction

Health plan members list coverage, benefits, and provider choice as the top factors in whether they are satisfied with their health plans, but an insurer’s member outreach underlies those top issues and is a direct link to health plan satisfaction, according to J.D. Power and Associates’ 2009 National Health Insurance Plan Study.

This is especially true for members of individual and small group plans, in which members ranked plan satisfaction lower than large group plans, according to the survey. Individual plans are an option for Americans whose employers are cutting benefits or laying off employees. Nine percent of people covered by health plans are in individual plans.

“The most important factor in this study, in terms of the relationship with member experience, is how the member rates their coverage and benefits,” says David Stefan, executive director for healthcare at J.D. Power and Associates in Phoenix. “We have seen that that rating is highly connected with the information and communication and knowledge of the plan. So if the member understands the plan very well, they understand what’s covered and what’s not and understand how to use those services.” (To see how health plans performed in 13 areas, see Figures 13–25 beginning below.)

J.D. Power and Associates’ third study measured member satisfaction for about 33,000 Americans enrolled in 131 health plans in 17 regions by examining seven factors: coverage and benefits, provider choice, information and communication, claims processing, statements, customer service, and approval process.

In the survey, J.D. Power and Associates asked members questions about their health plans and gave a point value to each question. It tallied the results and scored them on a 1,000-point scale. Health plan members with individual coverage or who worked for small employers (50 employees or fewer) were less satisfied with their health plans than those who worked for large businesses (501–5,000 employees) and jumbo employers (more than 5,000 employees).

Smaller employer groups averaged a score of 692 points, lower than those enrolled in individual plans (694), large employers (717), and jumbo employers (725), according to J.D. Power and Associates. The survey also found that those working for large employers are more likely to re-enroll and recommend the plans to others, compared to those employed by small employers or covered through individual plans.

The survey found that most members simply don’t understand their plans, Stefan says. Although a small percentage fully comprehend the offerings, close to two-thirds of members are confused about how their plans work to one degree or another. “We see a very big difference between people who say they fully understand how it works and those who have some level of confusion,” he says.

Whether a member understands a plan has a direct correlation to costs, usage of preventive services, and plan satisfaction. For example, if a member doesn’t understand all of a plan’s benefits, he or she isn’t taking advantage of the offerings. One way to resolve this is to communicate effectively with new members through multiple channels (e.g., phone, mail, e-mail, and the Internet) and send welcome kits that engage members and educate them about the plan and offerings. “The newer members that get that stuff both understand the plan better and tend to be more satisfied than the new member who does not receive some of that,” Stefan says.

Members who understand their plans are less expensive than those who don’t comprehend the plans. Those who are knowledgeable are less apt to call the health plan with basic benefit questions and spend less time on the phone asking questions. They will also take advantage of preventive services, such as wellness and disease management.

That education not only helps the member, but also the health plan and employer, who reap the benefits of a healthier member. Employers are becoming more aware that an educated member accesses preventive services and focuses on managing his or her health. “I think they are increasingly becoming more sophisticated about that. I certainly see that big difference now when we talk to plans than five or eight years ago,” Stefan says. “I see that shift gradually emerging over time.”

New England tops satisfaction levels

J.D. Power and Associates found that satisfaction levels for health plans increased significantly from 2008 in the New England, South Atlantic, California, Arizona-Utah, and Illinois-Indiana regions, with New England, Michigan, Pennsylvania-Delaware, California, and South Atlantic achieving the highest satisfaction levels overall.

The health plans that ranked highest on the member satisfaction index were Kaiser Foundation Health Plan (aka Kaiser Permanente), Harvard Pilgrim Health Care, Humana, Highmark Blue Cross Blue Shield, Health Alliance Plan, BlueCross BlueShield of Arizona, and Dean Health Insurance.

Given the challenges in today’s economy, Stefan says the study is a “win for the industry.” In general, health plan satisfaction levels are pretty low to start, but they have increased slightly from last year.

“I think it’s always challenging for health plans to invest in the right initiatives and efforts with their members and balance that against all their economic realities,” Stefan says.

Kaiser Permanente reaches out

One of the highest ranked insurers in the survey, Kaiser Permanente, enjoys an advantage over those that are strictly health insurers. Christine Paige, senior vice president for marketing and Internet services at Kaiser Permanente in Oakland, CA, says the integrated healthcare system communicates with its members more on care delivery than coverage, which is not the case for an insurer without an integrated system.

The integrated model, coupled with Kaiser Permanente’s focus on total health, allows the company to connect with members in an environment that goes beyond coverage questions. “We tend to see the experience of the care driving the satisfaction rather than the experience of the coverage per se,” Paige says. “We’re very focused on connecting people with the services and making sure they have good access to [Kaiser programs], and those in turn drive satisfaction.”

To connect with new members, which J.D. Power and Associates stated is critical in its study, a Kaiser Permanente representative reaches out to explain offerings and benefits and promotes the importance of forging a strong relationship with primary care physicians. During that call, Kaiser Permanente helps the new member choose a physician depending on the individual’s preference and background.

Kaiser Permanente also sends the new member a guidebook with information about services and promotes the company’s Web site, which provides online coaching and the ability to schedule physician appointments and renew prescriptions. The integrated system also sends a quarterly newsletter to members, which highlights health issues, emerging health trends, and service enhancements in the member’s area.

Although much of its communication is about care delivery, Kaiser Permanente has also broadened its outreach to include education about recent health insurance benefit changes, such as the popularity of deductibles in HMOs. This outreach is especially important for long-standing Kaiser Permanente members who are not used to those terms.

Kaiser Permanente has typically focused on accessing care delivery through communication, but benefit changes have caused the integrated system to spend more time communicating about plan administration, Paige says.

Survey respondents gave Kaiser Permanente high marks, but that doesn’t mean the integrated system doesn’t face the same communication barriers as other insurers.

Kaiser Permanente also struggles with reaching out to certain patient subsets, such as the so-called “young invincibles,” who don’t take advantage of programs, including preventive services, Paige says.

Instead, they use their health insurance only when they need urgent care. When these patients show up for urgent care, Kaiser Permanente connects with them to build better relationships and educate them about the importance of prevention.

In its study, J.D. Power and Associates highlighted that members in individual and small group plans are less satisfied than those in large group plans. Kaiser Permanente connects with individual and small group plan members with the same baseline coverage as large group members and includes a second communication stream that focuses on payer services, such as coverage renewal, Paige says.

Paige concurs with J.D. Power and Associates that maintaining a positive member experience influences other areas, such as coverage knowledge, and has a positive monetary correlation for the health plan. Happier members mean less turnover and fewer complaints.

Helping people anticipate their healthcare experience is critical, and more insurers are promoting prevention, she says.

“I think one thing you are seeing more and more of is a focus on communicating with people about not just how to access care when you’re ill, but more about prevention and wellness,” Paige says.