Education Leads to Satisfaction

Les Masterson, for Health Plan Insider, May 7, 2008

A health plan's communication with members is a critical component that directly influences whether the member feels engaged and will impact how a person ranks his or her health insurer.

That was the key finding in the J.D. Power and Associates 2008 National Health Insurance Plan Study. A total of 37,060 members of large commercial plans (excluding Medicare and Medicaid) completed the survey, which measured member satisfaction for 107 health plans. The study tripled the number of health plans in last year's survey. The study found that those who communicated most effectively with members received the highest scores.

"Broadly speaking, those plans that engage their members, they reach out and touch them more frequently, and do it with the best clarity of message and understanding for the member, tend to be ones that score the highest," says David Stefan, executive director, healthcare practices, at J.D Power and Associates.

A consistent issue throughout the health plans—regardless of where they ranked—was communications, which was positioned lower in terms of satisfaction than other factors. Less than half of members surveyed reported that they fully understood their coverage and member services.

The J.D. Power and Associates survey examined seven key factors:

  • Coverage and benefits
  • Choice of doctors, hospitals, and pharmacies
  • Information and communication
  • Approval processes
  • Claims processing
  • Insurance statements
  • Customer service

Though coverage, benefits, and choice were weighted as the top health plan factors, Stefan says health plans should focus on improving communications because member outreach touches upon every aspect of a plan. That communication can mean an engaged member and better health outcomes.

Stefan says some of the problems with health insurance communication are:

  • Plan benefits are not adequately relayed to members
  • Communication is too confusing or includes too much jargon
  • Members don't receive adequate information about copays and deductibles
  • Members don't know how to contact customer service

He adds that if a member doesn't understand the health plan's outreach and is not taking proper advantage of the health plan, the person will mostly likely rank the benefit and coverage lower.

"Members who understand how to use their health plans are better able to access preventive services and get the care and services they need," says Stefan.

One communication that members spoke most positively about were reminders via phone or e-mail about preventive services, such as a mammography or prostate examination. Plans that offered those communications received higher scores on communications and overall, says Stefan.

Not only can health plans learn from the J.D. Power and Associates' study, but employers should also take note. Survey participants were asked who they trust most when it comes to advice about how to stay healthy and how to get healthcare. Not surprisingly 70% of those surveyed listed their doctors as No. 1.

One figure that stands out though is the minuscule 2% given to employers. After the stories of corporate greed and the increasing number of businesses that are penalizing employees with poor health habits, this number is not surprising. These issues have created a divide between businesses and their employees. Employees think their businesses only care about the bottom line, rather than the health of their workers.

The survey did find a possible ally to help with that problem though—health plans. As much as 20% of those surveyed in particular plans listed their health plans as the place for their healthcare information. Stefan says members who trusted their health plans were more engaged.

This study, along with the Silverlink Healthcare Behavior Index that I featured last week, is a one-two punch to health plans, and shows that health plans should review their member communications to ensure they are properly educating and engaging members.

These findings also raise questions: How can health plans communicate with their members without overloading them with too much information? Where can health plans find the most benefit? What are the best ways to educate members? What are the barriers to an educated and engaged member?

Please send me your thoughts. I will share health plans' best communication practices in a future column.

Les Masterson is senior editor of Health Plan Insider. He can be reached at
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