Beyond the Data: A Closer Look at Health Plan Innovations, Assumptions

The story behind the story includes added insights from J.D. Power's Christopher Lis, a health plan success story, and the questions that linger.

The J.D. Power 2022 U.S. Commercial Member Health Plan Study identified call center support and digital tools as two key areas of customer dissatisfaction. Simultaneously, communication innovation is among the health plan approaches yielding results.

But key questions linked to customer experience, workforce, and other areas remain.

Results

There were four key findings from the J.D. Power responses, recorded January through April:

1. No change in customer satisfaction. Year-over-year results were flat, with no impact to the 17-point customer satisfaction increase over the past five years. Customer service, coverage, and network providers contributed to member dissatisfaction.
    
2. Respond and innovate for better results. Satisfaction was lower where customers rated their health plans as slow and conventional. Only 22% of members consider their health plans innovative, a number J.D. Power notes "has not changed in the past three years."
    
3. Call centers must do better. As part of an overall five-point decline, health plan member satisfaction hinged on customer service representative (CSR) engagement, knowledge, and response speed.
    
4. Traditional engagement is not enough. Health plan customers are dissatisfied with health plan text messaging (-14 points) as well as websites and mobile apps (both -6 points).
    

J.D. Power reports these takeaways from the responses of 36,366 members of 147 U.S. health plans and based on, but not limited to, six categories: billing and payment, cost, coverage and benefits, customer service, information and communication, and provider choice.

Health plan standouts

Amidst these results, a small group of health plans rated highly in their markets:

• Blue Cross Blue Shield (BCBS) – Plans in Illinois, Indiana, Massachusetts, Michigan, Oklahoma, and Rhode Island
   
• Additional BCBS affiliates in multiple states/regions – Anthem, CareFirst, Horizon, and Regence
   
• Capital District Physicians' Health Plan – New York
   
• Humana – Florida, Texas, and the East South Central region
   
• Geisinger Health Plan – Pennsylvania
   
• Kaiser Foundation Health Plan – CA, CO, MD, the Northwest and South Atlantic regions

Among these plans, HealthLeaders highlights BCBS of Massachusetts (BCBS-MA) and its behavioral-science-driven customer communications.

Success story: The BCBS-MA Nudge Unit

Both anecdotal and empirical evidence support that small wins matter.

The importance of nudges toward better outcomes is well documented. Nobel prize winner Richard Thaler, and co-author Cass Sunstein define nudge as "any aspect of the choice architecture that alters people's behavior in a predictable way without forbidding any options or significantly changing their economic incentives."

Health Affairs reports that BCBS-MA is one of the first health plans to apply this approach, establishing a Nudge Unit that, per the plan's recent press release, "uses behavioral insights to present information in new ways that can lead to improved decision making and better health outcomes."

Rebecca Oran, director of the Nudge Unit and Behavioral Insights at BCBS-MA, states: "Behavioral science techniques, such as framing or modifying the context in which choices are presented (choice architecture) to highlight the most critical information or make it easier to identify the possible options, can be particularly useful for helping consumers make decisions."

Hired to expand the plan's behavioral insight capabilities by working with internal teams and academic institutions, Oran adds: "To date, our Nudge Unit has had some initial wins that we aim to refine and scale."

Those wins include:

• A revised member letter that increased at-home colorectal cancer screening via test kits by 3%, with 500 more kits returned.
   
• A revised provider letter that increased PCP statin prescriptions by nearly 14% for patients with diabetes.
   
• An update to the MyBlue app led more than 300,000 members to report the race and ethnicity data that CMS will increasingly require for health equity initiatives.

These are among the 53 interventions that BCBS-MA reports the Nudge Unit has implemented.

It is a balancing act. Oran notes that "like many health plans, BCBS-MA has long used industry standard tools (e.g., prior authorization, education, economic incentives) to influence member and provider decision making."

She adds: "Behavioral insights … can complement or even substitute for some of these traditional approaches without restricting freedom of choice or creating member or provider abrasion."

Meeting the needs of a unique customer

The J.D. Power results present "a complex set of challenges and opportunities for health plans, which have been struggling to win member trust and loyalty."

Trust and loyalty are difficult to earn in our most intimate, daily relationships. Payer challenges are even greater, amplified by the fact that the healthcare and health plan customer are unlike any other.

"Healthcare decisions can be complicated," says BCBS-MA's Oran. "Many patients can make suboptimal decisions (i.e., decisions that don't align with their values and preferences) when they receive an overwhelming amount of information—especially when less-relevant information makes it hard to find the most critical information about a decision."

Christopher Lis, PhD, J.D. Power's managing director of global healthcare intelligence, notes the importance of trust. "The good news is, there has been a lift in satisfaction related to cost, communication, billing and payment so some areas moving in right direction."

Questions raised

The J.D. Power results suggest additional health plan challenges:

• Do customers know what kind of experience they want to have? Members want their questions answered quickly. But if fast answers lack clarity and/or accuracy and require additional customer service calls, what is the value of speed?
   
• How can front-line staff be supported? CSR salaries are among the lowest on health plan (and any industry) teams. What can payers do to better compensate them for providing critical, first-line information?
   
• Do customers assess digital innovation fairly? Humans use texting, websites, and apps every day. What then would customers prefer?

To this last question, Lis points out the importance of what different customers value: "Plans are all trying to be mindful of generational differences in customer communication. Maybe several decades ago, you could have more of a one-size-fits-all approach, but not now given rapid advances in technology and the number of new digital entrants."

Regarding the overall uniqueness of the healthcare consumer compared to other industries, Lis says: "Compared to other sectors of the economy, healthcare still has Information Age immaturity. There isn't full transparency on cost. There is growing but still not full transparency on quality and certainly not on outcomes and the ability to get good information."

He adds: "Despite this asymmetry of information, there has been significant improvement by plans and providers."