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Commercial health plan member satisfaction declining in key areas

Satisfaction is particularly lacking in Gen Y and Gen Z, who give low customer service and communication scores.

Jeff Lagasse, Associate Editor

Photo: Tempura/Getty Images

Despite an industry-wide transition to value-based payment models that incentivize preventive care and proactive communication between health plans and members, commercial health plans are missing the mark when it comes to patient engagement, according to the J.D. Power 2023 U.S. Commercial Member Health Plan Study.

Customer satisfaction with commercial health plans is particularly strained among members of Gen Y and Gen Z, driven largely by poor customer service and communication scores. Similarly, members with the lowest self-reported health status are most likely to experience communications challenges with their health plans.

According to Christopher Lis, managing director, global healthcare intelligence at J.D. Power, the move to value-based care hinges on the idea that payers and providers can drive better outcomes, at a lower cost, by improving patient engagement. But many commercial health plans are finding it difficult getting the right information and support to patients.

"Moreover, in patients with self-reported health status of 'poor and fair,' only 17% were assigned to a case manager," said Lis. "Yet for these patients with oftentimes complex health conditions, seeing multiple providers and taking several prescriptions, care fragmentation leads to poor health outcomes and higher spending in the very population that needs coordinated care the most."


This year, overall satisfaction fell 13 points on a 1,000-point scale, driven largely by a 33-point decline in satisfaction with customer service. Coverage and benefits (-20 points), provider choice (-16) and information and communication (-16) also declined significantly.

The Net Promoter Score for new members is poor, underscoring the importance of onboarding, the study found. The average NPS score for new members is 6 (on a scale of -100 to 100), whereas the average score for established plan members is 25. This significant difference suggests that new members are not receiving clear information and support on how to navigate their healthcare benefits.

At the same time, sicker patients are less likely to receive proactive care coordination. Among patients with a self-reported health status of "poor/fair," just 36% say their health plan helped them coordinate care. Among patients with a self-reported health status of "very good/excellent," 43% say their health plan helped to coordinate care.

Despite investment in digital health tools, health plan member usage remains low, the report found. Digital usage for all tools and support remains below 50%. Even among the sickest patients, use of online health assessments is 18%, use of chronic disease management tools is 8%, use of online triage and nursing support is 10%, and remote monitoring 6%.


The study also measured customer satisfaction with commercial member health plans in 22 geographic regions. The 10 highest-rated health plans, in order, are Kaiser Foundation Health Plan in California, Kaiser Foundation Health Plan in Colorado, Highmark Blue Cross Blue Shield Delaware, Aetna in the East South Central region, Florida Blue, Blue Cross and Blue Shield of Kansas City, Health Allied Medical Plans in Illinois and Indiana, Kaiser Foundation Health Plan in Maryland, Mass General Brigham Health Plan (formerly Allways) in Massachusetts, and Health Alliance Plan of Michigan.

The study is based on responses from 32,656 commercial health plan members and was fielded from January through April.

Twitter: @JELagasse
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