• Hypertrophic Cardiomyopathy (HCM)
  • Vaccines: 2023 Year in Review
  • Eyecare
  • Urothelial Carcinoma
  • Women's Health
  • Hemophilia
  • Heart Failure
  • Vaccines
  • Neonatal Care
  • Type II Inflammation
  • Substance Use Disorder
  • Gene Therapy
  • Lung Cancer
  • Spinal Muscular Atrophy
  • HIV
  • Post-Acute Care
  • Liver Disease
  • Biologics
  • Asthma
  • Atrial Fibrillation
  • RSV
  • COVID-19
  • Cardiovascular Diseases
  • Prescription Digital Therapeutics
  • Reproductive Health
  • The Improving Patient Access Podcast
  • Blood Cancer
  • Ulcerative Colitis
  • Respiratory Conditions
  • Multiple Sclerosis
  • Digital Health
  • Population Health
  • Sleep Disorders
  • Biosimilars
  • Plaque Psoriasis
  • Leukemia and Lymphoma
  • Oncology
  • Pediatrics
  • Urology
  • Obstetrics-Gynecology & Women's Health
  • Opioids
  • Solid Tumors
  • Autoimmune Diseases
  • Dermatology
  • Diabetes
  • Mental Health

Better-informed members are more satisfied


National Reports-Providing useful information is key to increasing satisfaction among health plan members, say industry experts.

National Reports-Providing useful information is key to increasing satisfaction among health plan members, say industry experts.

"Health plans are often more a commodity with respect to benefits, coverage and provider choice," says Clive Riddle, president and founder of Modesto, Calif.-based MCOL, a provider of business-to-business health management and managed care resources. "But plans have the opportunity to differentiate themselves based upon information, communication and education."

According to the 2008 J.D. Power and Associates National Health Insurance Plan Satisfaction Study, member comprehension is highest for copays, finding a doctor who is covered by the plan, prescription drug coverage, and EOBs-although even here, opportunities exist to strengthen member understanding of these critical plan elements, Stefan explains.

"Although satisfaction drops whenever health plan members do not completely understand how their health plan works, it declines . . . when these four most critical and common areas are not fully understood," he says.

A legitimate question, he says, is how much investment is needed to improve member satisfaction and whether that investment will pay off in greater financial returns.

"Efforts to improve satisfaction may incur a range of costs, and companies will weigh these costs against the expected benefits before investing further in customer initiatives," Stefan says.

By segmenting the 107 health plans in the study into high, medium and low levels of satisfaction, J.D. Power and Associates found that the plans in the high-satisfaction segment enjoy renewal intent, recommendation levels, and interest in additional products that are 24% to 39% higher than plans in the low-satisfaction category.

"These are all areas where increases in satisfaction can pay significant financial dividends to plans," Stefan says.

There are three major areas of focus for improving member satisfaction and the resultant positive impacts for plans: consistent performance on key metrics, improved communication, and better member engagement.


"For national carriers and Blue Cross Blue Shield licensees appealing to national employers through their Blue Card approach, it is important to manage certain metrics consistently across their respective networks of plans," Stefan notes.

According to him, some of these metrics include reducing the risk that a new member has to switch physicians when joining the plan, as well as communicating with members once every three months (at a minimum) with newsletters, health education literature and reminder calls.

"[Information and communication] is critically important given that member ratings on other major factors are influenced by how well plans communicate essential benefits and network information to members," Stefan says. "Everything plans can do to improve communication usefulness can have disproportionately positive impact on their satisfaction ratings."


"Getting the basics accomplished on a consistent basis and improving communication with members can accomplish a lot, but plans that want to accomplish more must seek to actively engage their members," Stefan says. There is a small group of satisfied members who have been effectively engaged by their plans that illustrate this. These members:

While disappointingly small in number-only 5% of the study respondents-engaged members define a clearly desired outcome for the plan-member relationship. "These members are disproportionately satisfied and loyal to the plan," Stefan says. "They are willing to purchase other products at a much higher level, and they are more efficient for plans to serve. Engaged members tend to spend significantly less time asking questions of the plan, and they are far more likely to participate in desired behaviors such as use of preventive services. This all adds up to engaged members being active partners with the plan. As a likely consequence, even though they have a somewhat greater likelihood to have a few common chronic conditions, engaged members are far more likely to report they are in excellent health."

Related Videos
Video 11 - "Closing Current Gaps within Fertility Benefits and Care"
Video 10 - "Shaping Fertility Coverage: Access, Costs & Medical Needs"
Video 9 - "Denial of Coverage in Fertility Care"
Video 8 - "Risks of Miscarriage and Multiple Births Associated with Fertility Care"
Video 7 - "Fertility Preservation: Egg Freezing Versus Embryo Freezing"
Video 6 - "Family Building Costs, Barriers, and Dropout Rates Associated with Fertility Care"
Video 5 - "Closing Payer Gaps and Improving Fertility Care Access"
Video 4 - "Increasing Employer Coverage and Maximizing Fertility Benefits "
Video 5 - "Relevance of NUTURE Study Findings for Patients, Payers, Providers"
Video 3 - "Improving IVF Success Rates & Utilizing AI in Fertility Health Care"
Related Content
© 2024 MJH Life Sciences

All rights reserved.