Integrated systems earn high marks from consumers for ease of access

NATIONAL REPORTS-Members of health plans under integrated delivery systems are considerably more satisfied, according to a recent study.

Greater satisfaction is linked to members' better understanding of their coverage and navigation of the system, according to the J.D. Power and Associates 2011 U.S. Member Health Insurance Plan Study. The study, now in its fifth year, reports that satisfaction among members of integrated delivery systems averages 741 on a 1,000-point scale. By comparison, satisfaction among members of other plans was 691 points.

The study, which surveyed 34,000 members of commercial health plans between December 2010 and January 2011, found 63% of integrated delivery system members reported they "completely understand" the benefits covered, compared with 52% of other plan members. Also, 44% of integrated delivery system members said they "completely understand" how to receive preventive services, although that was the case for just 24% of other plan members.

"We know that one of the things that drives satisfaction is being aware of how to access preventive services," Millard says. "That's logically something that is more convenient for a physician to communicate with a patient in the context of regular clinical encounters as opposed to something a health plan would communicate outside a physician's office. The physician employed by the plan seems to help improve that communication and, therefore, the member satisfaction."

Provider choice also is important. In that area, integrated delivery systems do not fare as well as other types of plans, Millard says.

Detroit-based Health Alliance Plan (HAP) scored high in member satisfaction in Michigan. It was the fourth consecutive year that the plan ranked the highest in its region.

The plan launched a member outreach initiative five years ago. Upon enrollment, a new member receives a telephone call and business card from a care coordinator who initiates contact four or five times over two years to ensure members receive the service expected.

"We try to create an emotional tie and bond with our members," says Richard D. Chaney, HAP's vice president, client services.

HAP uses surveys and focus groups, national benchmarks, member complaints and inquiries, call center data, and more to continuously target areas for improvement. Over the last decade, the plan has implemented new claims systems, eliminated the need for referrals for many services, and empowered front-line service staff to resolve low-end claims issues themselves rather than relying on management.

Interestingly, while the American Medical Assn. (AMA) complained in its latest "Competition in Health Insurance" study that patients pay higher health insurance premiums than they should in markets dominated by one insurer, members in such regions are not dissatisfied.

The AMA found Blue Cross Blue Shield of Alabama holds a 90% to 95% market share in two market segments in the area, while Group Health Cooperative in Washington controls as much as 99% of the state region for the HMO product market. Yet, in the J.D. Power and Associates survey, both plans topped their respective regions for having the highest member satisfaction among all types of plans.

As all avenues of healthcare become increasingly concerned about controlling costs, member satisfaction could take a back seat to efficiency, Millard says. Higher levels of satisfaction don't necessarily result in better control of costs.

"Now that there are increasing costs all over, the integrated delivery systems have gradually begun to adopt more complicated benefit designs, so the approaches that are going to be successful may end up being the ones that cost the least rather than those that satisfy people the most," Millard says.

HAP's Chaney argues that satisfying members ultimately saves money, because it costs less to retain members than gain new ones.

"We are not willing to sacrifice service, even in a cost-pressured environment," he says.