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Members ready to shop exchanges


Health insurance exchanges were meant to appeal to health plan members who purchase insurance on their own, but are members with employee-sponsored insurance dissatisfied enough with their current coverage to jump ship?

Almost 40% of health plan members with employee-sponsored insurance say they would shop for coverage through a health insurance exchange if they had the opportunity, according to the J.D. Power and Associates 2012 U.S. Member Health Plan Study.

A majority of health plan members who purchase insurance on their own indicate they would likely use one of the state health insurance exchanges (55%), which are conceived, in part, to address their needs. However, a sizable percentage of health plan members who are covered under an employer-sponsored program (39%) also indicate they would shop for insurance through an exchange if it were available.

In addition, the 2012 study finds increased levels of interest in state-sponsored health insurance exchanges, compared with the previous year. In 2012, only 37% of health plan members say they would not be likely to use an exchange, compared with 50% in 2011 who expected to continue obtaining coverage at work.

The study also finds substantial interest among health plan members in private health insurance exchanges, in which an employer might provide employees with vouchers for purchasing health insurance independently. Approximately 41% of employer-insured health plan members indicate they would use this approach if it were available.

The study measures member satisfaction among 141 health plans in 17 regions throughout the U.S. by examining seven factors: coverage and benefits; provider choice; information and communication; claims processing; statements; customer service; and approval processes. More than 32,000 members of commercial health plans responded to the survey.

“The J. D. Power and Associates 2012 U.S. Member Health Plan Study looks most closely at member perceptions of coverage, provider choice, and how well the health plan is at providing information and communication,” says Richard Millard, senior director of the healthcare practice at J.D. Power and Associates. “These factors have the biggest impact on member experience.  High-ranking health plans do well in these areas, while low-ranking plans do less well.”

In 2012, overall member satisfaction averages 702 on a 1,000-point scale, compared with 696 in 2011. There are notable gains in the information and communication; statements; and claims processing factors.

Millard says deficits in one area can be overcome by performing well in the other areas.  For example, some integrated systems have narrow provider networks that results in low ratings for provider choice, but can make up for that in other areas by communicating simpler, more transparent and consistent coverage and benefits. 

Health plan members in Michigan, the Illinois/Indiana region and Ohio are the most satisfied with their health plan experience, while members in the Mountain region and Colorado are the least satisfied.

For the fourth straight year, most top member-satisfying health plans in the U.S. are nonprofit (or otherwise non-investor-owned). According to the Alliance for Advancing Nonprofit Health Care’s analysis of the rankings, 76% of the health plans rated No. 1 in their regions are nonprofit, even though these plans represented only 40% of all the plans included in the study.

That may mean non-profits are doing better at communicating with their members.

“Much of our research specifies those actions which should be prioritized in order to produce the biggest improvements in member experience,” says Millard. “This requires a careful assessment of whether there are specific shortfalls, and then matching these to key performance indicators that can become metrics within dedicated performance improvement schemes. Some of the most common areas of concern have to do with perceptions about the dependability of coverage, and knowing how to access preventive services. Generally, these KPIs are not about transactions but concern the quality of communications that occur between the health plan and its members.”

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