Ratings drive consumer experiences

Medicare Advantage could set a precedent for plan switching


Consumer ratings are no longer just “nice to have.” Exchange marketplaces will begin to showcase health plan satisfaction scores in 2016, alongside price information and metal level to help shoppers choose a health plan. Higher satisfaction could translate into more business.

At the moment, however, consumers remain more confused by ratings than empowered by them, according to research conducted by PwC.

“If you look at the rating systems, there’s a lot out there,” says Vaughn Kauffman, a principal in PwC's Health Industries Payer Practice. “To some degree, there are too many choices from an ability to review quality scores for care, whether it’s through a government program, through healthcare companies, a rating system or just Yelp or Google.”

He says it’s information overload and consumers are unsure of who their trusted sources might be.

Data indicates that 48% of the 1,000 consumers surveyed report that they have read a healthcare review online, while only 24% report they have written a review. After reading a review, 68% use them to make decisions. Only 11% of respondents indicate they have used a review of an insurance company to make a choice.

Low participation can be attributed to factors such as consumers’ perception that they don’t have choices, and the fact that personal influence such as word-of-mouth often trumps rating information.

“There is a notion in healthcare that decisions about health plans are made through the employer, and the primary care physician is making the choice on the specialists,” says Kauffman. “Through consumer-directed healthcare and certainly the exchanges that are pushing more of a retail model, consumers are going to see that they get more choice.”

He says price will be the primary vehicle for choosing a health plan but when given choices, consumers will figure in satisfaction scores. As plans adopt more narrow-network products, provider ratings will become more significant.

Kauffman says the next step is to use consumer ratings to drive better customer experiences, and go to the next level by creating incentives around achievement of higher ratings.

“It’s not just a marketing thing,” he says. “They’re taking this information and combining it with other initiatives to become more consumer-centric. With health plans, that wasn’t much of a priority. They are reorienting the organization around incentives all the way through the evolution.”

PwC recommends:

• Ratings be sorted for relevancy among like-minded consumers;

• Health plans be aware of the Medicare Advantage precedent that allows enrollees to switch to higher performing plans at any time;

• Navigators be able to provide coordinated, ongoing decision support; and

• Insurers and providers combine data to create a more complete portrait of the consumer, especially when risk is shared.

 “It’s clear healthcare needs to simplify its language for consumers to better understand what their choices are,” Kauffman says. “There’s a long way to go to make that transition.”