Health plans struggle to meet members' financial expectations: report

Health insurance form payer plan enroll
Consumers complain about high co-pays when it comes to health plan satisfaction. (Valeriya/Getty)

There are still some major hurdles standing in the way of patients’ satisfaction with their commercial health plans, according to a recent report by J.D. Power.

According to the company’s 2019 Commercial Member Health Plan Study, the biggest irritants for patients are high co-pays for doctor visits and the coordination of care between providers.

“Health plans are doing a good job managing the operational aspects of their businesses, but they are having a harder time addressing the expectations members have based on their experiences in other industries where their service needs are more effectively addressed with better technology,” James Beem, managing director of global healthcare Intelligence at J.D. Power, said in a statement.

“Across the board, health plan members are satisfied with the coverage and benefits they have, but once they start looking to their health plans for guidance in areas like navigating issues related to cost or when to use primary care versus urgent care, many plans miss the mark on customer expectations," Beem said.

Overall, the study found that member satisfaction for commercial health plans is up seven points to 713 (out of 1,000) over the past three years. The increase in satisfaction is driven largely by an increase in coverage and benefits. Coverage and benefits are now the most important driver of customer satisfaction, making up 25% of total health plan member satisfaction.

RELATED: MA plans not 'maximizing their potential, J.D. Power says

Customer satisfaction has gone up in all factors of the study since 2017, except cost and mobile apps. The decline in cost satisfaction is directly related to high co-pays for physician visits, the study found. In fact, satisfaction scores are 254 points higher when members believe their plans keep out-of-pocket costs low, coordinate care and give adequate coverage. Yet only 54% of those surveyed say their plan delivers on these criteria.

Also, almost half (48%) of those interviewed say they are either very or somewhat likely to consider telehealth options. That number is even higher among Generation Y members, 51%.

The highest satisfaction scores were reported in Maryland, 734; California, 725; East South Central, 725; Michigan, 725; Illinois/Indiana, 723; and Virginia, 722.

RELATED: Study: Workers like their employer plans—when care is affordable

Some health plans that received top ratings include 805 points for Kaiser Foundation in the South Atlantic region; 799 points for Kaiser Foundation in Maryland; 792 points for Kaiser Foundation in California; and 774 points for Capital District Physicians Health Plan in New York.

The study examined 146 health plans in 22 regions across the U.S. by looking at billing and payment, cost, coverage and benefits, customer service, information and communication, and provider choice.