Forty-one percent of health plan members say they do not have enough coverage for routine visits, serious illness or injury, health and wellness programs, routine diagnostics and drug coverage, according to the “J.D. Power 2014 Member Health Plan Study.” And, more than any other issue, concern over a lack of coverage negatively impacts overall satisfaction by 133 points on a 1,000-point scale.
In 2014, member satisfaction averaged 669 points; the study measures member satisfaction at 136 health plans in the United States and examines six factors: coverage and benefits; provider choice; information and communication; claims processing; cost; and customer service.
"On average, members wait eight days for communication from their provider after a pre-approval request has been submitted," said Rick Johnson, senior director of the healthcare practice at J.D. Power. "Health plans must look for ways to promptly communicate both pre-approvals and cost in order to minimize member anxiety and mitigate concerns about access to care, ultimately increasing customer satisfaction."
Highlights from the report:
- 55 percent said they experienced cost increases in 2013, negatively effecting cost satisfaction.
- 35 percent said they received a notice of changes in their coverage, networks or rates in the past 12 months.
- 74 percent maintained their preferred physician and 83 percent retained their same hospital network in 2013.
- 75 percent submitted a claim in the past 12 months.
- The average monthly premium paid in 2013 was $285.
- 49 percent said their plan does not offer the most common types of health and wellness discount/incentive programs.
Satisfaction was highest in California and Michigan, which tied for first, followed by the Indiana-Illinois and Mid-Atlantic regions; the East South Central and South Atlantic regions. Satisfaction was lowest in the New England, New York-New Jersey and Southwest regions.
- Kaiser Foundation Health Plan ranked highest for the seventh consecutive year in California, with a score of 756.
- Kaiser Foundation Health Plan ranked highest in Colorado region for a seventh consecutive year, with a score of 703, followed by Anthem Blue Cross Blue Shield of Colorado, with a score of 671.
- SelectHealth ranked highest in the Mountain region, which includes Idaho, Montana, Utah and Wyoming, with a score of 698, for the fifth consecutive year. Next was Regence Blue Cross Blue Shield of Utah, with a score of 689; and BlueCross of Idaho, with a score of 672.
- Kaiser Foundation Health Plan ranked highest in the Northwest region, which includes Oregon and Washington, with a score of 732; followed by Group Health Cooperative, with a score of 706.
- Blue Cross Blue Shield of Arizona ranked highest in the Southwest region, which includes Arizona, New Mexico and Nevada, with a score of 675; followed by Aetna, 668 and Cigna, 666.
- Wellmark Blue Cross Blue Shield of Iowa ranked highest in the Heartland region, which includes Arkansas, Iowa, Kansas, Missouri, Nebraska and Oklahoma, with a score of 680; followed by Anthem Blue Cross Blue Shield of Missouri and Blue Cross Blue Shield of Kansas City, which tied with 678 points each.
- Health Alliance Medical Plans ranked highest in the Indiana-Illinois region, with a score of 692; followed by BlueCross BlueShield of Illinois, 689.
- Health Alliance Plan of Michigan ranked highest in Michigan for a seventh consecutive year, with a score of 711; followed by Priority Health, 685; and Blue Cross Blue Shield of Michigan, 683.
- Dean Health Plan ranked highest in the Minnesota-Wisconsin region, with a score of 703; followed by HealthPartners, 681; and Blue Cross Blue Shield of Minnesota, 671.
- Medical Mutual of Ohio ranked highest in Ohio region, with a score of 697; followed by UnitedHealthcare, 676; and Aetna, 673.
- Kaiser Foundation Health Plan ranked highest in the Mid-Atlantic region, which includes Maryland, Virginia and Washington, D.C. for a sixth consecutive year, with a score of 732; followed by CareFirst Blue Cross Blue Shield, 696.
- Tufts Associated Health Plans ranked highest in the New England region, which includes Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont, with a score of 681; followed by Anthem Blue Cross Blue Shield of Connecticut, 674; and Blue Cross Blue Shield of Massachusetts, 669.
- Capital District Physicians Health Plan ranked highest in the New York-New Jersey region, with a score of 727; followed by Independent Health Association, 705; and Horizon Blue Cross Blue Shield, 679.
- Geisinger Health Plan ranked highest in Pennsylvania, with a score of 705, for the third consecutive year, followed by Highmark BlueShield, 678, and Capital BlueCross and UPMC Health Plan, each with 672.
- Cigna ranked highest in the East South Central region, which includes Alabama, Kentucky, Louisiana, Mississippi and Tennessee, with a score of 689; followed by BlueCross Blue Shield of Alabama, 688; and Humana, 677.
- AvMed Health Plans and Humana tied at 690 points each in Florida; followed by Cigna, 680; and Florida Blue, 677. AvMed ranked highest in Florida for a third consecutive year.
- Kaiser Foundation Health Plan ranked highest in the South Atlantic region, which includes Georgia, North Carolina and South Carolina, for a fifth consecutive year, with a score of 784; followed by UnitedHealthcare, 684; and Blue Cross Blue Shield of North Carolina, 681.
- Aetna ranked highest in Texas region, with a score of 677; followed by Cigna, 672; and UnitedHealthcare, 668.
The “2014 Member Health Plan Study” is based on responses from more than 34,000 members of 136 commercial health plans across 18 regions in the United States, the company said. The study was conducted in December 2013 and January 2014.
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