The gap between the highest- and lowest-performing health plans is increasing as customer satisfaction is decreasing, according to a new J.D. Power report.
While overall satisfaction with commercial health plans declined slightly year over year, the study revealed widening performance gaps across brands, making the member experience a key competitive differentiator.
The findings, authors said, reflect broader industry pressures, as plans respond to rising expectations around cost transparency, digital access and personalized service.
WHAT'S THE IMPACT
The national average satisfaction score for commercial health plans is 563 (on a 1,000-point scale), but regional scores range from a high of 594 to a low of 523, suggesting meaningful differences in how members experience service, communication and value.
A notable 20% of employers cite low employee satisfaction as a top reason for switching health plans. Plans that invest in better engagement, education and service stand to gain both members and employer clients, the report said.
Members who understand their out-of-pocket costs and out-of-network coverage have higher satisfaction and fewer issues such as denials and inaccessible care. Conversely, among members who say they do not completely understand their out-of-network benefits, 48% had a claim denied and 56% said their choice of network doctors was not available.
Tools like chronic condition management programs, provider communication features and remote monitoring platforms deliver strong satisfaction gains but remain underused, pointing to a critical disconnect between digital availability and member awareness, the report authors said.
Deductibles hit employees of small business employers the hardest. The average deductible paid by commercial health plan members working for small employers is $2,847, which is 8% more than for those working for mid-sized employers ($2,630) and 10% more than those working for large employers. More than half (51%) of small business employees met their deductibles, compared with 52% of midsize business employees and 53% of large business employees.
THE LARGER TREND
The report also listed some of the highest-ranking health plans and scores.
Kaiser Foundation Health Plan in California took the top spot for the 18th consecutive year, with a score of 648, while Kaiser Foundation Health Plan in Colorado came in second with a score of 576. Highmark Blue Cross Blue Shield West Virginia came in third.
Rounding out the top 10 are Blue Cross and Blue Shield of Louisiana; AvMed in Florida; Arkansas Blue Cross and Blue Shield; Blue Cross and Blue Shield of Illinois; Kaiser Foundation Health Plan in Maryland; Blue Cross and Blue Shield of Massachusetts; Anthem Blue Cross and Blue Shield Wisconsin; and Regence Blue Cross and Blue Shield Connecticut.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.