Patients with Lowest Self-Reported Health Status Least Likely to Receive Proactive Outreach

Despite an industry-wide transition to value-based payment models that incentivize preventive care and proactive communication between health plans and members, commercial health plans are missing the mark when it comes to patient engagement. According to the J.D. Power 2023 U.S. Commercial Member Health Plan Study,^SM released today, customer satisfaction with commercial health plans is particularly strained among members of Gen Y¹ and Gen Z, driven largely by poor customer service and communication scores. Similarly, members with the lowest self-reported health status are most likely to experience communications challenges with their health plans.

“The transition to value-based care is predicated on the idea that payors and providers can drive better outcomes at a lower cost by improving patient engagement, yet many commercial health plans are having challenges getting the right information and support to patients when and where they need it,” said Christopher Lis, managing director, global healthcare intelligence at J.D. Power. “Moreover, in patients with self-reported health status of ‘poor and fair,’ only 17% were assigned to a case manager. Yet for these patients with oftentimes complex health conditions, seeing multiple providers and taking several prescriptions, care fragmentation leads to poor health outcomes and higher spending in the very population that needs coordinated care the most.”

Following are some key findings of the 2023 study:

• Overall satisfaction declines year over year: Overall satisfaction falls 13 points (on a 1,000-point scale) this year, driven largely by a 33-point decline in satisfaction with customer service. Coverage and benefits (-20 points); provider choice (-16); and information and communication (-16) also decline significantly.

• Net Promoter Score^®2 for new members is poor, highlighting importance of onboarding: The average NPS score for new members is 6 (on a scale of -100 to 100), whereas the average score for established plan members is 25. This significant difference suggests that new members are not receiving clear information and support on how to navigate their healthcare benefits.

• Sicker patients less likely to receive proactive care coordination: Among patients with a self-reported health status of “poor/fair,” just 36% say their health plan helped them coordinate care. Among patients with a self-reported health status of “very good/excellent,” 43% say their health plan helped to coordinate care.

• Despite investment in digital health tools, health plan member usage remains low: Digital usage for all tools and support remains below 50%. Even among the sickest patients, use of online health assessments is 18%; use of chronic disease management tools is 8%; use of online triage and nursing support is 10%; and remote monitoring 6%.

Study Rankings

The study measures customer satisfaction with commercial member health plans in 22 geographic regions. Highest-ranking health plans and scores are as follows:

• California: Kaiser Foundation Health Plan (749)
• Colorado: Kaiser Foundation Health Plan (716)
• Delaware/West Virginia/Washington D.C.: Highmark Blue Cross Blue Shield Delaware (725)
• East South Central: Aetna (760)
• Florida: Florida Blue (739)
• Heartland: Blue Cross and Blue Shield of Kansas City (743)
• Illinois/Indiana: Health Alliance Medical Plans (731)
• Maryland: Kaiser Foundation Health Plan (797)
• Massachusetts: Mass General Brigham Health Plan (formerly Allways) (711)
• Michigan: Health Alliance Plan of Michigan (735)
• Minnesota/Wisconsin: Quartz Health Plan (709)
• Mountain: UnitedHealthcare (721)
• New Jersey: Cigna (727)
• New York: Capital District Physicians’ Health Plan (773)
• Northeast: Anthem Blue Cross and Blue Shield Connecticut (730) and Blue Cross & Blue Shield of Rhode Island (730) in a tie
• Northwest: Aetna (723)
• Ohio: Anthem Blue Cross and Blue Shield Ohio (715)
• Pennsylvania: Geisinger Health Plan (732)
• South Atlantic: Kaiser Foundation Health Plan (785)
• Southwest: Aetna (720)
• Texas: UnitedHealthcare (729)
• Virginia: UnitedHealthcare (726)

The U.S. Commercial Member Health Plan Study, now in its 17^th year, measures satisfaction among members of 147 health plans in 22 regions throughout the United States by examining six factors (in alphabetical order): billing and payment; cost; coverage and benefits; customer service; information and communication; and provider choice. The study is based on responses from 32,656 commercial health plan members and was fielded from January through April 2023.

For more information about the U.S. Commercial Member Health Plan Study, visit

https://www.jdpower.com/business/resource/commercial-member-health-plan-study.

See the rank charts for each region at http://www.jdpower.com/pr-id/2023053.

About J.D. Power

J.D. Power is a global leader in consumer insights, advisory services and data and analytics. A pioneer in the use of big data, artificial intelligence (AI) and algorithmic modeling capabilities to understand consumer behavior, J.D. Power has been delivering incisive industry intelligence on customer interactions with brands and products for more than 50 years. The world's leading businesses across major industries rely on J.D. Power to guide their customer-facing strategies.

J.D. Power has offices in North America, Europe and Asia Pacific. To learn more about the company’s business offerings, visit JDPower.com/business. The J.D. Power auto shopping tool can be found at JDPower.com.

About J.D. Power and Advertising/Promotional Rules: www.jdpower.com/business/about-us/press-release-info

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1</sup> J.D. Power defines generational groups as Pre-Boomers (born before 1946); Boomers (1946-1964); Gen X (1965-1976); Gen Y (1977-1994); and Gen Z (1995-2004). Millennials (1982-1994) are a subset of Gen Y.

² Net Promoter,® Net Promoter System,® Net Promoter Score,® NPS,® and the NPS-related emoticons are registered trademarks of Bain & Company, Inc., Fred Reichheld and Satmetrix Systems, Inc.

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