Normalizing Utilization and Pivot to Value-Based Care Delivery Models Present Opportunities for Employer-Sponsored Health Plans, J.D. Power Finds

Call Center Customer Support and Digital Tools Emerge as Key Areas in Need of Improvement

With pandemic-driven volatility in healthcare starting to subside, health spending and utilization are projected to normalize¹ during the next two years. According to the J.D. Power 2022 U.S. Commercial Member Health Plan Study,^SM released today, that return to normal presents a complex set of challenges and opportunities for health plans, which have been struggling to win member trust and loyalty. At the top of the list, health plans need to focus on their customer-facing talent and their digital self-service tools.

“We’re entering a period in healthcare where we anticipate a relatively predictable ramp-up in healthcare utilization, which will create significant opportunities for health plans to deliver more customer-centric and differentiated care,” said Christopher Lis, managing director, global healthcare intelligence at J.D. Power. “It’s important to note, however, that customer expectations have evolved during the past two years, in tandem with increasing momentum around the adoption of value-based care delivery models. Health plan members expect a personalized, hands-on experience when dealing with customer support and they expect a seamless digital experience when engaging online. Health plans have some work to do to get the formulas right.”

Following are key findings of the 2022 study:

• Overall satisfaction flat year over year: Overall satisfaction has increased 17 points (on a 1,000-point scale) during the past five years, but there is no change in 2022 from 2021, due in part to declines in satisfaction in customer service and dissatisfaction with coverage options and desired network providers.

• Responsiveness and innovation drive higher satisfaction: The average overall satisfaction score among members who describe their health plan as being “responsive” is 847, which is 346 points higher than among those who describe their health plan as being “slow.” Similarly, the satisfaction performance gap between plans that are perceived as “innovative” (873) and those perceived as “conventional” (604) is 269 points.

• Call center talent in crosshairs: Customer service call center performance among health plans declines overall in several metrics; including an index score decline of 5 points year over year (791 from 796). Members indicate putting more effort into calls handled by a customer service representative, citing examples of having to repeat information and not having their questions, requests or problems resolved in a timely manner. Phone hold times have increased an average of 52 seconds, or 15% year over year, while knowledge and clarity of information provided has declined.

• Opportunities continue to leverage digital solutions and tools to improve care delivery: Although engagement activity has remained relatively consistent, members have declining satisfaction with text messaging support (-14 points), website (-6) and mobile app (-6). Consistent with this finding, just 22% of members describe their health plan as being “innovative,” a number that has not changed in the past three years.

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 (773)
• Colorado: Kaiser Foundation Health Plan (734)
• Delaware/West Virginia/Washington D.C.: CareFirst BlueCross BlueShield (729)
• East South Central: Humana (772)
• Florida: Humana (783)
• Heartland: Blue Cross and Blue Shield of Oklahoma (755)
• Illinois/Indiana: Blue Cross and Blue Shield of Illinois (747)
• Maryland: Kaiser Foundation Health Plan (791)
• Massachusetts: Blue Cross Blue Shield of Massachusetts (714)
• Michigan: Blue Cross Blue Shield of Michigan (748)
• Minnesota/Wisconsin: Anthem Blue Cross and Blue Shield Wisconsin (734)
• Mountain: Regence BlueCross BlueShield of Utah (749)
• New Jersey: Horizon Blue Cross and Blue Shield of New Jersey (729)
• New York: Capital District Physicians’ Health Plan (787)
• Northeast: Blue Cross & Blue Shield of Rhode Island (749)
• Northwest: Kaiser Foundation Health Plan (736)
• Ohio: Anthem Blue Cross and Blue Shield Ohio (725)
• Pennsylvania: Geisinger Health Plan (761)
• South Atlantic: Kaiser Foundation Health Plan (795)
• Southwest: Anthem Blue Cross and Blue Shield Nevada (742)
• Texas: Humana (768)
• Virginia: CareFirst BlueCross BlueShield (766)

See the rank charts for each region at http://www.jdpower.com/pr-id/2022061.

The U.S. Commercial Member Health Plan Study, now in its 16^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 also measures several other key aspects of the experience and member engagement. The study is based on responses from 36,366 commercial health plan members and was fielded from January through April 2022.

For more information about the U.S. Commercial Member Health Plan Study, visit https://www.jdpower.com/business/resource/commercial-member-health-plan-study.

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

¹ Health Affairs Journal, March 28, 2022: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2022.00113

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