2015 Health Plan Member Satisfaction Study Released by J.D. Power

Health plan overall member satisfaction averages 679, a 10 point improvement from 2014, found a new study by J.D. Power.

The study now in its ninth year measures satisfaction among members of 134 health plans in 18 regions throughout the U.. by examining six key factors: coverage and benefits; provider choice; information and communication; claims processing; cost; and customer service. Satisfaction is calculated on a 1,000-point scale, the firm said..

“Following a year filled with negative news coverage about health insurance, a bumpy start to the launch of the Affordable Care Act, and an atmosphere of fear, member satisfaction with health plans has increased significantly as plan administrators take a customer-centric approach, helping to build member trust and loyalty,” the study revealed.

The increase in satisfaction is driven by improved performance across all factors, most notably in information and communication (+17 points), which is primarily a result of efforts among many of the health plans to retool their approach by refining messaging, adjusting message frequency and upgrading their website. Satisfaction in the customer service factor has increased by 11 points, driven partially by matching communication methods to member preferences, such as mobile and text. Cost satisfaction increases by 13 points while fewer members indicate having experienced an increase in their monthly premium, as well as a decline in overall out-of-pocket expenses for individuals and families.

“Health plans have come a long way since last year as the focus has shifted toward better serving member needs and building trust. However, there is still a lot of work to do,” said Rick Johnson, senior director of the healthcare practice at J.D. Power.

“Health plans need to take a more customer-centric approach and keep their members engaged through regular communications about programs and services available through their plan. When members perceive their plan as a trusted health partner, there is a positive impact on loyalty and advocacy.”

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The study found that overall satisfaction is significantly higher among the 19 percent of members who strongly agree their health plan is a trusted partner in managing their health. Among members who say they “strongly agree” that their health plan is a trusted partner, satisfaction increases by 201 points.

 KEY FINDINGS

  • Members who say they “strongly agree” that their health plan is a trusted advisor are less likely to switch health plan providers.
  • Within information and communication, satisfaction ratings have improved from 2014 in the factor’s four attributes: ease of understanding your plan’s benefits and services (6.4 vs. 6.2, respectively, on a 10-point scale); frequency of communications (6.3 vs. 6.1, respectively); usefulness of information (6.4 vs. 6.2, respectively); and variety of communications (6.3 vs. 6.1, respectively).
  • Similarly, satisfaction ratings have also improved year over year in the attributes within the cost factor: premiums (5.9 vs. 5.7, respectively); deductible amount (5.8 vs. 5.7, respectively); co-pays for prescription medication (6.4 vs. 6.2, respectively); and co-pays for doctor visits (6.3 vs. 6.2, respectively).
  • Overall member satisfaction is 108 points higher among members who have contacted their plan via mobile app at least once in the past 12 months than among those who haven’t.  While members under 40 years old contact their plan via text and mobile app at a significantly higher rate than older members, the telephone is still the most frequently used contact method across all age cohorts.

Study Rankings

Satisfaction is highest among health plan members in the California (695), Northwest (693), IllinoisIndiana (689), Michigan (688) and Mountain (686) regions. Satisfaction is lowest among members in the New England (664) and the Southwest and MinnesotaWisconsin regions at a tie (665).

In a related development, J.D. Power plans to release a Health Insurance Marketplace Exchange Shopper and Re-enrollment Study (HIX), focused on member satisfaction with health plans purchased through public exchanges, as well as the shopping experience on those exchanges, this month. In October 2015, J.D. Power will also release a Medicare Advantage Study, focused on member satisfaction with Medicare Advantage plans.

The 2015 Member Health Plan Study is based on responses from more than 31,000 members of 134 commercial health plans across 18 regions in the United States. The study was fielded in November and December 2014. For more comprehensive health plan rankings for all 18 U.S. regions, please visit www.jdpower.com.

Following Are Member Satisfaction Index Rankings :

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Focus On Data in Era of Value-Based Models of Reimbursement

“Despite the continued prevalence of the traditional fee for service reimbursement models as the primary method of payment, over time healthcare’s reimbursement will give way to value-based models of reimbursement.”

That prediction made by longtime friend and consultant Russell Foster surrounding the need for accurate data as value-based models of reimbursement continue to emerge has come true.

You know that valued-based reimbursement today is a significant focus. Payer reimbursement strategies are tipping in favor of providers who can deliver the clinical and financial goods. In the mix are bundled payments, shared savings, pay for performance and bonuses.

Payment Bundling, PHO Shared Savings, and Pay for Performance are all in the mix of emerging models of episode-based payments, physician-hospital organizations and physician bonus structures.

One major health payer’s 6,300 enrolled primary care physicians can earn bonus payments across six measure sets — a broad spectrum of measures from clinical and quality measures to prescribing Continue reading

More than 4000 Physicians Now Designated Patient Centered Medical Homes by Blue Cross Blue Shield of Michigan

Some 4,022 primary care doctors, have been designated as patient-centered medical homes for the 2014 program year by Blue Cross Blue Shield of Michigan.

The doctors are members of 1,422 physician practices that combined care for more than 1.2 million BCBSM members in 78 of Michigan’s 83 counties.

The program, in its sixth year, continues to lead the nation in size and cost savings, BCBSM said.

The health plan said it recorded certified savings of $155 million in prevented ER and hospital claims from the first three years of the PCMH designation program.  Savings estimates for year four are expected later this year.

“Data from 2013-2014 shows adult patients in Blue-designated PCMH practices had a 27.5 percent lower rate of hospital stays for certain conditions than non-designated practices,” BCBM said. Continue reading

What is Being Thrown into Your Healthcare Reimbursement Stew: All with a Goal of Care Improvement

Bundled payments, new models of reimbursement, care transitions, value-based reimbursement, readmission penalties, are all part of the jargon in payer and provider circles today.

And there is no lack of opinions on what new or a combination of all is the answer to quality care, cost savings and outcomes results. All approaches come with some risks to providers and financially to payers.

On the eve of the new year, the Centers for Medicare & Medicaid Services (CMS) released the health care organizations selected to participate in  the Bundled Payments for Care Improvement initiative, an innovative new payment model.

“Under the Bundled Payments for Care Improvement initiative,” organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower cost to Medicare,” CMS said. Continue reading

What is Being Thrown into Your Healthcare Reimbursement Stew: All with a Goal of Care Improvement

Bundled payments, new models of reimbursement, care transitions, value-based reimbursement, readmission penalties, are all part of the jargon in payer and provider circles today.

And there is no lack of opinions on what new or a combination of all is the answer to quality care, cost savings and outcomes results. All approaches come with some risks to providers and financially to payers.

On the eve of the new year, the Centers for Medicare & Medicaid Services (CMS) released the health care organizations selected to participate in  the Bundled Payments for Care Improvement initiative, an innovative new payment model.

“Under the Bundled Payments for Care Improvement initiative,” organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower cost to Medicare,” CMS said. Continue reading

Driving Value-Based Reimbursement with Integrated Care Models

The burgeoning fee-for-value environment is rewarding networks of providers who collaborate and coordinate care, bridging the gap between health systems and physicians and sparking dialog and care compacts between primary care and specialists.

Even top-performing Pioneer ACOs are rethinking the role of specialists in care coordination.

Driving Value-Based Reimbursement with Integrated Care Models, a new report from the Healthcare Intelligence Network, examines WellPoint’s practice transformation effort and the reimbursement models that support it, while providing a framework in which to evaluate the patient-centered medical neighborhood (PCM-N) model.

Julie Schilz, director of care delivery transformation for WellPoint, and Terry McGeeney, MD, MBA, director of BDC Advisors, share their visions for this emerging care experience, from structuring incentives and reimbursement to rewarding high-quality and efficient care to identifying and engaging specialists in a medical home neighborhood.

Learn more about driving value-based reimbursement with integrated care models.

NEWS FACTS: This 45-page resource provides details on the following:

  • Three key practice transformation roles developed by WellPoint that address the critical elements of transformation;
  • How the physician practice transformation program complements WellPoint’s overall reimbursement strategy with fee-for-service and a shared savings component;
  • The Quality Gate for clinical and utilization metrics for WellPoint’s shared savings arrangement;
  • How to identify and engage specialists to participate in a medical neighborhood;
  • How to help physicians understand the link between meaningful use, the patient-centered medical home and medical neighborhoods;
  • Lessons learned in building medical neighborhoods;

and much more.

Learn more about driving value-based reimbursement with integrated care models.

Target Audience: Presidents/CEOs, CFOs, chief operating officers, vice presidents, medical directors, analysts, business development executives, consultants, directors, executive directors, financial/business managers, marketing executives, principals and strategic planning executives.

 

 

Physician Organizations – IPAs – PHOs Can Improve Care Management For Smaller Practices, New Study Finds

On average, physician practices participating in independent practice associations (IPAs) and physician hospital organizations (PHOs) provided nearly three times as many care management processes for patients with chronic conditions as nonparticipating practices did, the results of a new study found.

The difference is dramatic – 10.45 percent versus 3.85 percent, found the researchers. And, half of these processes were provided only by IPAs or PHOs.

All the recent initiatives surrounding physician practice including pay-for-performance, public reporting, and accountable care organization programs places pressure on physicians to use health information technology and organized care management processes to improve the care they provide.

The problem is physician practices that are not large may lack the resources and size to implement such processes.

The researchers said they used data from a “unique national survey of 1,164 practices with fewer than twenty physicians to provide the first information available on the extent to which IPAs and PHOs might make it possible for these smaller practices to share resources to improve care.”

Nearly a quarter of the practices participated in an IPA or a PHO that accounted for a significant proportion of their patients, the study found.

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IPA-PHO Database – The National Directory of Physician Organizations profiles more than 1,300 physician organizations. Listings include: physician hospital organizations (PHOs), independent practice associations (IPAs), multi-specialty medical groups, physician primary care networks, and management service organizations (MSOs) The National Directory of Physician Organizations

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These organizations may provide a way for small and medium-size practices to systematically improve care and participate in accountable care organizations, said the researchers.

“The data presented suggest that IPAs and PHOs may be able to provide an additional, potentially viable organizational alternative during an era of major changes in how health care is delivered and paid for,” the study authors wrote.

The research team was led by Lawrence P. Casalino, MD. The study results appeared in the August Issue of Health Affairs.