SAN FRANCISCO (MarketWatch) -- Privately held health insurers tend to outscore publicly traded ones when it comes to customer satisfaction, and health-plan members in the West proved less satisfied compared with three other regions in the U.S., according to a survey.
Performance varied widely both for not-for-profit and privately held plans and for-profit ones owned by publicly traded companies, according to a first-of-its-kind survey from J.D. Power and Associates released last week. The study examined seven categories of member satisfaction.
"There's considerable variation within the same company or the same type of plan," said David Stefan, executive director of J.D. Power's health-care division in Mesa, Ariz.
BlueCross and BlueShield of Florida and Premera in the West, for example, took top honors in their regions. But BlueCross and BlueShield of Texas came in last in the Southern region while Blue Cross of California was second to the bottom in the West.
Plans of private companies whose shares trade on a stock exchange came in consistently low. Though Anthem, a subsidiary of Wellpoint
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, scored above the regional average in the Northeast and South, it came in dead last in the Midwest. Aetna
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scored below the regional average in the four areas surveyed, while UnitedHealthcare
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managed to score above the regional average only in the West.
The most important drivers of satisfaction were coverage and benefits; choice of doctors, hospitals and pharmacies; and information and communication. The study also looked at approval processes, insurance statements, customer service and claims processing.
Harvard Pilgrim Health Care, which serves more than 1 million members in Massachusetts, New Hampshire and Maine, ranked highest in the Northeast with an overall satisfaction score of 785 on a 1,000-point scale, the survey found. It had the highest overall score of the 49 plans studied.
"There is a lot of outreach, a lot of high touch, from our organization to our members, and I think that's what swings a lot of the results," said Vin Capozzi, senior vice president of sales and marketing for Harvard Pilgrim in Wellesley, Mass.
Making a good first impression with comprehensive educational materials and outreach support is imperative and actually saves costs in the long run, he said. That means explaining to members who are new to high-deductible products how the benefit design works and keeping incoming member calls from being bounced all over the organization before the person's issue gets resolved.
"One of the statistics our member-services area prides itself on is first-call resolution, which basically says when someone calls in and talks to a service representative, 85% to 90% of the time that's where the call ends," Capozzi said. "I'm sure with some other carriers, that's a problem for them."
Top and lowest performers
Tufts Associated Health Plans took second place in New England with a score of 771. Highmark and Anthem also performed well, coming in at 762 and 759, compared with an average regional rating of 746. Bringing up the bottom of the 13 plans surveyed in the Northeast were United Healthcare, which had 735, Aetna, Cigna HealthCare and Oxford Health Plans.
The Blues swept the Southern region, with BlueCross and BlueShield of Florida ranking highest with a score of 779. BlueCross and BlueShield of Alabama followed at 773, while BlueCross and BlueShield of North Carolina and Anthem weren't far behind.
In the Midwest, BlueCross BlueShield of Minnesota took the top spot at 771, followed by BlueCross and BlueShield of Michigan at 762. Wellmark came in at 754, and BlueCross and BlueShield of Illinois was fourth with 748.
Premera BlueCross, a large insurer in Washington state and Alaska, ranked highest in the Western region with 775, followed by the Regence Group. BlueCross BlueShield of Arizona and Kaiser Foundation Health Plan tied for third place out of 12 regional contestants. Aetna was last with a score of 698. The regional average score was considerably lower than the other three at 726.
Take-home messages
Among the lessons health insurers can take from the results are that information and communication are key drivers of satisfaction, Stefan said. Coverage and benefits are the most important for members' experience, but improved outreach is the way to help them understand if valuable services such as preventive care are covered, he said.
"It underlies many of the other factors," Stefan said.
Still, health plans need to consider how to deliver the information so members will heed it. When asked which source they trust most for information about how to stay healthy and how to get the best health care, seven in 10 members surveyed said their primary-care doctors. Specialists, family and friends and health articles in the newspaper and online received 30%, 24% and 23%, respectively. About 12% said they trusted their health plan most while only 2.5% cited their employer.
The low level of trust in employers' motives surprised researchers, Stefan said.
"Employers could do well to look at whether they should deliver that information to their employees or have their health plans" do it, he said. The survey suggests communication on how to manage personal health would be more effective if it came through the health plan.
The study polled 10,552 members of large commercial health plans through online surveys in October and November of last year. Each of the 49 companies included had at least 750,000 privately insured members, representing 80% of U.S. commercial health-plan members.
Kristen Gerencher is a reporter for MarketWatch in San Francisco.