3 Key Metrics that Determine Member Satisfaction for Health Plans

Editorial Note 5/29/2024: This article has been updated to include comments from an expert at JD Power. 

Cost, convenience, and credence were three metrics that set apart high-performing and low-performing commercial health plans in a JD Power member satisfaction survey.

The JD Power 2024 U.S. Commercial Member Health Plan Study surveyed 147 health plans’ membership, adding up to 29,188 survey participants. The survey examined health plan performance and member satisfaction based on eight factors. JD Power conducted the survey, which is JD Power’s eighteenth U.S. Commercial Member Health Plan Study, from January through April 2024.

Overall, Capital District Physicians’ Health Plan, Inc. (CDPHP) in New York had the highest ranking on the 1,000-point scale for customer satisfaction, achieving 659 points. Kaiser Foundation Health Plan in the south Atlantic region followed with a score of 640 points and Kaiser Foundation Health Plan in Maryland took third place with 631 points.

Healthcare consumers have strong opinions about their commercial health plans, with the highest-performing payers scoring as much as 79 points above their lowest-ranked competitors. On average, satisfaction was up three points from the previous year’s survey.

Health plans with high customer satisfaction scores received high marks in three categories.

First, many high-performing health plans scored well on cost, both in terms of dollars and time. Members in the highest-ranking health plan gave the payer a satisfaction rating that was 87 points higher than the lowest-performing health plan.

The immediacy of access to care was a second distinguishing factor that differentiated health plans. The health plan that achieved the highest overall score had a convenience score that was 84 points higher than its lower-rated competitor.

Lastly, payers have long struggled to gain members’ trust. Success in this area was a key advantage for health plans in the JD Power survey results. High-performing health plans scored 84 points higher on trust than low-performing health plans.

But cost, access to care, and trust were not the only factors contributing to payers’ success. There were two categories in which nearly all health plans struggled to achieve a high member satisfaction score.

JD Power researchers also asked participants about the digital resources that payers used. Results showed that, overall, health insurer portals do not positively contribute to member satisfaction: health plans achieved 565 points for digital experience, compared to 730 points for mortgage origination or 652 points for the Medicare Advantage sector.

Payers did not perform well on consumer calls. Most consumer calls were related to basic coverage questions (73%), the study found. Around a third of members reported calling two times or more to resolve their insurance problem and even then 45% of consumers stated that their issue remained unresolved.

"Health plans can invest in digital to address lower performing areas of member satisfaction, including problem resolution and service recovery, and helping members save time and money, among other opportunities," Christopher Lis, managing director of global healthcare intelligence at JD Power, told HealthPayerIntelligence in an email statement. "Digital offers promise for transformation on the front end of the member experience, and on the back end to optimize efficiencies for members.  At the same time, health plans would be wise to meet members where they are at, as important generational differences exist in digital preference and utilization."

Lis directed plans to look into best practices in the hospitality industry in order to improve their customer service track record.

Additionally, the average wait time to see providers grew. The gap is different between low- and high-performing health plans. On average, patients wait 15 days to schedule a physical exam, but for low-performing health plans the wait could extend to 18 days or more.

As payers and employers design benefits and programs to address commercial plan members' needs, this data on drivers behind member satisfaction scores can act as a north star.