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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 normalize during the next two years. According to the J.D. Power 2022 U.S. Commercial Member Health Plan Study, released , 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.

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“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”

“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.”

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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.

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