Value-based care (VBC) has been a major focus over the last several years in healthcare. However, commercial health plans appear to be falling short on many drivers of success in VBC, including proactive patient engagement, enhancing preventive care, and facilitating seamless communication between health plans and members. It’s being felt by plan members and they are clearly reporting their feelings in survey results.

Christopher Lis, managing director of global healthcare intelligence at J.D. Power, notes, “Many commercial health plans are having challenges getting the right information and support to patients when and where they need it.” This challenge is particularly prevalent among patients who self-reported ‘poor and fair’ health statuses. Among these patients, who often grapple with complex health conditions, only 17% were assigned to a case manager. This oversight can lead to care fragmentation, compromising health outcomes and escalating spending within the population that necessitates coordinated care the most.

J.D. Power’s U.S. Commercial Member Health Plan Study is based on responses from 32,656 commercial health plan members representing 147 health plans across 22 different U.S. regions. Responses were captured from January through April 2023. It measures satisfaction by examining six factors: billing and payment; cost; coverage and benefits; customer service; information and communication; and provider choice.

Key Findings of the Study

1. Declining satisfaction: Overall satisfaction dipped by 13 points this year, on a 1,000-point scale, largely due to a dramatic 33-point decline in satisfaction with customer service. Drops in satisfaction levels, year-over-year, were also noted in coverage and benefits (-20), provider choice (-16), and information and communication (-16). 

2. Poor onboarding experience: The Net Promoter Score® for new members is a dismal 6, on a scale of -100 to 100. Compare this to the average score of 25 for establish plan members. This study suggests the difference shows new members are not receiving clear information or effective support in helping them navigate their health benefits information.  

3. Lack of proactive care for sicker patients: Only 36% of patients with ‘poor/fair’ self-reported health status felt that their health plan assisted them in coordinating care, compared to 43% of patients with ‘very good/excellent’ health status.

4. Low usage of digital health tools: Despite health plans’ investment in digital tools, member usage remains stubbornly low. Even among the sickest patients, usage rates of online health assessments, chronic disease management tools, online triage and nursing support, and remote monitoring are alarmingly low.

These findings underscore an urgent need for commercial health plans to enhance their patient engagement strategies. Improvement will more important than ever, as a new report from Milliman shows coverage costs rising considerably in 2023—estimated at more than $31,000 for a family of four. Employees healthcare costs are estimated to increase by 4.4% and employers are expected to have a rise of 7.2%.