THE 'EDGE REPORT BLOG

Why Medicare Advantage Plans Have the Most Satisfied Members

While it may not have been a completely shocking revelation, I was excited to see one of the results of our recent survey of 3,000 consumers indicating that Medicare Advantage (MA) plans have highly satisfied members, with 55% of respondents with MA plans giving their insurance providers five stars.

MA has been an explosive area of growth for many of the health plans that we collaborate with. In many cases, it’s been a whole new line of business for organizations, or even the basis for some new health plans startups; for others, it’s been the expansion of their existing MA business in membership numbers or geography, or both. Not only is there still a large portion of the baby boomer population aging into Medicare, but increasing familiarity with and understanding of MA offerings opens the opportunity for conversion of existing members from traditional Medicare and Medicare Supplement to MA plans, including some of the older Medicare population.

With this growth opportunity comes a highly competitive health insurance marketplace, making a positive member experience critical to retaining members and growing the business. And health plans have delivered. Again, it’s not overly surprising that MA received such satisfactory scores; it’s a very high-touch, highly regulated business, down to the communications that need to be delivered appropriately and timely to that high-utilizing population, who rely on and appreciate the visibility.

On the flip side, health plans individually purchased on a public exchange received the lowest satisfaction scores from the consumer respondents, with almost 25% of respondents giving their plan a 2-star or 1-star rating. Furthermore, more than half (52%) of these members plan to scan the market during open enrollment. These statistics, along with the documented recent growth in the ACA coverage as more Americans have signed up on the federal exchange since its reopening, signify an opportunity to increase satisfaction in order to gain and retain ACA members. As health plans analyze these findings, they may consider investing or reinvesting and improving their ACA offerings. 

Given the disparity in satisfaction levels between Medicare Advantage and ACA members, health plans with both lines of business have a significant opportunity to take advantage of lessons learned. They can look at both the regulated activities and best practices that have evolved in their Medicare Advantage business to see what could be applied to individual ACA plans to improve the member experience― bearing in mind, of course, the variances in funding and other regulatory activities in these distinct markets.

Additional results of the consumer survey clearly indicate that members across product lines want to fully understand their benefits and to be equipped with self-service tools that allow them to navigate and utilize their plans effectively – ultimately, to successfully manage their health.

Based on these findings, health plans may want to consider evaluating the effectiveness of existing communications and opportunities for enrichment, as well as assessing the underlying technologies and customer-facing tools in place to meet their populations’ needs.

About the Author

DIane Pascot

Diane Pascot, Director of Sales Solutions, HealthEdge
LinkedIn
dpascot@healthedge.com

Diane Pascot is a senior healthcare technology professional with deep expertise and extensive experience collaborating with health plans and benefit administrators of all types and sizes on their technology strategies. Diane primarily focuses on core administration system replacements within the context of overall IT ecosystems. As Director of Sales Solutions for HealthEdge, she regularly engages with prospective payer clients to understand their current state, ascertain near-and long-term goals and objectives, and formulate and convey proposed solutions that will help them transform their business, ultimately to help facilitate seamless transitions to new client implementations. Prior to joining HealthEdge in 2017, Diane spent many years in the healthcare payer technology space with organizations that included Evolent Health (Aldera), Mphasis Eldorado, and Cognizant/TriZetto.

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Health Plans Must Modernize Technology to Improve Member and Provider Satisfaction

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