Gap growing between best- and worst-performing health plans

 Gap growing between best- and worst-performing health plans

Photo: Martin Barraud/Getty Images

For employees enrolled in commercial health insurance plans, the quality of their overall healthcare experience is largely dependent on the insurers with whom their employers have contracted, but their satisfaction with their plan is not dependent.

According to the J.D. Power 2024 U.S. Commercial Member Health Plan Study, there is a notable gap in customer satisfaction separating the top-performing health plan from the bottom-ranked plan of 79 points (on a 1,000-point scale), with the top-ranked insurers significantly outperforming on cost, access to care and trust.

The highest-ranking plan was Kaiser Foundation Health Plan in the South Atlantic. Other top performers included Anthem Blue Cross and Blue Shield in Colorado; Highmark Blue Cross Blue Shield Delaware; Aetna; UPMC Health Plan; Cigna; SelectHealth; HealthPartners; and Capital District Physicians’ Health Plan in New York.


Overall satisfaction with commercial health plans is 565, up three points from 2023. Beneath that improvement, however, a 79-point gap in customer satisfaction has emerged between top- and bottom-ranked health plans. While the highest-performing plans in the study see their overall satisfaction scores rise 20 points this year, those for the lowest-scoring performers have declined eight points.

The overall gaps in customer satisfaction between top- and bottom-performing health plans are biggest in the categories of helping to save time and money (87 points); ability to get health services how/when I want (84); and trust (84).

One universal challenge observed across nearly all health plans evaluated in the study is digital customer experience. The overall satisfaction score with the commercial health plan digital experience is just 565, which is significantly lower than for other service industry digital experiences, such as mortgage origination (730); direct banking (718); telehealth (698); and Medicare Advantage (652).

Meanwhile, the average wait time to see a specialist is now 22 days, and the average wait time to schedule an annual physical exam is 15 days. These wait times climb to 25 days and 18 days, respectively, among the lowest-performing health plans.

This year’s study is based on responses from 29,188 commercial health plan members fielded from January through April.


The J.D. Power 2023 U.S. Commercial Member Health Plan Study, published last May, found commercial health plans are missing the mark when it comes to patient engagement. Customer satisfaction with commercial health plans is particularly strained among members of Gen Y and Gen Z, driven largely by poor customer service and communication scores. Similarly, members with the lowest self-reported health status are most likely to experience communications challenges with their health plans.

A HealthEdge Survey, released in August, showed only 45% of healthcare consumers are fully satisfied with their health insurance. When asked what health plans can do to improve member satisfaction, the top five responses were incentives and rewards for healthy behaviors; easy access to health records; access to providers who offer care based on member preferences and personal traits; good customer service; and tools or information to help members find less costly care.


“In many cases, employer-sponsored health insurance is consumers’ primary window into the healthcare system,” said Christopher Lis, managing director, global healthcare intelligence at J.D. Power. “Access to care, cost of care, chronic condition management – the central pillars of the consumer healthcare experience – are all heavily influenced by commercial health plans. That’s why it’s so concerning that J.D. Power sees such a large gap in overall performance between plans across everything from cost to digital tools to provider choice.”

Jeff Lagasse is editor of Healthcare Finance News.
Healthcare Finance News is a HIMSS Media publication.

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