Entries in Surveys & Reports (62)


March Brings Three Different Slices of Health Plan Consumer Experience Ratings

by Clive Riddle, March 28, 2014

This month, three annual proprietary consumer experience studies have yielded separate slices of the health plan consumer experience. J.D. Power, Temkin Group and Saatmetrix have all weighed in, and each shed favorable light on Kaiser Permanente, among other plans.

J.D. Power released results from their eighth annual Member Health Plan Study, in which they provide member satisfaction index rankings by region. Their 2014 Member Health Plan Study is based on responses from more than 34,000 members of 136 commercial health plans across 18 regions in the United States. The study was fielded in December 2013 and January 2014.  

J.D. Power ranks satisfaction on a 1,000 point scale. Satisfaction is highest among health plan members in the California and Michigan regions (in a tie); the Indiana-Illinois and Mid-Atlantic regions (in a tie); and the East South Central and South Atlantic regions (in a tie). Satisfaction is lowest in the New England, New York-New Jersey and Southwest regions. 

Top ranked plans by region, according to the J.D. Power study, were compiled in healthsprocket, in these regional lists:

J.D. Power 2014 Member Health Plan Study: Top Plan Scores - Southern United Stated

  • Kaiser Foundation Health Plan (784) ranks highest among health plan members in the South Atlantic region (which includes Georgia, North Carolina and South Carolina) for a fifth consecutive year
  • AvMed Health Plans and Humana (in a tie at 690 each) rank highest among health plan members in the Florida region, AvMed ranks highest in the Florida region for a third consecutive year
  • Cigna (689) ranks highest among health plan members in the East South Central region (which includes Alabama, Kentucky, Louisiana, Mississippi and Tennessee)
  • Aetna (677) ranks highest among health plan members in the Texas region

J.D. Power 2014 Member Health Plan Study: Top Plan Scores - Eastern US

  • Kaiser Foundation Health Plan (732) ranks highest among health plan members in the Mid-Atlantic region (which includes Maryland, Virginia and Washington, D.C.)
  • Capital District Physicians Health Plan (727) ranks highest among health plan members in the New York-New Jersey region
  • Geisinger Health Plan (705) ranks highest among health plan members in the Pennsylvania region for a third consecutive year
  • Tufts Associated Health Plans (681) ranks highest among health plan members in the New England region (which includes Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont)

J.D. Power 2014 Member Health Plan Study: Top Plan Scores - Midwestern US

  • Health Alliance Plan of Michigan (711) ranks highest among health plan members in the Michigan region for a seventh consecutive year
  • Dean Health Plan (703) ranks highest among health plan members in the Minnesota-Wisconsin region
  • Medical Mutual of Ohio (697) ranks highest among health plan members in the Ohio region
  • Health Alliance Medical Plans (692) ranks highest among health plan members in the Indiana-Illinois region
  • Wellmark Blue Cross Blue Shield of Iowa (680) ranks highest among health plan members in the Heartland region (which includes Arkansas, Iowa, Kansas, Missouri, Nebraska and Oklahoma)

J.D. Power 2014 Member Health Plan Study: Top Plan Scores - Western US

  • Kaiser Foundation Health Plan ranks highest among health plan members in the California region for a seventh consecutive year, with a score of 756
  • Kaiser Foundation Health Plan (732) ranks highest among health plan members in the Northwest region region (which includes Oregon and Washington)
  • Kaiser Foundation Health Plan (703) ranks highest among health plan members in the Colorado region for a seventh consecutive year
  • SelectHealth (698) ranks highest among health plan members in the Mountain region (which includes Idaho, Montana, Utah and Wyoming) for a fifth consecutive year
  • Blue Cross Blue Shield of Arizona (675) ranks highest among health plan members in the Southwest region (which includes Arizona, New Mexico and Nevada

Temkin Group pronounced the health plan industry “mediocre” and bestowed the highest customer experience rankings to Kaiser Permanente and Humana respectively, in releasing results from their fourth annual ranking of companies based on a study of 10,000 U.S. consumers that “examines the quality of the customer experience delivered by 268 organizations across 19 industries: airlines, appliance makers, auto dealers, banks, car rental agencies, computer makers, credit card issuers, fast food chains, grocery chains, health plans, hotel chains, insurance carriers, Internet service providers, investment firms, parcel delivery services, retailers, software firms, TV service providers, and wireless carriers.”

Bruce Temkin, managing partner of Temkin Group, tells us "consumers give pretty bad ratings to most health plans, as this entire industry needs a customer experience makeover.  Overall, the health plan industry averaged a 56% rating in their study and tied for 17th place out of 19 industries.

Temkin ratings by plans included in the survey were:

  1. Kaiser Permanente (68%)
  2. Humana (63%)
  3. Medicare (62%)
  4. TriCare (62%)
  5. United Healthcare (59%)
  6. Blue Shield of California (58%)
  7. Aetna (57%)
  8. Health Net (55%)
  9. CIGNA (54%)
  10. Anthem (BCBS) (53%)
  11. CareFirst (BCBS) (48%)
  12. Medicaid (45%)
  13. Highmark (BCBS) (44%)
  14. Empire (BCBS) (42%)
  15. Coventry Health Care (41%).

Temkin noted that Humana (+12 points), Blue Shield of California (+7 points), and United Healthcare (+5 points) improved the most between 2013 and 2014. Coventry Healthcare (BCBS) (-18 points), TriCare (-9 points), Empire (BCBS) (-7 points), and Highmark (BCBS) (-6 points) declined the most since 2013. Kaiser Permanente with their 68% rating, was in 109th place overall out of 268 organizations across 19 industries. Humana, with a rating of 63% placed 160th overall. Coventry Health Care (BCBS) was in last place across all 268 companies in the ratings with their score of 41%.

Satmetrix Systems released results for their 2014 Satmetrix® Net Promoter® Benchmarks which measure and rank customer loyalty more than 219 brands across 22 U.S. industry sectors, including financial services, insurance, technology, online services, retail stores, electronics, travel and hospitality, and telecommunications. The Satmetrix Net Promoter Benchmark rankings are based on survey responses from more than 24,000 U.S. consumers nationwide who indicated they had significant experience with a company's products or services in the previous 12 months. A company's Net Promoter Score is based on customers' likelihood to recommend the company's product or service. The score is the percentage of customers who are promoters, rating the company 9 or 10 on a 0 to 10 point scale, minus the percentage who are detractors, rating 6 or lower.

The Satmetrix study for the health insurance sector followed these nine companies:

  • Aetna
  • Anthem
  • BlueCross BlueShield of Florida
  • BlueCross BlueShield of California
  • Cigna
  • Humana
  • Kaiser
  • Medicare
  • United Healthcare

Like J.D. Power and Temkin, Satmetrix found Kaiser Permanente to be a dominant force, leading the health insurance category for the fourth consecutive year  and “improving to an all-time high [Net Promoter Score] score of 40 points. The provider rated highest on a number of important key loyalty drivers, as patients appreciated its service features, company reputation and the feeling that Kaiser Permanente acts in their personal best interest.” Kaiser’s score was 23 points higher than the industry average. Like Temkin, Satmetrix ranked Human in second place: “with a score of 32 points, Humana saw significant improvement from 2013, moving up 14 points to beat out last year's second place finisher, Medicare (27 points).”


That's Not the Way I Always Heard It Should Be

by Kim Bellard, March 11, 2014

Now that the initial open enrollment period under ACA is drawing to a close, we’re starting to hear more about how the enrollment is going, and the news is not encouraging.

The Administration has touted that 4 million have gotten coverage through the exchanges – still several million short of their goals – but they claim to not know much about whether ACA’s impact on the uninsured rate.  Fortunately, outside organizations are helping to fill in some of the gaps. 

The McKinsey Center for U.S. Health System Reform released the results of their individual market enrollment survey, with results from February 2014.  Only 27% of those who had obtained new coverage in 2014 reported having been previously uninsured.  Even more discouraging, only 10% percent of all previously uninsured now reported having coverage.  The faint sign of hope in the numbers is that both numbers are up sharply from previous surveys – 11% and 3%, respectively – but I doubt anyone who supported ACA’s passage thought they were signing up for only helping 10% of the uninsured.

Adding insult to injury, only three-quarters of those with new coverage reported actually having paid their premium, confirming reports that health insurers had warned about.  And that percentage was only 53% among the previously uninsured, which does not inspire much confidence that they will remain insured for very long.

Perceived affordability remains the key barrier to buying coverage, even though 80% of those citing it were actually eligible for subsides, a crucial fact that two-thirds were unaware of.

One glimmer of good news is that Gallup reports that the uninsured rate has, in fact, dropped, down to 15.9% (versus 17.1% in 4Q 2013).  To be fair, though, their results showed spikes in late 2013, and the 1Q 2014 results are on par with 1Q 2013 and 1Q 2011.  Coverage through an employer dropped two percentage points from 4Q 2013, while both individual coverage and coverage through Medicaid were up by slightly under 1%.  

The Urban Institute released their own survey results on ACA enrollment, conducted in December 2013.  Among all adults 18-64, 12% reported having looked for information on health plans in the marketplace (Orwellian for “exchanges”), with another 17% planning to do so.  More significantly, among the uninsured still only 19% had looked, another 33% thought they would look – and 23% had not heard about the marketplaces.  The comparable numbers for those below 138% of the federal poverty level were 13%, 25%, and 27%, respectively, highlighting that the most vulnerable groups are not getting the message.

The picture isn’t really rosy anywhere.  The people who were already in the individual market continue to be buffeted by changes in the rules of the road.  For example, there is Administration’s executive decision to allow subsidies for policies purchased outside the marketplaces, in recognition that some consumers may have been too frustrated by the marketplace websites to buy from them. 

Then there is the “bare bones plans” mess.  After the uproar last fall about people having to lose their health plans because they didn’t meet ACA minimum standards, the Administration belated announced a one year delay in the enforcement of those standards, and has just extended that delay for yet another year, potentially meaning they won’t apply until 2016.   

It’s anyone’s guess about what has happened with premiums in the individual market.  A recent analysis by the Robert Wood Johnson Foundation in selected states found (with the exception of Alabama) more competitive markets and premiums, while a report from the Manhattan Institute last fall found an average increase of 41% (much due to benefit changes), and a study by the presumably objective Society of Actuaries last spring also expected significant increases, especially for younger consumers.

Any employer with a health plan or 401k plan – or any state Medicaid director – could have warned us that voluntary enrollment typically leaves lots of eligible people not taking action..  We should have taken the approach many 401k plans have adopted – “automatic enrollment.” Driven by disappointing participation in 401k plans, the federal law was changed to allow employers to automatically enroll employees in their 401k plan, with a default contribution rate.  Employees could still opt-out, or change the default contribution level, but employers have found that participation rates are higher and average contribution rates are higher under this approach.  What’s not to like?

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting


mHealth on my Mind

by Clive Riddle, February 28, 2014

With the HIMSS14 gargantuan annual conference being held this week in Orlando, the spotlight has been shining bright on mHealth and other health information technology as of late.  In conjunction with the conference HIMSS Analytics released results from their 3rd Annual HIMSS Analytics Mobile Survey.

Here’s some highlights shared in their report:

  • 59% of respondent stakeholders have a mobile technology plan; another 29% are developing a plan.
  • Of those with a policy in place, here’s what the policies addressed: (1) 82% listed Means of securing devices (i.e. storing information on device); (2) 78% listed Use of personal devices for clinical/work use; (3) 71% listed Management of lost/stolen devices; (4) 71% listed Ability to access data from remote locations 71.43%; (5) 63% listed Types of apps approved for use ; (6) 45% listed Brand/version of device 44.90%
  • Respondents scored HIPAA highest as the federal legislation with the most nHealth impact; Meaningful Use was second
  • 95% use at least one security tool to secure data on mobile devices;  Of those with security tools, 94% used Passwords; 71% used encryption measures; and 69% used remote wipe capability
  • 83% indicate their physicians use mobile technology to facilitate at least some patient care.
  • 71% indicated their nurses used mobile technology to facilitate at least some patient care
  • Clinicians are most likely to use technology to support patient care by either: Looking up patient information (69%); or Looking up non personal health information (65%). Rounding out the top five responses were  Use for education/training purposes (49%);  Clinical notifications (42%) and Secure communications regarding patients (39%)
  • The top five tools used to engage patients/consumers in their healthcare were (1) App-Enabled Patient Portals (56%);  (2) Telehealth Services (52%);  (3) Provide Remote Monitoring Devices (36%);  (4) Prescribing Apps (23%); and (5) Discharge Kit with Mobile Technology (13%)

On another front, moving to specific, Citrix released ranking of the Top 10 Mobile Health Apps By Number of Network-Connected Subscribers, which was posted in Healthsprocket as follows:

  1. Runtastic
  2. My Fitness Pal
  3. RunKeeper
  4. Weight Watchers
  5. Nike+
  6. Map My Run
  7. Pregnancy
  8. Period Diary
  9. Lose It!
  10. Baby Bump

Stakeholder Views on Trends, Winners and Losers for 2014

By Clive Riddle, February, 14, 2014

MCOL recently conducted its annual Future Care e-Poll, asking stakeholders their perspective of trends, winners and losers for the coming year and beyond. Here’s a sneak peek at some of the results from the soon to be released report on this year’s findings. The full report still being compiled addresses additional e-poll questions, breaks down responses by stakeholder category and compares results to previous years.

Here’s a table of how respondents view the business trend that will have the greatest overall impact in 2014. The Affordable Care Act of course dominates all other issues, and even more so than last year, when exactly half of respondents list it as the trend with the greatest impact.

Affordable Care Act Implementation


Government Spending Cuts


Consumerism Initiatives


Effects of the Economy


Increased Consumer Cost Sharing


Compliance Issues




Advances in Health Care Technology


Population Health and Wellness Initiatives


Below is an infoGraphoid MCOL published earlier this week illustrating the e-poll results on this question. The designer of this graph informed me it looked like a green Pac-Man (the ACA respondents) vomiting a rainbow (of all the other respondents.)

Regarding winners and losers, here’s what stakeholders thought 2014’s fortunes would bring to other stakeholders:


Hospitals – 56% say Hospitals are the big losers (only 18% said better off; 26% the same)

Physicians – 53% view Physicians as worse off (only 8% said better off; 38% the same)

Employers  - 52% think Employers are worse off (only 15% said better off; 33% the same)

Consumers  - 51% placed them in the losers column (34% said better off; 15% the same)

Status Quo:

Pharmaceutical – 60% see Pharmaceutical organizations as staying the same (29% said better off; only 11% said worse off)


Health Plans – 47% say Health Plans as the big winners (29% said they will stay the same; 24% said they will be worse off)

It’s interesting that the stakeholder that the ACA was designed to benefit – the Consumer – is not viewed by stakeholders as the biggest beneficiary. It’s also interesting that last year respondents didn’t view health plans fortunes near as positive – at the start of 2013, 27% replied health plans would be better off;  34% said the same; and 39% said worse off.


Grading the Emergency Care System

By Clive Riddle, January 17, 2014

For the first time since 2009, the American College of Emergency Physicians (ACEP) issued their report card on the emergency care system at the state and national levels. Our grades have slipped. Their 149-page report “America’s Emergency Care Environment: A State-by-State Report Card” — examines 136 different emergency system measures in five categories, as follows:

Category % of Overall Grade 2009 National Score 2014 National Score
Access to Emergency Care 30% D- D-
Quality and Patient Safety 20% C+ C
Medical Liability Environment 20% C- C-
Public Health and Injury Prevention 15% C C
Disaster Preparedness 15% C+ C-
Overall 100% C- D+

The point ACEP wishes to illustrate through the report is that the current health care system, as well as the health reform environment rely heavily upon the nation’s emergency care delivery, and the state of emergency care is not necessarily up to the task going forward.

ACEP President Dr. Alex Rosenau, tells us “there were more than 130 million emergency visits in 2010, or 247 visits per minute. People are in need, but conditions in our nation have deteriorated since the 2009 Report Card due to lack of policymaker action at the state and national levels. With so much changing in health care, emergency care has never been more important to our communities. This Report Card is a call to action.”

In the report’s state-by-state rankings, these states stand out at the top and bottom five:

District of Columbia (1st, B-)

Massachusetts (2nd, B-)
Maine (3rd, B-)

Nebraska (4th, B-)

Colorado (5th , C+)

Kentucky (47th, D)

Montana (48th, D)

New Mexico (49th, D)

Arkansas (50th, D-)

Wyoming (51st, F)

What to do about these poor grades? Here are the recommendations made in the report:

  1. Protect access to emergency care as health care reforms are implemented.
  2. Support programs that recognize the pivotal role emergency medicine plays in care coordination and transitions of care.
  3. Reduce the incidence of hospital crowding and boarding of admitted patients in the emergency department.
  4. Enact federal and state medical liability reforms that enhance timely access to quality care, particularly those that provide appropriate liability protections for EMTALA-mandated care.
  5. Increase coordination and regionalization of specialized emergency services and support funding of federally authorized regional pilot programs.
  6. Devote consistent federal and state funding to ensure adequate and sustainable local and regional disaster preparedness.
  7. Continue to increase the use of systems, standards, and information technologies to track and enhance the quality and patient safety environment.
  8. Continue pursuit of state laws that help reduce the number of preventable deaths and injuries, particularly those that address traffic-related injuries and fatalities.
  9. Expand access to standardized and user-friendly state and/or federal prescription drug monitoring programs to decrease unintentional deaths by drug overdose.
  10. Fund graduate medical education programs that support emergency care, especially those related to addressing physician shortages in disadvantaged areas and in rural areas.
  11. Support emergency medicine research, including basic, clinical, and translational research into improving the delivery of emergency care services.