Members want more from their health plans, and the top-performing plans are finding more ways to connect with them on the phone, online and in person.
Overall satisfaction with commercial health plans is up from 2023, but the gap between top-performing and low-performing plans is widening, according to the J.D. Power annual Commercial Member Health Plan Study. The top-performing plans saw their customer ratings jump by 20 points on J.D. Power's scale, while the lowest performers fell by eight points on average.
Becker's connected with leaders at 14 health plans rated the best in their region by J.D. Power to learn what members want from health plans and how payers can evolve.
Executives pointed to creating better digital experiences, investments in value-based and preventive care and leveling up customer service as keys to succeeding in the current environment.
Here is what 14 payer leaders said members want from their health plans:
Editor's note: Responses have been lightly edited for length and clarity.
Mike Avotins. Central Region President at Aetna: The holy grail is engaging members in their own healthcare. It has been a challenge since day one, and it continues to be a challenge. We need to continue to view healthcare as no different than any other service or product that someone purchases, and that we expect them to be engaged in. When you think about that, really what our members expect of us is that we're easy to work with, that we're convenient, that they can access our capabilities, that it's personal and it's affordable. Those are the bedrocks of our strategy.
From there, what we do is we look at each one of those levers, and we talk about where we are today, where we need to go to continue to engage the member.
John Bennett, MD. CEO of Capital District Physicians' Health Plan: In society today, people want what they want when they want it, and they don't want to wait. Especially in healthcare. The healthcare system in general, not only the insurance system, but the delivery system, hasn't been very good at delivering that. We've tried to anticipate what they're going to want to need and give it to them.
People want care when they want it and how they want it. We have what we call our customer intimacy platform, and that, combined with our member-centric approach is what we strive for. One of the examples of that is our new building, Wellness Way, which is a 260,000-square-foot building. Only 60,000 square feet is administrative health plan offices. The rest is clinical. We have our partners, Community Care Physicians, which has a big chunk of their operations there. They have multiple specialities, outpatient surgery, inpatient, lab, everything from physical therapy, audiology, and primary care. We also have our CDPHP ConnectRx pharmacy, as well as a customer connect center. I think when you go there, you see the energy of what happens when health insurance comes together with physician providers.
Greg Brown, Chief Customer Service Officer at Blue Cross Blue Shield of Illinois: We do really well at resolving problems and complaints, and we do really well at helping save time or money compared to the national average. To me, it goes back to being a purpose-driven organization. Every member matters. If there's one complaint, it's very important for us to be able to resolve that.
Of course, we have all the mechanisms in place that we do on a regular basis, but we also invest in additional artificial intelligence. … This is all around enabling our customer advocates to deliver a better experience to the member, to the employer and to the provider. The human-powered aspect is critically important along those lines. We record 100% of our calls, and we use natural language models to determine — and it doesn't happen very often — if there's an opportunity to improve that experience. We identify it and it routes over to our customer loyalty team. Those are the most experienced customer advocates that we have, and they review those calls and they make outbounds to the member to ensure if there's any sort of issue, they will resolve it quickly. I think that's one of the reasons why we're getting really good at resolving problems or complaints.
Bob Crawford. Vice President of Corporate Marketing and Customer Experience at Blue Cross Blue Shield of Michigan: [Members] want healthcare to just work. It should be clear, easy, and work when they need it. … That's something we have a whole program around. That's what consumers want. What we saw with COVID was a rapid escalation of expectations. It wasn't just during that period of time; it stayed and continued to evolve and advance.
Even with the ongoing aging of the population, and more tech-savvy young people — frankly, we see our seniors being more tech-savvy than ever before — we see a push with higher expectations. It's because of other experiences they're having, and it falls over into healthcare also. There's a lot of pushes on, "You need to understand me. You need to meet my needs. You need to meet me where I am. It needs to be easy. It shouldn't be a burden on me. Don't give me homework." Those are the kinds of things we hear and we really work hard to address.
Brandon Cuevas. Executive Vice President of the National Health Plan at Kaiser Permanente: Kaiser Permanente provides care and coverage in a way that is different and better.
Our members are at the center of everything we do. Kaiser Permanente’s connected care is designed to support members' total health. Our doctors, specialists and health plan all work together to get members and patients the right care at the right time — and our advanced technology is built to meet patients where and when they need us.
We offer 24/7 access to virtual care and a variety of telehealth capabilities in order to provide care in the most convenient setting for our members, such as video visits, phone visits and remote patient monitoring.
Kaiser Permanente's integrated healthcare model creates a coordinated care experience and allows us to care for all our members' needs. Members can often visit their doctor, lab, and pharmacy all at the same location, while our electronic health record system enables patients and care teams to access all their health information in one secure place.
Kaiser Permanente is continuously expanding our digital platform to deliver more personalized, seamless experiences that enable and connect our integrated care model. This includes easy access to health information and actions through our Kaiser Permanente app and website, such as intuitive appointment booking, personalized symptom triage, quick access to detailed benefit and claims information, convenient self-service pharmacy options, and new ways to communicate with care teams.
Jennifer Danielson. Chief Health Plan Officer at HealthPartners: The things patients find most important right now are really about a desire for them to be valued and heard on an individual basis, and for them to know that they're really working with a partner they can trust.
We do a lot of listening to members. We do a lot of working to understand where those unmet needs really are. We really dug in to meet the members where they are and understand that a lot of that engagement with us happens long before somebody is ever on the phone with us. So we look specifically for digital tools to enhance them so people have a much richer experience in what they are able to access and find and understand. If there is still that real need for them to talk to somebody on the phone and work through a problem or an issue, that we've got the right resources to help them not just quickly, but completely.
Lou Gianquinto. President of Anthem Blue Cross Blue Shield of Connecticut: Members are expecting the highest access to care. … They want to make sure they have access to the providers they need when they need them. Since the pandemic, that's been our number one priority when it comes to member satisfaction.
Over the last years, [Anthem Blue Cross Blue Shield of Connecticut is evolving to meet] the members digital needs as well. We have our Sydney app that provides a lot of digital solutions for them, gives them the ability to see their benefits, their health records, and they can leverage telehealth services. Also, what we've seen evolve with our membership is the shift to chat. Our member contacts now are 41% chat, and that's really something that's evolved in the past years.
Pam Kehaly, CEO of Blue Cross Blue Shield of Arizona: Members are demanding more. They want healthcare that’s easier to access, easier to understand and easier to use. That's why our mission at AZ Blue is clear: Inspire health and make it easy. How do we make that happen? By closely listening to our members and working to make member care easier.
To do this, our team:
1. Focuses on solutions. It’s not just about health insurance. It’s about finding new ways to get care to our communities. Our launch of Prosano Health Advanced Primary Care Clinics, for example, brings affordable, personalized care in person or virtually.
2. Make getting healthcare easier. We’ve updated user experiences across all our platforms and portals and are piloting members being able to schedule directly with providers from our physician search tool.
Nick Moriello. CEO of Highmark Blue Cross Blue Shield of Delaware: Expectations increase all the time. There's more and more desire for services on demand. It's critical for us and other service industries to try to meet people where they are, and bring the services that they desire to them and find a way to try and do it without increasing the cost.
Anne Palmerine. Vice President of Member Services at UPMC Health Plan: The complexity of healthcare has gone exponentially up. It's hard for the layperson to fully understand their benefits. … It's really important that members have access to something that will tell them how much something is going to cost them. They want to be able to self-serve. They want to be able to use the app, they want to be able to use the portal. Our digital utilization has doubled over the past year. People want to be able to go on there for whatever they need. They want to be able to see what their benefits are, they want to know what the cost of this procedure is going to be. We've worked hard to set up tools within our contact center so that our concierge can easily answer that question for our members. We also have those tools within our portals so people are able to go and see what their costs are.
People want to understand their plan — they really need help in understanding how their plan works. It's not just procedures. A lot of it is pharmacy spend, what drugs are covered, how much am I going to pay if I get the brand versus generic. All of those things, people need to be informed of and unfortunately, it's gotten harder. But it's important that we're here to support them and get that information for them.
Matt Pickett. Colorado Commercial State Plan President of Anthem Blue Cross Blue Shield: Keeping costs down continues to be a key priority for our clients but also a clear priority for Anthem overall. Affordability is a key tenet that I don't think has changed, there just continues to be more and more of a focus on how we make healthcare more affordable. For us, we're focused on affordability in a few key ways. One is through our value-based care arrangements, digital solutions and preventive care.
The first one, on value-based care, we are keenly focused on collaborating with Colorado providers to expand these value-based care delivery, payment methodologies focused on quality and health outcomes instead of volume. The second one, we provide members digital tools that continue to evolve and enhance, that expand access to care, and provide members a more simplified and personalized healthcare experience. Third is really around preventive care. We encourage our members to access preventive care to stay up to date on their health screenings. Chronic conditions can be costly, and preventive care is the best way to identify and manage those conditions earlier.
Daniel Royer. Associate Vice President of Customer Experience Marketing at Select Health: Customer experience is really the sum of all the interactions a member has with a health plan. Over the years, consumer expectations, behaviors and preferences have increasingly shifted to favor digital channels. Along with this shift, consumers increasingly demand more personalization in those channels and want to feel that the experiences they have with a company are tailored to their individual needs. This change has significantly influenced the health insurance industry and impacted Select Health's engagement strategy to ensure those needs are met.
Our goal is to create simple experiences, based on user-centered design best practices, that our members find valuable and useful as they navigate their healthcare and health insurance journey. Whether it's Select Health's website, mobile applications, web portals or digital outreach campaigns, we strive to create hyper-personalized experiences that are relevant, timely and actionable. We also remain flexible to adapt to ever-changing technology and consumer needs.
Jeff Russell. CEO of Blue Cross Blue Shield of Nebraska: What members want from their health plans is the same thing that members want in the rest of their life. They want it to be easy, they want it straightforward. If they run into a problem, they want someone who's knowledgeable to help them. One of the things we've really focused on is how is it when somebody calls us that we are really helping them proactively walk through their issues? You look at many times when people are calling, it's a stressful time in their life. They're working through a health issue. What we're trying to do is help alleviate rather than give them more burdens.
Steven Tringale. President of Mass General Brigham Health Plan: The place that's changing the most is around the expectation to help [members], not just by paying claims, but by supporting them in terms of how they access [care], and what their expectations should be of the delivery system. Because we are integrated with one of the world's best delivery systems, we have relatively high expectations of our ability to help our members do that. We view that integration with Mass General Brigham and its 90,000 employees and the vast delivery system that it represents, and the enormous intellectual property the research and teaching represents, as a key differentiator that the health plan wants to make available to its members, and wherever possible, tries to integrate those services into the health plan experience.