Patient Satisfaction with Health Plans Over Time

Most health plans are required to and want to measure member satisfaction.  One interesting question is whether satisfaction and engagement with a plan tends to vary depending on how long the person has been enrolled.  A survey from the Employee Benefits Research Institute provides some insight into this question.   (EBRI Survey)   The survey had over 3560 adults aged 18 to 64 who had employer-sponsored health care coverage and was conducted in August and September of 2017.  Prior research had indicated that satisfaction was lower for people in high-deductible health plans, but engagement tended to be higher.  This survey looked at whether that changed over time.  For those employees in a traditional PPO or HMO style plan, satisfaction tended to peak after the member had been enrolled in a plan for five years or more.  For members in a high-deductible plan paired with a savings account, satisfaction did not increase over time, and was highest before the person had been in the plan for five years.  For members in a high-deductible plan with no savings account, satisfaction did tend to rise in years 5-9, and was lower both before and after that.  On an absolute level, at 5-9 years of enrollment, 73% of traditional plan members were extremely or very satisfied; 60% of pure high-deductible plan members were; and only 42% of those in an HD plan coupled with savings options were.  This may be related to the fact that high-deductible plans paired with savings accounts are more complex, fewer members in those plans felt they had adequate information on plan choices.

In regard to patient engagement, as measured by checking the quality rating of a provider before receiving care and talking to a doctor about drug options and costs, consumers were generally more likely to check quality ratings than to ask about drug options, which I find surprising, but maybe reflects that one is impersonal and one is a personal interaction.  Members in all plan types were almost identically engaged in the first five years of enrollment.  In years 5 to 9, traditional plan enrollee engagement dropped slightly and that for high-deductible with a savings account members rose slightly, which pure HD plan engagement rose more significantly.  After ten years, engagement was about the same for traditional members, but dropped somewhat dramatically for both types of high-deductible plans.  Contributions to health savings accounts tended to rise with length of enrollment.  I am somewhat surprised at both the satisfaction and engagement findings.  I might have expected lower satisfaction with especially the pure high-deductible plans.  And I am surprised there wasn’t a greater gain in engagement with length of enrollment.