Abstract

Research Objective:

In an effort to improve consumer experience in Medicare Advantage (MA), the Affordable Care Act allocated incentive payments to MA insurers based on consumer ratings of their health plans. Plans have responded by increasing their focus on improving the consumer experience. We sought to identify plausibly modifiable factors that influenced consumers’ self-reported satisfaction with their health plans.

Study Design:

Members of Anthem MA plans with Part D coverage (MAPD) were invited to complete mixed-mode surveys (online/phone/mail) about their health plan experience from 12/01/2015 to 03/31/2016. Members were asked to rate their health plan on a scale of 0 (worst) to 10 (best). The member responses were linked with claims, plan benefit design, and participation in plan-offered health programs. Two modelling approaches (LASSO/ENET and classification tree) were used to select variables and to assess the relationship between different plan components and overall plan satisfaction. The models were developed using a training dataset with 2/3 of the study population and assessed using area under curve (AUC) with the remaining 1/3. Plan satisfaction was dichotomized into “high” (scores of 9 or 10) or “low” (scores below 9).

Population Studied:

MAPD members with at least 1 year continuous coverage prior to survey response.

Principal Findings:

Of 33,000 MAPD members who received the invitations or outreach attempts, 1,655 completed the surveys and 1,340 met the study eligibility criteria. They were, on average, 71years old (SD: 6 years) and 47% were female. They had, on average, 1.4 health conditions (indicated by ECI, SD: 1.7) and spent an average of $90 (SD: $295) out-of-pocket (OOP) for medical services and $48 (SD: $134) on prescription drugs in the month preceding the survey. The Lasso model achieved 0.57 AUC and the classification trees also achieved 0.57 AUC. Among the 128 variables included in the models, the member’s receiving credits for completing wellness/screening, participation in fitness promotion programs, having Out-of-Network (OON) ER services paid for by the plan, and dollar amount the plan allowed for pre-authorized services were significantly positively associated with satisfaction scores. The member’s receiving both in-network and OON bills for same-day services, the number of non-formulary drug fills, pharmacy OOP spending, and OOP limit (independent of realized OOP spending) were significantly associated with lower satisfaction scores. Pharmacy OOP spending over $420 in the six months preceding the survey strongly predicted lower scores. Medical OOP spending was not a significant predictor of satisfaction in most models.

Conclusions:

Participation in plan offerings, such as credits for completing wellness programs and fitness promotion, were positively associated with MA members’ satisfaction with their health plan. Plan payment for an OON ER visit was positively associated with plan satisfaction. Several pharmacy-related utilization and OOP spending measures were negatively associated with plan satisfaction, more so than corresponding measures of OOP medical spending and utilization.

Implications for Policy or Practice:

Members experiencing medical emergencies greatly value plan payment for OON services. Health plans might increase MA members’ satisfaction by expanding wellness rewards and making OOP pharmacy spending more predictable for members.