Though they may not directly provide patient care for their members, managed care organizations (MCOs) play a substantial role in the patient experience of millions of Medicaid enrollees.The Scope of Medicaid Managed Care
Perhaps somewhat counterintuitively, Medicaid managed care is big business, and the enactment of the Affordable Care Act (ACA) made it even more lucrative; in the last 5 years, health insurers skyrocketed up the rankings of the Fortune 500, generating billions in revenue by covering millions of newly eligible Medicaid beneficiaries. Of the 71.7 million Americans enrolled in Medicaid, 55.2 million (77%) are covered by a managed care organization (MCO)
These unique insurance companies contract with state Medicaid agencies to oversee the delivery of health benefits and other services for patients enrolled in Medicaid through complex networks of providers.
All but 2 states now offer some form of Medicaid managed care plans, spurring a healthy competition between MCOs and elevating the priority of patient experience and satisfaction for Medicaid enrollees.
Customer Satisfaction in the Health Insurance Industry
The health insurance industry as a whole performs relatively poorly on customer satisfaction ratings, and is consistently ranked in the bottom quartile of all industries studied by the American Consumer Satisfaction Index (ACSI). While customer satisfaction on the provider side of healthcare has been (unfavorably) compared to that of the fast food industry
the experiences of health insurance customers are more appropriately compared to those of other types of insurance. As shown in the chart below, consumers are significantly less satisfied with their health insurance than with property and life insurance.
Chart: Insurance Customer Satisfaction by Industry3
Consumers find health insurance statements difficult to understand, and are particularly dissatisfied with the web-based and call center services offered by their plans. However, “the least satisfying aspect of health coverage is the range of available plans with differing levels of coverage, premiums, deductibles and copays, indicating that consumers are looking for more choice
Further, healthcare consumers are comparison shopping for better health plans
and Medicaid enrollees in many states now have competing options if they’re less than satisfied with their experience.
The Business Case for Improving Patient Experience
Clearly, MCOs and other health insurers have room for improvement in patient satisfaction, and regulatory and consumer trends are creating even more compelling incentives for organizations to provide excellent customer service to Medicaid enrollees. For instance, patient satisfaction ratings help determine incentive payments under Medicare’s Hospital Value-Based Purchasing Program,5
and some MCOs expect similar incentive structures and contract award criteria to be implemented for Medicaid plans as value-based contracting extends to that program.
Further, studies show the drivers of poor patient experience also drive increased costs for health plans
and their members.6
In other words, improving patient experience reduces costs. To realize these upsides, MCOs can leverage the drivers of patient experience by implementing strategies to improve customer satisfaction both with the care they receive from their providers and the member services they receive from MCO personnel.
Provider-Focused Patent Experience Initiatives
In Medicaid managed care settings, the drivers of patient experience ratings of providers include:
how well providers and staff communicate with patients
timeliness of appointments, care and information; and
patient-centered practices such as after-hours access, addressing social determinants of health and establishing personal health goals.7
MCOs can address these provider-side drivers of patient experience by offering patient-centered provider training; developing actionable, provider-specific data and offering providers metric-aligned performance incentives.