In October 2015, Deft Research published the 2015 Medicare Member Experience and Engage-ability Study. Now in its 10th year, the study measures loyalty among members of MAPD, Medsupp, and PDP plans. By examining consumers’ experience with their plan, we are able to identify which factors are the most influential in satisfying and retaining members.

The study shows that in the past two years loyalty to Medicare Advantage plans has declined significantly. As evidence, the MAPD industry Net Promoter Score has dropped from 38 in 2013, to 23 in 2015. Amid this decline, Aetna announced a $37 billion take-over bid for Humana. As federal authorities determine whether or not to approve the merger, one dimension they will consider is the consequential gain or loss of consumer value.

“Consumers want and expect health insurance to be as easy to use as Uber or Amazon.”

Mark Bertolini, Aetna, CEO

 

Is the merger part of the vision? At a September 29 hearing, Aetna’s CEO Mark Bertolini discussed how the merger would lead to better consumer value. He said that the changing health insurance market hinges on engagement and simplification of insurance products, “consumers want and expect health insurance to be as easy to use as Uber or Amazon,” he said. For Bertolini, increasing consumer value depends on the realization of these strategic goals, but while he convinces us that Aetna is committed to a consumer-centric strategy, he is not clear on how strategy and merger will integrate in ways that make realizing the vision more likely.

The Medicare Member Experience and Engage-ability Study provides insight into how the merger might create value. The study obtained responses from over 5,000 seniors. Based on the responses of each insurer’s members, the study gives us a profile of the consumer experience and value delivered by both Aetna and Humana.

COMPANY COMPARISON

AETNA

Loose Connections. During the ten years Deft Research has conducted member experience studies, including our current 2015 information, we have observed Medicare member ratings of Aetna’s services that are generally below the national standard. The picture given is that Aetna has a difficult time forming a connection with its members. The research shows that the company has never had a well-defined market position that signaled meaningful differentiation or a unique brand promise. As of this year, the company is well below the sinking national average in MAPD Net Promoter Score, turning in a score of 10.

Best Performance. According to the study’s results, Aetna’s best member ratings are in the area of access to care. Between 55% and 65% of Aetna’s Medicare members are satisfied with access to doctors, facilities, and services. Aetna’s highest ratings, however, are not significantly different than the national average.

Poor Performance. In the crucial area of member communications, Aetna’s members give their insurer below average ratings. Members are not satisfied with the insurer’s help in understanding the coverage, nor are most confident they know how to use their plan. As a particular example, the company does worse than the industry at providing cost comparisons ahead of the member receiving the service. By providing this information ahead of time, so it can be factored into a decision before it is made, this service is supposed to be an important advance for empowering the health care consumer, and an important advance for all interested in controlling the cost of health care. Aetna’s members give it below average ratings despite Aetna’s push for technology development and promotion of this capability on their website.

HUMANA

Large Insurer Challenge. Generally, Humana’s 2015 Medicare member ratings are better than Aetna’s, but most are just above national averages, not among the best. This is the large insurer’s challenge: because of centrally administered customer services and provider relations which seek to standardize the treatment of all customers and providers alike, it is difficult for geographically dispersed national insurers to deliver customer experiences rated above industry averages.

Brand Positioning. In 2015, Humana’s members turned in a Net Promoter Score of 18, like Aetna, below the industry average. In contrast to Aetna, over our years of studying member experience, we have observed Humana’s ability to carve out a meaningfully differentiated Medicare brand. The company has emphasized their ability to provide information and guidance when members need it, and, in past years, our research has shown that these values were delivered – Humana members have given higher ratings of their plan’s communication and it’s help for members trying to save money.

Strength. The area where a combination with Humana might serve Aetna most, is health plan engage-ability*. Humana’s members give it much higher marks as a source of high quality information, as providing information that is relevant to them, and as providing information that motivates them to be healthy. Combining these dimensions, we find that the percent of Humana’s MAPD members who find their insurer to be highly engage-able is 29% compared to 26% nationally and 21% for Aetna. As a consequence, Humana is also rated above Aetna in its members’ sense of confidence that they know how to use their coverage.

CONCLUSION

The merger has benefit. The 2015 Medicare Member Experience and Engage-ability Study indicates that Humana serves the Medicare consumer better than Aetna in areas that are key strategic emphasis at Aetna. We conclude that the merger should bring the strengths of Humana’s MAPD approach to Aetna and more consumers will be served better as a consequence.

On the other hand, while superior to Aetna, Humana is generally rated only at the national average for most dimensions of member experience, including engage-ability. So arguing that the merger will lead to more consumers being served better is really arguing that the below standard experience of some consumers will be brought up to an average experience. And, consumers are telling us that the average experience is turning sour.

Strategy and Merger Integration. If consumer value is to be generated beyond the unsatisfactory average, Mark Bertolini’s corporate strategy will have to take effective form that is independent of and beyond whatever Humana brings to the table. The question remains open as to whether Aetna’s ambitions to be more consumer-centric will be more easily accomplished with the merger than without it.

*Deft Research leveraged over 10 years of survey data to develop the concept of engage-ability. Three characteristics consistently show high correlations to key business outcomes: 1) health plan addresses what’s important, 2) health plan’s reminders motivate action, 3) health plan is a high quality resource. By averaging members’ perceptions of the 3 characteristics, we produce an engage-ability composite scores.

ABOUT THE RESEARCH

The 2015 Medicare Member Experience and Engage-ability Study is the third report in Deft Research’s annual 3-part Medicare series: Senior Market Intelligence Service. The study is based on the responses of 5,797 members of Medicare Advantage, MedSupp, and PDP plans across the United States. The study was fielded in July of 2015. The report includes performance scorecards for the largest national and regional plans.

For more information on Deft Research’s Senior Market Intelligence Service reports, visit www.deftresearch.com/medicare

Media Contact: Maren Conradi, 612-436-8313, info@deftresearch.com