Health Connect 'Customer Satisfaction' Survey Yields Mixed Results

Sep 16, 2015

The state has spent $229,000 to find out what insurance customers think of Vermont Health Connect. The results, not surprisingly, aren’t exactly stellar. But officials say the survey will help them improve consumer satisfaction in the future.

The survey was conducted by the University of Massachusetts Medical School, and it included responses from about 2,500 people who either bought, or tried to buy insurance on Vermont Health Connect.

UMass asked people to rate the exchange on a scale of 1 to 10, with 10 being the best possible insurance marketplace. Vermonters gave the program an average score of about 5.

Steven Costantino, commissioner of the Department of Vermont Health Access, says the state needs to work hard to improve that number. And he says the survey, paid for with federal dollars, will help his department do just that.

“So it’s a really good management tool to make sure the customer service experience of the exchange … is really meeting the needs of Vermonters,” Costantino says.

Chief among the complaints were problems with billing issues, delays in processing applications and renewals, and making changes to existing policies.

Credit Vermont Health Connect Customer Satisfaction and Experience Evaluation Executive Summary / Center for Health Policy and Research/University of Massachusetts Medical School (screen shot)

Not everyone had bad things to say about the exchange – 33 percent gave it an overall rating of 8 or higher; 28 percent gave it a rating of 4 or worse.

But a closer reading of the numbers shows that an important subsection of the Health Connect consumer base is far less pleased with the product.

Vermont Health Connect serves as the insurance portal for more than 200,000 residents, a population that includes Medicaid beneficiaries as well as individuals purchasing private plans from Blue Cross Blue Shield of Vermont and MVP.

People signing up for Medicaid reported vastly higher rates of satisfaction with Vermont Health Connect than did people using the site to purchase private plans. And nearly one-quarter of the approximately 70,000 people using the site to buy private plans, according to the survey, gave the Vermont Health Connect an overall rating of 2 or less.

More than half of people on Medicaid gave VHC an overall rating of 8 or higher.

The survey included people who had gone through the change-of-circumstance process, but not people who were on the backlog at the time the survey was being conducted.

Costantino says the poor marks owe largely to problems with so-called change-of-circumstance functionality, and he says the technological shortcomings that were still plaguing the system when the survey was conducted, back in May, have largely been resolved.

Vermont Health Connect in June installed software upgrades designed to address problems that had created a backlog of more than 10,000 customers waiting to have changes made to their insurance policies.

The survey included people who had gone through the change-of-circumstance process, but not people who were on the backlog at the time the survey was being conducted.

“Knowing what they were concerned about, and the wait times, when they were having frustrations about changes, we have now dealt with that issue,” Costantino.

Complaints about Vermont Health Connect transcended customer-service issues. While 42 percent of people say their insurance plans fit their needs “very well,” many were caught off guard by the out-of-pocket costs associated with those plans.

People who used navigators reported higher satisfaction levels with Vermont Health Connect than people who didn't. And the survey showed that many customers lack fluency in insurance terminology, which often led to unanticipated out-of-pocket costs.

One-third of all VHC customers say out-of-pocket costs exceeded expectations, and nearly half of consumers didn’t realize that the tax credits available for plans sold on the exchange could affect their federal income tax obligations.

The survey also showed that many customers lack fluency in insurance terminology, and that failure to understand the meaning of terms like “co-insurance” or “advance premium tax credit” often led to unanticipated out-of-pocket costs.

“We have to make sure they understand these words, and understand what they mean,” Costantino says.

The survey showed that people who used navigators – these are people paid to assist customers in the purchasing process – reported higher satisfaction levels with Vermont Health Connect than people who didn’t use navigators.

Credit Credit Vermont Health Connect Customer Satisfaction and Experience Evaluation Executive Summary / Center for Health Policy and Research/University of Massachusetts Medical School (screen shot)

“What the survey proves is that this kind of one-on-one assistance is very, very important,” Costantino says.

The budget for navigators, however, has been decreased significantly for the coming open-enrollment period, due to a drop in federal funding.

Costantino says the state will try to improve educational outreach via informational kiosks at more than 50 public libraries, and through in-person informational sessions at at least 11 locations across the state.

The survey itself was one component of the $229,000 contract with UMass, which worked for more than a year on a project designed to determine how customers interact with and feel about Vermont Health Connect. UMass’ duties included: in-person meetings with navigators, VHC staff and other people involved in deployment of the program; the development of survey design; holding smaller focus groups with individual VHC customers; and an qualitative analysis of the data the survey yielded.

The Centers for Medicare and Medicaid plans to conduct a consumer survey of the federal version of the exchange – healthcare.gov – but the results won’t be available until at least next year. State officials say they’re unfamiliar with any published surveys of other state-based marketplaces, and Michael Chin, an assistant professor at UMass Medical School who worked on the Vermont survey, says there’s “no real good public benchmarks” to compare Vermont’s results to.

This post was edited at 8:30 a.m. on 9/16/15 to include more detail about the scope of work in the state's contract with UMass Medical School