While customer satisfaction with health insurance plans slightly increased between 2018 and 2019, patient satisfaction with hospitals fell in all three settings where care is delivered — inpatient, outpatient, and the emergency room, according to the 2018-2019 ACSI Finance, Insurance and Health Care Report.

ACSI polls about 300,000 U.S. consumers each year to gauge satisfaction with over 400 companies in 46 industries. For historic trends, you can check out my coverage of the 2014 version of this study here in Health Populi.

The 2019 ACSI report bundles finance/banks, insurance (property/casualty, life and health) and hospitals together in one document.

Health insurance companies garnered an aggregate satisfaction index of 74 in 2019, one point up from 2018. The top-ranked health plan for customer satisfaction was Humana, with a score of 79, up one point from 2018. The second plan ranked in customer sat was Kaiser Permanente, down one point from 78 to 77, followed by Aetna (merged with CVS Health in the past year) gaining one point to 76, and UnitedHealthcare, Cigna and the Blues in fourth through sixth places at or below the median customer sat index of 75, shown in the second chart.

ACSI noted in the report that the health plans are transforming as health/care companies, pointing to Humana’s investment in pharmacy and primary care underpinned by technologies and a relationship with Microsoft for digital transformation. ACSI’s 2019 survey found that Humana’s consumer satisfaction also ranks best in class for primary and specialty care doctors among the plans studied.

The key benchmarks on which the health plan satisfaction index is calculated include, in order of 2019 rankings, quality of the plan’s mobile app, up 3 points over 2018. After that, key satisfaction levers were, in order of experience rankings, reliability of the app, access to primary care doctors, access to specialty care doctors and hospitals, coverage of standard medical services like office visits and tests, ease of submitting a claim, prescription drug coverage, website satisfaction, ease of understanding insurance statements, range of plans available, and timeliness of claims processing. Call center satisfaction ranked last on this list in terms of experience.

ACSI also measured patient satisfaction with hospitals, results of which appear in the first chart. ACSI found that patient satisfaction with hospitals sharply dropped, down from an index of 76 in 2018 to 72, a 5.3% drop. Emergency room satisfaction had a precipitous decline from and index of 73 to 67 in 2019, as ACSI called out waiting times as a “clear issue” for EDs. I would also add growing dissatisfaction with out-of-network hospital bills related to emergency room costs, frequently covered in hometown news media.

As the issue of price transparency has become central to President Trump’s health care reform tactics — with a final rule for hospital transparency published this month, to go into effect in January 2021 — the issue of hospital costs will grow increasingly important as patients could gain greater clarity of their personal out-of-pocket financial exposure to medical bills charged by their community’s hospitals. The intention of this mandate is to enable patients-as-consumers to more readily shop for health care services that are “shoppable.”

Health Populi’s Hot Points:  The last chart organizes ACSI’s customer satisfaction benchmarks by industry in 2019. Note where hospitals, with an index of 72, rank versus other sectors: toward the bottom with telephone operators, and the US Postal Service. Only internet service providers and subscription TV services rank the lowest.

Health plans rank slightly higher, with an index of 74, aligned with airlines and gasoline stations, and just below wireless providers, hotels, and coop energy utilities.

As I explain in my book, HealthConsuming: from Health Consumer to Health Citizen, patients-as-payors expect (excellent, enchanting) retail service levels as people pay more first-dollar medical costs. The ACSI chart here shows highest satisfaction with breweries, personal care and household products, food, soft drinks, TVs and video players, sit-down restaurants, and appliances.

What can health care learn from beer? Well, there’s a proliferation of craft brews more personalized for taste and lifestyle, increasingly marrying to healthier, greener, and sportier life-flows. In personal care, it’s about sustainability and self-care, transparency, accessibility and empowerment. In food and soft drinks, grocery stores are capitalizing on health and “lighter” trends, food-as-medicine and less sugar and cleaner drinks. And so on.

People seek health engagement where we live, work, play….and shop. That is why we’re spending more time in consumer-facing retail health front doors that engage people in personal, family and community health — where patients-as-consumers can get more satisfaction. The ACSI data tells an important story for hospitals to heed — and if they do, they can ensure their relevance and viability in patients’ lives beyond the ER and intensive care areas.