Healthcare and Customer Satisfaction: Not ALWAYS Mutually Exclusive

you've all experienced it there's a problem with your healthcare bill or you have difficulty getting coverage for the care you need your doctor or hospital tells you to talk to your insurer your insurer tells you to talk to your doctor hospital you're stuck in an endless runaround small patient advocacy industry is sprung up to help but that help can cost several hundred dollars an hour that are way to get the customer service we deserve that's the topic of this week's healthcare triage special thanks to austin frac from who's up shot column this episode was adapted some kinds of health insurance plans provide better customer service than others among those that do are plans offered directly by hospitals or health systems according to results from a recent study by austin Garrett Johnson and Zoe Lyon their conclusions are based on an analysis of Medicare Advantage plans private insurance alternatives to traditional Medicare Medicare Advantage plans are often offered by major insurers like United Healthcare Humana Aetna Blue Cross and Blue Shield affiliates and others like nearly one quarter of the plans are issued by hospitals or health systems these provider offered plans are more likely found in dense urban areas in the Northeast and the West the government collects data on healthcare quality from surveys and medical claims then aggregates them into weightings of plans these are publicly reported in units of stars five stars represents the highest quality and one the lowest plans offered by insurers have average ratings of just over three and a half stars for both non drug and drug service an average provider offer plan has quality ratings that are about one-third of a star higher for both after adjusting for factors that could confound the comparison like socioeconomic status and the types number of doctors where plans are offered their study published this month in the health policy journal Health Affairs found that provider offered plans have higher quality ratings for instance measures the preventive screening like that for colorectal cancer or management of chronic conditions assess the quality of care delivered by doctors and hospitals and a plans network provider offered plans performed somewhat better than insurer offered plans in such areas other aspects of quality pertain to customer service in measures of complaints responsiveness to customers and the enrollees overall experiences provider offered plans really shine in each area of customer service they examined provider offered plans are rated one half star higher than insurer offered one this is a big difference for comparison over half of plans are within one star of each other in overall quality these results make some sense when a customer has an issue like a problem with a hospital bill the this thing for a health plan to do is pass it off to the hospital likewise the hospital's easiest course of action is to blame the health plan the patient's stuck in the middle is not likely to rate his plan or Hospital highly for customer service in that case however when the plan in hospital or one of the same neither can pass the buck to the other problems may be resolved faster they may be less likely develop in the first place this could lead to the higher customer satisfaction reflected in the quality rating if the higher ratings are enough to interest you in trying a provider offer plan how would you find one unfortunately there's no readily accessible source to inform consumers or researchers about this feature of plans sometimes the plans name gives away the relationship though the UPMC health plan practically has the health system that offers it right in the name UPMC stands for University of Pittsburgh Medical Center in other cases consumers can identify the relationship on plans or health systems websites for example the vital traditions plan website identifies its parent company the largest nonprofit hospital system in Texas Baylor Scott and White but in many cases it's not so easy to figure out in fact this is why there's been so little analysis to provider vs. insurer plan for this study Austin and his colleagues had to scroll through hundreds of websites news articles and documents to build a research data set on provider offer plans from 2011 to 2015 because of the work involved there are very few studies in the subject another published in health services research by Austin Roger Feldman and Steve peiser found a similar quality relationship when looking at 2009 data that earlier study also found that provider offered Medicare Advantage plans charge higher premiums but a recent study of marketplace plans found that provider offered ones are not necessarily the most expensive for some a higher premium may outweigh the benefits of greater quality but for others it may not from their study they can't be certain the provider sponsorship of plans causes higher quality it could be that higher quality providers are the ones that choose to offer plans nevertheless such tight integration between plans and providers is at least a signal of higher quality even if it doesn't cause recent trends suggest more health systems are offering plans and other healthcare markets for the working-age population not just a medicare advantage not all markets may be hospitable to provider offered plans however some systems that did offer plans going back according to The Wall Street Journal Catholic Health Initiatives which runs over 100 hospitals across 18 states is divest in itself of some of its health insurance plans after struggles with profitability tenant health care and several other health systems have said they're going to do the same provider offering plans may increase convenience for consumers but the financial risk it confers in the organizations that offer them may be more than some can handle healthcare triage is supported in part by viewers like you through patreon comm a service that allows you to support the show through a monthly donation your support makes this show bigger and better we'd especially like to thank our Research Associates Joe sevens and Jonathan Dunn and of course our Surgeon Admiral Sam thanks Joe Jonathan and Sam more information can be found at slash healthcare triage


  1. Obamacare was a failure. State funded health care is less efficient, and produces health care of a sub-standard level.

  2. I didn't completely understand all that, but I'm throwing you a like anyway.

  3. I spent a year volunteering with Legal Aid, which does some patient advocacy, and often wondered how the cost of equivalent for-profit services might be driven down to improve access.

  4. The city of Seattle, where I live, is considering creating a safe-injection site for heroin and other drugs, on the model of InSite in Vancouver, B.C. I've looked at a few studies, most of which are positive, but I'm also seeing a lot stories about record breaking overdoses in Vancouver. I would love to hear an informed opinion on it, and maybe you could cut through the noise with your expertise.

  5. How is this different from the HMO model? I remember in the 90s everybody was complaining about the quality of HMO plans.

  6. Could you do an episode on direct primary care?

  7. So… since you guys went through and matched up hospitals with their in-house insurance, why not release that as a public listing? I mean, I know it was valuable work and a public release doesn't pay for the hard work you did, but aren't you trying to improve the system and make people's lives easier?

  8. Just another reason why we need Universal Healthcare like the rest of the modern world! =)

  9. I have one of the kinds of plans you talk about. Kaiser in CA. Many of the pros you talk about seem right, but one side effect that I think may be hiding problems is that the doctors have more incentives to be cheap with their patients. Service is quick, but I can also feel rushed or like… I dunno, cattle? Prices are definitely cheaper in general (so far).
    But to continue, one of the worst problems is there's no good review system for any of their doctors. I dont know if this is a common problem with these kinds of providers… but with every other insurer provided plan I could go to a site like and look at many useful reviews on my doctor. All Kaiser has is a doctor-written description of themselves (canned) and their degrees (plus maybe one /useful/ review)… but nothing else. I certainly did not get enough to feel confident that I got a good or the right doctor for me… and I can't get a /annual/ physical and try out a new doctor more than once a year…

  10. The first video I've seen on YouTube without a dislike (that has at least a few thousand views)

  11. Only in the U.S is the idea that a market based service like healthcare customer service isn't a priority.

  12. Interesting

  13. 4:45 Glitch!

  14. Go to a surgery center or retail clinic. Always been so much better for me. Capitalism ftw!

  15. Move to any other first world country.

  16. Hey look all stuff that healthcare exchanges could help provide, to bad the US government is terrible at offering internet based anything, especially healthcare.

  17. Hi.

  18. Improved lighting ? =P

Leave a Reply

Your email address will not be published. Required fields are marked *