The CMS databases showing Medicare Star ratings for Medicare Advantage (MA) and Medicare Prescription Drug Plans (PDP) are out. Analysis shows that CMS is keeping a tight reign on the number of 5-star plans, while allowing slightly more 4.5-star plans and significantly more 4-star plans in 2014.
More MA plans, but fewer rated in 2014
There are 677 MA plans (664 MA-PD plans that include prescription coverage and 13 MA-only plans that do not include prescription coverage) listed in the 2014 report card, but only 437 of those plans received a star rating from CMS. In 2013, there were 578 total MA plans (563 MA-PD and 15 MA-only), with 454 of those plans being rated by CMS. The difference appears to be a large influx of new plans that have not been in existence long enough for CMS to measure member experiences and plan performance. There were 52 plans in the 2013 rating year that were designated as “too new to be rated” while there are 176 plans in the 2014 rating year with this designation.
A few changes at the top of the MA plan rankings
Four MA-PD plans and one MA-only plan slipped from 5-stars in 2013 to 4.5-stars for 2014. Conversely, four MA-PD plans managed to raise their scores from 4.5-stars to 5-stars over the same time period. No plan jumped a full star rating to attain the ranks of the 5-star plans and no former 5-star plan fell more than one-half star compared to 2013. In fact, four plans (HealthPartners, Humana, Kaiser of OH and Medical Associates of WI) have been straddling the fine line between a 4.5 and a 5.0 star rating for several years with each plan receiving 4.5-stars in 2012, then 5-stars in 2013 and 4.5-stars for 2014.
The five plans that lost their 5-star rating in 2014 are:
- Humana WisconsinHealth Organization Insurance Corp
- Health New England (HNE) Medicare Advantage Plans
- HealthPartners (Group Health Plan of MN)
- Kaiser Permanente of Ohio
- Medical Associates Clinic Health Plan of Wisconsin (MA-only plan)
The MA plans that attained a 5-star rating for 2014 are:
- Cigna-HealthSpring (FL) – new for 2014
- Group Health Cooperative (WA)
- Gundersen Health Plan, Inc. (WI)
- Kaiser Foundation Health Plan, Inc. (CA)
- Kaiser Foundation Health Plan, Inc. (CO)
- Kaiser Foundation Health Plan, Inc. (GA) – new for 2014
- Kaiser Foundation Health Plan, Inc. (HI)
- Kaiser Foundation Health Plan of the Mid-Atlantic States (MD/VA)
- Kaiser Foundation Health Plan of the Northwest (WA)
- KelseyCare Advantage (TX) – new for 2014
- Providence Health Plans (OR) – new for 2014
- Dean Health Plan, Inc. (WI)
- Kaiser Foundation Health Plan, Inc. (CA)
- Medical Associates Health Plan, Inc. (IA & IL)
More volatility in PDP rankings
The number of Medicare prescription plans (PDPs) that received a 5-star rating increased from four to five and the number of PDPs receiving 4.5-stars increased from four to six from 2013 to 2014. The total number of PDPs also increased slightly from 79 in 2013 to 85 in 2014. While the overall counts for PDPs did not change significantly, the roster of 5-star plans did change dramatically with three new plans attaining the 5-star rating in 2014, two plans lost their 5-star rating (Excellus and Wellmark) and two other retained their 5-star rating from 2013. Two of the additions for 2014 are Employer/Union organizations (Missouri DOT and national Rural Electric Coop). PDPs either gained a full star rating to climb into the 5-star category or lost a full star rating to lose the coveted 5-star ranking from 2013.
- Catamaran Insurance Of Delaware, Inc. (DE)
- Hawaii Medical Service Association (HI)
- Missouri Department of Transportation (MO) – new for 2014
- National Rural Electric Cooperative Association (most of US) – new for 2014
- Tufts Health Plan (MA) – new for 2014
Many articles and comments have been written about the trials and tribulations of the trying to access the Federal Marketplace (formerly known as an “exchange”) beginning on October 1. Like many consumers, consultants and researchers, I wanted to see what the Federal Marketplace looked like and get a sense of how well (or poorly) complex health insurance information was being presented to many first-time buyers.
Wide range of issues encountered
It was not surprising that problems were encountered. The secrecy during the development process (i.e. no public review of the website was made available before October 1) and concerns from politicians and industry insiders clearly offered many warning signs, if not, bona fide red flags. However, the extent of the problems was probably greater than many anticipated. Some of the specific issues I personally encountered were:
- Site was down or inaccessible. I received this message at 6:20am Central on October 1 and numerous times throughout the first day and week the marketplace was “open” for business.
The common, system is down message
- Site is busy. The most common response to attempted access to the Federal Marketplace, but I have received this message at 2am on a weekday, at 6am on a Saturday, at 10pm on a Sunday and many times in-between. So I am certain this issue goes beyond unusually high demand at popular times of day, revealing instead a systemic problem that the site is unable to handle even a moderate number of users.
Website is busy message
- Page not found. Every website occasionally experiences a page not found (also known as 404 errors in HTML-speak), but this is uncommon for a brand new website. These message usually occur when old pages are decommissioned or edited and moved to a new location as part of a restructuring. A newly built website should not experience these kinds of messages on day 1 unless something has been overlooked or was left incomplete.
Some pages can't be found on the site
- Unexpected errors. I frequently received this message the first few days trying to access the exchange and still see it occasionally even 12 days later. It usually appears as a red box somewhere on the screen, saying “Unexpected Error” and the text “Error ID”, but never lists a more detailed message or ID that might be useful in tracking the problem down. With such a cryptic message, the user doesn’t know whether to quit, close the message box or try something else.
An example of the common red error box and its lack of meaningful information
- Access denied. I received this and similar messages on a few occasions. This particular example occurred when trying to access a menu for “places to contact for local help” – very helpful indeed!
Access denied message received when trying to access list of contacts for local help.
- Failure messages. The most common failure I received was regarding the creation of a Marketplace account. You can’t do anything meaningful in the Federal Marketplace until you have a valid user account and the site repeatedly failed at creating the account. It often crashed or generated an error before completing the initial application process. Other times, I made it to the point of generating the account, before seeing a message like this one.
One of several attempts to create a valid login that failed for some unknown reason which was not disclosed
- Non-functioning pages. This one is already well known by many people, the case of being asked to fill out security questions during the initial account creation process, but being unable to do so because the dropdown list of security questions was blank. Trying to continue without answering the questions is met with a message to fill-in the security questions. The same message is received if you type random answers into the three answer boxes. Refreshing the page numerous times did not seem to work, but risked putting you at the back of the line where you might have to wait 20 to 30 minutes for another chance to re-enter all your account information again (and hope this time the security questions are filled in). I received this message at 6:45am on October 1 and I was still receiving it two days later when I was fortunate enough to get an opportunity to try and create an account.
Many people saw the page where all the security questions are blank and it becomes impossible to move forward
- Unknown issues. This example appeared when trying to login after having created an account (at least I thought so at the time, but later found my account had not actually been created). This is an unusual sight that has not appeared again, but obviously shows that the information meant to be filled in on the page was not available in time to display the page.
Unknown problem with login page
- No help at all. On October 1, if you clicked on the link for “Live Chat”, you saw this message stating that “Live Chat isn’t available right now.” I am not sure when the link was activated. I know the Live Chat option functions now, but last time I tried it and filled in my name and email address, I did not receive a response to my “live” request in the 30 minutes I was willing to wait.
Message that Live Chat was not available when the Marketplace launched
- Account verification failure. Account creation and verification is the most frustrating portion of the Federal Marketplace. Without a valid account, you can not view the health insurance options available in your area. Besides the missing security question issue, regular crashes and long waiting times, once you complete the initial phase of creating an account, you have to wait for an email from the Marketplace to verify your account. On a few attempts, the email never came. On other attempts, the email from the Marketplace came, but the website could not process the verification link. In the most egregious example, the first time I was able to go completely through the process, I completed the account creation process around 9:30pm on October 1 after trying all day long to get through. I received a link from the Marketplace at 10:06pm and immediately clicked on that link to verify my account. I tried it more than 10 times over the next hour, always receiving a system is unavailable message or some other error message. I finally gave up a little after 11pm on October 1. First thing the following morning (around 6:30am October 2), I received a message saying I waited too long to verify my account, therefore, I must repeat the entire process. Ahhhh!
Reached someone unspoken limit trying to verify my identity
- Identity verification problems. After finally creating a valid account on October 2, I spent the next few days trying to verify my identity. Despite knowing personal information intimately and answering truthfully all questions presented, the system would not recognize my identity. I received numerous error messages and system busy or system shutdown notes, forcing me to start the process over from the beginning. At one point I was told the I had tried too many times to verify my identity and therefore must now contact Experian via telephone to verify my identity. This happened on Saturday (October 5), so I called Experian’s tool-free number. The recorded message immediately informed me that the waiting period was longer than normal due to unexpected high call volume (expected on a weekday, but not on a Saturday at 12pm) – then the system hung up on me. I thought the hang up might be a mistake, so I called about an hour later, only to be hung up on again. I then tried uploading an approved document to the Marketplace, but never received any acknowledgement of the upload or contact of any kind from someone at Experian or HHS (no telling where that document actually went or who has seen it). I ultimately was able to verify my identity on October 9, after having created and verified a third Marketplace account.
One of many examples where identity verification failed
Congratulations to everyone working on the Covered CA marketplace for getting the site up and running before the October 1, 2013 deadline (see for yourself at CoveredCA.com). The site is attractive and functional, but leaves both users and insurance carriers wanting for more. We know this site is a work in progress, but wanted to comment on what has been published so far.
Issues found with site
After a cursory review of the “Shop and Compare” portion of the website, here are some things we noticed:
- No assistance is provided for selecting a health plan. There is a link to seek personal assistance from a navigator and there are glossaries and general benefit descriptions, but no mechanism for helping consumers determine which benefit package will best meet their needs. An interactive plan comparison tool or means of helping consumers rank order the importance of premiums, deductibles and out-of-pocket expenses is needed to help consumers make a more informed decision regarding the differences between Bronze, Silver, Gold and Platinum plan designs.
- Can’t verify if your doctor is in the network. Those who already have a personal doctor or clinic they are familiar with have no way of determining whether that doctor or medical facility is included in any of the plans being offered. There is no option to eliminate carriers that do not include a particular doctor or hospital and no external links to provider directories for specific carriers. Even those consumers who do not have a personal doctor relationship, have opinions of hospitals and other health care providers in their neighborhood or just want to know how many doctors are available within a few miles of their home or work location. It is not clear how consumers will obtain network information at this point.
- Limited listing of carriers may be misleading. Only four carriers are shown at a time when evaluating plan options within a metal tier. The number of options is reasonable given the amount of space available, but the way in which the first four plans are displayed makes it appear to the casual viewer that these are the only options available. You have to place your cursor over one of the plan designs and notice that a small arrow appears to the right of the fourth plan design, suggesting that other options might be available. There is also two or three dots under each list of four products, indicating that there are two or three screens of products to view, but this might be overlooked by some as a cosmetic detail. So any plan design that is not among the four lowest cost options for a metal tier may be far less likely to even be viewed by many consumers, placing it at a distinct disadvantage.
- Pricing data may be confusing. Three price figures are shown for each plan option, Total monthly premium, Monthly premium assistance (tax credit) and Your total monthly payment. Someone new to health insurance and not fully understanding the federal subsidy / tax credit may be confused by all the pricing information, particularly since it may not be obvious that the third price is the result of subtracting the second price from the first. Focus on the price each individual will pay, then show how that price is calculated (if necessary) to keep things as simple as possible. The plan names are allowed to take a variable amount of space so that the pricing information does not always line up across carriers. This makes it more difficult to quickly scan across plans to compare prices or confirm that the same level of subsidy is offered on all plans in a metal tier.
- No out-of-pocket cost estimates provided. An easy way to determine which metal tier is a better fit for a consumer is to provide an estimate of out-of-pocket costs under different assumptions regarding health care usage levels (e.g. the costs for a light user versus someone with a chronic condition or the difference between plans if an ER visit or hospitalization is incurred). Adding the projected out-of-pocket costs for services to the monthly premium provides a more realistic picture of what the consumer is likely to spend under each plan. No cost projections are provided in the current iteration of the marketplace.
- Biased towards Silver and Bronze plans. No matter what your income level, the Bronze or Silver metal tier is listed first. While it makes sense for the lowest income consumers to focus on Silver plan designs where they may be eligible for substantial cost-sharing, they are not even allowed to view or compare the benefits for a Gold or Platinum plan to the Bronze and Silver options being displayed. Those with incomes over 400% of the Federal Poverty Level are initially shown only the Bronze and Silver metal tiers. They must look carefully to the upper left-hand corner of the screen to notice that they can toggle between these two metal tiers and the Gold and Platinum options.
All in all, the consumers most targeted for health reform (i.e. the uninsured and low income) are likely to find the Covered California website unable to effectively assist in selecting a health plan that is right for them. Expect lots of calls to the marketplace’s call center and overwhelmed navigators in the weeks and months ahead. Unless you are one of the four lowest priced Silver plan designs (or one of the lowest cost Bronze plans for higher income consumers), carriers risk not being seen by many consumers who do not expend the time and energy to fully review all available options.
DSS has conducted numerous health insurance exchange / marketplace studies where consumers are guided through a virtual shopping exercise to evaluate and select a preferred health insurance plan. When the appropriate federal subsidies are in place and a wide range of product alternatives are offered, most consumers find something that they would be willing to purchase to cover themselves and their families. These studies are proprietary, so I cannot share any direct results here.
However, we recently added a simulated health insurance marketplace purchase to our quarterly DSS Health Care Engagement (HCEI) survey. In August 2013, we asked consumers 18 to 64 nationwide to evaluate the four metal tier products that will be offered on the Covered California marketplace beginning October 1, 2013. One Bronze, Silver, Gold and Platinum plan was made available to each consumer, with monthly premiums adjusted to reflect the individual’s age and their eligibility for federal subsidies. Those with incomes below 250% of the Federal Poverty Level (FPL) were shown a Silver plan with reduced cost sharing as appropriate (i.e. acturial values of 73% for those 200% – 250% of FPL, 87% for those 150% – 199% of FPL and 94% for those under 150% of FPL).
Brand names were removed from consideration to make this generic plan comparison extensible to the entire US. In this hypothetical insurance purchase, provider networks were assumed to always include the consumer’s preferred doctor in order to eliminate the strong resistance that most consumers have towards selecting plans that do not include their doctor. This assumption will not have much impact on the metal tier consumers actually choose if networks are broad and vary enough across carriers to allow individuals to find a combination of brand, network and metal tier that meets their needs. However, if Bronze plans regularly leverage very small networks that are unlikely to include the majority of consumers’ personal physicians or a particular carrier uses a narrow network across all metal tiers, the final product choice and metal tier could change significantly.
The results show that only 18% of eligible consumers would not consider purchasing one of the available plan designs. However, almost one-third of the uninsured (the primary target of health reform initiatives) indicated they would not purchase any of the available options, even though most of these uninsured individuals would receive substantial federal subsidies to help offset the monthly premiums.
The last chart below shows that over 60% of the lowest income group (those with incomes below 150% of the Federal Poverty Level) prefer the Silver plan design that has an actuarial value of 94% (meaning that the health plan pays 94% of authorized medical costs incurred). When income rises to 200% – 249% of FPL, the cost sharing for Silver plans and the available federal subsidy is reduced substantially, leaving only 28% who would prefer the Silver plan with 73% actuarial value and very little federal subsidy to help pay for monthly premium. The percentage of consumers likely to go uninsured is fairly consistent across income groups, except that the group receiving the smallest federal subsidies and no cost sharing on Silver plan designs (300% – 399% FPL) may experience the greatest financial burden, leaving 29% to declare they would go uninsured.
We asked US consumers “What is the strangest thing you have seen in a doctor’s office or hospital waiting room?” Besides the usual screaming kids, extremely sick patients, sometimes questionable decor and rude behaviors of patients and office staff, here are some of the most interesting comments we received:
- A man who had his entire head wrapped in a bandage like Claude Rains in The Invisible Man.
- A couple comes into the ER, asks the name of the doctor on duty, then appear disappointed and leave. An hour later, we saw that doctor and now understand why they left.
- A woman dressed in a feather boa – who turned out to be a male cross-dresser who had fallen off the stage during a performance.
- A fire drill goes off and watching all the people in wheelchairs struggle to get out of the hospital without using the elevators.
- A woman holding two fibroids in a plastic cup.
- Ash trays.
- A man choking on a remote (We wish more details had been provided on this one)
- A guy ran into the window outside because he thought it was the automatic door.
- Anatomy charts of the female body in a men’s clinic.
- A woman breast feeding a rabbit (Is that possible?)
- A woman gave birth in the ER waiting room with no medical personnel helping her (Wonder if she was charged for labor and delivery).
- A set of quadruplets all sick at the same time (Sympathy for those parents).
- A woman with an unusual service animal – a small pony.
- Dog – not a service animal and not sure it belonged to anyone there.
- Someone holding a fish tank
People behaving badly…
- A woman cutting her toenails.
- Couples getting amorous (numerous mentions)
- A sleeping person who fell out of her chair and then had to be treated for a head wound.
- People fighting (multiple mentions)
- A man who literally undressed in the waiting room.
- A drunk woman singing loudly (numerous mentions for drunk men and women, but not usually singing)
- A Penthouse magazine sitting in my dentist’s waiting room.
- A woman with the shortest shorts I have ever seen. Left nothing to the imagination. (Multiple mentions of inappropriate or odd attire)
- People sharing way too many details about their bowel movements, symptoms, etc.
- Pharmaceutical rep discussing his commissions on a cell phone call.
- A man carrying his severed arm after an industrial accident.
- A knife stuck in a toe.
- Kid with a Chinese throwing star stuck in his eye.
- A man with a stick coming out of his head.
- Can’t think of anything. However, the last time I went to an emergency room it was because my cockatoo bit me.
- A man with a knife stuck in his neck.
- A roach stuck in a woman’s ear.
- A nail sticking out of a man’s hand.
An finally, a comment that sums up the frustration that many people feel when waiting in an emergency room:
- A guy with a gunshot wound to the stomach sitting in the waiting room. He was still there three hours later when I left.
Consumers of all ages participated in a number of risky behaviors in the last month. The most common activity is spending more than 20 hours per week watching TV or surfing the Internet. Over three-quarters of seniors reported spending at least 20 hours per week in this sedentary mode last month. Not wearing sunscreen and driving more than 10 miles per hour over the speed limit are the next most common behaviors.
Nearly one-quarter of 18 – 30 year olds reported having 5 or more alcoholic drinks in one day and 25% sent a text while driving in the past month. The wealthiest, best educated and those most Engaged in their personal health are the most likely to text or email while driving. The most Engaged consumers are more likely to wear a seat belt, but they also have a greater likelihood of driving more than 10 miles per hour over the speed limit compared to Disengaged consumers.
Only 21% of consumers did none of the activities on this list. However, if we remove spending 20 hours in front of the TV or on the Internet as a risk factor, 44% of consumers overall and 66% of 65 – 79 years did not perform any of the other activities on this list.
||18 – 30 year olds
||65 – 79 year olds
|Spent more than 20 hours per week watching TV or surfing the Internet
|Did not wear sunscreen when outdoors for an extended period of time
|Drove more than 10 miles an hour over the speed limit
|Had five or more alcoholic drinks in one day
|Sent a text or email while driving
|Not worn your seatbelt when driving or riding in an automobile
|Rode a motorcycle or bicycle without a helmet
|Took a new prescription drug without reading the warning label
|Used an indoor tanning bed
|None of the above
|Only watched 20 hours of TV / surfed Internet
|Did none of the above or only watched 20 hours of TV / surfed the Internet
Supporters of the Affordable Care Act (ACA / PPACA / ObamaCare) are very interested in targeting uninsured consumers and encouraging them to seek health insurance coverage through their state insurance marketplace or the federal marketplace. Health plans may also wish to identify uninsured consumers in order to maximize their marketing dollars or even direct them to a private exchange that provides more control over how their products are presented.
Predicting who is uninsured
In order to strategically target the uninsured (or avoid them if that is part of your marketing plan), a model is needed that will identify those most likely to be uninsured from among prospect lists and marketing databases. To build our predictive model, we examined over 7,000 survey responses from a national study on insurance status that included adults of all ages and income levels. Using only third-party data that can be purchased from numerous list vendors, we paired survey responses to these third-party variables based on the name and address of each survey respondent. We then created predictive models of their self-reported insurance status using only third-party data.
A logistic regression model predicts insurance status with 70% accuracy using only third-party data. Almost 73% of the uninsured are correctly identified by the model along with 67% of the insured. CHAID and discriminant analysis models produced similar results. The table below shows the percentage of consumers who fall into each of the four possible outcomes from the logistic regression model:
||Actual insurance status
|Predicted to be Insured
|Predicted to be Uninsured
Roughly 40 variables are used to predict insurance status. Standard demographics such as age, household size and occupation are used along with financial inputs (e.g. online purchases, home ownership, investments, etc.) and attitudinal factors (e.g. political party, voting history, media usage, etc.).
Putting the model to use
The next time you are purchasing a prospect list, consider acquiring variables like these in order to filter out the insured or uninsured households in your list. You can also work directly with the list vendor to target your list purchase by filtering out undesirable prospects prior to purchasing the list.
If you want to know more, give DSS Research a call.
Only 8% of consumers have never heard of health insurance reform under the name Patient Protection and Affordable Care Act (PPACA or ACA) or “ObamaCare” which was passed in March 2010. One-third of consumers have heard of the law, but have no idea what’s in it. Over 40% say they know something about it while only 3% boldly proclaim that they know almost everything in the 2,000+ page law.
Although the percentage who have not heard of the law has declined from 21% in Q2 2011 to 8% in Q2 2013, the percentage who say they know everything about it has remained virtually unchanged and the percentage who know a lot about it has only increased from 7% to 15% in two years.
Knowledge of ACA / Health Insurance Reform
2011 vs. 2013 results
The uninsured and those who purchase individual insurance coverage directly today are expected to receive the most benefit from ACA. Yet, the uninsured know the least about ACA and those with an individual product are polarized with 12% saying they have never heard of it and 30% saying they know a lot or everything about it. College graduates and the highest income consumers are the most knowledgeable. Over 57% of Disengaged consumers know nothing about the law while only 18% of Engaged consumers know nothing about it.
Testing their knowledge of ACA
Those who are at least aware of ACA were asked to select amongst six statements the ones they believe to be true. Only 59% of consumers correctly indicated that the biggest changes due to ACA are coming in 2014 when federal and state marketplaces go into effect. Similarly, 58% correctly indicated that some parts of ACA have already been implemented (e.g. universal coverage of children up to age 26 on parents’ plans, phasing out maximum coverage limits, etc.). However, 12% said nothing has happened so far and 4% think the law is completely implemented. Almost 6% think the law was ruled unconstitutional by the Supreme Court and 9% incorrectly believe the law was repealed by Congress.
The 65 – 79 year olds were least likely to select any of the incorrect responses while 18 – 30 and 31 – 44 year olds were much more likely to do so. Although the most Engaged consumers say they know more than Disengaged consumers about ACA, they do not know as much as they think. Engaged consumers were no more likely than the Disengaged to select one of the two true statements from our list and they were slightly more likely to incorrectly say the law was repealed by Congress. Here are the percent of consumers overall who selected each statement:
- 59% indicated that the “biggest changes go into place in January 2014”
- 58% indicated that “parts of it have been implemented already”
- 12% incorrectly indicated that “nothing has happened so far”
- 9% incorrectly indicated that “it was repealed by Congress”
- 6% incorrectly indicated that “the Supreme Court ruled the entire law unconstitutional”
- 4% incorrectly indicated that “it has been completely implemented”
Employers are not spreading the word about ACA
Only 28% of consumers with group health insurance coverage say their employer has provided any information regarding health reform (ACA or “ObamaCare”). The low proportion could be due to inattention from less engaged employees since 51% of Engaged consumers say their employer has provided some information related to ACA while only 20% of Disengaged consumers gave this response. Whether Engaged consumers are more attentive or not, there are a lot of employers who have done nothing to let their employees know what is coming up with regard to health reform. Large employers will be required to notify their employees while small employers that do not offer coverage should find some value in promoting this new source of health insurance coverage and the potential federal subsidies that some employees will be eligible to receive.
Involvement is below where it needs to be, but most people know they need to be doing something
One-third of consumers say they are actively involved in their health. At the other extreme, 5% don’t even think about doing anything to improve their health. Everyone else is at least contemplating doing something about their health. Those with the lowest income levels and older consumers are most likely to be doing nothing.
Stated level of involvement in personal health
Involvement is related to perceptions
Level of involvement or engagement in personal health impacts consumers’ perceptions of their own health status. Engaged consumers are much more positive regarding their self-reported health status compared to the Disengaged consumers:
Self-reported health status
By level of health care engagement
Perceptions are often based on reality
It is not surprising that personal involvement has a direct impact on the physical state of consumers, such as being overweight. The most Engaged consumers are much more likely to be at or near a normal weight level based on their Body Mass Index (BMI) while three-quarters of Disengaged consumers are classified as obese.
Body Mass Index
By level of health care engagement
39% of consumers have never recommended their current health insurance plan to a friend or family member. Another 20% have recommended their health plan at some point, but not in the last year. Only 16% recommended their plan once in the last year and one-quarter have recommended their health plan more than once in the past year.
18 – 30 year olds are much more likely than 65 – 79 year olds to recommend their plan multiple times (32% vs. 20%). Those with an individual plan they selected themselves are much more likely to recommend their plan (79% have recommended it 1 or more times) compared to commercial group (59%) and Medicare members (53%). The highest income consumers are much more likely to recommend their plan multiple times compared to the lowest incomes (31% vs. 13%). The reasons are not absolutely clear, but frequent exercisers are much more likely to recommend their current coverage multiple times compared to those who seldom or never exercise.
As you might expect, the most engaged consumers are significantly more likely to recommend their health plan with almost half the Engaged consumers recommending their plan two or more times in the last year:
Consumers who recommended current health plan
By level of health care engagement