The “Home” Setting Is Best


DSS Research created a “home survey” to capture the level of satisfaction of consumers receiving dialysis treatments in a home setting.  After several implementations of the home survey, comparisons were made between the home survey results and the more traditional in-center setting.  In-center results were collected using the ICH CAHPS® instrument across a variety of facilities and clients.  Since the home survey leveraged the key questions from the official ICH CAHPS questionnaire, direct comparisons between in-center and home dialysis patients were readily available.


We have two years of home dialysis survey results using both mail and telephone data collection in a mixed-mode approach.  DSS compared these data to four years of ICH CAHPS research collected using the same mixed-mode methodology of mail surveys upfront and telephone calls to non-responders.


Satisfied.  Overall ratings are high with 65% to 70% of dialysis patients rating their doctor, the staff and the center a 9 or 10 and over 80% rating these factors an 8, 9 or 10. On average, almost 86% of survey respondents said they always or usually receive a high level of service on a variety of items in the ICH survey.

Consistent.  Satisfaction ratings and affirmations of various statements related to their treatment and ongoing care have remained very consistent since the inception of the ICH CAHPS program.  Over the last four waves (Spring and Fall 2015; Spring and Fall 2016), only a handful of measures have declined or improved from one wave to the next by more than 5% on a relative or absolute basis.

Equivalent.  The phone and mail methodologies produce similar results.  Average satisfaction ratings between mail and phone data collection methodologies are very similar.  Phone respondents are one percentage point higher on Top 2 box scores and two percentage points higher on Top 3 box scores on the overall satisfaction scales with 0 to 10-point scales.

Home and In-center patients very similar

Home care and in-center dialysis patients have similar perceptions of their health status

Situational.  Those receiving home dialysis treatments are significantly more satisfied than in-center dialysis patients on aspects related to their training, care and general feelings about the dialysis center coordinating their care.  Training nurses for home dialysis patients are rated significantly higher than staff members at dialysis centers.  However, almost 50% of home patients have experienced some type of problem during dialysis, much more often than the typical in-center patient (an average of 27% have experienced a problem in the last three months).  Home dialysis patients are also somewhat less likely to say they were able to handle dialysis problems on their own.  Physical and mental health ratings are comparable between in-center and home dialysis patients, but home patients are healthier overall with significantly fewer patients reporting having high blood pressure, a heart condition or diabetes and fewer saying they have vision or hearing problems.

Home patients are more satisfied

Home dialysis patients are more satisfied than In-center dialysis patients


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A little stamp can make a difference


The basic fundamentals of survey research are well known.  Draw a representative random sample.  Make sure that the source file includes all eligible members, and does not systematical exclude some populations.  With a large, representative, random sample, based on historical response rates, there will be enough respondents to accurately represent the target population.  These survey results can then be used to reliably compare health plans and guide activities to improve the member experience.  This logic chain anchors the importance of the member experience across several important measurement initiatives.

However, health care is changing and life remains busy for all involved, including those that receive health care.  Consequently, as some are aware, response rates from most member populations have been slowly declining over time.  DSS Research carefully tracks the response rates of all of our clients and examines them annually across each population of insured members.  We take pride in consistently having among the highest response rates for insured populations in the survey research industry.

This also means we remain alert to opportunities to strengthen member response rates.  Recently, we ran a carefully constructed test to improve member response rates, with a specific successful result.


Standard protocols provide the member with prepaid postage on the return envelope as a courtesy and convenience when completing a mail survey, and to increase the likelihood of responding to the survey.  These are called business reply envelopes (BRE).  The typical BRE has a small box that states “NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES” where the stamp would usually go.

The purpose of the test was to see if using a standard postage stamp (Stamp), similar to those used to send cards and letters, would increase member response rates.  Two groups of 500 members each were randomly selected to receive either a BRE (the Control group) or Stamp return envelope (the Enhanced group).  This was done for two populations, Medicaid and Commercial health plan members.  (Note:  This was done in conjunction with a DSS Research client, who has graciously agreed to share these results.)


We checked to make sure there were no differences by either age or gender between the BRE and Stamp member samples in the Medicaid or Commercial populations.  There were none.  As has been long recognized, responding members to both the BRE Control and Stamp Enhancement were generally older than the members that were sent the survey ( i.e., older members are generally more responsive to health plan surveys, and were so in this test).

Overall, Medicaid members were more likely to respond when the BRE contained a stamp while commercial group members were not impacted by the presence of a stamp.

Both member populations, Medicaid and Commercial, responded more often when a stamp was placed on the return envelope.  The improvement was minor among Commercial members (< 1%).   There was a meaningful improvement in the response rate of the Medicaid member population.  Medicaid members receiving the Stamp Enhancement responded much more often compared to the Medicaid BRE Control group.  There was a net gain of 3.6 percentage points in the response rate, or a 26.5% increase, of Medicaid members receiving the Stamp Enhancement compared in the BRE Control group.

A stamp on the BRE encourages more Medicaid females to respond, but did not affect commercial group members the same way.

Interestingly, this increase was entirely associated with female Medicaid members, which even exceeded the response rate of Commercial female members in both groups.  Medicaid males in the Stamp Enhancement group responded similar to Commercial males in both groups, but were slightly less likely than males in the Medicaid Control group to participate when then Stamp was present.


The use of a postage stamp on the return envelope resulted in a substantially improved response rate among Medicaid members.  Since this gain was exclusive to female Medicaid members, and historically the female population has long been accepted as the primary health care decision-maker, there is also the exciting possibility that these survey results will more effectively guide improvement and provide more meaningful comparisons of health plan results on behalf of the primary health care decision-makers in the Medicaid population.

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A lack of confidence and knowledge

Under the Affordable Care Act (ACA, also known as “ObamaCare”), every American is encouraged to seek health insurance coverage.  However, many consumers lack confidence to make health insurance choices on their own.  Less than half the Federal and state exchange purchasers, Medicare members and others who have a choice of multiple health plans each year said they are extremely or very prepared to make the right choice.  Not surprisingly, the uninsured are least prepared to make a health plan choice.  Only one-third of Medicare members have a high level of confidence in their ability to select a health plan while 50% of individual product buyers are confident in their preparedness.

Health insurance in general is a mystery

Even when contemplating general issues regarding health insurance, something is lacking.  Only 22% of consumers surveyed said they are very confident that they “know most of the things they need to know about health insurance.”  A similar percentage indicated they are very confident they “understand health insurance terms.”  Males are more confident than females, college graduates are more confident than High School graduates and high income households are more confident than low income ones, but even in the most extreme cases less than one-third of consumers are very confident regarding health insurance usage and terminology.

They looked, but couldn’t find

To compensate for unpreparedness and a lack of confidence, over 40% of consumers said they looked in the last year for information in written materials or on the Internet regarding how their health plan works.  Individual product members are more likely to search for information than Medicare members.  Younger consumers are almost twice as likely as seniors to seek this kind of information about their health plan.  More importantly, almost one-quarter of those who sought information on their plan did not find what they were looking for in every situation.  In separate questions, one quarter of consumers said they looked for information regarding the expected out-of-pocket costs for various medical services and nearly one-third looked for information regarding the cost of prescription medications.  Once again, at least 40% of searchers sometimes had trouble finding the cost information they sought.

At the core of bad decision-making

A lack of confidence in their ability to select health insurance and a lack of information to guide their decisions appears to be leading many consumers to make poor decisions related to the health insurance coverage and health care in general.  Twenty percent of consumers do not have a personal doctor, including 74% of the uninsured.  The least healthy adults under 65 years of age are also the most likely to be uninsured. When choosing their current health plan, fifty percent of consumers spent less than 1 hour evaluating the options and selecting their plan. In total, 75% spent less than 2 hours on this important decision.

Despite a wide variety of choices and steadily increasing prices industry wide, two-thirds of consumers did not change health plans from 2014 to 2015.  Three-quarters of Medicare members did not change plans in the past year.  Furthermore, when faced with a hypothetical situation where their health insurance premium increases 20% at their next renewal, 44% said they would just pay the rate increase to keep their current plan.  Only 49% would try to find another plan closer in price to what they have today and 7% said they would drop health insurance coverage entirely.  Over half those with Medicare and employer group coverage said they would renew their current plan and pay the rate increase.

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Five years later, ACA is still a mystery to many

It has been more than five years since the Patient Protection and Affordable Care Act (take your pick whether to call it PPACA, ACA or ObamaCare) was passed in May 2010 and public exchanges are wrapping up their third year of operation, yet one-third of consumers are still clueless concerning the law.

Never heard of it!

As of October 2015, 6% of US adults have never heard of the Affordable Care Act or ObamaCare and 27% know nothing about it other than its name.  Only 19% say they “know a lot about it” while 4% foolishly believe they “know almost everything in it” according to the most recent DSS Health Care Engagement Index Survey.  Even among the most Engaged health care consumers, 5% have never heard of the ACA and 13% only know its name.  Years of news stories, political rhetoric, community outreach efforts and health plan marketing / advertising expenditures have had little impact as these percentages have not changed appreciably since 2013.

Still can’t afford coverage!

The uninsured rate has certainly declined significantly the last two years, but “affordability” is still a barrier for many consumers.  The percentage of people who say they have postponed seeking care because of costs or had a problem paying a medical bill has trended upwards since 2013 while the percentage receiving flu shots, having a colorectal screening or receiving a physical exam has not changed despite these services being free under the ACA.  Consumers’ perceived “value” of health plans relative to the benefits received and premium paid has declined since 2013.  Rising premiums, ever higher deductibles and consumers’ lack of motivation to understand health care policy issues seem to be constraining the marketplace.

I worry more than ever about medical costs!

Furthermore, 12% reported that their health plan does not pay for care their doctor said was needed on a regular basis.  Only 63% say they never have an issue with their plan paying for care their doctor says is needed.  Similarly, 13% of consumers said they regularly have to pay out-of-pocket for services they thought would be covered by their plan while only 55% never have to do so.  The magnitude of medical expenses are a worry for many, with 16% always or usually delay visiting a doctor because of worries about costs while another 24% sometimes feel this way.  Even prescription costs create concerns with 10% always or usually delaying filling a prescription and 20% sometimes delaying the filling of a prescription due to costs.

Too much trouble to change plans!

With greater choices than ever before (new entrants, co-ops, both private and public exchanges), you would hope that consumers would carefully shop for a new health plan like they for their next TV or smartphone – but the opposite is true.  When faced with a 20% increase in premium, people in 2015 are likely to say they would simply pay the price increase rather than go to the trouble of changing health plans (37% in Q4 2013 vs. 44% in Q3 2015). When consumer do make a health plan choice, they spend about the same amount of time in 2015 that they did in 2013 with just over half the market spending less than one hour on one of the biggest financial decisions they will face all year.

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Medicare STAR Ratings are Out!

You can download the latest Medicare STAR ratings from CMS here and read our brief summary below.

MA-PD Ratings Consistent

STAR ratings for MA-PD plans have remained fairly consistent since 2014, with slightly more companies receiving a 4.5 or 5.0 rating.  However, significantly more MA-PDs received a 4.0 rating in 2016.

Summary of Medicare STAR ratings for MA-PD and PDP plans between 2014 and 2016.

Summary of Medicare STAR ratings for MA-PD and PDP plans between 2014 and 2016.

Number of Plans Continues to Decline

The number of MA-PDs and PDPs that receive a STAR rating from CMS has declined each year.  The number of MA-PDs declined 15% from 2014 to 2016.  The number of PDPs receiving a STAR rating declined 18% from 2014 to 2016.

Top Performing Plans

Kaiser continues excel with five of the 12 MA-PDs receiving a 5-star rating.  Kaiser and Gundersen Health Plan are the only MA-PD plans to receive 5-stars in 2014, 2015 and 2016.  Martin’s Point is the only other 5-star MA-PD plan that remained on the list from 2015.  The 5-star MA-PD plans for 2016 in alphabetical order are:

  • Cigna Healthcare Of Arizona, Inc.
  • Erickson Advantage / Sierra Health And Life Insurance Company, Inc.
  • Essence Healthcare, Inc.
  • Gundersen Health Plan (2014, 2015 and 2016)
  • HealthPartners / Group Health Plan, Inc. (MN)
  • Kaiser Foundation HP, Inc. (2014, 2015 and 2016)
  • Kaiser Foundation HP Of CO (2014, 2015 and 2016)
  • Kaiser Foundation HP, Inc. (2014, 2015 and 2016)
  • Kaiser Foundation HP Of The Mid-Atlantic States (2014, 2015 and 2016)
  • Kaiser Foundation HP Of The NW (2014, 2015 and 2016)
  • Martin’s Point Generations (2015 and 2016)
  • Tufts Associated Health Maintenance Organization

Dean Health Plan, Medical Associates Clinic Health Plan of Wisconsin and Medical Associates Health Plan are the MA-only plans receiving 5-stars in 2016.  Dean Health Plan and Medical Associates Health Plan also received 5-stars in 2014 and 2015.

Amongst PDPs, only Tufts Health Plan and Wisconsin Physicians Service (WPS) received 5-stars for 2016.  WPS also received 5-stars in 2015 and Tufts received 5-stars in 2014.



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Older is “better” with many Home Health Agencies


Data published by the Centers for Medicare & Medicaid Services (CMS) provides information on 12,261 home health agencies.  Types of services offered by each agency along with certification date is included for all agencies.  The 7,828 agencies (64% of the total) that participated in the Home Health CAHPS© program and received a sufficient number of completed surveys show results on five key measures from that survey along with the total number of surveys completed and the overall response rate among patients contacted.

A summary of Home Health CAHPS results for all reporting agencies nationally

A summary of Home Health CAHPS results for all reporting agencies nationally

Longevity is linked to better results

Whether more experienced agencies have learned to provide better care or attrition weeds out the less effective agencies over time, satisfaction with with home health agencies increases with length of time since the agency was certified.  Agencies in operation for more than 15 years received significantly higher scores on “giving care in a professional way”, “communicating well”, “discussing medicine, pain and home safety” and “overall rating of care.”  Patients are also more likely to say they would “definitely recommend” an agency with more than 15 years experience.

On average, there are no significant differences between agencies with less than 6 years experience (certified in 2010 or later), those with 6 to 10 years experience and those with 11 to 15 years experience on the satisfaction and recommend questions.  However, agencies with 16 to 20 years experience receive significantly higher ratings than those with less than 20 years experience and agencies with more than 20 years experience receive significantly higher scores than those with 16 to 20 years experience.  For example, on the overall rating of care question, the percentage of 9 and 10 responses on the 0-to-10 point scale is shown below by length of time since certification:

  • 85.4% for agencies with 21+ years experience (29% of agencies)
  • 84.4% for agencies with 16 – 20 years experience (21% of agencies)
  • 82.8% for agencies with 11 – 15 years experience (15% of agencies)
  • 82.7% for agencies with 6 – 9 years experience (25% of agencies)
  • 82.3% for agencies with < 6 years experience (9% of agencies)

Survey response rate has even more impact than longevity on results

The total number of surveys completed by an agency is not correlated with level of satisfaction (i.e. having more surveys does not by itself imply better scores), but the percentage of patients who complete an HHCAHPS survey among those that were invited to participate (the “response rate”) is closely linked to satisfaction scores.  Agencies with higher response rates consistently receive higher satisfaction scores and a greater percentage of patients willing to recommend those agencies.  Agencies in operation for 15 or more years do tend to have higher response rates, but even a relatively new agency receive scores comparable to the older agencies when they achieve a high response rate on the survey.

The average response rate is 32.5% across all reporting agencies.  The top 10% of agencies had response rates of 46% or higher while the bottom 10% of agencies had response rates less than 20%.  The overall rating of care question varies by response rate as follows:

  • 79.1% for agencies with <20% response rate (11% of agencies)
  • 81.8% for agencies with 20% – 29% response rate (28% of agencies)
  • 84.7% for agencies with 30% – 39% response rate (37% of agencies)
  • 86.8% for agencies with 40% – 49% response rate (18% of agencies)
  • 88.1% for agencies with 50% or greater response rate (6% of agencies)


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Key differences between Engaged and Disengaged consumers

Engaged consumers have more favorable attitudes and behaviors
Compared to Disengaged consumers, Engaged consumers are…

  • More confident filling out medical forms (87% vs. 40%).
  • Much more likely to feel prepared to select health insurance coverage for themselves (78% vs. 17%).
  • Much more likely to know what they will pay out of pocket when visiting a doctor (97% vs. 35%).
  • Much more likely to carefully research what their doctor says before acting on his or her instructions (81% vs. 34%).
  • In much better health overall (62% excellent or very good health vs. 16%).
  • Much more likely to have a normal Body Mass Index or BMI (60% vs. 16%).
  • More likely to have visited a dentist in the past year (96% vs. 37%).
  • More likely to have a personal doctor (96% vs. 60%).
  • More likely to have visited a doctor in the past year (97% vs. 64%), but fewer total visits on average compared to Disengaged consumers (2.4 visits vs. 3.2 visits).
  • Less likely to have visited an ER in the past year (18% vs. 29%).
  • Less likely to have visited a hospital in the past year (7% vs. 14%).
  • Exercising at least three times per week (77% vs. 21%).
  • Receiving annual physical exams (96% vs. 49%).
  • Concentrating on eating healthier (90% vs. 46%).
  • Much more likely to have had their cholesterol checked in past year (72% vs. 37%).
  • Receiving flu shots each year (68% vs. 25%).

Engaged consumers more satisfied with and more loyal to their health plans
Engaged consumers are much more likely to have private health insurance coverage that they pay for out of their own pocket (46% Engaged vs. 20% Disengaged) and less likely to have government coverage such as Medicaid or state-based plans (8% Engaged vs. 20% Disengaged) or be uninsured (3% Engaged vs. 25% Disengaged).  Having a larger financial stake generally leads consumers to be less satisfied with their health insurance coverage, yet Engaged consumers are significantly more satisfied with their coverage and more loyal to their plan.

  • 43% of Engaged consumers rate their health plan a 9 or 10 on a 0 to 10-point scale compared to 22% of Disengaged.
  • 65% of Engaged consumers rate their health plan a, 8, 9 or 10 on a 0 to 10-point scale compared to 34% of Disengaged
  • When considering overall value for the price paid, 41% of Engaged consumers rate their health plan a 9 or 10 compared to 19% of Disengaged.
  • 61% of Engaged consumers rate their health plan’s overall value a, 8, 9 or 10 compared to 31% of Disengaged.
  • When faced with a 20% premium increase, 59% of Engaged consumers say they would pay the higher price to remain with their current plan compared to 36% of Disengaged consumers.
  • Under the assumption of a 20% premium increase, only 34% of Engaged consumers would change plans and 7% drop coverage while 46% of Disengaged expect to change plans and 18% say they might drop coverage in this situation.
  • Between 2014 and 2015, 16% of Engaged consumers changed plans within the same health insurer (8% for Disengaged), but only 13% actually changed carriers compared to 15% for Disengaged.

When asked to review several statements related to their health plan, more Engaged consumers were much more likely to make positive associations with their plan.

  • 77% of Engaged consumers said “my plan is perfect for people like me” (40% Disengaged).
  • 75% of Engaged consumers think of their insurer as “my health insurance company” (40% Disengaged).
  • 67% of Engaged consumers agree with the statement “the people who work at my plan understand me” (27% Disengaged).
  • 59% of Engaged consumers say the people at their insurer are “sympathetic to my problems” (32% Disengaged).
  • 50% of Engaged consumers believe “my health plan has benefits no other plan has” (19% Disengaged).

Engaged consumers are not…
Engaged consumers are not older on average than their Disengaged counterparts.  Contrary to some expectations, Engaged consumers are slightly less likely to be female (54% Engaged vs. 60% Disengaged) and can be found amongst all ethnic groups and all household sizes.  Engaged and Disengaged consumers are equally likely to choose leading health insurance companies such as Blue Cross Blue Shield, Aetna, Cigna, Humana, Kaiser or United HealthCare.

Despite reporting to be in much better health, Engaged consumers are only slightly less likely to have one or more of the most common chronic conditions like diabetes, high cholesterol, hypertension or mental health issues.  Fewer Engaged consumers smoke cigarettes today, but they are just as likely as Disengaged consumers to have smoked at some point in their life.

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Health Insurance Attitudes Vary By Age and Level of Engagement

Consumer attitudes regarding the importance of health insurance in their lives does not vary dramatically across most consumer groupings, but is significantly more meaningful to the oldest and most engaged consumers.

Engaged consumers value health insurance from every perspective
The most engaged consumers are much more likely to see health insurance as a means of keep their families healthy and protecting them financially.  Engaged consumers are also more likely to feel at ease with insurance, but have worries of potential bankruptcy without it.  Twenty percent of Engaged consumers say their family and friends turn to them when they have questions regarding health insurance and health care providers compared to only 4% of Disengaged consumers.

Engaged consumers are more committed to having health insurance from every perspective considered.

Engaged consumers are more committed to having health insurance from every perspective considered.

Older consumers are also concerned about financial risks without health insurance
The oldest consumers (65 to 79 years of age) are much more likely than the youngest (18 to 30 years of age) to be worried about bankruptcy without adequate health insurance and to feel at ease when properly covered.  The oldest consumers also consider it their duty to provide health insurance for their families, but they are only slightly more likely to have a passion for keeping themselves healthy, to expect health plans to reward healthy members or to be a resource for family and friends who have questions about health insurance and health care.

Older consumers value the financial protections of health insurance more so than younger ones.

Older consumers value the financial protections of health insurance more so than younger ones.

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Opportunities to improve doctor satisfaction

Almost 80% of US consumers have a physician they consider to be their personal doctor and many of them are very satisfied with the care they receive or they would look elsewhere for a new doctor.  However, the latest DSS Health Care Engagement Index (HCEI™) survey shows there is still room for improvement.

Uninsured and new HIX members need doctors.  It is not surprising that with more limited access to medical care, only 37% of uninsured consumers have a personal doctor.  Something harder to explain is why only 76% of consumers with an individual health insurance plan have a personal doctor despite paying for coverage out of their own pocket and having free access to checkups.  New health plan enrollees in general and public exchange enrollees specifically are less likely to have a personal doctor.

Half are extremely satisfied, but half are not.  On a scale of 0 to 10 where 10 means the best possible personal doctor, 45% of consumers rate their doctor a 9 (20%) or 10 (25%).  Consumers heavily Engaged in their health care, those 65 to 79 years of age and those with Medicare coverage are significantly more likely to have a personal doctor and to rate their doctor a 9 or 10.  That still leaves 50% of consumers less than delighted with their current physician.

Infographic on doctor preferences from the DSS Health Care Engagement Index (HCEI) survey.

Infographic on doctor preferences from the DSS Health Care Engagement Index (HCEI) survey.

Not enough consumers saying their doctor is the best ever.  When given a choice of describing their doctor as the “best ever“, “good enough for the moment“, “the only doctor I have ever had” or choosing from a list of complaints, only 34% said their doctor is the “best ever.”  Another 11% said they have “never had another doctor” to compare against, so they are uncertain how good their doctor really is.   One-quarter of all consumers say their doctor is “good enough for the moment“, which implies they will look elsewhere at some point in the future.  Half of those who said their doctor is “good enough for the moment” also selected one or more complaints such as taking too long to get an appointment, long waits at the doctor’s office, a dismissive attitude when asking questions, language issues, etc.  One-third of consumers who said their current doctor is the “only one they have ever had” also mentioned one or more complaints, indicating that they already recognize opportunities for improvement despite their limited experience.

60% of doctor relationships could be upgraded.  In a separate question, 27% of consumers said they “would drive across town and pay more” to continue seeing their current physician – a clear sign of loyalty for their physician.  However, 30% said they stay with their doctor out of convenience more than anything else, 14% said they would change doctors if they could easily find a better one and 17% stay with their doctor out of fear that they might end up with an even worse doctor.  That means about one-third of consumers are ready to change doctors if the process is easy and there is enough information to insure a good decision.  Another 30% of consumers might switch if circumstances change.

Utilization is skewed.  The typical US adult visited a physician 2.3 times during the past year, but utilization varies across many respondent groups.  Almost every Engaged consumer said they visited a doctor at least once in the past year while only 64% of Disengaged consumers did so.  When Disengaged consumers visited a doctor, the often did so multiple times, averaging 3.2 visits per year compared to only 2.4 visits for the typical Engaged consumer.  Despite a lack of insurance, 50% of uninsured consumers visited a doctor at least once while 89% of those with an individual plan and 97% of those with Medicare had a doctor visit in the past year.  Those with 1 chronic condition are not much different from consumers with no chronic conditions, but both groups have significantly fewer visits than those with 2+ chronic conditions (3.4 visits per year versus 1.5 visits per year for those with no conditions).  Grouping consumers by BMI produces results similar to those based on number of chronic conditions with overweight individuals having slightly more utilization than those with a normal range BMI, but significant less visits than consumers classified as obese (1.8 visits per year for normal BMI verses 2.7 visits per year for obese BMI).

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2015 Federal Exchange Summary

The infographic below summarizes statistics from the Department of Health and Human Resources regarding enrollment on the Federal health insurance exchange for 2015.

2015 Federal Exchange Enrollment Infographic

Over two-thirds of the 8.8 million consumers (69%) chose a Silver plan, but given that 87% of the Federal exchange enrollees are receiving a subsidy, the proportion of Silver plans should be even higher.

For those not choosing a Silver plan, Bronze is the metal tier of choice.  The Bronze plans should minimize monthly premium (with or without Federal subsidies), but out-of-pocket costs will be significantly higher if medical services other than preventive care are received during the year.  This is particularly true for anyone who chooses a Bronze plan when eligible for one of the cost sharing Silver plan designs (note: cost sharing plans reduce out-of-pocket costs such as deductibles and copayments for consumers with incomes below 250% of the Federal Poverty Level).

Just over half of those who enrolled on the Federal exchange did so for the first time in 2015 (or during the opening enrollment period at the end of 2014 – for 2015 coverage).  Among the 47% who re-enrolled on the exchange for 2015, slightly more than half actively selected their 2015 plan (even if it ended up being the same plan they had in 2014) while the remaining consumers auto-enrolled in their previous plan for 2015.

The age distribution of Federal exchange purchasers relative to the US population (those under age 65), is heavily skewed towards older consumers.  Only 8% of enrollees are under 18 years of age compared to 27% of the US population.  Almost 50% of Federal exchange enrollees are between 45 and 64 years of age while only 31% of the US population falls within this age range.

Some additional factors not shown on the infographic are:

  • Only 2% of all 2015 Federal exchange purchasers have incomes over 400% of the Federal Poverty Level (FPL) compared to 43% who have incomes below 150% FPL.
  • 65% of enrollees are White, compared to 14% Black / African American, 11% Latino and 8% Asian.  Despite special plan designs for native Americans, very few have enrolled via the Federal exchange.


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