Expectations_Satisfaction_Enrollment

© 2005 Frederick H. Navarro

Modeling health plan length of membership as a

function of met expectations, satisfaction,

intentions to return and recommend

Supplemental analysis of met expectations, months of

membership, and total medical claims as a function of the

Patterns of Adapting to Health (PATH)

Frederick H. Navarro

2004

1


2

Modeling Expectations, Satisfaction, Word of Mouth, and Retention

Met

Expectations

Satisfaction

Length of

Membership

Willingness to

Recommend

Willingness

to Re-enroll

It is reasonable to expect that length of health plan membership is in part determined by a

member’s willingness to re-enroll in a health plan. A member’s willingness to re-enroll in a

health plan is also influenced by their satisfaction with the plan. Given the established

relationship between expectations and satisfaction, it makes sense to say that met

expectations should predict higher satisfaction with a health plan, and a member’s

willingness to re-enroll and recommend the health plan.


3


Meeting

Expectations

Satisfaction

Length of

Membership

Willingness to

Recommend

Willingness

to Re-enroll

This model was tested using the data from five variables from a BCBS member satisfaction

study using responses from over 8,000 members in 2004:

Q16. Would you re-enroll?

Q17. Would you recommend?

Q18. Overall satisfaction with the health plan

Q19. Were expectations met?

Real months of membership from member records.


4

Testing the Modeling: Review of Correlations

A correlation analysis was used to identify the basic relationships between the five variables.

The matrix of simple correlations is as follows:

Enrolled

Months Q16 Q17 Q18

Q16 .12

( 8115)

P= .000

Q17 .11 .90

( 7597) ( 7552)

P= .000 P= .000

Q18 .07 .80 .82

( 8108) ( 8054) ( 7535)

P= .000 P= .000 P= .000

Q19E .05 .62 .65 .70

( 7926) ( 7874) ( 7373) ( 7868)

P= .000 P= .000 P= .000 P= .000

All correlations were

significant and positive.

Enrollment months had the

strongest associations with re-

enrollment (q16) and

recommendation (q17)

tendencies. It had the weakest

relationship with expectations

(19E).

Satisfaction (q18) had the

strongest associations with re-

enrollment and

recommendation tendencies.

Expectations had the

strongest relationship with

satisfaction.


5

Testing the Model: Correlations and Regression Analysis

Meeting

Expectations

Satisfaction

Length of

Membership

Willingness to

Recommend

Willingness

to Re-enroll

The figure below identifies all of the basic relationships listed in the previous table of simple

correlations.

These relationships can be further teased out using multiple regression analysis to test

specific relationships while controlling others. Regression analysis allows you to test the

relationship between variables while holding constant others.

r=0.12

r=0.07

r=0.05

r=0.11

r=0.90

r=0.62

r=0.70

r=0.80

r=0.82

r=0.65


6

β = beta coefficient

In regression analysis, a beta coefficient is the correlation

between two variables while holding constant the effects of

other variables in the same equation.

Beta coefficients in regression allow the examination of the

relationship between two variables while controlling for the

influence other variables. This is something that simple

correlations cannot do.

Testing the Model: Regression Analysis and Beta Coefficients


7

Testing the Model: Factors Influencing Re-Enrollment

Meeting

Expectations

Satisfaction

Length of

Membership

Willingness to

Recommend

Willingness

to Re-enroll

The first multiple regression analysis (MRA) used met expectations and satisfaction to predict

willingness to re-enroll.

The betas (β) in this analysis were all significant beyond p<.0001 and showing that

satisfaction had a much larger impact on willingness to re-enroll when the influence of

expectations were controlled for.

β =0.12

β =0.71

R2=0.64

r=0.70


8

Testing the Model: Factors Influencing Recommending

Meeting

Expectations

Satisfaction

Length of

Membership

Willingness to

Recommend

Willingness

to Re-enroll

This first step said that a member’s willingness to recommend the health plan was influenced

predominately by satisfaction. Since correlations existed between the willingness to

recommend, satisfaction and expectations, a second MRA included looked at these three

variables.

The betas in this MRA were all significant beyond p<.0001, and showed that satisfaction had

a much larger impact on willingness to recommend when the influence of expectations was

controlled for, again supporting the model.

β =0.13 r=0.70

β =0.73

R2 = 0.68


9

Testing the Model: Factors Influencing Length of Membership

The initial model postulated that length of membership is influenced only by willingness to re-

enroll and willingness to recommend. Since correlations exist between all four variables and

months of enrollment, the third MRA included all four variables to predict months of

membership.

The only significant betas in this analysis were willingness to re-enroll and satisfaction. Of the

two, willingness to re-enroll dominated. These findings mean that the earlier correlations

between willingness to recommend and length of membership, and expectations and length

of enrollment were spurious.

Meeting

Expectations

Satisfaction

Length of

Membership

Willingness to

Recommend

Willingness

to Re-enroll

β =0.05 n.s

r=0.70

β =0.12,

p<.000

R2 = 0.01, p<.000

β = -0.05 p<0.03

β = -0.02 n.s.


10

Testing the Model: Factors Influencing Length of Membership

Based on this analysis, the willingness to recommend a health plan does not influence the

actual length of membership. Only willingness to re-enroll has an influence on length of

membership. Also, the willingness to enroll is most influenced by satisfaction with the plan,

which is in term heavily influenced by the meeting of expectations.

Meeting

Expectations

Satisfaction

Length of

Membership

Willingness to

Recommend

Willingness

to Re-enroll

β =0.05 n.s

r=0.70

β =0.12,

p<.000

R2 = 0.01, p<.000

β = -0.05 p<0.03

β = -0.02 n.s.


11


This indicates that the key focus of member retention must begin with a better

understanding of and meeting member expectations!

Meeting

Expectations

Satisfaction

Length of

Membership

Willingness to

Recommend

Willingness

to Re-enroll

PATH Groups Arrayed by Met Expectations (Q19)

and Months of Membership

77%78%

81% 81%82% 82% 83%

86% 86%

90%

82%

70%

75%

80%

85%

90%

95%

Nat

ural

ist

Gen

eric

Inde

pend

ently

Hea

lthy

Una

ssig

ned

Clin

ic C

ynic

Avo

ider

Family

Cen

tere

d

Rea

dy U

ser

Loya

list

Traditio

nalis

t

Total

Me

t E

xp

ec

tati

on

s

30

35

40

45

50

55

60

Mo

nth

s o

f M

em

be

rsh

ip

Q19-Expectations

Months of Membership

Length of Membership, Meeting Expectations and PATH

The Patterns of Adapting to Health (PATH) were used to assess the relationship between

deep health behavioral profiles within the membership and their impact on met expectations

and length of membership. Analysis showed that member’s met expectations varied across

the PATH. This indicated that PATH provides insight into the risk of unmet expectations.

Claims and Membership Length Identify Prime PATH Targets

In a supplemental analysis, the months of membership and total annual medical claims were

arrayed across the PATH. The results indicated that those PATH with a longer length of

membership tended to have higher claims, while those PATH with the shortest membership

tended to have the lowest claims.

Total Average Yearly Claims and Months of Membership by

PATH Groups BCBS of Florida, N=7520

$5,194

$9,478$7,256

$7,234

$7,168

$6,989

$6,654$6,635

$6,620

$6,540

$8,675

54

53

56

5152

5150

57

48 48

49

$5,000

$5,500

$6,000

$6,500

$7,000

$7,500

$8,000

$8,500

$9,000

$9,500

$10,000

Rea

dy Use

r

Traditio

nalis

t

Family

Cen

tere

d

Nat

uralis

t

Total A

vera

ge

Clin

ic C

ynic

Una

ssig

ned

Loya

list

Inde

pend

ently H

ealth

y

Gen

eric

Avo

ider

To

tal A

vera

ge C

laim

s

45

47

49

51

53

55

57

59

Avera

ge M

on

ths o

f M

em

bers

hipTotal Avg Sub Claims

Months of Membership


14

Modeling PATH, Expectations and Satisfaction

The Patterns of Adapting to Health (PATH) provided insight into members’ initial

expectations and, thus, represented a gateway to meeting these expectations

better and improving satisfaction among those low claim members with shorter

lengths of membership.

Initial

Expectations

Satisfaction

PATH

Clinic Cynic

Avoider

Generic

Traditionalist

Family Centered

Loyalist

Ready User

Independently

Healthy

Naturalist

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Expectations_Satisfaction_Enrollment