KCA Research performs qualitative and quantitative marketing research and assists with market based planning studies. Offices are located in Sacramento , California and Alexandria , Virginia.

Most health maintenance organizations conduct periodic research with members who have ended their coverage with a particular plan. Typically, this is done to determine if any pattern of dissatisfaction has caused this exodus, says Lynne Cunningham, vice president for health care research, KCA Research Inc.

“The HMO is trying to find out why someone made the switch, in the hopes not so much that they can get that person back but that they can plug the hole so that they don’t lose more people for the same reason.”

Results of most surveys show that many of the members who have switched plans did so because they:

  • changed employers and the new employer didn’t offer the HMO;
  • moved out of the geographic area covered by the HMO;
  • switched to a less expensive plan;
  • selected a plan with more comprehensive coverage because of a family status change, i.e. marriage or birth of a child.

“Reasons for leaving are very consistent with what we hear in patient- or member-satisfaction research,” Cunningham says. “You leave because you can’t get the access you want, you can’t get an appointment, you can’t see the doctor you want to see. Another reason that we’re hearing more and more these days is that the cost has gone up. People will say ‘My employer is covering XYZ HMO completely, and they’re not covering ABC HMO completely and I just can’t afford to keep paying out of my pocket, so I have to switch.’”

Most surveys with members who have terminated their coverage with one health plan are conducted by mail and response rates vary considerably. To solicit information from a more randomly selected sample of health plan members who had changed coverage, KCA recently completed a telephone survey for one of its HMO clients.

Cunningham says a telephone survey was undertaken because the client wanted the information quickly.

“Mail surveys usually take two mailings to get effective returns. And with this telephone survey, we got a better response rate and we got more random responses than we typically would get from a mail survey. To use an example, if you had just switched toothpaste brands, and six weeks later you get a letter (from your former brand) asking why you switched, how much incentive do you have to respond? But if I call you Tuesday evening in the middle of dinner, you’re probably more likely to respond.”

The client is a group practice model HMO which provides care at a series of centers throughout a major metropolitan area. Members are seen at these centers by physicians who only see HMO participants. The doctors do not have separate fee-for-service private practices in other locations.

KCA called members who had "voluntarily terminated" their coverage during 1988. These potential respondents had stayed with the same employer but selected a different health plan.

Specific results of the survey are proprietary but the recollection of health plan switching produced an intriguing pattern.

300 members who had terminated their coverage were contacted. The following results are interesting and may produce a pattern which will be repeated in surveys with other members who have changed health plan coverage.

  • Six percent do not have any current health plan coverage.
  • 40 percent reported switching to a variety of other HMOs.
  • 12 percent report still belonging to the client HMO.

Perhaps the most amazing finding of the survey is that over 40 percent of the survey participants did not remember switching health plans in the past year. When these people were specifically told that health plan records showed they had switched, almost three fourths still denied making a change. Upon further probing with this group it was found:

  • Over 80 percent said no one else in their household had changed health plans in the last year.
  • Over 80 percent said they had never belonged to an HMO.
  • Only three fourths of the respondents who remembered they had switched health plans in the last year said this switch was from the client health plan.

Cunningham says these results surprised everyone. "We were flabbergasted. It wasn't as if we had a list that we knew was going to have some inaccuracies in it, we had a list from the client of people they knew had switched.

"If you had switched from Aetna to Prudential, for example, I would not at all have been surprised at those results, but the client in this case was a staff model HMO, which means that you go to the HMO's clinic for your care, and if you go anyplace else (it isn't covered), so it's not as if you can go to your regular doctor and not remember that your health insurance has changed."

While neither KCA nor the client HMO can explain why so many respondents knew so little about the status of their health plan, Cunningham hopes that making other HMO's aware of the survey's findings will enable an explanation to be found through further research.