Utah Qualified Health Plan Enrollee Experience Survey Report

Utah Qualified Health Plan Enrollee Experience Survey Report

This report describes how satisfied health plan members are with their experiences obtaining care from their Qualified Health Plan (QHP). These data come from an annual survey entitled the Qualified Health Plan Enrollee Experience Survey. All QHPs are required to conduct the survey through a CMS-approved survey vendor using a standardized survey protocol. The purpose of the report is to give consumers and purchasers information they can use to make an informed decision when selecting a health plan.

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Qualified Health Plan Enrollee Experience Survey

Under the Affordable Care Act (ACA) a Qualified Health Plan (QHP) is an insurance plan that is certified by the Health Insurance Marketplace and meets ACA requirements such as coverage of essential health benefits. QHPs are insurance plans that: (1) Have been certified by the state Health Insurance Marketplace ("Exchange"); (2) Provide coverage of essential health benefits; and (3) Follow established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts). All QHPs offer the same core set of benefits, including preventive services, mental health and substance abuse services, emergency services, prescription drugs and hospitalization. Some plans include benefits beyond the core set.

  • Scores are calculated as mean scores and are reported on a 0-100 scale. In mean scoring, the score values correspond to the original scale values. For example, a 0 to 10 rating question has a mean score between 0 and 10, while a question with response options of “Never (1)”, “Sometimes (2)”, “Usually (3)”, and “Always (4)” has a mean score between 1 and 4.

  • In 2020, Data collection was suspended before telephone outreach due to COVID 19. The trending to the 2020 scores should be reviewed with caution since differences may be partially attributed to mode effect.

  • NOTE: These results are not case-mix adjusted and should only be used for quality improvement purposes.

There are two different types of measures for the Survey: ratings and composite measures.

For the ratings, four questions assess overall consumer satisfaction with health care, personal doctor, specialist seen most often, and health plan. Response options for overall rating questions range from 0 (worst) to 10 (best). In the results below, ratings of 8, 9, or 10 are considered achievements, and the achievement score is presented as the mean score of members whose response was an achievement.

Composite scores are calculated for survey topics of member experience. The composite scores provide a summary assessment of how the plan performed across the domain, and are scaled mean scores.

Other Measures

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Ratings

Doctor Rating

Plan 2021 2020 2019
Molina Healthcare Marketplace 88.0
SelectHealth Marketplace 88.0 87.5 86.7
U of U Healthy Premier Individual Marketplace (EPO) 88.6 87.9 88.4

Health Care Rating

Plan 2021 2020 2019
Molina Healthcare Marketplace 78.4
SelectHealth Marketplace 82.0 79.4 78.5
U of U Healthy Premier Individual Marketplace (EPO) 84.1 81.2 82.4

Health Plan Rating

Plan 2021 2020 2019
Molina Healthcare Marketplace 72.8
SelectHealth Marketplace 72.4 72.3 69.8
U of U Healthy Premier Individual Marketplace (EPO) 74.0 69.3 71.1

Specialist Rating

Plan 2021 2020 2019
Molina Healthcare Marketplace 83.8
SelectHealth Marketplace 84.9 84.4 83.4
U of U Healthy Premier Individual Marketplace (EPO) 87.0 87.1 87.8

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Composite Measures

Access to Care

The Access to Care composite is made up of four items. It asks about member experiences with receiving care and getting appointments in a reasonable amount of time (Questions 20 and 21) and member experiences when attempting to get care from doctors and specialists in the last six months (Questions 23 and 39). The Summary Rate represents the percentage of respondents reporting “Always” or “Usually.”

Note: The Access to Care composite contains the questions from Getting Needed Care and Getting Care Quickly Composites.

Plan 2021 2020 2019
Molina Healthcare Marketplace 74.1
SelectHealth Marketplace 72.5 74.7 76.5
U of U Healthy Premier Individual Marketplace (EPO) 78.0 79.9 80.8
Getting Care Quickly
  • The Getting Care Quickly composite measures member experiences with receiving care and getting appointments in a reasonable amount of time (Questions 22 and 23). The Summary Rate represents the percentage of respondents reporting “Always” or “Usually.”
Plan 2021 2020 2019
Molina Healthcare Marketplace 77.3
SelectHealth Marketplace 72.8 78.0 76.8
U of U Healthy Premier Individual Marketplace (EPO) 79.2 75.7 75.3
Getting Needed Care
  • The Getting Needed Care composite measures member experiences when attempting to get care from doctors and specialists in the last six months (Questions 25 and 41). The Summary Rate represents the percentage of respondents reporting “Always” or “Usually.”
Plan 2021 2020 2019
Molina Healthcare Marketplace 70.9
SelectHealth Marketplace 72.2 71.5 73.6
U of U Healthy Premier Individual Marketplace (EPO) 76.8 75.2 74.3


Access to Information

The Access to Information composite is made up of three questions and measures member experiences about whether written materials or the Internet provided the information needed about how the plan works, how often the member found out from the health plan about the cost of a health care service or equipment, and how often the member found out from the health plan the cost for specific prescriptions (Questions 3, 4 and 5). The Summary Rate represents the percentage of respondents reporting “Always” or “Usually.”

Plan 2021 2020 2019
Molina Healthcare Marketplace 55.6
SelectHealth Marketplace 52.0 50.4 52.6
U of U Healthy Premier Individual Marketplace (EPO) 55.9 47.4 47.3

Care Coordination

The Care Coordination composite is made up of six questions and asks members to report whether their doctor had medical records or other information about their care and whether the doctor talked about prescription medicines. This composite also contains questions asking members if they got help managing their care and if the doctor was informed and up-to-date about their care from specialists. Additionally, this composite evaluates whether the member’s personal doctor’s office followed up to give them test results and if they got the test results as soon as they needed (Questions 31, 32, 33, 34, 37, and 41). The Summary Rate represents the percentage of respondents reporting “Always” or “Usually.”

Plan 2021 2020 2019
Molina Healthcare Marketplace 77.4
SelectHealth Marketplace 79.6 79.7 76.3
U of U Healthy Premier Individual Marketplace (EPO) 84.8 83.3 83.2

Cultural Competence

The Cultural Competence composite is made up of three questions and asks members about how often they got a needed interpreter, how often forms were available in their preferred language, and how often forms were in their preferred format such as large print or braille (Questions 11, 12 and 24). The Summary Rate represents the percentage of respondents reporting “Always” or “Usually.”

Plan 2021 2020 2019
Molina Healthcare Marketplace 76.4
SelectHealth Marketplace 62.4 61.8 69.4
U of U Healthy Premier Individual Marketplace (EPO) 66.3 68.9 60.9

Doctor Communication

The How Well Doctors Communicate composite includes four questions measuring how well providers explain things, listen carefully to members, show respect for what members have to say, and whether they spend enough time with members (Questions 29, 30, 31 and 32). The Summary Rate represents the percentage of respondents reporting “Always” or “Usually".

Plan 2021 2020 2019
Molina Healthcare Marketplace 87.7
SelectHealth Marketplace 87.7 87.6 87.4
U of U Healthy Premier Individual Marketplace (EPO) 89.4 90.1 88.5

Enrollee Experience with Cost

The Cost composite asks members how often their health plan did not pay for the care their doctor said they needed. Additionally, members are asked how often they had to pay out of pocket for care they thought their health plan would pay for. Finally, the composite asks members how often they delayed visiting a doctor or filling a prescription because of cost (Questions 13, 14, 15, and 16). The Summary Rate represents the percentage of respondents reporting “Never” or “Sometimes”.

Plan 2021 2020 2019
Molina Healthcare Marketplace 78.1
SelectHealth Marketplace 80.2 80.2 78.7
U of U Healthy Premier Individual Marketplace (EPO) 81.3 78.1 78.5

Plan Adinistration

The QRS Plan Administration measure is made up of five items, all of which are coded on a 1-4 scale in the QHP questionnaire (i.e., 1 = Never, 2 = Sometimes, 3 = Usually, and 4 = Always).

The Plan Administration composite asks members to rate the ease of getting information or help from customer service, how often they were treated with courtesy and respect by customer service staff, how often they waited longer than expected to talk to customer service, how often forms from the health plan were easy to fill out, and how often the health plan explained the purpose of forms (Questions 6, 7, 8, 9 and 10).

Plan 2021 2020 2019
Molina Healthcare Marketplace 69.4
SelectHealth Marketplace 72.3 72.6 75.8
U of U Healthy Premier Individual Marketplace (EPO) 77.4 74.5 75.5

Other Measures

Prevention: Flu Vaccinations for Adults

The Flu Vaccinations for Adults Ages 18-64 measure is the percentage of members 18-64 years of age who received a flu shot or flu spray in the nose since July 1, 2020. The Summary Rate for the Flu Vaccinations for Adults Ages 18-64 measure is the proportion of respondents between the ages of 18-64 who responded “Yes” to Question 45, “Have you had either a flu shot or flu spray in the nose since July 1, 2020?”

Plan 2021 2020 2019
Molina Healthcare Marketplace 44.2%
SelectHealth Marketplace 50.6% N/A N/A
U of U Healthy Premier Individual Marketplace (EPO) 67.9% 65.8% 57.8%



Total Completed Surveys

Plan 2021 2020 2019
Molina Healthcare Marketplace 126
SelectHealth Marketplace 252 225 320
U of U Healthy Premier Individual Marketplace (EPO) 296 239 323

Response Rates

Plan 2021 2020 2019
Molina Healthcare Marketplace 15.4%
SelectHealth Marketplace 18.9% 17.4% 24.6%
U of U Healthy Premier Individual Marketplace (EPO) 26.1% 15.0% 26.9%

Data Note: Data represented in these tables represents data collected Jan-June of the current year, asking respondents about their care in the past calendar year.

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Content updated January 2022