None of 17 insurers studied was deemed excellent on customer satisfaction in a consumer survey by Forrester Research and most were ranked as poor.

Kaiser Permanente gets the best reviews from consumers for customer satisfaction among 17 health insurance companies in a study by Forrester Research Inc. But health insurers as a whole don’t score very high in customer satisfaction, says a new ranking from the research firm.

Forrester’s consumer experience index ranking of 17 leading insurance companies gives excellent grades to those insurers that garner 85-100 on several measures of customer satisfaction, followed by good (75 to 84 points), Okay (65 to 74 points), poor (55 to 64 points) and very poor (0-54 points).

Forrester didn’t release individual point scores. But none of the 17 insurance companies was rated as excellent in the customer experience index rankings. Kaiser, Humana, Empire Blue Cross and Health Net received ratings of good. All other health insurers—Florida Blue, United Healthcare, Blue Cross and Blue Shield of Texas, CareFirst BlueCross and BlueShield, Blue Cross Blue Shield of Michigan, Other Blue Cross, Blue Shield of California, Anthem Blue Cross and Blue Shield, Cigna, Blue Cross and Blue Shield of Illinois, Aetna, Highmark Blue Cross Blue Shield and Anthem Blue Cross—were ranked as poor.

“As a group, health insurers consistently rank among the lowest for CX [customer experience] quality, and even the top performers get away with the rough equivalent to a ‘C’ grade,” Forrester says. “Stagnant performance reflects the fact that the small improvements that the best insurers have made are not good enough to win, serve, and retain their customers in the long run.”

The small improvements that the best insurers have made are not good enough to win, serve, and retain their customers in the long run.

Kaiser is able to build a more effective customer experience because of the unique way to the health system is structured and the fact it has made web-driven consumer healthcare a business priority, Forrester says. “Where it really differentiates in is in digital investment,” Forrester says.

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Kaiser has poured more than $400 million into digital healthcare and electronic health records technology in the past decade. The insurer and healthcare provider reported that digital transactions with patients totaled about 678,000 interactions per day in 2016, an increase of 31.4% from 516,000 daily interactions in 2015. Kaiser defines its digital interactions as log-ins to its patient portal, telehealth visits, secure text messaging and related online transactions.

In its annual report, Kaiser, which serves 10.7 million members in eight states and the District of Columbia, also says 61% of visits to KP.org are now done from a mobile device. Although insurers lag in converting from analog to digital, Kaiser Permanente is further along in providing access to online tools via the web as well as apps for insurance and care delivery, Forrester says. “The insurer makes it easier for members to understand their care options, both in terms of access and affordability.”

Forrester uses 46 metrics across six categories and a panel of 118,000 adult U.S. consumers to compile its customer experience rankings for health insurers. Interestingly, customer service was the top factor for Forrester’s final index rankings and websites and mobile apps the least important. “Health insurers still lag behind industries like retail and finance in delivering engagement through digital experiences, especially mobile,” Forrester says. “This has left many U.S. online adults with lowered digital expectations.”

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