Assessment of Customer Satisfaction

A qualitative look at the Vital Plan

The Medicaid program in Puerto Rico, marketed to the general public as Plan Vital, provides healthcare services to over 1.5 million beneficiaries among all its categories, however, there are 1,406,000 people (43% of the total population*) who are exclusive to Plan Vital, excluding dual cases known as Platino, OPM (Oficina de la Procuradora de las Mujeres), and the beneficiaries who correspond to the corrections system. The program expands on previous models by allowing the enrollees to choose their Managed Care Insurance Provider. This freedom of choice changed the health industry from a regional monopoly to promoting competition between the providers themselves. In turn, forcing those providers to improve their services and provider networks.

The program is administered by the Puerto Rico Department of Health and the Puerto Rico Health Insurance Administration (Commonly known as ASES – Administración de Seguros de Salud). The Puerto Rico Department of Health is the Single State Agency** for the Medicaid Program. As such assumes the responsibility of determining eligibility, implements policy and administers the Medicaid State Plan.

ASES oversees, monitors and evaluates the services offered by the Managed Care Organizations (MCO’s). As part of their mandate, they are tasked with evaluating the performance of all contracted insurance providers.

In an effort to help ASES and the Puerto Rico Department of Health on their mission, Truenorth Corporation, as an independent firm, has developed a Customer Satisfaction Survey. The goal is to assess and understand the consumers’ experience with the public healthcare system starting with the enrollment process, their Managed Care Organizations, interactions with their healthcare physicians and the overall experience with their health care.

*The population of Puerto Rico according to the US Census Bureau - 2020 Census is 3,285,874. (https://www2.census.gov/

**The single State agency is responsible for determining eligibility for all individuals applying for or receiving benefits. (42 CFR § 431.10).