What customers really want from a health insurance app

Our recent research reveals how healthcare payers can improve member satisfaction with digital features like transparent billing, condition management and Medicaid-specific services.

There’s good news and bad news when it comes to healthcare payers and digital capabilities, according to our most recent Voice of the Member survey. On the one hand, the number of members downloading payers’ apps has nearly doubled since our 2018 study. On the other, the most desired features are often missing from the apps.

That’s a cause for concern: The survey—our fourth installment since 2016—also showed a plan’s digital capabilities are a top-three factor when members decide whether to switch plans.

To build sticky, long-lasting connections with members and capture greater lifetime value, payers need to populate their apps with the features members want.

Payers that incorporate these features, especially into their mobile apps, stand to increase member adoption of digital channels, raise satisfaction scores and improve outcomes. We’ll discuss each and what it takes to deliver them.

1.    Modernize members’ financial experience

Healthcare billing is complicated. Members receive multiple bills and statements from their providers and their health plan. Members also make multiple payments: a copay at the point of care and then payments after their providers submit claims. This can make it difficult to understand what they owe. Some providers may bill in error, not realizing a member has met their deductible. While disputing a bill, members may find it’s been reported to a collection agency. It all adds up to an unpleasant experience that can also hurt payer net promoter scores.

Payers can greatly improve member experiences and satisfaction by streamlining this process. A “health bill 360” feature would consolidate provider billing by episode of care, conditions and/or providers. Members could see what they owe each provider and then pay directly from the feature. At year end, a statement could be generated, showing expenditures on each episode of care or for managing an ongoing condition.

• Benefits: Members get greater cost transparency and frictionless, intelligent service. Providers could more quickly collect the patient liability portion of their bills and with less friction—a big marketplace differentiator. Payers could offer members discounts for participating in it, improving the member experience and loyalty.
  
  
• Required capabilities: Payers will need connections to providers’ billing systems, which is possible through large payment consolidators. Many providers use third-party intermediaries such as InstaMed to collect on their behalf. Payers can link to these intermediaries to quickly build provider participation and bring the feature to market. 
  
  In markets with large providers that do not use intermediaries, payers may consider building direct links to them. Payers also will need episode grouping software to tag and associate claims with specific episodes of care. In time, artificial intelligence/machine learning models will improve episode tagging for even more streamlined service.

2.    Help members manage their health conditions

In our survey, members said they want health payers to help them meet their health and wellness goals. Members are willing to share their digital health data with payers in return for guidance on how to use it.

To that end, payers can build an immersive condition management experience that maximizes adherence to care plans and expedites the journey to recovery. Each feature should be dedicated to managing a specific health condition. Payers can create unified health management experiences by consolidating all the care tools, health tracking, provider appointments and communications, medication and prescription management within the feature.

For example, a diabetic care feature could move beyond monitoring blood sugar levels to become a holistic diabetes management solution. The feature could include medication reminders, personalized guidance, easy appointment scheduling, trackers for calories consumed, steps taken, sleep and more. Members could seamlessly coordinate with their healthcare team, never miss a medication dose and keep tabs on their health.

• Benefits: In addition to delivering what members want, condition management features should lead to better outcomes by making it easier to follow care management plans. Easily accessible coaching and advice should lead to optimal health choices, early intervention, improved outcomes at lower costs, and improved STAR ratings. For example, a diabetes management capability could help manage blood sugar levels and medication adherence and set reminders for eye exams.
  
  
• Required capabilities: To deliver a feature that truly reflects members’ health in near-real-time, payer systems must consume and make sense of data from an array of wearable and in-home monitoring devices. This will require a strong data management strategy and robust data orchestration capabilities on a flexible, modern platform. Supporting a condition management feature across multiple digital channels will be key to delivering a seamless experience.

3.    Improve access to neighborhood-based care

Our survey showed specific member cohorts have different needs. This was especially clear with Medicaid members, who are very much a mobile-first population.

Among the eligible Medicaid population, 97% have access to cell phones, and 76% have access to smartphones. Further, this population's reliance on cell phones as the sole method of internet access has doubled since 2013. Yet payers apparently have not invested enough in mobile app-based services to tap into the Medicaid population’s extensive use of mobile phones.

Just 32% of Medicaid members in our survey downloaded their plan’s app. For those who did, only 33% of the features they wanted were available. These are features that would help them access services available to them under their plans.

Payers can offer access to their own administrative services as well as various social services, from appointments at neighborhood clinics, to arranging transportation, to grocery and prescription deliveries.

• Benefits: Easier access to care should improve outcomes and population health. It can also reduce contact center volume and costs by helping members serve themselves. A neighborhood care feature also aligns with the growing focus on social determinants of health and health equity measures by the Centers for Medicare & Medicaid Services (CMS), NCQA, the Joint Commission and others. Payers should expect increased requirements for whole-person health services as states and CMS emphasize SDOH and health equity measures.
  
  
• Required capabilities: Payers will need to integrate features and coordinate with various services and agencies with varying levels of technical sophistication. By making connections with a digital-first service provider, such as a ride-sharing service, insurers can expedite prototyping and proofs of concept. Initial pilots should focus on Medicaid cohorts known for frequent smartphone use.

Think ‘mobile first’

By designing transparent billing, condition management and neighborhood care features for mobile-first use, payers can embed valuable services into members’ daily lives. When payers deliver needed features through members’ preferred channels, they’ll create an edge in an ever more competitive industry.

To learn more, download the full report on our 2023 Voice of the Member survey or contact us to discuss opportunities to conduct your own member surveys, perform competitive benchmarking, or implement new apps and capabilities for members that can lead to competitive differentiation.