In today’s increasingly complex health care landscape, members navigate a system filled with fragmented services, evolving benefit designs, and a growing number of innovative digital solutions, it can all create confusion and frustration.
That’s why delivering a strong member experience has now become a critical strategy—not only to provide clear guidance and assistance, but also to promote easier access to care, better support and greater transparency. When members feel informed and supported, they’re empowered to make confident decisions about their healthcare.
Benchmarking against everyday experiences
Consumers are increasingly influenced by their daily experiences in other industries, where clear communication, seamless technology and proactive support are the norm. Take the airline or grocery industry – customers can easily complete every transaction from their phone, receive real-time alerts throughout the process and engage with the experience to track updates.
But health care remains one of the most challenging industries to navigate, with many steps and decision points that can make the experience overwhelming for members. Nearly 1 in 2 consumers report difficulties resolving insurance-related issues, with many unable to find a satisfactory resolution. The system is complex, and members need a better way to navigate it.
Why does health care member experience matter?
Member experience refers to the overall perception and satisfaction a consumer has when interacting with an organization. In health care improving this experience means making processes—like choosing a provider, managing prescriptions, understanding coverage or accessing care—simple, transparent, and personal.
It’s not just about optimizing one part of the journey; it’s about reducing friction across every touchpoint and building a sense of trust, clarity and support through the entire journey.
An effective member experience can lead to improved engagement and greater satisfaction. It also reinforces a plan’s commitment to their members’ well-being, driving trust and long-term loyalty when members have an intuitive, user-centered experience.
What plan sponsors can do—with the right partner—to improve their member experience
Here are some core strategies to consider:
- Increase price transparency: Implement plan designs to offer greater financial predictability for members, promote digital tools for members to price medications and guide to annual cost summaries which can not only build trust, but experiences help members better understand their coverage and feel more confident using it.
- Improve benefit education: Encourage usage of digital tools including email and text adoption to be able to equip members with clear tools and resources that explain how to use their pharmacy benefits. Timely education allows members to know what options they have and how to use them, they’re more likely to make informed choices and maximize their benefits from day one.
- Deliver personalized guidance: Guide members through timely communication outreaches and digital engagement—driven by personalized, proactive recommendations for things such as savings opportunities. Personalization in each step helps members feel seen and supported, like they’re not navigating their benefits alone, increasing their confidence and engagement.
- Streamline specific encounters: Combine relevant benefit information into fewer, more focused messages to members. This helps reduce confusion and makes it easier for members to see how the different parts of their pharmacy benefit work together—without feeling overwhelmed.
- Create connected experiences: Build a more connected experience by simplifying the health care ecosystem and empowering members to share their feedback—leading to a more informed and personalized benefit experience.
Each of these strategies offers value on their own. But when all are implemented together, they create a powerful opportunity to deliver impactful experiences to support members now and into the future. For plan sponsors, creating a seamless member experience is no longer optional — it’s essential.
