What Member Engagement Means to Today’s Healthcare Consumers

Members view payers as instrumental in improving their health as well as their experience navigating the healthcare system. However, far too many still think health plans can do more to support personalized care and information sharing.

In 2021, Wellframe surveyed 1,126 health plan members across the United States to better understand the expectations of healthcare consumers. Respondents spanned three age groups — 18–34 (32%), 35–55 (32%), and 55+ (36%) — providing a reliable representative sample of the general population.

While most respondents indicated positive experiences with digital advocacy (57 percent) and personalized care (51 percent, an improvement from 60 percent in 2020), a sizeable minority wants more from the health plans.

Building on these positive experiences, digital advocacy can bridge the gap between what members want and what health plans can do to help. For instance, 43 percent reported they are unable to understand their health insurance coverage and benefits. Another 19 percent believed their health plans do not understand their needs, and 21 percent felt disengaged as a result of being unable to easily access care from a healthcare provider. Digital advocacy can address all of these concerns by giving members a single person to reach out to—from their smartphone, on their own time.

When it comes to personalized care, 49 percent indicated they received health information that was too generic and lacked personalization. Increasingly, the vast majority of members (85%, up from 80 in 2020) are interested in services that enable them to find and schedule appointments with providers suited to their individual health needs. Something as simple as making care advocates available to these individuals could streamline this process.

Chronic disease is prevalent among the United States population. The Centers for Disease Control & Prevention (CDC) reports that 60 percent of adults live with one chronic disease and 40 percent live with two or more. Those figures hold true for survey respondents, of which 64 percent are managing at least one chronic condition — primarily mood disorders (16 percent), arthritis (17 percent), asthma (12 percent), and diabetes (12 percent).

Managing chronic diseases is a daily activity, one which members often struggle to handle on their own. More than one-third of respondents (35 percent) say they are proactively managing their health “somewhat well” or “not well” between doctor’s visits. Ten percent skip a step in their care plan daily, with 20 percent skipping a step weekly. Roughly a quarter missed one or more appointments with their provider in the past year, and 26 percent missed a dose of their prescription. However, nearly half of those living with a chronic disease (47%) see promise in virtually interacting with their providers via a mobile app, video conference, or the web to give them the motivation to take control over their health.

Without a doubt, the COVID-19 pandemic has shone a light on challenges to accessing necessary care during a public health crisis. Mental health services are in high demand, with 38 percent of respondents seeking support from their health plans since March 2020. Of those with mood disorders, that percentage is nearly twice as high, at 65 percent. Clearly, there is much more that payers can do to address mental health coverage and access, especially in light of a growing body of literature indicating a strong connection between physical and behavioral health.

A lack of care access is an even greater threat to members facing a variety of barriers due to social determinants of health (e.g., financial instability, housing, food insecurity). Nearly a third of respondents have a household income below $20,000. Of these vulnerable individuals, nearly one in five (22%) had difficulty finding a provider and/or making appointments, and a similar percentage (21%) lacked availability to meet with a provider. Considering the prevalence of chronic disease and the risks associated with missed care, health plans must identify opportunities to support these members. Robust care management technologies can empower care plans to provide greater convenience and improve communication with members.

When it comes to reaching vulnerable members, seniors are often discounted. Misconceptions abound about seniors and their purported unwillingness to use digital health technologies, but they couldn’t be further from the truth. Many seniors see the benefits of virtual health tools and are largely interested in solutions tailored to specific actions or resources:

• Finding a care provider and appointment scheduling (68%)
• Reviewing an explanation of benefits and eligibility (65%)
• Receiving medication reminders (56%)
• Providing condition monitoring (50%)
• Accessing digital health coaching (43%)

For one-third of seniors, virtual care serves as motivation to actively manage their health and well-being. What’s more, health plans simply helping seniors find and schedule appointments with doctors would be well received by more than three-quarters of these respondents (78%).

Health plans have a crucial role to play in supporting their members’ efforts to improve their quality of life. But first, they need to address the reality that 42 percent of members are frustrated by the experience of seeking help from their health plans. Even still, 60 percent of members believe health plans want to support them in proactively addressing their health concerns, solving health issues quickly (58%) and making their lives easier (52%).

Members view their health plans as a means to a healthier life. The time is ripe for health plans to implement digital tools and services that eliminate the inefficiencies that have historically plagued the healthcare system and forced individuals to forgo care or neglect their health. The solution is to meet members where they are and provide resources tailored to their specific needs.

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Wellframe partners with health plans nationwide to reimagine member relationships. With solutions for care management and advocacy, the Wellframe Digital Health Management platform empowers health plans to become a trusted advocate for all their members' health needs. Learn more at wellframe.com.

Visit the Focus on Member Experience, sponsored by Wellframe!