We now live in an on-demand world. Almost every service and product–entertainment, food, information, shopping–can be instantly accessed through a seamless, personalized digital experience.
There is one notable exception, however: healthcare.
As digital technology continues to radically transform the speed and convenience of e-commerce, the healthcare experience remains slow, highly fragmented, and difficult to navigate. Members still struggle to schedule timely appointments, access their medical records, or understand their insurance benefits—all tasks that should be as simple as ordering groceries or streaming a movie. This disconnect between consumer expectations and the actual healthcare experience not only frustrates members, it also undermines trust, engagement, and ultimately, health outcomes.
For health plans, however, this poor member experience is more than just a pain point to be addressed—it’s a strategic opportunity to gain a competitive advantage. That’s because payers are uniquely positioned to transform the healthcare experience for its members. Unlike other players in the system, health plans have the wealth of clinical, claims, and behavioral data required to create a comprehensive view of each member’s health journey. By leveraging this wealth of information, health plans can identify gaps in care, anticipate needs, and move beyond merely providing coverage to becoming a trusted partner with their members. And that’s exactly what members are looking for.
According to a recent national consumer survey conducted by The Harris Poll for Pager HealthSM, the vast majority of insured Americans want their health plans to deliver more value and become an active resource in their healthcare. The survey found that 74% of members want to receive health and wellbeing recommendations from their insurance plan immediately following a medical appointment related to that specific medical concern. 79% say having access to a 24/7 online nurse would enhance both their sense of wellbeing and peace of mind.
Members Are Seeking More Than Coverage; They Want a Relationship.
Simply put, members want their insurance providers to go beyond providing coverage when they are sick and take a much more proactive approach helping members manage their overall health and well-being. All of this provides forward-thinking health plans with the opportunity to differentiate themselves competitively by building a member experience that delivers the three essentials the modern healthcare consumer desires.
1) HIGHLY PERSONALIZED: The Power of One-Size-Fits-One
Members today expect healthcare recommendations and wellness programs to be tailored to their specific needs and delivered proactively. According to the survey, 74% want health and wellbeing recommendations tailored to their needs. By leveraging the ever-expanding capabilities of GenAI to conduct deep-dive analyses of all-encompassing data that include claims, health history, social determinants of health and consumer research, health plans can facilitate the personalized experience that makes each member interaction more relevant and engaging. Contextual alerts can dynamically change in real time as the member’s health status changes, reminding and motivating members to engage in their next-best-action to achieve better health.
2) SEAMLESSLY INTEGRATED: The Power of Fully Coordinated Care
Members want seamless transitions as they move through the system. They want their care and their data to be coordinated across multiple providers and services. Health plans can act as connectors in the care ecosystem, incorporating multiple point solutions, healthcare applications and services into a unified care experience. Facilitating better coordination among healthcare providers and offering 24/7 access to nurses and care teams on each member’s preferred communications channel are other ways health plans can build stronger relationships with their members.
3) EFFICIENT AND COMPASSIONATE: The Power of a Human-AI Partnership
A surprisingly large percentage of insured Americans are already comfortable with health plans using AI to enhance their interactions. For example, 75% of consumers trust AI to find doctors in their health plan network that have availability and schedule an appointment. 69% are comfortable with nurses or care teams using AI behind the scenes to support efficiency and reduce administrative burdens.
Given this confidence in AI-powered solutions, there are a multitude of ways health plans can be leveraging this technology to improve care and reduce friction in the healthcare system. AI agents can welcome members, schedule appointments with in-network physicians, send automated appointment reminders, provide highly contextualized content, and a step-by-step guide to better health. Sentiment analysis can detect changes in a member’s emotional state and improve care quality. And soon, facial-scanning technology will be used to check vital signs such as heart rate, blood oxygen levels and stress. There is one caveat, however. Because 79% of members value access to integrated nurse support, any interaction involving AI must also provide immediate access if desired to the human care that members want and expect.
Seizing the Opportunity
Health plans have reached a tipping point. At this point, a mere 25% of Americans trust their health plan to help them make important health decisions. Something must change. Through hyper-personalization, seamless integration, and AI supported by human care, health plans can demonstrate to their members that they are listening, responsive and ready to win their trust and satisfaction. This transformation will create a new level of member engagement that not only improves health outcomes and brand loyalty, it will also secure a strategic competitive advantage for any health plan that seizes this opportunity.
Rita Sharma
Rita Sharma is Chief Product Officer at Pager Health, bringing deep healthcare technology expertise to lead product innovation and growth. Previously, she was GM and VP of Product Management for Healthcare & Life Sciences at Salesforce, where she launched Health Cloud to transform patient and member experiences. She also held leadership roles at Glooko, overseeing commercial marketing and product management, and at Johnson & Johnson, where she led diabetes management innovation. Sharma holds an MBA from UCLA Anderson.
