Healthcare consumerism is the idea that individuals have the right to make informed choices about their care and coverage. It is reshaping the industry, with providers leading most of the conversations about healthcare consumerism. Health systems, professional practices, primary care physicians, telehealth providers, and even retailers like Walmart and resume have been steadily claiming their stake in the market.
Health plans are lagging behind, but that needs to be changed a lot.
Not long ago, payers focused almost exclusively on misunderstanding numbers. They just need to get the risk and cover it correctly, and then cut checks when medical services are needed. If we are honest, insurance companies want to interact with members at least, because most contacts mean they are spending money. But the feeling is mutual and people don't want to talk to their insurance companies. They just want to deal with their claims.
In this context, it is not surprising that health planning has earned a dismal reputation in customer experience. In fact, Forrester recently released the “2025 U.S. Health Insurance Company Ranking” to make health insurance companies lasting in all industries where the company tracks are for customer experience.
This should be a wake-up call to health plans. We are in the middle of a fundamental shift that allows consumers to create healthy competition in the market while providing more power and choice within their health coverage. Consumer expectations are justified, and people want a more pleasant, frictionless and digital experience from their health plans – just like other parts of their lives.
The market factors driving this transformation will only flourish.
The first major driver is consumer choice. With reliance on employer sponsorship programs, individuals increasingly choose coverage. This year, more than 24 million Americans were selected to re-register within coverage through ACA communication. Now, reaching more than 30 million Americans through the Medicare Advantage program, which surpasses traditional Medicare in 2023. Here, the company provides employees with pre-tax taxes to purchase their own coverage, up 29% between 2023 and 2024. Most importantly, the market is increasingly dependent on employer’s health care plans, which means that it is no longer dependent on employer’s health care plans, which means that it is directly sold and can be sold directly.
Even if plans relying on employer-sponsored programs are disappearing, the business market is still adding pressure to a better experience. In a highly competitive job market, welfare plays an important role in attracting and retaining top talent. The best companies that want to hire the best talent need to offer more and better options for health coverage.
Finally, technology makes the healthcare market easier to access than ever before. The coverage of healthcare is very complex, and historically for individuals, if they expect high utilization, or if they think they are healthy, they cannot simply choose the most expensive plan. Other than that, no one can patiently review plans or spend hours on the phone trying to get answers to choose the right one. But this is no longer the reality of our lives, thanks to the technology that already exists and it will get better every day.
The biggest asset of a health plan is data. They have access to data about individuals than almost anyone. Retailers such as Amazon and Walmart are the gold standard for providing personalized experiences, but they have access to PALES' data compared to information from health plans. Health plans can and should use this data to recommend and personalize coverage to make shopping easier. Perhaps more importantly, they can and should use that data to provide better, more personalized care.
Health plans must develop from trading entities to trusted partners. By leveraging their data and delivering a seamless personalized experience, they can be core players in the future of consumer-oriented healthcare.
Photo: Mykyta Dolmatov, Getty Images
Alan Stein has nearly three decades of experience consulting for technical health programs and helping develop systems that power their most important value streams. He is currently the Chief Product and Strategy Officer at HealthEdge, where he is committed to advancing HealthEdge Product Suite with a focus on consistency and interdependence throughout the business. Prior to HealthEdge, Alan had a broad career as senior executive at Trizetto, leading its $2.7 billion sale to Cognizant, before he served as senior vice president of overseeing the healthcare product group.
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