The bright spots in health insurance — and where plans need to improve

Wellframe’s second annual survey of health insurance consumers is out. And it reveals some critical leadership opportunities for health plans.

The survey polled more than 1,000 people across the U.S. who have either public or private health insurance. It provides a unique touch point for understanding the relationship between health plans and members.

In short, there's good news and there's bad news.

The good news is that many American consumers believe that their health plans are beneficial overall.

The bad news is that many Americans also feel that the care they receive is not personalized enough. And many don’t understand their coverage and benefits well.

This gap reveals at least two major opportunities for health plans. Wellframe acts on the observation that American healthcare suffers from two primary problems: poor member experience and rising care costs. The survey reveals that health plans have a crucial role to play in addressing both problems—perhaps as unexpected heroes.


Improving health insurance member experience

The survey found that, compared to 2020, more members are receiving the personalized care they expect. In 2020, 60% said that the information and care they receive is too generic — but in 2019, that number dropped to 49%.

This is an important step in the right direction. What’s more, healthcare consumers report that they’re willing to work with their care teams to access the right care. Digital engagement features (like secure chat services) can help in this respect. These features allow for more consistent communication between care managers and members. This kind of communication promotes greater trust and more beneficial working relationships.

In addition, 85% of respondents said they are interested in using a service that could help them find a doctor suited to their specific health needs—and schedule an appointment. That’s an increase from 2020, when 80% were interested in this kind of feature.

Addressing chronic conditions and cost of care

The study revealed that many people with chronic conditions are struggling to manage their health. Of those surveyed, 64% experience a chronic condition. The most common conditions are: arthritis (17%), mood disorders (16%), asthma (12%) and diabetes (12%).

Of those with a chronic condition, 45% sought help from their health plan for mental health concerns during the pandemic. By contrast, only 26% of those without a chronic condition sought such help.

Chronic conditions account for a large segment of poor health outcomes and costs—especially members with multimorbidities. This presents an opportunity for health plans.

These members need extra support. Health plans have the data and visibility into these members’ needs. This information can help members manage their own health between doctor visits. Care managers can use digital tools to help keep members on track with medication, nutrition, exercise, and more. Regular check-ins through secure messaging tools can help members stay connected to care. With continuous care, members will stay healthier and, in turn, reduce the odds of hospital readmission. It can also increase good health outcomes, and lower care costs for members and plans alike.

Closing the information gap

There’s a third area of opportunity for health plans to turn themselves into health care heroes.

According to Wellframe's 2021 survey, members want more and better information from their health plans. Specifically, 43% of consumers say they don’t understand their health insurance coverage and benefits. That means only 57% feel well informed.

Obviously, this is a huge opportunity for health plans to communicate better. Members want their health plans to understand their needs, provide personalized information on their benefits and health, and partner with them.

Instead of a mere business relationship, health plans have an opportunity to engage in a true dialog with their members as partners. But that can’t happen if members are too overwhelmed by options and too overloaded with information to navigate complex websites or other sources.

Digital advocacy solutions can help care teams and plans explain benefits better. And they can proactively share information with members — for instance, about COVID-19 and the Delta variant. Some plans are already doing this: Wellframe observed a 633% increase in the number of messages from health plan managers to their members about COVID-19 since July 2021.

Takeaways from the research

Health plans play a key role in supporting members and improving their experiences. Their leadership teams can coordinate with providers, ensuring members have access to the information they need to make informed health decisions—and make the most of their benefits.

Shifting member-plan interactions from sporadic outreach to a continuous journey can make all the difference for members living with multimorbidities. Health plans have the power to coordinate care teams and resources to maximize member reach and improve outcomes.

To find out more, view the full interactive report: What do members actually want from a health plan experience?