Consumer Sentiment

Key Trends In Healthcare Member Expectations And Satisfaction

Health plan members report high satisfaction with their insurers

HealthEdge Survey respondents shared priority areas for improving satisfaction as greater transparency regarding benefits and coverage, personalized support, and preventative care. View the complete consumer survey findings here.

BURLINGTON, Mass.–(BUSINESS WIRE)–HealthEdge, a next-generation healthcare SaaS company, today released a substantial consumer survey of 3,500 healthcare members to gain insights into their challenges and evolving expectations. Most health plan members (<86%) are ‘very satisfied’ or ‘satisfied’ with their insurers, but one-third of respondents are likely or very likely to switch insurers next year.

The survey features responses from members with a variety of health insurance types, including employer-provided, Medicaid, dual-eligible, and individually purchased. The survey shows equal representation across all ages, demographics, and health statuses.

The health insurance industry remains competitive with 92% of members in the marketplace now having access to 3+ insurance options. On top of increased competition, consumers continue looking for more from their health plans. Below is a snapshot of the challenges and opportunities facing members today.

  • Care Managers are Beneficial, but Members Lack Access to this Resource: 26% of respondents have been assigned a care manager. This group is among the most satisfied – but the level of satisfaction varies.
  • Insurance Switching is Likely for Many Members: One-third of respondents are ‘Likely’ or ‘Very Likely’ to Switch Insurers Next Year. Members with individual and employer-sponsored coverage are the most likely to switch.
  • Members are Interested in AI: 65% are likely to opt for a health insurer that provides cutting-edge solutions and AI-powered tools for personalized healthcare experiences.
  • Healthcare Access Remains a Challenge: When asked to rank the top challenges in their health management, members reported: long wait times (51%), managing health insurance coverage (37%), managing their prescriptions and refills (33%), and researching health information (29%).
  • Chronic Conditions Impact Most Members: Nearly half of respondents report having 1-2 Chronic Conditions. 12% of those with chronic conditions note tools to find less costly care or to find a doctor or specialist to improve satisfaction with their health coverage.

“At HealthEdge, we are working with health plans to address critical challenges across the landscape. Those challenges range from rising healthcare costs and more choices for consumers which puts health plan members in the driver’s seat. Now more than ever, members are expecting more from their insurers,” said Alan Stein, chief product and strategy officer and chief commercial officer at HealthEdge. “This latest survey highlights the importance of investment in personalized plans that meet members where they are.”

More than half of survey respondents (55%) noted personalized support & preventative care as top of mind, with clear explanations of benefits and coverage trailing closely behind (50%). Members are seeking more tailored support and preventative care that will improve engagement and satisfaction.

Care managers remain a key feature in driving more personalization and engagement with members. When implemented appropriately, care managers play a vital role in:

  • Supporting wellness programs and helping members manage their health
  • Reviewing medical services against necessity standards and coordinating with healthcare providers
  • Conducting assessments and establishing personalized care plans to encourage positive health behaviors
  • Utilizing automation, digital engagement, and integrated clinical data to enhance care delivery and member experience

The full findings and report can be found here. To learn more about HealthEdge, visit:




About HealthEdge
Innovating a world where healthcare can focus on people, HealthEdge® is driving a digital transformation through a single digital ecosystem that delivers advanced automation and clinical engagement among healthcare payers, providers, and patients. The next-generation healthcare SaaS company provides an integrated ecosystem of advanced solutions for core administration (HealthRules® Payer), payment integrity (HealthEdge Source), care management (GuidingCare®) and member experience (Wellframe) that empower health plans to accelerate business, reduce costs and improve outcomes. Follow HealthEdge on Twitter or LinkedIn.