Who actually owns the health benefit experience?

While user-friendly interfaces have become table stakes across most industries, much of today's consumer-facing healthcare technology lags behind. These barriers contribute to low engagement and underutilization of employee health benefits, ultimately driving up costs and negatively affecting the user experience.

Currently, no single entity in this ecosystem takes full accountability for user experience. Responsibility is dispersed among employers, member groups, brokers, third-party administrators and networks, leading to a lack of ownership. This fragmentation contributes to ineffective technology solutions and prevents healthcare benefits from reaching a consumer-grade level, particularly in self-funded plans when disparate components often fail to integrate seamlessly.

Self-funded plan designs often assume that members will act as informed healthcare consumers, researching and considering costs in their decisions. However, the complexity of healthcare makes it nearly impossible for the average consumer to navigate effectively. Expecting members to fully understand their benefits – and make informed spending decisions – without proper tools and technology is unrealistic.

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A recent Goodroot survey found that 43% of people with commercial insurance through their employer have racked up medical debt. Of those, 92% have skipped at least some medical care to avoid costs.

One of the main drivers of medical debt is confusion. Patients often do not understand the scope of their coverage. When this crucial information is difficult to access – hidden in clunky apps – members get frustrated and either avoid seeking care or revert to familiar, albeit costly, options. Ensuring intuitive and efficient app or platform design can make a significant difference in user experience, engagement and financial well-being.

Why does the user experience in health benefits lag behind? Unlike most competitive markets whose customer experience drives loyalty and innovation, healthcare lacks a strong incentive for technological advancements. This is primarily because patients often have limited choices and must navigate a complex system without the influence of market competition driving improvements. As a result, improving user experience is frequently viewed as an unnecessary expense, given that benefits still can be delivered without addressing it. 

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However, just as businesses-use tools like accounting and task management software to streamline operations, similar tools should be applied to optimize health benefits, especially since it's the second-largest cost for employers after payroll. Progressive consultants and forward-thinking employers recognize that enhancing the user experience can lead to higher employee satisfaction, stronger retention and potential cost savings.

The newest generation of healthcare benefit users are more connected than ever. They don't want to sift through paperwork, read PDFs online or sit on hold waiting for someone in a call center to pick up. It just won't happen. They're conditioned to want it all and want it now because that's what the overall customer experience has become.

Administrators that can make benefits more intuitive and accessible for members will see a positive difference in member engagement. The top three things administrators should be looking for in a tech tool to improve member experience include the following: 

• Highly customizable solutions: The ability to activate and deactivate features, as well as customize the menu and brand, ensure that the technology aligns with the member's specific benefit and avoids confusing dead ends.

• Member technology that combats point-solution fatigue: Increasing the number of apps members need to access their benefits usually is not ideal. Solutions that combine or replace existing apps are likely to produce better engagement.

• AI and human expertise to help employees through the complex scheduling and billing issues they encounter: Members deserve personalized calls to action, with choices, and those choices should improve both their health and financial well-being. The use of generative AI to synthesize complex and customized data is already becoming standard in industries such as travel and entertainment. Health benefits are a clear use case for this technology and solutions that leverage it effectively are becoming more accessible.

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Expectations have shifted, and good enough is no longer acceptable. Ownership of the health benefit experience remains decentralized and undefined, but fostering collaboration and innovation can elevate the industry standard. The healthcare experience needs to be consumer-grade, and organizations that take responsibility for it will win the future.