Must-Have Member Experiences for 2025: Top 3 Priorities

Consumer choice in healthcare continues to expand. The Health Insurance Marketplace® saw record-breaking enrollment for 2025, and Medicare Advantage enrollment has consistently increased 7% to 8% each year. Additionally, individual coverage health reimbursement arrangements (ICHRAs) grew by 29% from 2023 to 2024, reflecting a shift in employer-employee healthcare arrangements.

As more people explore their options, payers must prioritize experiences that enhance member satisfaction. If members aren’t happy, they can and will look for coverage elsewhere, increasing churn rates and acquisition costs.

A key component of making members happy is providing experiences that are convenient, user-friendly, and personalized. However, healthcare data shows several pain points:

• 65% of health plan members expect a more convenient experience.
• 60% of people have had a problem with their health insurance in the past year.
• 42% of insured adults had issues using their health plan’s portal or app.
• 75% of U.S. consumers wish their healthcare experience was more personalized.

It’s safe to say there’s room for improvement. Fortunately, there are many strategies that health plans can implement to enhance the member experience. Below are three key priorities to address in 2025.

1. Digital Wallet Integration

Convenience is a critical factor in member satisfaction. A survey from Bain found that 65% of healthcare consumers expect a more convenient experience, so health plans must find ways to prioritize ease and accessibility.

One way to make the member experience more convenient is to use digital wallets to store healthcare ID cards. Digital wallets, such as Apple Wallet and Google Wallet, allow users to store virtual versions of credit cards, tickets, and other important items for quick and easy access.

For example, instead of retrieving a physical credit card at the supermarket checkout, users can simply tap their phone to pay for their groceries. This streamlined process can also apply to healthcare ID cards. If a member stores their ID card in a digital wallet, they no longer need to worry about misplacing a physical card, creating a more seamless experience.

Key benefits of digital wallet integration:

• Save on costs by reducing printing and postage expenses.
• Eliminate the risk of lost or misplaced ID cards.
• Provide an environmentally friendly alternative for ID cards.
• Customize card designs to include branding elements and relevant plan details.

2. Data-Driven Digital Outreach

According to NICE, 80% of members prefer to interact with their health plan using digital communication channels (e.g., email and text) because they’re faster and make accessing information easier. However, it’s challenging for plans to obtain the correct information and permissions from members to actually send digital communications.

To address this challenge, plans should prioritize capturing and utilizing member preferences to create comprehensive profiles. These profiles should include contact information, communication channel preferences (email, text, portal notifications, etc.), and barriers to care. Plans can then use these insights to build targeted communication strategies that align with member preferences.

Luckily, health plans have several opportunities to encourage members to opt in to digital communications. For example, including a checkbox in enrollment forms allows members to indicate their preference for digital communications when they join. Similarly, when members set up their profiles in an app or portal, a dedicated section can prompt them to select their digital communication preferences. Make sure these options are easy to find and select.

Once member preferences are identified, plans can use the data to create a strategy for sending core communications, such as Explanation of Benefits (EOBs) and ID cards, through digital channels while incorporating next best actions tailored to their unique health profiles.

Key benefits of data-driven digital outreach:

• Reach members faster with important plan details.
• Enable anywhere, anytime access to essential information.
• Drive more engagement without the added cost of print production.

3. Next Best Actions in Core Communications

Core communications, such as ID cards, member guides, and EOBs, offer meaningful moments in the member journey that plans can use to drive personalized engagement. By integrating next best actions into each touchpoint, plans can drive member participation in health programs, improve outcomes, and enhance satisfaction.

Next best actions are the follow-up steps recommended to members based on their health profile, providing them with a highly personalized and strategic call to action. That next-level personalization is what speaks to members and influences them to take action because it demonstrates that their plan understands and anticipates their needs.

For example, let’s say a member’s EOB indicates they had an MRI on their hip. A relevant next best action to feature on that EOB would be a QR code directing them to enroll in a musculoskeletal (MSK) management program. Similarly, if a member receives their EOBs by mail and has not yet registered for the plan’s digital portal, a strategic next best action would be to include a QR code linking them to the portal registration page.

Plans should align next best actions with both their business objectives (e.g., digital adoption, condition management, or care access) and member needs. For instance, if a member is already enrolled in the portal, their next best action should focus on a different relevant objective.

Key benefits of next best actions in core communications:

• Elevate every touchpoint for engagement.
• Reduce unnecessary outreach by integrating key actions into existing communications.
• Drive added value by delivering relevant, timely calls to action.

Final Thoughts: Prioritizing Member Experiences in 2025

Health plans that prioritize member experiences that are convenient, easy to use, and personalized will stay ahead of the curve in 2025 and beyond. Implementing digital wallets, data-driven digital outreach, and next best actions can significantly boost member satisfaction, improve retention, and drive better health outcomes.

If plans don’t have these strategies in place yet, now is the time to start having conversations and crafting implementation plans to better meet members’ expectations. This may seem intimidating at first, but plans can take small, manageable steps to create a more seamless and engaging member experience.

The Clarity team is here to help. We specialize in crafting measurable, impactful, and member-focused communications that encourage people to live healthier lives. Our best-in-class technology puts people first, ensuring healthcare communications are clear, engaging, and tailored to individual needs. Contact us today to explore how we can elevate your members’ experience with meaningful, personalized communication strategies.