The healthcare digital experience has come a long way—at least on the surface. Over the past few years, payers have launched redesigned portals, refreshed mobile apps, and cleaner user interfaces. Many of those experiences are more intuitive than they’ve ever been. 

But the results often don’t match the investment. 

Despite better-looking platforms, member frustration remains high. Adoption plateaus. Satisfaction scores slip. And retention—particularly for commercial plans—is increasingly at risk. 

This disconnect isn’t because payers missed the UX memo. It’s because the healthcare member experience doesn’t stop at experience design.

In fact, that’s where the real work begins. 

The Healthcare Digital Experience Got a Makeover. The Member Experience Didn’t.

Design isn't the problem. The gap is in the follow-through. 

More than 60% of member dissatisfaction stems from what happens after enrollment: missed communications, lack of clarity, and conflicting answers across channels. 

This isn’t about aesthetics. It’s about consistency, responsiveness, and clarity—especially when members are trying to understand or use their coverage. A modern portal can look polished and still leave people in the dark when: 

• A claim status is vague or missing key context
• An eligibility question gets different answers from chat, email, and the call center
• A “personalized” experience doesn’t reflect the member’s actual situation 

These aren’t design problems. They’re signs that the healthcare digital experience isn’t contextually relevant to the individual users' needs.

Where the Healthcare Member Experience Breaks Down Most

Most healthcare leaders understand that the member journey is complex. What often goes under-appreciated is where that journey breaks and why. We see it most often in these four areas: 

1. Post-Enrollment Drop-Off 
There’s no proactive communication, no contextual guidance, no continuity. Members are left to self-navigate experiences that are often not clearly articulated in conversational language—and many fall through the cracks. 

2. Inconsistent Channel Logic 
A member might receive one answer in their app, another via email, and a third on the phone. The result is both confusion and lost trust. 

3. Static Personalization 
Demographics-based personalization is still the norm and doesn’t reflect the needs of the member. The result is content that feels irrelevant because few payers personalize based on behavior or engagement even though those capabilities exist and can deliver not only improved experiences, but a lower cost to serve.

4. Disconnected Feedback Loops 
Teams can’t see where friction is happening—or they can’t respond quickly enough. So, these opportunities to recover a broken experience are missed entirely. 

Breakdowns like this are rarely caused by a lack of effort. They’re symptoms of disconnected systems, legacy workflows, and a fragmented approach to managing the healthcare member experience. 

Technology Isn’t the Limiter. Activation Is.

Most payers already have the right platforms. Tools like Optimizely, Salesforce, and Adobe are capable of delivering world-class digital experiences. But capability doesn’t equal activation. 

Just 27% of healthcare organizations say they’ve implemented personalization at scale. Even fewer are effectively using Machine Learning or AI to deliver these experiences. 

To truly improve the healthcare digital experience, organizations need more than technology. They need a strategy for turning it on and keeping it evolving. 

That includes building on a composable foundation, where content, services, and decision logic can move independently but still operate as one. Composability doesn’t mean scrapping everything. It means scaling what works, faster. 

Here’s what that kind of system supports: 

• Behavioral and contextual signals that inform real-time decisions, like what content to show, what step to prompt, or when to follow up
• Content orchestration that works across departments and tools
• Ongoing testing and learning, not just once, but always
• AI that helps teams prioritize and respond without adding complexity 

AI isn’t the endgame. But it can make the system smarter, faster, and more adaptive—especially when supported by the right workflows and governance. 

Why Redesign Alone Won’t Fix the Healthcare Digital Experience

A new portal or app may be necessary. But it’s almost never the sole solution. 

If your system is too slow to adapt, too fragmented to respond, or too manual to scale—members will notice. 

Some payers are beginning to shift that reality. Humana, for example, streamlined post-enrollment workflows and simplified digital navigation. That work helped them earn the top ranking in Forrester’s 2024 U.S. Customer Experience Index for Health Insurers, based on feedback from more than 12,000 consumers. 

A better front end only works if the rest of the experience can keep up. That’s the part most teams are still struggling with—not because they don’t care, but because the systems underneath weren’t built for this kind of responsiveness. 

The healthcare member experience isn’t judged at launch. It’s judged when something’s unclear, something breaks, or someone needs help and how the system responds in that moment. 

What a High-Performing Healthcare Digital Experience Looks Like

Here’s what we’re helping organizations build and what members increasingly expect: 

• Enrollment flows that adapt in real time based on behavior
• Content systems that reflect actual plan details, not just generic journeys
• Experience testing that improves outcomes—not just metrics
• AI-powered orchestration that responds at speed and scale
• Cross-channel continuity that delivers clarity no matter the touchpoint 

These are not future-state ideas. They’re already possible. But unlocking them requires operational alignment focused on improved outcomes, not just software. 

The Outcome is the Experience 

If your digital experience in healthcare looks modern but can’t scale, it’s not working. 

Members don’t judge your platform by its design. They judge it by how clear, responsive, and consistent it is when they actually need help. 

If your experience isn’t meeting those expectations, you don’t need to rebuild from scratch. You need to make what you have work better, faster. 

The real opportunity isn’t in launching new tools. It’s in finally making the ones you already have actually work. 

Because if you can’t measure the outcome, it doesn’t matter how good the interface looks.