Half of health plan members are overwhelmed by managing care

58% of health plan members are overwhelmed by managing their health and treatment plans. We surveyed more than 1,000 health plan members across the U.S. to uncover what they need to better manage their health—and what health plans can do to help. With this survey, we aimed to understand what conditions members are living with, how they manage their health, and their perspectives on how helpful their health plans are in supporting their health and wellness. Most health plan members are confused about their health insurance benefits, citing infrequent or unclear health plan communications. Even though roughly one-third of respondents have been insured for more than 20 years, this sentiment was almost equally present for new and long-term insured members. This confusion could be fueled by the shift in benefits offerings based on market demands for health plans to modernize their offerings and integrate technology. In addition, health plans must alter their benefits to adhere to new regulations, making it harder for members to keep track of what health resources are available. Health plans can use this information to adjust their member engagement strategies to holistically address member health needs. This information may also help determine which tools and communication channels may be most helpful for different member populations.

Q4 2022 Health Plan Member Engagement Survey REPORT

52%

47%

Female

33%

18–34 years old

32%

35–55 years old

35%

56+ years old

Male

Demographics

Medicare 43%

Medicaid 26%

Employer 20%

Private 9%

VA 2%

Non-binary/ third gender

White

Hispanic

Black or African-American

Asian

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Gender

Age

Race

Income level

Wellsquared makes it easier for your health plan to proactively engage with members based on key insights gathered from care team interactions. To learn more about how Wellsquared can help your health plan amplify resources and improve outcomes, visit our Member Marketing page.

To learn more about how Wellsquared can help your health plan amplify resources and improve outcomes, visit our Member Marketing page.

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14%

19%

58%

.05%

Current healthcare coverage

Even though members believe their health plans care for their whole health, they still struggle to understand and use their full benefits.

Three key findings:

Much like in the 2021 member survey, health plan members still believe that health plans are beneficial, with 63% of members agreeing with the statement "My health insurance plan understands me and cares for my wellbeing." In fact, 75% of members said their health plans understand and support their whole health needs. Despite their positive feelings toward health plans, many members don’t understand the information they receive from their insurers—including important materials like Explanation of Benefits. About 27% of members understand all their health plan communications “sometimes,” “rarely,” or “never.” And 24% of members said they are “often” or “always” confused by health plan communications.

The U.S. healthcare system is confusing—especially for members who are new to insurance coverage. Nearly 30% of survey respondents have only had health insurance for 5 years or less. Of the newly insured members, about 60% reported being confused by health plan communications “always,” “often,” or “sometimes”—compared to 42% of all survey respondents. If members aren’t aware of their benefits, they can’t use their benefits. This could be a major reason why health plan members are overwhelmed. For example, more than 44% of members were unaware they could access a team of nurses at no cost to them through their health plan. And 75% of members have never used the nurse hotline service available to them. As health plans continue to build and modernize their offerings, it is crucial to share updated information with members in the most accessible ways possible. For many members, the easiest way to access this information is through a smartphone or tablet, and to ensure that communications are written at an accessible reading level.

Newly insured health plan members are overwhelmed and confused about their benefits. Health plans can ease this stress by sending clear, concise information about benefits that help them navigate the system.

Navigating the healthcare system can be stressful even when you’re in good health. But for members managing a chronic condition (or helping a loved one do so), these challenges can escalate anxiety and/or depression. A whopping 65% of all members with a chronic condition reported that managing their chronic condition increased anxiety, depression, or both. Health plans already have resources and care teams available to help support members managing stress and chronic conditions. But 46% of respondents have never heard the term “care manager,” and nearly 56% dont know what a “care manager” does. Making it clear to members that they can reach out to a medical professional at their convenience is critical to earning their trust and empowering them to make better health decisions.

Health plans have a responsibility to educate their members on their full benefits to improve their overall health and ease the stress of navigating the healthcare system.

Members may have vastly different healthcare experiences based on factors such as income, age, race, physical ability, and where they live. These and other social determinants of health can make it difficult to access the right care or treatment. Here, we highlight responses from four vulnerable member populations to demonstrate potential intervention points for health plans.

Member population insights

Medicaid members

Low-income households may face more barriers to healthcare access than middle- or upper-income households. They may not have reliable access to transportation, or be able to afford copays or treatments. Uncovering this kind of information can make it easier for health plans and care teams to address these issues and prevent gaps in care.

38%

have been insured for 5 years or less

35%

sometimes, rarely, or never understand health plan communications

53%

are not aware their health plan offers a team of nurses to help them at no additional cost

57%

said managing a chronic condition increased anxiety, depression, or both

64%

report that they sometimes, often, or always feel overwhelmed by managing their care

Despite their high level of understanding when it comes to health insurance, some Medicare members still feel overwhelmed by managing their care. And, despite common misconceptions, many seniors embrace healthcare technology—especially when it comes to making and keeping doctors appointments.

Medicare members

Of those surveyed, 75% live with at least one chronic condition.

arthritis

20%

75%

asthma

13%

diabetes

12%

45%

45% said managing a chronic condition increased anxiety, depression, or both

43%

43% have been insured for 20 years or more

24%

24% don’t understand health plan communications

Managing a chronic condition often means juggling medications, appointments, and regular life. And that could make it easier for members to get overwhelmed, and for a care gap to appear. Of members with a chronic condition, the three most common are arthritis (23%), mood disorders (19%), and asthma (18%).

Chronic conditions

32% of members with a chronic condition are overwhelmed by managing their care

26% “sometimes” or “rarely” understand health plan communications

65% have felt depression, anxiety, or both while managing their condition

43% do not know what a “care manager” is

47%

believe a “health plan” and “health insurance company” are different entities

45%

were not aware their health plan offers a team of nurses at no additional cost

61%

are “sometimes,” “often,” or “always” confused by health insurance communication

62%

of newly insured members don’t know what a “care manager” is, compared to 52% of those insured for 20+ years

75%

have never used their health plan’s hotline service

Members who are new to health insurance may struggle to understand healthcare terminology, or how they can access their benefits. Health plans have an opportunity to build strong, trusting relationships with these members. A positive member experience can improve retention, as well as benefits utilization and care outcomes.

New to insurance

13%

19%

17%

30%

<$20K

$20-35k

$50-75k

$75-100k

$100-150k

$35-50k

>$150k