Across the health insurance industry, success has traditionally hinged on speed. Those companies that were fast and efficient at processing and managing claims, and therefore able to make payouts on time, generally had the happiest customers. That was particularly true if the adjudication process was so efficient that it enabled cost savings and ultimately lowered insurance premiums.

And while this view of payers as little more than claims processors persisted for decades, today that’s no longer the case. These days, customers have much higher expectations and no qualms about taking their business elsewhere if an insurer isn’t able to meet those expectations. That’s because in the digital age, everyone’s looking for the same kinds of personalized, always-on experiences they’re accustomed to getting in every other aspect of their lives.

Over the past decade, other industries have gone to great lengths to try to understand their customers and their particular needs, while taking the time to build personalized relationships with them. You don’t have to look any further than your own experiences with big consumer brands like Apple and Amazon to find some examples. It’s because of these superior customer experiences that now 76 percent of consumers expect every company to understand their needs and expectations.[1]

Given this shift, it’s not hard to imagine why today’s customers are tired of the lackluster experiences that some payers are providing. Nor can you blame them for switching to any competitor that does a better job. Let’s look at some of the frustrations members currently have with payers in terms of overall customer experience. We’ll then consider what those members actually want, as well as offer some tips on how to best point your business in that direction.

Reality Check

Anyone who has ever interacted with an insurance company knows that it can be a frustrating experience at times. Some of the most common pain points people mention include issues such as:

  • Portals that provide little more than an explanation of benefits, when customers are looking for an interactive, informative, and data-driven experience and access to the information they need in real time.
  • Websites with unnecessary steps, such as users having to re-authenticate themselves multiple times while visiting a website.
  • Phone contact with long hold times and having to provide information to customer service agents that the organization already has on file.

Problems like these need to be resolved because today’s customers want payers to be partners who play an active role in helping ensure their long-term health.

What Customers Actually Want

Across the health insurance industry, customers are actively looking for a better level of service. Specifically, they’re looking for:

  • Customers want to know how much things cost, what they’ll have to pay out of pocket, and how one insurer’s prices compare to everyone else’s. Having easy access to this information is critical.
  • In addition, customers want the ability to see their information at any time and from any device. In other words, they want to be able to engage with you on their terms whenever and wherever it suits them.
  • Precision medicine. Customers also want treatments tailored to their individual needs based on their unique situation, medical history, and genetic makeup. The one-size-fits-all approach that doctors and insurers historically relied on is no longer good enough.
  • Predictive insights. Customers want insurers to be able to glean insights from vast and often disparate data sets about their health. In other words, they want them to go from their current diagnostic capabilities to prescriptive and ultimately predictive capabilities. Imagine, for example, a health insurer analyzing the data it has available to predict that you’re at risk of contracting a particular disease and then working with you to help take the necessary actions to offset those risks. 

Ultimately, what today’s customers want is a much more customized member experience that offers a combination of convenience and personalization to meet their unique needs more effectively. While pulling this off isn’t going to be easy, any health insurer that isn’t working toward this as their ultimate goal is at risk of getting left behind.

The Way Forward

The good news is there are insurers that are working toward this member engagement and demonstrating excellence and innovation. Some insurers, for example, already have patient portals they can update in near real time. Humana stands out as one example for its Blue Button, a function that allows users to view, print, and download their personal health data, thus simplifying their individual experience and making it easier to take charge of their health.[2] Additionally, companies like Blue Cross Blue Shield are dedicating time and talent to better understand the social determinants of health so they can help their members get in front of chronic disease rather than wait until after the fact.

While clearly more work needs to be done, health insurers need to adopt a new mindset to get there. The move to customer-centric healthcare will require a combination of innovation and compliance. Unfortunately, the digital transformation required to make that shift possible is often a bumpy road. Fortunately, cloud adoption can help smooth out that journey while also playing a critical role in keeping sensitive healthcare data secure.

If you’re afraid to start because your business is tied to legacy systems that take 18 months to provision, or you’re worried that the costs will be prohibitive, it’s time to reconsider the long-term costs of keeping or losing your customer base. Moving to the cloud is an ideal first step on the road to digital transformation. It’s flexible, scalable and affordable, all while giving you optimal security.

At a time when change isn’t a nice to have, but rather a business imperative, taking this journey with a trusted partner with cloud and healthcare expertise can make all of the difference in helping ensure your long-term success.



[1] “Salesforce Research: Customer Expectations Reach All-Time Highs,” retrieved from

[2] “Blue Button: Accessing your personal health data is easy as 1-2-3,” retrieved from