The State of Member Experience
The Satisfaction Freefall
J.D. Power's 2023 U.S. Commercial Member Health Plan Study sent shockwaves through the payer industry. Member satisfaction dropped 13 points year-over-year—the largest decline in the study's history. And the underlying data was even more concerning: 78% of members described their experiences as “less than seamless.”
But what do these numbers actually mean? Survey scores tell us that members are unhappy. They don't tell us why. And without understanding the why, health plans are left guessing at solutions.
What Qualitative Research Reveals
To understand the drivers behind these statistics, we analyzed qualitative interviews with health plan members using Qualz.AI. Several themes emerged consistently:
1. Prior Authorization Frustration
Members consistently describe prior authorization as the single most frustrating aspect of their health plan experience. The common thread: a sense of being caught between their doctor and their insurer.
“My doctor said I needed this medication. My insurance said I needed to try two other drugs first. It took three months and multiple appeals. By then, my condition had worsened.”
2. Digital Experience Gaps
While payers have invested heavily in digital portals and apps, members report significant usability issues. The most common complaint: inability to complete tasks that seem simple.
“I just wanted to find a dermatologist who was in-network. The app showed me 50 results, but when I called, half weren't accepting new patients, and three had left the network months ago.”
3. Cost Transparency Failures
Despite regulatory requirements for price transparency, members report ongoing difficulty understanding their actual costs. Surprise bills remain common, even for in-network care.
“I called to ask how much my procedure would cost. They said it depended on what the doctor billed. The doctor's office said it depended on what insurance covered. Nobody could give me a number until after I'd already had the surgery.”
4. Care Coordination Breakdowns
Members with complex health needs consistently report feeling abandoned during care transitions. The handoffs between primary care, specialists, and the health plan itself create gaps where members fall through.
“After my hospital stay, I was supposed to have home health visits and physical therapy. Nobody coordinated it. I spent two weeks making calls, and by the time it was set up, my recovery had stalled.”
How Payers Are Responding
Forward-thinking health plans are moving beyond annual surveys to continuous qualitative research. The goal: catch issues before they drive members away.
AI-moderated interviews offer a scalable way to understand member experiences in depth. Unlike focus groups that capture 8-12 voices at a time, AI-moderated research can reach hundreds of members continuously—in their preferred language, on their schedule.
The payers seeing the best results are those who:
- Conduct qualitative research immediately after key touchpoints (enrollment, claims, prior auth decisions)
- Segment insights by member demographics and plan types
- Connect qualitative findings to CAHPS survey domains
- Share insights with operational teams, not just market research
The Bottom Line
The 13-point drop in member satisfaction isn't a mystery. Members are telling us exactly what's wrong—in their survey comments, in their call center interactions, in their social media posts. The question is whether payers are listening deeply enough to act.
Qualitative research at scale—powered by AI moderation—offers a path forward. Not to replace surveys, but to understand what they mean. Not to guess at solutions, but to hear them directly from the members whose satisfaction depends on getting this right.
Ready to understand your members better?
See how Blue Lens Research helps health plans capture the member voice at scale.
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