In recent years, consumer expectations for digital self-service have evolved and become table stakes across various industries. To meet this demand and keep up with competitors, health plans rapidly developed member portals—often without setting an overarching strategy. This means that portals were often created without specific ROI goals set in advance. Now that most plans have a portal, it is time to retroactively adjust to meet plan-determined ideas of success. To optimize these investments plans must first ask “what is the point of our portal?”

Health plan executives commonly cite three primary reasons for developing a member portal:

1. Keep pace with other industries and plans

As mentioned above, consumer and market expectations spurred plans to set up their portals. This dynamic continues today as plans may add features because another plan has added that feature. Keeping pace with other plans may prevent disruption, but it won’t guarantee ROI.

2. Digital self-service for members

For all plans, a subset of members don’t want to ask the plan for help; they want to quickly find answers digitally. Self-service also decreases plans’ call center volumes and drives an immediate, calculatable ROI for the portal as every avoided customer service call saves the plan $6 to $10.

Portals should reduce the number of calls from members by fulfilling basic requests such as asking for a new ID card or checking the balance of a health savings account. In contrast, when members aren’t able to find answers on the portal, because the portal is hard to use or the information isn’t available, they will contact the plan.

When we asked consumers what they would do if they can’t find an answer on their portal, the top answer was to call their plan.

3. Increase member satisfaction

The third priority plans maintain for their portal is to increase member satisfaction. The hypothesis is that if members receive a seamless technological user experience then they will view the plan more favorably.

Plans use NPS to measure member satisfaction and select plans have even started measuring a portal-specific NPS. NPS provides another tangible measure for plan executives to monitor ROI for portals.

Our consumer survey shows that portal utilization correlates with overall plan NPS. The NPS is 22 points higher for members who have used their portal versus those who haven’t.

Furthermore, significant differences exist in NPS for members who had issues on the portal versus those who did not. Members who had an issue using the portal had an NPS similar to that of the average plan member— around 13. However, the NPS jumps to 32 for those who used the portal with no issues. To put this in context, popular retail company Nike has an NPS of 30.

This correlation was even stronger than the correlation between care utilization and NPS. A striking data point considering that members who seek care more often tend to score plans higher on NPS because they are receiving value when the plan covers their care.

Portals are worth health plan investments

Certain plans or executives may still think that portals are not worth the investment because of limited utilization among members. However, our data shows that when executed correctly, portals are worth plan investments of time, money, and strategic thinking—most directly as a means of decreased call center volumes and increased NPS.

More importantly, these are just the quick-win results. Ultimately, portals should aid plan goals of reducing medical spend, as discussed later in this report.

No plan portal feature is particularly popular

Of the portal features listed, none are particularly popular among consumers. Said differently, when members were asked which feature they find most important, the results were low across the board. By far the most important feature for members was information about their benefits, at two times more popular than the next closest feature. It's clear that members want their plans to provide them with their basic info in an easy to navigate/access fashion.

Less is more

Plans looking to keep up with competitors and other industries have perpetuated an arms race to add the most tools to their portal. However, the popular cliché “less is more” is definitely apt for health plan portals. When members were asked which feature they don’t currently have, but would want, the most popular answer was that they don’t want any additional features.

Quality over quantity

Members don’t complain about a lack of available features on their portals but that doesn’t mean they aren’t complaining. Over half of the members we surveyed reported experiencing at least one problem on their portal in the past 12 months.

While the most likely consequences of a member struggling to use their portal are increased call center volumes and decreased NPS, it could also result in poor or expensive care decisions by members—or a member forgoing care altogether.

Members experienced three primary problems with their plan portals:

The most common complaints about portals reaffirm that most members desire to perform basic tasks without facing any issues. To continually improve portal functionality, plans should develop ongoing mechanisms to enlist member feedback whether it be through pop-up surveys on the portal, 1:1 interviews, focus groups, or satisfaction surveys sent via email after a member uses the portal.

Efficient commodities, not differentiators

It’s time we faced the facts: plan portals are commodities not differentiators. Members don’t want portals with all the bells and whistles; they want to perform basic tasks without issue. Rather than racing to differentiate their portal from competitors, plans should be racing to make the most efficient commodity for their members.

Plans need to improve upon their portal design to get members to more regularly use their portal, but that’s only the first step. The next action step for plans is communicating the value of the portal to their members.

The good news is that 95% of members are aware that plan portals exist and registration rates have increased significantly over the past few years. However, the bad news is that 63% of these members registered but never logged back on.

Move past registration to action

Plans need to move past portal awareness and registration to drive behaviors and action that will help decrease medical spend.

For example, members can reduce medical spend by using a virtual visit instead of going to the emergency department or using the doctor finder to access an in-network PCP. As such, select plans have recognized this need for action and set outcomes-based metrics for their portal—such as the percent of portal registered members who use a virtual visit versus an emergency room visit. This measurement strategy aligns with the overarching goal to spur members to action, rather than chasing a 100% registration rate.

Currently, plans do not consistently drive portal users to action which is why portals have had limited impact on medical spend. Our data supports this: the majority of members who have been on their plan portal, don’t remember seeing basic information such as benefits info or a doctor finder function. Members don’t recall these features because they aren’t taking action while on the portal.

Plans can move past mere registration goals to drive member action on the portal by sending the right message to the right people at the right time.

Target the right person

The first step is to target the “right” person. For instance, members with employer sponsored and individual marketplace insurance prefer communicating with the plan via their portal relative to members in other lines of business.

Also, certain members—often the care decision makers of the household—find great value in the portal while others won’t utilize portals for any reason. As such, plans should prioritize outreach efforts to the people who are more likely to use portals and more likely to derive value. Plans can find potential, future users by analyzing demographics of the people who have responded positively to portal outreach in the past.

Reach out at the right time

Our survey data shows that very few members register for their portal after they’ve been with their plan for three months or more. 66% of members who have been with their plan for fewer than three months are registered on the plan’s portal (compared to 61% of all members). Plans should focus their efforts during the onboarding process because members are listening to their plan at that time; it is also the period when plans can have the greatest impact on their future costs—before members have utilized care.

The other opportune time to reach out is after a member has utilized care. Members are more engaged in health care when they need or have just used care and plans can tailor messages to this time. For example, an email saying “did you know that you could have found an in-network doctor on the plan portal and saved $200 last week?” may capture a member’s attention.

Promote the right message

Different people will find value in different parts of the portal, so the message plans send is crucial. The right message should promote a portal feature that the member could gain value from using. You can target the right members for a certain message based on: LOB, age, occupation, psychographics, and more. Our research shows that while everyone wants information on benefits, older members enjoy information on how to be healthier, and mothers like information on virtual visits (even more so than Millennials).

Going above just the promoted feature, the right message is sent via the preferred mode of communication with tailored verbiage/images as well. Email is the preferred mode across the board but there are differences: Medicaid members like texts more than members of other LOBs. Plans can check which mode members actually looked at historically, and also use A|B testing to find the words and images that appeal to specific segments.