Health plans are rethinking the member experience from the member’s perspective. Becker’s asked leaders from health plans and partner organizations how they’re improving it, and most started in the same place: listening to members, finding where coverage and care get confusing or slow, and fixing those points first. Their answers ranged from call centers and online portals to prior authorization, provider relationships and the affordability pressures behind nearly every member’s experience.
Some plans are pulling work closer to members, bringing service teams in-house and pushing to make their digital tools as reliable as their phone lines. Others are betting on data and AI to spot needs earlier, predict what members will need next and guide them to the right care. Across the group, one idea held steady: members don’t experience their health plan and healthcare systems separately, so plans can’t fix the total experience on their own.
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Editor’s note: Responses have been lightly edited for clarity and length.
Question: How are you working to improve the member experience?
Andreana Santangelo. CFO of Aetna (Hartford, Conn.): Improving the member experience starts with looking at affordability and the care experience as a whole. We bring finance, clinical, product, and operations teams together to understand where members face friction and where an investment can make the biggest difference. That includes making benefits easier to understand, helping members navigate their care, using technology to simplify service, and removing unnecessary friction with providers. Our member is also their patient, so when we make it easier for providers to work with us, we can create a simpler, more seamless experience for the member. We weigh those investments against the value they can create over time, including better health outcomes and lower costs. The goal is to make disciplined choices that deliver meaningful, measurable value for members today and over the long term.
Joy Kincaid. Vice President of Product Development and Innovation for Elevance Health (Indianapolis): We’re focused on making healthcare simpler, more personal and easier to navigate. That means using data and technology to anticipate members’ needs, connect them with the right support earlier, and provide clearer guidance for their next step.
Nebeyou Abebe. Senior Vice President of Social Health for Highmark Health (Pittsburgh): Through our Living Health model, Highmark is transforming the member experience by bringing together health, coverage and care in a way that is more connected, personalized and easier to navigate. We recognize that every member’s health journey is unique, and that social barriers to health can affect anyone, often emerging as life circumstances change. That’s why we’re embedding social health into our approach, looking beyond clinical care to address the everyday factors that influence health outcomes. By connecting members with the resources and support they need, we’re meeting people where they are and helping them overcome challenges that can impact their ability to engage in care. Through strong collaboration with providers, community organizations and digital solutions, we’re creating a more coordinated, whole-person experience that anticipates needs, simplifies the healthcare journey and ultimately helps improve health outcomes and quality of life.
Jennie Nowak. Director of Population Health Activation for Priority Health (Grand Rapids, Mich.). As a population health leader, Ms. Nowak is focused on transforming member experience through more personalized engagement strategies that reflect each member’s unique needs, complexity, and preferences. Her work explores how health plans can better connect with individuals across both healthcare and community settings, creating more meaningful opportunities for support and engagement. By aligning outreach, care coordination, and community-based resources, she aims to make healthcare easier to navigate and more responsive to what matters most to members. Ultimately, her goal is to reduce barriers to care, strengthen engagement, and improve health outcomes for individuals and the broader populations they serve.
Michael Bagel. Vice President of Public Policy for Alliance of Community Health Plans (Washington, D.C.): Improving the member experience starts with making it easier for people to choose the coverage that best meets their needs and get high-quality, timely care. At the Alliance of Community Health Plans, we are working every day to advance policies that build on our member companies’ close partnerships with clinicians to design coverage and care around the patient, not paperwork. Our goal is to give people fewer administrative hurdles, fewer surprises and more time to focus on their health.
Seniors deserve a clear, reliable way to compare plans based on what matters most to their health and everyday lives. In Medicare Advantage, we’re championing the MA STARS Act to put clinical quality, patient outcomes and patient experience at the center of Star Ratings. We’re also working to streamline prior authorization through electronic, real-time decisions so patients can get timely care with fewer delays and less paperwork. And because affordability is essential to access, we’re pushing for policies such as the Biosimilar Red Tape Elimination Act to help people get the medications they need at a price they can afford.
Elizabeth Benz. Senior Vice President of Strategy and Government Relations for Network Health Plan (Menasha, Wis.): At Network Health, member experience is at the core of everything we do and we maintain and improve member experience by listening closely to members and using their feedback to act on the issues that matter most to them. We combine CAHPS and Net Promoter Score insights to inform targeted outreach to members, including deeper analysis of concerns related to provider access, claims and pharmacy experiences, so we can identify and address pain points more effectively.
We are also expanding how we meet members where they prefer to engage, including portal messaging and evaluating a broader digital outreach strategy, while working with providers to help members better understand and manage their health. At the same time, our quality teams are using in-home services, follow-up outreach and clinical data to help members access needed care more easily. This work is reflected in strong recent CAHPS performance, including five-star performance on five of eight weighted measures.
Ken Cohen, MD. Chief Medical Officer for Optum Health (Eden Prairie, Minn.): Improving member experience within our Optum Health clinician network is a major initiative for 2027. Immediate solutions will include, among others, a robust online scheduling platform, widespread use of ambient technology to improve the experience of patients in the exam room, virtual specialist care to augment our virtual primary care, and new technology and analytics to direct our patients to our highest performing specialists in any given network. The future state includes robust AI-enabled technologies such as a digital front door managed with agentic AI to allow patients to “self service” their initial approach to any given problem and help them decide next best step in care and when best to engage our clinicians. We are also learning how to use our vast data assets to create “digital twins” so that we can accurately predict how any given patient would respond to a test or procedure by exact matching to a large cohort of patients who had these procedures done.
Jennifer Volm. Vice President of Medicare and Exchange Markets for Jefferson Health Plans (Philadelphia): Improving the member experience starts with listening—understanding the voice of the customer and looking at the journey through the member’s eyes. Where are things confusing? Where are we making something harder than it needs to be? What are we hearing consistently from members and the teams who support them?
Then it’s about turning that feedback into action: prioritizing the opportunities, taking ownership, and checking whether the changes made things better for members. Even small improvements can make a big difference.
Jennifer St. Thomas. Senior Vice President of Commercial and Medicare Markets for Mass General Brigham Health Plan (Somerville, Mass.): Improving the member experience starts with listening closely to what employers and members need most and evolving our products and services to meet those needs. As the industry continues to experience rising healthcare trends, affordability remains a top concern. This is why we’re focused on building a comprehensive portfolio that offers meaningful choice, value, and access to high-quality care. Our new Value HMO is one example of that commitment, providing employers with an option designed to help manage costs while maintaining a strong member experience and access to trusted providers.
Faris Ahmad, MD. Senior Medical Director and Associate Chief Medical Officer of Physician Success and Network Optimization for Blue Cross Blue Shield of Michigan (Detroit): One of the biggest opportunities in healthcare is making it easier for people to get the care they need. That’s why we continue to work closely with providers to reduce barriers, expand access through digital tools and telehealth, and create a more connected experience for our members.
We’re also focused on advancing value-based care because better outcomes, better experiences, and healthier communities are what matter most. By listening to employers, members, and providers, we can turn their feedback into meaningful action and keep people at the center of the decisions we make.
Ultimately, our goal is simple: to help create a healthcare experience that feels more personal, more seamless, and more responsive to the needs of the people we serve.
Nishant Anand, MD. President and Chief Executive Officer of Altais (Oakland, Calif.): As a physician, I want every patient to feel known, understand what comes next, and know they have someone to turn to for help. That’s the experience we’re working to create at Altais by strengthening care coordination, providing clearer guidance, and helping physicians spend less time on administrative tasks and more time with patients. Technology and data help our teams recognize needs earlier and provide support at critical moments, including the transition from hospital to home. For me, improving the member experience means making those connections stronger so people feel supported by a team they trust.
Aleesa Jansick. Senior Director of Government Programs for Sanford Health Plan (Sioux Falls, S.D.): Coming from an integrated payer-provider perspective, I believe improving the member experience starts well before a member ever needs assistance. One of the opportunities we’re actively pursuing is better alignment between the clinical care we deliver and the insurance coverage we offer in the communities we serve. Every decision, from benefit design and network development to care coordination and claims administration, has the potential to make healthcare easier or more difficult to navigate. Even when things don’t work as intended, downstream functions like appeals offer opportunities for service recovery and valuable insight into where the experience may have broken down. Ultimately, improving member experience isn’t the responsibility of any single department; it has to be reflected in how the entire organization operates.
Shawn Larsen. Vice President of Quality Stars for Medica (Minnetonka, Minn.): Healthcare is already complicated, so one of the most important things a health plan can do is avoid adding to that complexity. As a nonprofit health company, we at Medica recognize that member experience, quality and health outcomes are interconnected. We look at the member experience across the entire healthcare journey, using data to identify barriers earlier and partnering with providers because members don’t experience the health plan and the healthcare system separately. The goal isn’t simply to improve an experience score, but to create a better experience that helps people access care, engage in their health and ultimately live healthier lives. The question we keep coming back to is simple: Did we make healthcare easier and more useful for the member?
Meredith Duncan. President and CEO of Texicare (Austin, Texas): For us, the member experience is woven into the fabric of our business. A clear example of that is the decision we made to bring our member services function in-house, staffed by Texans who understand the businesses and communities we serve. Our goal is for every member who turns to us to walk away knowing someone owned their problem and cared enough to see it through to resolution.
Syed M. Ali. Assistant Vice President of Strategy Implementation for EmblemHealth (New York City): EmblemHealth is making member experience a core part of how we operate, with the goal of making healthcare easier to navigate, more proactive and more connected. We’re redesigning high-impact journeys end-to-end through a digital-first, human-support-always approach, creating greater parity across digital, phone and in-person channels and giving members more choice in how they complete tasks and access support. We’re also giving frontline teams greater visibility into member needs and potential disruptions so we can resolve more in each interaction, connect members to the right support and intervene earlier. At the same time, we’re embedding CX standards into how we design enterprise initiatives, select and manage partners, and communicate with members so we can anticipate experience risks upfront and deliver a more consistent experience across the member journey.
Brandy Thompson. CEO of Benefitbay (Kansas City, Mo.): At Benefitbay, we’re improving the member experience by helping people choose and use coverage that fits their needs through ICHRA (CHOICE). Members can compare all available carriers and plans based on their preferred doctors, prescriptions, and budget needs within our platform. One-on-one guidance from our licensed team is available year-round when members need help. A dedicated Care Concierge is available for more complex needs like continuity-of-care concerns and claims issues. Additionally, we’ve recently brought Medicare support in-house so members navigating Medicare can work directly with our team.
Magda Lenartowicz, MD. Chief Medical and Innovation Officer for Clever Care Health Plan (Huntington Beach, Calif.): At Clever Care Health Plan, we’re making it easier for our members to get the information they need in the languages and formats that work best for them. We have a redesigned website and member portal that allows members to handle more of their care when it’s convenient for them. Our Member Services team is also getting better tools to respond to requests faster and work with colleagues across departments in real time. By combining technology with human support, our members will be able to reach out to us the moment they need help, regardless of when our offices are open. Finally, we are developing new resources for our care partners, so they can better support members on their journey to a healthier, more fulfilling life. We look forward to sharing more about this soon and we’ll continue listening to our members to drive what we do next so we can keep them at the center of their care.
Beth Roberts. President and CEO of Blue Cross and Blue Shield of Vermont (Berlin, Vt.): At Blue Cross VT, one thing we’re most proud of is the excellent customer service we provide members. Consistently, we’ve been recognized as a top performing call center, including achieving world class certification. Now, we’re focused on bringing that same level of service to our digital experience. We’re working on revamping our online portals to make it easier for members to find answers and resolve issues on their own, while also improving the experience for those who call us. We’re streamlining what customer service representatives see so they have a single view of member information and, eventually, will have insight into why a member may be calling even before they pick up the phone. By making information easier to access and issues faster to resolve, we’ll be able to deliver a more seamless, personalized experience across every interaction.
Stella Lehmann. Market Director of Florida for Oscar Health (New York City): At Oscar Health, members are at the center of everything we do. Our goal is to make healthcare work better in real life — helping people afford, access, and navigate high-quality care with greater choice and control over their coverage. We pair tailored health plans to meet members’ specific needs and life stages with clear information, digital tools, and our dedicated Care Team. For example, HelloMeno is designed for women experiencing perimenopause and menopause symptoms, providing $0 access to essential menopause care—including bone density scans, labs, hormone therapy, and gynecologic and behavioral health visits.
Dipul Patadia, MD. Associate Chief Medical Officer of Client Growth and Innovation for Cigna Healthcare (Bloomfield, Conn.): We’re focused on making healthcare feel simpler, more meaningful to the individual, and easier to navigate, and our Health Sense member experience platform is an important next step in that work. It brings together what we know about a member’s health needs, benefits, costs, and previous interactions with us to provide more personalized, proactive support and help them understand the right next step. That could mean helping someone close an important gap in care, schedule a recommended screening, or understand the cost differences among appropriate care options. And importantly, the technology is designed to strengthen, not replace, the relationships members have with their physicians and care teams, as well as the thousands of clinicians who support our members at Cigna Healthcare. We believe the investment will not only drive improved health outcomes and greater peace of mind, but improved affordability throughout the healthcare system.
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