Member Journey Mapping for Health Insurance Selection

In the healthcare industry, the bottom line is driven by the acquisition and retention of members. These are two separate issues. Winning a new client, while essential for business, is only half the battle. Health insurance providers essentially have a 12-month cycle to retain that client. After all the effort, healthcare research, and marketing spending on acquiring new clients, poor member experiences throughout the year can devastate retention rates.

This makes member journey mapping absolutely crucial for healthcare providers. But understanding and improving the overall experience map for members is not without its challenges. Gathering data and actioning insights in this field hinges on properly understanding the unique challenges associated with the healthcare sector.

The Significance of Member Acquisition and Retention in Healthcare

One key factor that makes the healthcare sector so different from other industries is its very defined sales cycle. Unlike other industries, such as retail fashion, for example, healthcare allows members to reselect their health insurance plan every 12-month cycle. This allows members dissatisfied with their plan to switch after just one year.

In contrast, when buying a new pair of running shoes, the retailer doesn't have a year try-out period with an option to return. In healthcare, providers have an entire year to win over – or lose – each and every customer. This creates both significant pressure and a stellar opportunity to build loyalty. In the healthcare scenario, both acquisition and retention are critical for maximizing the lifetime value of members. 

Although most people obtain healthcare through their employer, health insurance plans must cater to various needs and preferences, especially state-provided Medicaid and those plans operating on the Marketplace for individual purchase. With most states operating under managed care, there is a wide range of options for members to choose from. Because of this, understanding what attracts and, most importantly, keeps members loyal is key. To do this, we use member journey mapping.

The member journey for health insurance members is unique and can be divided into three main stages:

  1.   Pre-enrollment (open enrollment): This stage is about raising awareness and shaping the perception of potential members.

  2. Selection and Onboarding: This involves making members aware of the entire ecosystem and the benefits, such as gym memberships and rides to appointments, for example.

  3.  Utilization of the plan: This concerns the ongoing interaction with the plan, such as determining if members can visit the doctors they prefer and whether the expected benefits were realized.

Healthcare providers must be intentional about both qualitative and quantitative research around key areas throughout the member journey, and address any pain points that arise to affect retention.

Understanding The Member’s Journey in Health Insurance Selection

Another factor making healthcare unique is the intensely personal nature of coverage – many elements are at play, and those relate to each member’s very personal healthcare needs, circumstances, economic situation, and more. Mental, physical, and even sexual health are factors that members may not willingly discuss anywhere outside of their health insurance plan selection process. This vulnerability and the way it is handled has the potential to dramatically influence members’ feelings around their insurers.

Healthcare coverage selection, therefore, depends on a high degree of trust and is heavily influenced by event-dependent experiences. Importantly, member sentiment around health insurance and health providers is often influenced by outside factors unrelated to their insurance plan. This might include a bad experience with a staff member at their doctor’s office or having difficulty finding a dentist in their area (although dentistry is not a part of their health insurance coverage at all). Members’ sentiments and experiences around all aspects of their healthcare journey – even pieces unrelated directly to their insurer – can have an enormous impact on retention.

If health plans fail to identify and address pain points that cause attrition and address them in time, they risk losing members and, ultimately, significant revenue. Each of these elements means that the member journey in healthcare requires an approach, unlike any other consumer journey mapping.

consumer journey mapping

As researchers, we understand that the whole picture is a little wider when it comes to member journey mapping in healthcare. A slightly different approach is required when designing and implementing studies. We cannot understand a member’s experience around their child’s doctor without understanding the broader picture that colors that experience, for example. Asking questions about not only whether they have reliable access to healthcare for the child, but whether they have reliable access to food, outdoor spaces, and even, transportation to get the child to and from doctor’s appointments can all help us better understand the whole picture.

Some of the key considerations for achieving the best outcome in member journey mapping for healthcare include:

  1.     Understand the Bigger Context: Healthcare providers and plans must consider the entire healthcare ecosystem in their members' minds. Factors unrelated to health insurance, such as childcare, dentistry, sports, and socioeconomic issues, can impact members' perception of the plan. So too, can past experiences, either related or unrelated to their plan. Having a bad experience with a doctor or staff member or not being able to find a dentist can all have an emotional and, therefore, very real impact on a member’s sentiment around healthcare in general. These determinants must be understood and addressed to provide a comprehensive picture of members’ experiences.

  2.     Map the Whole Journey: Providers should map the entire member journey, from enrollment to the usage of the plan, and even dis-enrollment. Insights specialists need to make connections and distinguish between members’ initial expectations and their actual, real-world experiences. For example, if they were promised access to a certain doctor or certain OTC benefits, were those realized? And were they realized without significant effort and/or consternation on the member’s side? Additionally, longitudinal understanding is crucial for assessing how well these expectations align with reality. Dis-enrollment studies can also help identify the reasons behind members leaving the system and inform strategies for improvement.

  3.     Use What You Learn: Healthcare providers must act on their insights and not let findings sit on the shelf. As the healthcare industry relies on changes within specific windows, failing to act on learnings can result in lost opportunities and decreased member lifetime value. Time is of the essence when it comes to retention in health insurance.

consumer journey mapping

Health insurers have a unique opportunity to foster loyalty even in the face of negative experiences. After all, patients interact with their health insurers during some of the most difficult events – after a car accident, when their child is gravely ill, or when trying to access crucial mental health services. When people feel taken care of, they become loyal supporters, and when insurers get it right, even under challenging circumstances, they can capture mass loyalty from members. The emotional and deeply personal aspects of healthcare set it apart from other industries, offering the potential for truly meaningful partnerships between payers, providers, and members. Member journey mapping with these things in mind makes all the difference.

consumer journey mapping

Expert Member Journey Mapping for Business Growth

Member journey mapping for health insurance selection is essential for understanding and addressing the unique challenges and opportunities in the healthcare industry. By considering the bigger context, mapping the entire journey, and using insights to inform swift and decisive action, health insurers can enhance member satisfaction and drive business growth. With the right approach, insurers can become true partners in helping people achieve wellness, creating a stronger healthcare industry and a healthier future for all.

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