Digital Disconnect: Why Health Plan Members Are Still Calling, Clicking, and Quitting
Summary
Despite significant investments in digital tools, health plan members continue to face major issues when using those tools to understand coverage, find providers, and resolve issues. This brief highlights key pain points such as confusing terminology, poor navigation, and frustrating automated phone systems, all of which drive members to abandon digital channels in favor of calling or quitting their plans.
Improving member engagement means simplifying language, streamlining digital workflows, and making human support more accessible.
About MB360 Insight Briefs:
MB360 Insight Briefs are monthly, research-driven snapshots of the healthcare experience designed to highlight real member and patient pain points and what to do about them.
Each brief focuses on a specific challenge in the healthcare journey, from digital frustrations and call center overload to in-clinic confusion and missed communication moments. Using direct quotes, usability findings, and survey data, we distill three critical insights into a concise, highly visual format that’s easy to skim and act on.
What to expect:
One core topic per month (e.g., checkout experiences, digital engagement, wait time communication)
Three actionable insights each illustrated with real user feedback and followed by clear fixes
Concise, practical takeaways for healthcare leaders, designers, and operational teams
Empathetic tone and plain language backed by real-world research, not just theory
MB360 briefs are built for teams who want to move fast, from insight to impact.
How to Identify Friction Across Your App, Portal, and Call Center
This checklist helps health plans assess common engagement breakdowns and identify opportunities to simplify, streamline, and humanize the member experience.
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Task
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Section 1: Access & Navigation
App and portal have clear, prominent log-in access on the homepage
Members can find “View Benefits,” “Pay My Bill,” and “Find a Provider” within 1–2 taps or clicks
Member ID card is available in both the app and the portal without navigating through menus
App and portal use a consistent structure and terminology (e.g., “Coverage,” “My Plan,” “Providers”)
Key tasks (e.g., changing PCP, viewing eligibility) are accessible without calling in
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Section 2: Language & Clarity
Billing and claims pages use plain language (e.g., “You Owe” vs. “Patient Responsibility”)
Technical terms (like EOB, MOOP, coinsurance) are explained or clickable
Notifications, prompts, and labels are written at an 8th-grade reading level or below
Terms used in the call center IVR match those used in the app and portal (e.g., “Change Doctor,” not “PCP Reassignment”)
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Section 3: Self-Service Capability
Members can complete top 5 tasks digitally: ID card, change PCP, view benefits, pay bill, find care
Real-time eligibility and claims info is visible (not delayed or pending behind PDFs)
Members can view their next available benefits (e.g., preventive visit, prescription refill eligibility)
Provider directories include availability, network status, and member reviews or ratings
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Section 4: Call Center Experience
Callers can reach a live agent in under 3 steps or 60 seconds
IVR menus use natural language and reflect the same structure as the app/portal
A “press 0 to speak to an agent” option is offered or understood early in the menu flow
Callers are informed of hold time and place in queue
A callback option is available when wait times exceed a set threshold
Voice tone and gender are tested with real users for comfort and clarity
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Section 5: Trust & Continuity
Members can start a task in one channel and finish in another without re-entering information
Portals and apps save in-progress tasks (e.g., claims questions, provider searches)
Contact center agents have access to what the member saw in the portal or app
Virtual care and digital services are clearly labeled and consistently promoted across channels
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Section 5: Scoring (Optional for Internal Use)
21–25 – Excellent: Your system supports high-value, cross-channel member experiences
15–20 – Moderate: Friction points exist and likely impact satisfaction and call volume
< 15 - At-Risk: Digital gaps are likely increasing cost, frustration, and attrition risk
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Next Steps
Use this checklist as a conversation starter across digital, PX, and contact center teams
Pair with our Digital Engagement Audit or Quarterly Insight Report for deeper evaluation
Want help applying it? Book a free 30-minute walkthrough with our team
