MERGE identifies key opportunities for health insurers to transform member portals and close experience gap

MERGE, a leading marketing and technology agency, released new research today that found most health insurance portals are falling short of member expectations, creating frustration, inefficiency, and financial strain. The white paper, “The Portal Payoff: A Study of 13 Leading Payer Portals,” examines how insurers can transform their portals into high-value assets, improving member experiences and reducing operational costs. “In a world where the consumer has choice, they're going to choose the engagement where they feel seen and receive value,” said Nasim Afsar, MD, MBA, MHM, Health Tech Executive and former Chief Health Officer at Oracle Health. “This is true whether we're caring for people, talking about drug discovery, adjudicating claims, or putting wearables on their wrists.”

MERGE researchers examined 13 health plan portals of the top health insurance and benefits brands and conducted one-on-one, 75-minute interviews with 25 members across 17 states. Findings reveal an industry-wide member experience gap. Long viewed as a cost center, the member portal has the potential to become a powerful engine for engagement, satisfaction, and financial performance. As the digital entry point for an insurance company’s brand, the portal often defines members’ first and most frequent interactions, making design and usability crucial for building trust.

Key highlights from the research include:

• Health insurers rank 16th out of 20 industries in customer experience.
• Nearly one-third of portals fail to meet basic usability standards.
• 80% of members say their portals need improvement.
• Health plans earned a D in usability with an average score of 67.
• More than 60% of consumers would consider switching insurers for a better digital experience.
• Poor portal experiences lead members to high-cost call centers, while better-designed portals can save up to $89 per user annually and make members five times more likely to renew coverage.

Stephanie Trunzo, MERGE CEO, notes, “Research confirms the payer portal has become healthcare's digital front door, but the very use of the word 'portal,' a web concept from 30 years ago, signals an outdated model. The front door isn't very welcoming when it is always locked behind a login, and that friction erodes trust before care even begins. People don’t feel seen by complexity, and simply layering on AI can't fix a system that keeps the human locked out.” She concludes, “The organizations that win will be those that see their portal not as a digital tool, but as a living relationship that honors the individual through empathetic, intentional experience design.”

While fragmented systems and outdated tools have long hindered progress, the opportunity for market leadership is wide open. With no established leader in the space, health plans that invest in innovative, human-centered design can set a new benchmark for digital excellence in healthcare. By improving usability, accessibility, personalization, and integration, health plans can transform their portals from costly platforms into trusted digital companions. The result is a more connected, confident member experience that builds loyalty and positions insurers as innovators committed to improving care through digital experiences.

“Healthcare is complex. People don’t want to add to that complexity by having to navigate confusing systems — they want to feel like the system works for them; show them you know them,” said Pat McGloin, Managing Director, Health and Life Science Division at MERGE. “A well-designed portal can be the bridge between confusion and clarity, providing a way for health plans to show they truly understand and value the person behind the policy. When you force members to navigate a confusing experience without demonstrating you respect their time or value them as an individual, you erode trust. Further, each suboptimal step in the experience further erodes that trust. At MERGE, we help organizations bring humanity to technology by creating digital experiences that simplify access, restore trust, and empower people to take charge of their health.”

To download the white paper, visit: https://bit.ly/4rQPLPw. Readers can connect directly with MERGE research experts for a no-charge personalized look into the key findings from the analysis of leading member portals and actionable insights for elevating member experience. Readers can also schedule a collaborative work session with MERGE experts to identify opportunities, prioritize challenges, and create a customized roadmap for portal success.

About MERGE

MERGE is a marketing and technology agency built for the intersection of health and wellness. We combine deep expertise in health and consumer behavior with strategy, creativity, experience technology, and digital marketing to design personalized experiences that drive meaningful results.

Powered by human insight, creativity, and AI, we weave storytelling through technology to turn complexity into clarity — strengthening relationships between people and brands.

With 750+ specialists across Atlanta, Boston, Chicago, Denver, Kansas City, Los Angeles, New York, and Raleigh, MERGE partners with leading brands like Abbott, GE Healthcare, American Express, T-Mobile, Coach, and Meta to advance health, wellness, and happiness.

Learn more at mergeworld.com.

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“The organizations that win will be those that see their portal not as a digital tool, but as a living relationship that honors the individual through empathetic, intentional experience design.” - Stephanie Trunzo, MERGE CEO