Executive Summary: Member-Facing Technology: Why Most Level Funded Apps Do Not Get Used
LFP-13.05 — The Technology Gap#
The J.D. Power 2025 U.S. Healthcare Digital Experience Study scored commercial health plan mobile apps at 653 on a 1,000-point scale, ranking health plan digital experiences last among the service industries evaluated. Those scores measure the largest national carriers. The mid-market TPA’s member app, built on a fraction of the budget, operates a full generation behind what J.D. Power even measures.
The typical level funded member app provides a digital ID card, a provider directory, a claims history view, and a deductible tracker. These four features satisfy the line item on the broker’s RFP. They do not solve any problem the member actually has. The digital ID card is used once. The provider directory returns stale data: providers not accepting new patients, providers who left practices months ago, disconnected phone numbers. The claims history displays adjudication results weeks or months after the service, using terminology most members do not understand. The deductible tracker shows progress toward the annual deductible without any context for what that means for the cost of the MRI the doctor just recommended. The member does not know whether getting that MRI at the hospital outpatient department versus the independent imaging center will cost $2,200 versus $350 in out-of-pocket responsibility.
What the member actually needs falls into four categories the app does not address: finding a provider who is in network, accepting patients, and geographically convenient; estimating what a procedure will cost before committing; understanding a complex explanation of benefits in plain language; and finding lower-cost pharmacy alternatives. The app was designed for the RFP, not for the member. The design follows the TPA’s data structure rather than the member’s decision flow. The engagement consequence is predictable: J.D. Power found that when members have a poor digital experience, only 27% say they would use the channel again.
The gap is not cosmetic. The member who cannot use the app to find a lower-cost provider or compare pharmacy prices makes decisions that cost the plan more money. A single MRI routed to an independent imaging center instead of a hospital outpatient department saves the plan $2,350. The consumer technology standard the workforce described in Series 12 demands is the same standard the plan’s economics reward. Redesigning the app from the member’s decision points rather than the TPA’s data structure is the technology investment most likely to improve both member experience and plan economics.