Member-Facing Technology: Why Most Level Funded Apps Do Not Get Used

The J.D. Power 2025 U.S. Healthcare Digital Experience Study measured member satisfaction with health plan digital properties on a 1,000-point scale. Commercial health plan mobile apps scored 653. Medicare Advantage apps scored 597. For comparison, full-service wealth management apps scored 794. Property and casualty insurance apps scored 700. Automotive finance apps scored 672. Health plan digital experiences rank last among the service industries J.D. Power evaluates. The study, based on 6,259 member evaluations of the 15 largest commercial and Medicare Advantage plans, found that 39% of health plan digital properties fail to make it easy for members to find the information they need. Those are the large national carriers. The mid-market TPA’s member app, built on a fraction of the budget and a fraction of the design investment, 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.

What the App Provides vs. What the Member Needs

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The digital ID card is useful exactly once: at the provider’s front desk when the member needs their group number and member ID. After that first visit, the ID card function sits unused. Some members photograph their physical ID card and never open the app again.

The provider directory is the most consequential feature and the most unreliable. The member searches for an in-network primary care physician within 10 miles. The directory returns results. The member calls the first listed provider and is told the provider is not accepting new patients. The member calls the second provider and is told the provider left the practice six months ago but the directory has not been updated. The member calls the third provider and reaches a number that has been disconnected. Provider directory accuracy is a documented problem across the health insurance industry. Network directory inaccuracy in rural and underserved areas is covered in LFP-07.03. For the level funded member using a TPA’s leased network, the directory data passes through multiple layers (network vendor to TPA to app) with each layer introducing potential staleness.

The claims history shows what happened after the fact. The member received a service, the provider billed the plan, the claim was adjudicated, and the app displays the result: allowed amount, plan payment, member responsibility. The information arrives weeks or months after the service. The member cannot use it to make a decision about the service because the service has already occurred. The explanation of benefits data is presented in the same format the TPA’s claims engine produces it, using terminology most members do not understand: allowed amount, contractual adjustment, coordination of benefits, coinsurance. A 2024 J.D. Power study found that the overall digital experience satisfaction score for commercial health plans was just 565 on a 1,000-point scale, with digital properties significantly underperforming other service industries including mortgage origination, direct banking, and telehealth.

The deductible tracker shows how much of the annual deductible the member has met. This is useful information presented without actionable context. The member knows they have met $800 of a $3,000 deductible. They do not know what that means for the cost of the MRI their doctor just recommended. They do not know whether getting the MRI at the hospital outpatient department versus the independent imaging center will cost them $2,200 versus $350 in out-of-pocket responsibility. The deductible tracker tells the member where they stand. It does not tell them what to do.

What the member actually needs from a health plan app falls into four categories, none of which the typical TPA app addresses.

Finding a provider who is in network, accepting patients, and geographically convenient. The app’s provider directory is unreliable and does not answer the accepting-patients question. A functional version would show real-time provider availability, verified acceptance of new patients, wait times for appointments, and cost and quality ratings.

Estimating what a procedure will cost before the member decides to proceed. The app does not provide cost estimates. The member who is told they need an MRI has no tool for comparing the cost of that MRI at the hospital ($2,800) versus the independent imaging center ($450) versus the ambulatory surgery center ($650). The price transparency tools required by federal regulation exist in machine-readable files that no consumer can interpret. A functional app would translate that data into a member-facing cost estimate specific to their plan design, their deductible status, and their geographic options.

Understanding a complex claim or explanation of benefits. The EOB is incomprehensible to most members. The app displays the same data in the same incomprehensible format, adding a screen interface to paper-era information design. A functional version would explain in plain language: “Your doctor billed $3,200 for this procedure. Your plan’s negotiated rate was $1,800. Your plan paid $1,440. You owe $360 because you have not yet met your deductible.”

Finding a lower-cost alternative for a prescribed medication. The app does not include pharmacy cost comparison or therapeutic alternative identification. A functional version would show the member that their prescribed medication costs $340 at the retail pharmacy and $45 through the mail-order pharmacy, or that a therapeutic equivalent is available at $12 through the plan’s formulary.

Why Engagement Is Low

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The app was designed for the RFP, not for the member. The broker’s RFP asks: “Does the TPA provide a member portal?” The answer is yes or no. The TPA builds a portal that answers yes. The portal’s features are determined by the RFP checklist, not by member research. The question of what problems members actually need solved was never asked because the procurement process does not ask it.

The design follows the TPA’s data structure, not the member’s decision flow. The app displays what the TPA has: claims data organized by date of service, eligibility data showing coverage status, provider data pulled from the network vendor’s directory feed, and deductible accumulation from the claims engine. The app does not organize information around what the member needs to do: find care, estimate cost, understand bills, make decisions about treatment options.

The engagement consequence follows directly. The member opens the app once to get their digital ID card. They may check a claim. They do not return because the app does not help them with the problems they actually have. J.D. Power’s 2025 study found that 37% of commercial health plan members had used their insurer’s mobile app within the past year, up from 31% in 2024. That growth reflects the largest national carriers investing in app improvement. For mid-market TPAs, whose app investment is orders of magnitude smaller, usage rates are likely lower. The J.D. Power data also showed that when members have a poor digital experience, only 27% say they would use the channel again.

The Consumer Technology Gap

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The workforce that level funded plans predominantly serve has been reshaped by the patterns described in Series 12. The AI-augmented fractional worker, the digital-native professional managing multiple income streams, the service economy employee who conducts their financial life through mobile apps. These members use consumer technology that is responsive, intuitive, and useful. Their banking app lets them deposit checks with a photograph, transfer money with a tap, and see their financial position in real time. Their rideshare app shows them the cost before they commit. Their food delivery app displays prices, estimated arrival times, and ratings.

They open the TPA’s member app and find an interface built to a 2015 design standard, with a provider directory that returns stale data, a claims history they cannot interpret, and no ability to estimate the cost of anything before they receive it. The gap between consumer technology expectations and TPA member technology is wider than at any previous point because the workforce the TPA serves increasingly lives in a consumer technology environment that makes the TPA app feel broken by comparison.

This is not a cosmetic problem. It is an economic one. The member who cannot use the app to find a lower-cost provider, compare pharmacy prices, or evaluate treatment options makes decisions that cost the plan more money. The member who could use the app to find the independent imaging center instead of the hospital outpatient department saves the plan $2,350 on a single MRI. The member who could compare pharmacy costs and switch to mail-order saves the plan $295 per fill on a single specialty medication. Across a 25-person plan over a 12-month period, member-directed cost avoidance through functional technology produces measurable claims savings.

What Redesign Requires

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Redesign starts from the member’s decision points, not the TPA’s data structure. During a plan year, a member makes four categories of consequential decisions that affect plan cost.

Where to get care. The provider selection decision determines whether the member sees an in-network provider or goes out of network, whether they use a high-cost or low-cost facility, and whether they access primary care or go directly to the emergency department. An app designed around this decision provides accurate, real-time provider information with cost and quality data, verified acceptance of new patients, and appointment availability.

Whether a recommended treatment is the right choice. The member told they need surgery has no tool for evaluating whether surgery is the best option, what it will cost at different facilities, or whether a second opinion is warranted. An app designed around this decision provides decision support: comparative cost data across facilities, quality metrics, and direct access to second opinion services.

Which medication to fill and where. The pharmacy decision determines whether the member pays retail or mail-order prices, whether they fill a brand-name drug or a generic equivalent, and whether they use the plan’s preferred pharmacy or a non-preferred location. An app designed around this decision provides pharmacy cost comparison with therapeutic alternative identification.

Whether to seek care at all. The access decision determines whether the member uses the healthcare system for a given concern or defers. An app designed around this decision provides telehealth as a first-point-of-contact option, nurse line access, and symptom triage that routes the member to the appropriate level of care.

The claims data, the provider data, the pharmacy data, and the plan design data needed to support these features exist within the TPA’s technology stack. The current app architecture does not connect the data to the member’s decision. Connecting it requires the integration architecture that LFP-13.01 identified as the primary constraint on TPA capability and the domain knowledge that LFP-13.03 identified as the root cause of poor system design.

The member app is the TPA’s most visible product and its worst. Redesigning it 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. The member who can find lower-cost care and make informed decisions produces lower claims. The consumer technology standard the workforce described in Series 12 demands is the same standard the plan’s economics reward.