Why providers should care about health plan member experience

By Thomas H. Lee, MD, Chief Medical Officer, Press Ganey

Health plan disruption is increasingly felt at the point of care—from access challenges and behavioral health needs to confused patients and delayed care.

That’s why providers should pay close attention to Press Ganey’s 2026 report on the “State of Health Plan Member Experience 2026.” While the research focuses on health plans, the findings reveal something larger: Patient and member experience are deeply interconnected, creating new pressures—and new opportunities—for payer–provider collaboration.

I want to highlight two particular reasons providers should pay close attention to this report:

1. Health plans are in a period of extraordinary turmoil. Declining member experience is now directly affecting providers and patient care.

2. Because member and patient experiences are fundamentally intertwined, health plans and providers have a shared interest in improving them together. This creates an opportunity to improve collaboration and reshape payer-provider relationships for the better.

Three critical priorities for health plans depend on effective collaboration with providers:

1. Access to care is a shared problem for health plans and providers. A broad network of credentialed physicians means little if patients cannot secure timely appointments. When delays occur, frustration is directed at both the health plan and the provider. Improving access will require providers to rethink care delivery and health plans to invest in and support new models of care. According to Press Ganey client data, only 58% of members report being able to obtain a timely appointment today—far below the 90% benchmark goal.

2. People who have recently changed their health plans—often for reasons beyond their control, like employer contracting decisions—are especially vulnerable to confusion about policies—particularly during the first 90 days of enrollment. Clinicians often face the same uncertainty. The first 90 days are, therefore, a critical period of heightened risk for members and patients, when confusion can easily lead to delayed care, disrupted treatment, and poor overall experiences. Health plans and providers should treat this onboarding window as a shared responsibility, working together to deliver proactive guidance, clear communication, and coordinated support during the transition.

3. Behavioral health access remains a major driver of dissatisfaction. When behavioral health needs go unmet, cost rise and outcomes worsen. Health plans and providers can—and should—collaborate to address this high-stakes issue. Today, only 56% of members are able to secure a behavioral health appointment within 10 days. Yet once patients are seen, satisfaction with care exceeds 90%—clear indication that the central challenge is access, not the quality of care itself.

The organizations that move fastest to align patient and member experience strategies will be better positioned to improve access, strengthen trust, and reduce friction across the care journey.

As health plans and providers face growing pressure around affordability, access, and outcomes, collaboration is becoming less optional—and more strategic.

Download Press Ganey’s “State of Healthcare Member Experience 2026” here.