WHY PRESS GANEY

Health plans have invested in digital tools, care management programs, and member engagement initiatives over the past decade. Yet our latest market intelligence suggests the greatest opportunity isn’t nudging members to do more, it’s making healthcare easier to navigate.

The June 2026 Press Ganey Market Intelligence Survey of more than 1,100 U.S. healthcare consumers unearthed a consistent theme: Members who are engaged, satisfied, and loyal don’t necessarily use fewer services. They simply encounter fewer barriers along the way.

Engagement is the result, not the starting point

For years, “member engagement” has been treated as a goal in itself. But the data suggests engagement is often a reflection of the experience health plans create. That is, better experiences begets better engagement. The same with poorer experiences.

Consider prescription benefits. Nearly 94% of engaged members say they understand what their current medications will cost, compared to just 50% of disengaged members. Likewise, 89% vs. 52% are satisfied with their medication costs, respectively.

The pattern continues throughout the member journey. Disengaged members are less likely to:

Register for their member portal (50% vs. 88%)
Download the plan’s mobile app (31% vs. 59%)
Use mail-order pharmacy (30% vs. 48%)

Engagement isn’t created by resource use. It’s the result of an experience that builds trust and confidence.

Friction compounds around prescription benefits

Prescription experiences continue to be one of the strongest drivers of overall satisfaction—as well as one of the greatest opportunities for improvement.

Disengaged members were more likely to need prescription prior authorization than engaged members (45% vs. 31%, respectively) and less likely to receive it when they needed it (49% vs. 74%). They consistently identify the same pain points:

Unanticipated medication costs
Delays receiving medications
Preauthorization complexity
Mail-order pharmacy challenges
Difficulty using preferred pharmacies
Coverage confusion

These barriers create a snowball effect, where each point of friction makes the next one harder to overcome. For example, a delayed prescription is far more frustrating when members don’t understand what they’ll owe at the pharmacy counter or why it wasn’t covered in the first place. Member experience is only as strong as its weakest link, but alleviating small frictions can boost it, too.

More isn’t always better

Surprisingly, satisfied and dissatisfied members use many of the same healthcare services. The difference is the quality and predictability of their experiences.

Consumers who rate their health plan a 9 or 10 were significantly more likely to:
Know what they’ll pay out of pocket (86% vs. 66%)
Feel confident they understand their insurance (84% vs. 60%)
Receive the help they need from customer service (80% vs. 60%)
See the same provider consistently (94% vs. 74%)
Receive routine care as soon as needed (86% vs. 69%)
Receive prescription preauthorization when needed (73% vs. 49%)

Satisfied and dissatisfied members are likely to call customer service in equal measure. They’re also almost as likely to change doctors as each other. The difference is whether they can navigate problems successfully when they occur.

Expectations matter almost as much as access

Improving access remains a priority, but experience depends as much on expectations as wait times. Members judge the experience against what they expected—not just how long they actually waited.

For urgent care appointments, members whose care met expectations rated scheduling positively more than 80% of the time, compared with just 26% among those whose expectations weren’t met. Yet the average difference in wait time was only about 1.5 days (3.1 days vs. 4.6 days).

Health plans can’t always shorten the wait, but they can reduce the uncertainty around it.

Delayed care underscores unmet member needs

Members who delay care because of cost represent one of the greatest opportunities to improve the healthcare experience. While affordability is often the immediate barrier, their experiences also reveal how difficult it can be to understand coverage, access care, and make informed healthcare decisions.

These members are:

More than 3x as likely to report difficulty understanding written healthcare information
Nearly 4x as likely to say it’s difficult to determine whether a specialist is in-network
3x as likely to say their doctor feels cold or emotionless
Nearly 3x as likely to report extremely long waits at the doctor’s office
3x as likely to have a specialist serving as their primary care provider

These symptoms are endemic of a member experience that feels confusing, fragmented, and, ultimately, unpredictable

How health plans can design the kinds of experiences that drive engagement

Health plans don’t need to convince members to be more engaged. They need to eradicate the frictions that stand in the way.

At Press Ganey, we help health plans do just that. Our approach brings together continuous member feedback, market intelligence, journey analytics, predictive insights, and consulting expertise to help organizations uncover the root causes of friction, then focus investments where they’ll have the greatest impact on member experience and business performance.

The health plans that outperform their peers will be those that simplify the healthcare experience—because when members can easily get the care they need, engagement follows naturally. To learn more, reach out to our team here.