Key features of a health insurance member portal

Personalized member dashboard

Member portals need to streamline the most relevant information for the user immediately through a personalized member dashboard. Leveraging advanced data analytics, these tools should bubble the most important actions to the top of a user's dashboard and filter less important information to the bottom.

To that end, each member's dashboard should look at least slightly different, as member portals pull personalized data and information into the display. For example, a healthy 25-year-old might have information about their next wellness visit at the top of their dashboard, while a 50-year-old member with diabetes might see lifestyle suggestions to lower their A1c.

Personalization should go beyond clinical recommendations, too. For instance, member dashboards recommending a preventive service should account for the geographic location of the user.

Member education

Member education is critical to a good beneficiary experience, but it's a wide-ranging task for payers. Notably, member engagement entails informing individuals both of their health or clinical needs as well as their health plan benefits.

The member portal can help streamline member education by segmenting information into different buckets.

Tools should feature information about health plans and benefits by providing a digital copy of policy details and explanations of benefits. Insurers might also include information about prescription benefits and any relevant prior authorization requirements.

In addition to plan information, healthcare payers should outline important clinical information for members.

For example, member portals might display information about key preventive services, including why preventive screenings are important and where members can have them done. Health plans can employ a similar strategy to educate members about chronic illnesses, including risk factors for certain diseases and lifestyle changes that can help stave them off.

Payers can personalize this information through data analytics. For example, advanced analytics might flag a patient who is at high or rising risk for diabetes and push information about effective chronic disease prevention strategies. Likewise, data analytics could help sift out individuals eligible for certain preventive screenings based on age or other demographics.

By ensuring member education presented is personalized and relevant, health plans increase the odds that members truly heed the advice given and ideally see good outcomes.

Member self-service features

Member portals are critical to the health plan experience because they give beneficiaries the means to autonomously manage their own health. As such, adding key self-service features is essential.

Self-service features in a health plan member portal will have some overlap with those included in provider patient portals, but with some key differences. For example, a health plan member portal will have a different provider directory and provider search function compared to their healthcare provider counterparts.

In a health plan's provider directory, members can skim clinicians from various practices in their set geographic region, as opposed to just the providers in a given practice or health system.

Ideally, the health plan's provider directory will only include clinicians within the payer's covered network, but data has shown provider directories are not always up-to-date. Health plans should focus on data integrity and work with providers to ensure they give accurate information to members.

Advanced tools might also offer self-service appointment scheduling, although functionality might be limited. Health plans will need to employ tools that are interoperable with the appointment scheduling tools offered within provider offices, and that level of integration is not a given.

In addition to find-a-provider tools, member portals should offer find-a-pharmacy tools and provide information about prescription formularies.

Member communication tools

The member portal can and should go beyond how the member seeks out information. It should also push out information to members through strong member communication tools.

Enabling push notifications to alert members when they have an action item due or are eligible for a certain preventive screening can help drive engagement. Moreover, messages tailored to a member's health and well-being goals are important. For example, a member portal might push a notification reminding a member to exercise or take their medication.

Member communication should be omnichannel. After all, users can always silence or turn off push notifications, making other communication lines might be more effective. Members should be able to customize their communication preferences in their portal profile and select whether they'd like to hear from their payer via the app, email or another channel like mailers or phone calls.

Notably, insurgent technologies like generative AI are making a splash in healthcare communication, including on health insurance member portals.

Chatbots leveraging gen AI can streamline and automate member communication and help members navigate their portal apps. For example, AI chatbots could help generate information about a member's benefits, alleviating the burden of navigating to the digital explanation of benefits and parsing through what is often convoluted information for the member.

But not every user will be receptive to AI. Indeed, studies have indicated that although healthcare consumers see value in gen AI, they still view it with skepticism. Health plans should still invest in portal messaging with payer representatives to ensure members can access the information and personnel they need.

Financial, billing and cost information

Beneficiaries should be able to locate information about their healthcare costs and other relevant financial information within their member portals.

These functions should include benefits checks and access to cost estimates or price transparency tools. This information helps members budget and understand their financial responsibility when they get to a healthcare provider.

Notably, price transparency should be complemented by quality information. By understanding not just the cost of a certain provider but also their quality metrics, members can make better decisions about accessing high-value care.

Although data has shown that healthcare consumers do not always use price transparency information, health plans can take steps to make cost information more usable. Price transparency tools should be centrally featured on the member portal and written with member financial and health literacy in mind to ensure members can meaningfully engage with it.

In addition to price transparency, member portals should give users an overview of the financial aspects of their benefits. For example, members should be able to check the status of their deductible and whether they have hit it yet.

Moreover, insights into their healthcare claims will be helpful. Member portals should display a claims history and let users check the status of a current claim.

Access to member profile information

Finally, any high-quality member portal will give users the ability to manage their own profile information.

This includes updating their contact details and preferences, their demographics and other relevant personal information. In doing so, members can ensure the information their payers have about them -- and therefore the information their payers serve up to them -- is the most relevant for managing their own health. For example, updating their home address is a central way members can ensure insurers are tailoring provider directories to them.

In addition to profile information, member portals often provide a digital version of a member's insurance card.

Considering the breadth of protected health information that member portals contain, it is essential that these tools have adequate security protections.

As healthcare payers continue to adjust to trends of healthcare consumerism, which suggest that members want a healthcare experience that mirrors their experiences with other service sectors, these features will be essential.

By enabling member education, self-service functions and personalization, health plans can begin to empower members in their own care.

Sara Heath has reported news related to patient engagement and health equity since 2015.