For years health plans have been focused on financial performance and operational efficiency: managing medical spend, processing claims faster, and meeting service levels. However with the advent of consumerism in healthcare, plans are at an inflection point.

New research from Cognizant’s 2026 Voice of the Member study reveals a significant shift in consumer expectations. Members increasingly want their health plans to do more than administer benefits. They want proactive guidance, wellness support, financial transparency and personalized experiences that help them stay healthy — not just navigate illness.  

The 2026 Voice of the Member study found that 85% of members in employer-sponsored health plans expect their health plan to take an active role in orchestrating their health and well-being, signaling a dramatic shift from the traditional view of insurers as claims administrators. 

This evolution presents both a challenge and an opportunity for health plans. While many organizations continue to focus on optimizing claims, authorizations and other core administrative processes, members are increasingly evaluating their health plan through a broader lens: How easy is it to manage my health? Does my insurer understand my needs? Is it helping me prevent health issues before they occur? 

The health plans best-positioned to win in the years ahead will be those that move beyond transactions and become trusted partners in their members’ well-being journeys.

The experience gap is growing 

The healthcare industry has spent decades perfecting what many call “sick care” — supporting members during acute episodes, managing claims, handling authorizations and coordinating treatment. 

Yet member expectations have evolved faster than many healthcare experiences. According to the Cognizant study, members continue to experience friction in some of the most foundational interactions. 

Nearly one-third (29%) of members report waiting more than two weeks for a primary care or specialist appointment, while almost half report transparency and efficiency issues related to prior authorizations and referrals. Beyond access challenges, many members also face: 

  • Confusion around benefits and eligibility 
  • Inaccurate cost estimates 
  • Difficulty navigating referrals and authorizations 

Every unanswered question, every transferred call, every confusing process creates friction at the exact moment members need confidence. 

Consumers increasingly compare these experiences not to other health plans — but to the effortless experiences they receive from banks, retailers, travel brands, and technology companies.

Members want more than coverage 

Perhaps the most important finding in Cognizant’s research isn’t about dissatisfaction. It’s about aspiration. 

Member expectations are evolving beyond traditional insurance services:  

  • The importance of wellness features has climbed from 57% in 2021 to 85% in 2025 
  • 78% of members say access to a dedicated care manager is important  
  • 76% of members value telehealth and virtual support networks 

Together, these findings point to a growing expectation that health plans actively support members’ health and well-being — not simply administer benefits. 

This represents a profound shift. Historically, health plans engaged members episodically — when a claim was submitted, a benefit question arose or a care event occurred. Today’s members expect continuous engagement. 

They want proactive support, personalized guidance and experiences that help them make better decisions before they need care. Most importantly, they expect organizations to understand their unique circumstances, preferences and goals. 

In other words, they want healthcare experiences that are personalized, proactive and connected.

Why modern capabilities are changing the equation 

Meeting these expectations at scale would have been nearly impossible just a few years ago. Today, AI is changing what’s possible. 

Across the healthcare industry, organizations are increasingly turning to AI-powered experience orchestration to create more connected member journeys.  

Rather than treating every interaction as a standalone event, AI can help unify data, understand member context and coordinate personalized engagement across digital and human touchpoints. The result is a more seamless experience that anticipates needs instead of simply responding to requests. 

Imagine a member who receives: 

  • A personalized reminder before a preventive screening is due 
  • Real-time answers about benefits through conversational AI 
  • Accurate cost estimates before scheduling care  
  • Guidance to the best provider based on their needs 
  • Proactive wellness recommendations tailored to their needs 

And when the situation becomes more complex, they’re seamlessly connected to a human advocate who can provide empathy and support. 

None of these interactions should feel like separate transactions. Together, they create a relationship. 

Healthcare organizations are already demonstrating what’s possible. Modivcare, for example, uses Genesys Cloud AI to support healthcare interactions for millions of members, with 63% of routine inquiries now handled through AI-powered chat experiences. By automating routine requests, organizations can free up care teams to focus on higher-value conversations where human expertise, empathy and advocacy matter most. 

This is where healthcare leaders have an opportunity to rethink engagement — not as a series of isolated interactions, but as an ongoing journey that helps members stay informed, supported and healthy long before a claim is ever filed. 

The new loyalty strategy 

The Cognizant research introduces an important framework built around three layers of member experience: essentials, enhancements and delights. Together, these layers represent the evolution from being a health insurer to becoming a trusted health partner. 

Essentials are the foundational experiences that build trust—core processes such as claims, benefits administration, provider search, prior authorizations and customer support. Members expect these interactions to work seamlessly every time. Yet the research found significant friction remains:  

  • 29% of members wait more than two weeks for appointments 
  • 91% of members expressed high importance for the ability to search for healthcare providers in their insurance plan and compute out-of-pocket expenses 
  • 1 in 4 members have contacted their health plan’s call center simply to understand their benefits and eligibility 

Enhancements are the capabilities that simplify healthcare management and help members navigate their health more effectively. These include cost transparency tools, chronic condition management programs, wellness resources and support for social determinants of health.  

Yet expectation gaps remain here as well:  

  • 25% of members’ estimated cost were close to actual costs 
  • 34% of members are unaware of or have never used the wellness features available through their health plan 
  • 25% of members with chronic conditions are unaware of or have not used chronic care management services designed specifically to support them 

Delights are the personalized interactions that create emotional loyalty. This is where health plans move beyond transactions and begin helping members live healthier lives.  

  • 95% of commercial members said spending management tools are important 
  • 44% of commercial members value high-cost claim alerts 
  • 30% of commercial members want payment assistance tools 

These aren’t simply feature requests — they reflect a growing expectation that health plans actively participate in supporting members’ personal and financial well-being. 

Many organizations are still focused primarily on the first layer. And they should be. Broken experiences cannot be hidden behind digital innovation. But leading health plans recognize that loyalty is won through effortless experiences which are referenced in the second and third layer.  

Members remember how an organization made them feel. They remember whether getting help was easy. They remember whether someone seemed to understand them. And, increasingly, they remember whether their health plan helped them stay healthy — not just helped them pay for healthcare. 

The future of member experience won’t be defined solely by how efficiently organizations process claims. It will also be defined by how effectively they build trust through essentials, simplify healthcare through enhancements, and create lasting relationships through personalized, proactive experiences. 

From transactions to relationships 

Healthcare is entering a new era. One where experience can become a competitive differentiator. 

The study by Cognizant makes this shift clear. Members are no longer looking to health plans solely for claims processing and administrative support. They increasingly expect guidance, transparency and proactive engagement throughout their healthcare journey.  

That requires more than adding new digital channels or deploying AI-powered tools. It requires connecting every interaction, every channel and every moment into a cohesive member journey. A benefits question should inform future care recommendations. A provider search should become an opportunity to deliver cost transparency. A wellness interaction should trigger personalized guidance that helps members make healthier decisions before a health issue escalates. 

Genesys sees this shift happening across industries. Customers no longer evaluate organizations based on isolated touchpoints. They judge them based on the total experience — the ease of getting answers, the relevance of recommendations and the feeling that the organization understands their needs. 

Healthcare is no exception. 

The future belongs to health plans that move beyond managing episodes of care and begin orchestrating lifelong relationships. We believe the organizations best-positioned to succeed will be those that use AI, data and human expertise to create experiences that are connected, proactive and deeply personal. 

Ready to learn more? Explore our healthcare resources to see how leading payers are leveraging AI-powered experience orchestration to deliver seamless, personalized member journeys — and download the latest Cognizant Voice of the Member research for deeper insights into evolving consumer expectations. 

Together, Genesys and Cognizant also combine industry-leading experience orchestration technology with deep healthcare consulting expertise to help health plans create connected journeys that build trust, improve engagement and support better health outcomes. Contact us to start reimagining the future of member experience.