Why Consumers Leave Their Payer/Provider

Navigation challenges are the top reason consumers stop seeing healthcare providers, while experience issues are the main reason consumers leave their health insurer, a new survey found.

The Accenture report, released last week, surveyed more than 9,700 insured consumers and 8,000 consumers who sought or received care in the prior year. The survey is a follow-up to a 2021 report, which examined why people are loyal or not loyal to their payer or provider.

“We wanted to leverage our patient and member experience surveys to continue to track the state of consumerism in health care, assessing how providers and health insurers perform across a number of key touchpoints that drive selection, loyalty, value and ease of use,” said Sarah Sinha, a managing director in Accenture’s health business, in an email.

The new report discovered that in the last year, about one in five people switched healthcare providers and one in 10 switched healthcare insurers.

When asked why they switched or stopped seeing their healthcare provider, 89% of respondents said navigation issues. This includes the provider being difficult to work with, having a poor experience with the administrative staff or digital support not meeting their needs. Another 44% of respondents listed clinical experience as a reason for leaving, while 13% said access/network challenges and 10% said value.

About 52% of respondents said they switched insurers because of experience factors, like not receiving the correct information, not getting questions answered, bad customer service or poor digital methods. An additional 42% said they switched insurers because of the benefits, while 31% left because of healthcare access issues and 20% left because of value.

“These findings are a reminder that payers and providers should address the foundation of an experience operating model and that its corresponding digital core is a non-negotiable for sustainable success,” Sinha said. “The increasing need for data and insights to drive experiences, along with the rapidly evolving landscape of digital and AI capabilities means that siloed improvement efforts will not only lack the scope and scale for real change, but will further impede organizations’ ability to evolve to meet changing needs.”

Accenture also found that access (such as having a convenient location and hours) is an important factor in choosing a new provider. When it comes to choosing a new insurer, benefits/coverage, access to care and payer experience are more important than price for consumers.

“Those that truly transform will create the ability to drive and scale change throughout the organization – including the ability to understand their customers, enable a connected journey, engage more proactively with patients, and balance the human plus machine equation, empowering the workforce to best meet their patients’ needs. … Those organizations that can achieve high levels of patient or member loyalty are those that show empathy to improve access, experience and outcomes by providing a personalized health journey built on trust,” Sinha stated.

Photo: sdecoret, Getty Images

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