Screenshots from the Google Play App Store (Sept 2016)

America’s Biggest Health Insurer Can’t Find a Single Person Who Likes their Mobile App

No seriously, not a single one

The year is 2016. While companies like Uber and Amazon race to compete for the mobile consumer’s attention, the health insurance industry still hasn’t learned how to tie their own shoes.

A new press release from the biggest health insurance company in the country shines some light on how bad things still are. In the interest of not embarrassing anyone, let’s just call them “Untied Healthcare.” You know, Untied…because of the shoe thing.

Google Play App Store (Sept 2016)

A fresh press release boasts of a new set of features for users of their flagship mobile app. Chief among these new features are personalized care notifications, which will alert people about “preventive services and if they are missing recommended medical treatment or tests.” Untied will also introduce new features like prescription refills and drug cost estimators, Apple Pay and fingerprint scanners. The existing features include tools to find local healthcare providers and shop based on cost and quality.

This sounds pretty good so far. Health plan mobile apps have a simple job: Make it easier to access the information or the treatment you need, from the convenience of your purse or pocket. This should span both administrative convenience as well as improved clinical access. There was a pithy quotation in the press release that sums it up:

“[The mobile app] helps me better use my health benefits and improve my overall well-being,” said [member name], a [mobile app] user in Oak Ridge, Tenn. “The navigation is easy and streamlined, making it simple for me to learn more about my treatment options and costs, and make the most of my health benefits.”

This was the first red flag: Some quick Googling quickly reveals this is the same canned, manufactured quotation Untied Healthcare used in a different press release 18 months ago.

That’s right, an insurance company issued a press release to announce a new app, and since they couldn’t find anyone to say anything nice about the new version, they re-used the same quotation about an older version of their app.

On the surface, this just looks like some sloppy PR, right? It goes from bad to worse when you look up reviews in the app store to see what people actually do think about the mobile app. I’ve sprinkled some of the most recent reviews from the last couple of months throughout this piece. These are not cherry picked — I just started with the most recent reviews and scrolled back a few weeks. As you can see, it’s not a pretty picture.

Seriously, pause for a moment and scroll around to read some of these. As The Donald might say, Untied is really having a tough time.

Some common complaints:

Google Play App Store (Sept 2016)
  • The app crashes all of the time
  • The app doesn’t load properly, or gets stuck at the loading screen
  • It takes too long to fill out information before being able to use any of the features
  • The app doesn’t remember user information and forces manual reentry, sometimes within the same session and seemingly always when a new version is released
  • The Drug Estimates, Online Pay, Refills, and Find a Provider features don’t seem to be working correctly for many
  • The app requires location services to be on all of the time
  • The app is very slow and buggy
  • The app is ugly — the logos and screens are not proportionate to the screen
iTunes App Store Reviews (Sept 2016)

It’s one thing to have a dinky app. And yes, for a smattering of reasons, one should take online customer reviews with a grain of salt.

But these are not simply annoying consumer complaints. The app doesn’t even appear to load for many people! How can a healthcare company release a product that doesn’t work at all when the people on the other end are ostensibly using it for access to urgent care, or emergency care, or child care?

If the whole point of a mobile health insurance app is to make accessing and navigating benefits easier, then forcing people to re-enter information using their finger tips whenever they need to do something health-related makes exactly zero sense. A truly innovative company would crave the volume and honesty of this feedback — Untied is seemingly ignoring it altogether.

Untied covers over 115 million lives, according to their most recent quarterly statement — yet they had to recycle canned feedback?

That same quarterly statement proudly proclaims that the company invests nearly $2.9 billion into ‘technology and innovation’ every year. Surely that includes some nominal user testing or a focus group before new consumer facing products are released?

Surely there’s at least one of the company’s 225,000 employees who makes sure their flagship consumer app actually turns on without freezing when it’s opened up on a smartphone?

It also begs the question — why would a company bother to issue an official statement when there’s so very little to applaud?

To answer that question, let’s revisit the press release: The new features that Untied want people to know about are push notifications to help patients get needed care. The prompts they highlight in this version are “an immunization for a child or a blood-sugar test for a diabetic.” Anyone who’s familiar with quality measurement will quickly point out this is a thinly veiled reference to two common HEDIS measures. The press release is quick to point out that the app will be available for Medicaid beneficiaries in 17 states.

Translation: This has very little to do with improving the consumer experience. For every poor kid who gets a measles shot, Untied Healthcare gets closer to hitting their quota and getting a cash payout.

When an app is built to herd people into a numerator column like cows into a pen, you’re going to wind up with a bullshit product. Untied is only concerned with Star Ratings from CMS, not star ratings in the App Store.

Google Play App Store (Sept 2016)

So what’s the rub? How can the forces of consumerism possibly break through the wall of baffling, sprawling incompetence?

First things first: The consumer movement in healthcare is alive and well. There are a wave of well-designed, experience-centric apps hitting the marketplace. These span collaborative care planning (Twine, HealthLoop) to group classes (Omada, Canary) to virtual sessions with trained clinicians and care coaches (Livongo, TalkSpace). These apps go around the proverbial wall by connecting patients directly with doctors and caregivers. Patient risk is shifting towards health systems - innovators should consider this transition as an opportunity to reinvent the health care experience and earn trust and mindshare among millennials who will be starting businesses, starting families, and caring for their aging parents for years to come.

Beyond care delivery, a class of new entrants are building more modern administrative, navigational, and other service-layer tools for members. Amino, HealthSparq, Castlight, PatientPop, and a growing list of others are trying to turn walls into walkways by empowering us with tools for better accessibility, shopping, navigation. Furthermore, health care provider systems are beginning to invest in things like ride sharing (e.g. CareMore and Lyft), and broader patient relationship management platforms (e.g. Influence Health, Relatient) to consumerize their patients’ experiences directly.

There’s plenty of work remaining — but the probability for progress seems much higher when the companies involved seem to care about caring.

Back to that wall.

We’re going to build a wall…and make consumers pay for it.” — Every Health Insurer

If you’ve been on the conference circuit and heard their executive teams on the podiums, it’s clear that insurers know exactly what they’re supposed to be saying and what they’re supposed to be doing. It appears they just haven’t the foggiest idea of how to go about and actually design for today’s mobile-first consumer.

More realistically, they simply don’t care. It goes a lot deeper than the mobile app: Whether it’s awful customer service, a stubborn insistence on archaic enrollment and billing practices, or providing access to health care providers — health plans typically place the entire burden of grinding through lousy experience after lousy experience squarely on the shoulders of their members.

For Untied and the rest of the Big Health Insurers, there are two paths forward:

Path One: Admit Mistakes and Course Correct for Tomorrow

If the goal is better engagement and more satisfied enrollees, the best path forward is simple: Admit it — you don’t know what you’re doing, and you don’t know where to start. Just admit that when it comes to digital health, you’ve missed the mark, badly. Hire a design firm like MadPow or IDEO or Projekt202 or Involution Studios or Frog. Recruit some smart designers and quality assurance teams who don’t suck at their jobs — competent people who will build apps that don’t freeze upon opening. Shake some pennies out of your $3 billion innovation budget and buy some startups who understand how to improve the system because they exist outside of it.

Just try harder. Or, you know, just try at all.

Path Two: Ignore Us and Pay Little Consequence

By this point, most of us simply shrug off a miserable health insurance experience as an inevitability, like a delay at the airport.

People select their coverage based on cost and benefit structure, not on how easy a health plan is to use. That’s because the latter option doesn’t exist. Until CMS decides to leave CAHPS measures by the wayside and move to a more modern, accurate measurement of patient experience, payers won’t have to worry about competing against more agile, consumer-friendly competitors on customer loyalty — That’s just not how the insurance business works. Exhibit A: Oscar.

Consumers have come to expect that insurance just sucks, and as one reviewer wrote, “this app is just a further extension of that.” We’ll simply navigate around the shoddiness with a little help from our employer, or our doctor, or one of the many emerging companies who understand the tremendous opportunity in cultivating consumer loyalty. Insurance companies don’t care; health insurance is different from health care.

So, to the health plans building garbage apps: Keep pushing out hollow press releases to show shareholders you’re working on capturing those Medicaid bonus payments. Keep ramping up that innovation budget — maybe another billion can buy you a new patient testimonial for next year. Just one word of caution: Don’t wander onto the App Store reviews page — you won’t like what people are saying about you from the other side of the wall.

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