Reduce costs. Rebuild trust. Deliver better member outcomes.
A new approach to customer experience for US health insurance companies focused on what actually drives financial performance.
Download Healthcare Member Experience Report 2026
Download the full reportHealthcare Member Experience Report 2026: The reality facing healthcare payers
The model isn’t working.
Despite significant transformation efforts, many organizations are seeing worsening outcomes across both cost and experience.
At the heart of this challenge lies an inability to demonstrate how customer experience translates into commercial value.
A critical turning point for the industry
Our latest research shows a sustained decline:
- Falling satisfaction across the sector
- Sharp drops in trust and perceived value
- Increasing difficulty resolving member issues
Why current approaches fall short
Across the payer ecosystem, the same issues persist:
- Fragmented member journeys and siloed teams
- Legacy systems and disconnected data
- Reactive claims and error correction
- Complex, unclear member communications
- Friction between payers and providers
These challenges are often addressed in isolation, leading to more cost, more complexity, and limited impact.
A smarter way to improve performance
The report introduces a targeted approach built around Strategic Optimization Points (SOPs):
- The specific moments where experience breaks down
- The points where cost is disproportionately concentrated
By focusing here, organizations can deliver fast, measurable improvements without large-scale transformation programs.
What you’ll get from this report
1
Insight
- Why CX programs fail to deliver ROI
- What’s really driving declining trust and satisfaction
- Where cost is being created across the member journey
2
Practical guidance
- How to identify high-impact SOPs
- How to connect operational data to experience outcomes
- Where to focus first for the fastest results
3
Actionable blueprint
- A step-by-step approach to improving CX and reducing cost simultaneously
- Real examples of operational and experience transformation
Healthcare payers
Our mission is to assist organizations to transform and innovate in order to effectively compete in tomorrow’s fast changing and dynamic healthcare industry.
Who this is for
This report is designed for leaders across:
- Healthcare payers and healthcare insurance companies
- Customer experience and digital transformation teams
- Operations, service, and contact center leaders
- Strategy, growth, and cost optimization functions
Dive into our thinking:
Start connecting customer experience to cost, performance, and growth.
Download the full reportAbout KPMG Healthcare
KPMG supports healthcare organizations globally to transform operations, improve member and provider experiences, and deliver sustainable performance across increasingly complex systems.
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