Most health plans have digital tools. Fewer have digital operations.
The distinction matters more than ever. Over the past decade, plans have invested heavily in technology—member portals, mobile apps, email platforms, SMS capabilities, and digital document delivery. The tools exist. But for many organizations, these capabilities operate as discrete systems rather than an integrated infrastructure. The result is a gap between what’s technically possible and what members actually experience.
Industry analysts are converging on a similar observation. Deloitte’s 2026 Health Care Outlook emphasizes that digital platforms and AI tools are essential levers for improving access, affordability, and engagement. EY’s health sector trends highlight that third-party vendor consolidation and the development of trusted ecosystems are becoming strategic priorities. HIMSS points to the shift from cloud adoption to true operational intelligence. The common thread: digitization was the first chapter, but digital maturity is what separates organizations that are genuinely transforming from those still assembling disconnected capabilities.
For health plan executives focused on member experience, this shift has immediate implications for how communication infrastructure is designed, operated, and measured.
What Digitization Accomplished—And Where It Plateaued
The digitization era delivered real value. Members gained online access to ID cards, EOBs, and plan documents. Email and SMS opened new channels for outreach. Self-service portals reduced call center volume for routine inquiries. Digital delivery options created cost savings on print and postage for members who opted in.
These were meaningful advances. But digitization, by itself, didn’t resolve the underlying complexity of member communication. It often added channels without consolidating them. Plans found themselves managing separate systems for print production, email delivery, SMS, web content, and preference management—each with its own data model, workflow, and reporting structure.
The member experience reflected this fragmentation. A member might receive a mailed EOB, an email notification about the same EOB, and a portal alert—all generated by different systems with slightly different timing and formatting. Preferences set in one channel didn’t always propagate to others. The communication felt digital, but it didn’t feel coordinated.
More fundamentally, digitization didn’t necessarily improve the speed or responsiveness of member communication. Many organizations found that their digital channels still operated on batch production cycles designed for print. The technology changed, but the operational architecture didn’t.
What Digital Maturity Actually Looks Like
Digital maturity isn’t about having more tools. It’s about how those tools work together—and how quickly the organization can act on insight.
In a mature communication operation, member data flows through a unified architecture rather than being replicated across disconnected systems. Content is managed centrally and rendered appropriately for each channel—print, email, SMS, web, mobile—without requiring separate production workflows for each. Preferences are honored consistently because they’re stored in one place and respected everywhere.
Speed changes fundamentally. When an insight surfaces—a care gap identified, a claim processed, a question answered—the communication response can happen in hours rather than days. Compliance review is embedded in the workflow rather than operating as a separate approval queue. Personalization scales because the infrastructure supports it natively, not as a bolt-on capability.
Perhaps most importantly, mature communication operations can measure what matters. When all channels operate within a unified platform, attribution becomes possible. Organizations can connect specific communication behaviors to downstream outcomes: How does outreach timing affect appointment completion? Which message variants drive engagement versus which get ignored? What’s the relationship between communication experience and retention?
This level of operational intelligence transforms member experience from an aspiration into a discipline—something that can be tested, optimized, and continuously improved.
The Integration Imperative
The path from digitization to maturity runs through integration. Not integration in the technical sense of connecting APIs—though that matters—but integration in the operational sense of unifying how communication is planned, produced, delivered, and measured.
For many plans, this means reconsidering vendor relationships that made sense when each channel was a separate project but create friction now that omnichannel experience is the expectation. The print vendor, the email platform, the SMS gateway, the content management system, the preference center—each was selected to solve a specific problem. Each probably does its job adequately. But the cumulative cost of managing, integrating, and reconciling across all of them may exceed the value of any individual capability.
Leading plans are approaching this as an architecture decision rather than a vendor procurement exercise. The question isn’t which point solution is best for email, SMS, or print. The question is: what unified platform can deliver a coordinated member experience across all channels while providing the operational speed and measurement capabilities that a modern engagement strategy requires?
This doesn’t mean every plan needs to rip and replace everything simultaneously. Thoughtful migration paths exist. But the strategic direction is clear: the communication infrastructure built channel by channel needs to evolve toward platforms designed for omnichannel operation from the ground up.
Member Experience as Operational Capability
The stakes for getting this right continue to rise. STAR ratings weigh member experience heavily. CAHPS scores reflect members’ perceptions of their interactions with the plan. Retention depends on whether members feel informed, supported, and valued. In a market where product differentiation is increasingly difficult, experience differentiation becomes essential.
But member experience can’t be achieved solely through strategy. It requires operational capability—the ability to execute personalized, timely, coordinated communication at scale. Plans that have invested in this capability are positioned to deliver on their experience vision. Those still operating with fragmented infrastructure face a persistent gap between what they intend and what members receive.
The digital tools are no longer the differentiator. Everyone has them. What separates leading plans is digital operations—the integrated infrastructure that turns tools into capability and capability into member experience.
The plans that recognized this early are already operating differently. For everyone else, 2026 is the year to close the gap.
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O’Neil Digital Solutions helps health plans bridge the gap between digital tools and digital operations. Our ONEsuite platform provides unified communication infrastructure—integrated data, omnichannel orchestration, embedded compliance, and real-time analytics—that enables member experience strategy to translate into member experience reality. To learn how leading plans are making this transition, visit oneildigitalsolutions.com.
