Health insurer Web sites are still quite immature — as such, there is not much to draw consumers to them, nor is there much functionality to keep them using the Web sites. As greater financial and medical-outcome risk is shifted to consumers, more-extensive and personally tailored decision-making capabilities are required of health insurer Web sites.

• Gartner's 2008 and 2009 consumer survey revealed that general healthcare information sites (e.g., WebMD) dominate consumers' preference when performing health-related activities (such as getting health information and using disease management tools).
• In the same survey, consumers indicated a 32% increase in the preferred usage of health insurers' Web sites from 2001; however, this is still a comparatively low rate of adoption over an eight-year period.
• Except for the drug company Web site, the health insurer Web site was the least preferred Web site by consumers performing health-related activities.
• The total number of uninsured individuals in the U.S. grew by nearly 10 million.

• Adopt a multichannel strategy to govern communications with your consumers. Evaluate the purpose of each communication, and identify the most appropriate technology channel for that purpose.
• Evaluate communications channel options in terms of the sensitivity of the data and consumer preference. The biggest challenge is learning about consumer preferences.
• Routinely conduct competitive assessments of noninsurance Web portals to understand what consumers expect from "best of breed" sites, regardless of the industry. Also, recruit "early adopter" consumers to test-drive early-release Web portals.

Consumers increasingly are being urged to participate in — and even direct — the management of their own healthcare. To facilitate decision making, health insurers provide consumers with healthcare information through their Web sites. Despite continued investment in Web portal functionality for consumers, healthcare insurers are not getting much return on investment (ROI). The evidence for the lack of consumer adoption of the healthcare insurer Web site and ROI is compelling, and healthcare insurers have the ability to respond to it in intelligent ways to meet consumer expectations.

In December 2008 and January 2009, Gartner conducted multiple consumer studies. The first was a brief computer-aided telephone interview (CATI) omnibus survey (1,000 respondents in the U.S. and 988 respondents in the U.K.); it determined the size and demographic profile of the online population in these two countries to establish weighting targets for the subsequent online surveys and to establish full population incidence rates for a few key technologies. Results of the omnibus survey were weighted and projected to be representative of the overall household and individual adult populations in these countries.

The second study was a Web-based survey of 3,988 consumers aged 18 years and over in the U.S. (1,970 respondents) and in the U.K. (2,018 respondents) on consumer attitudes and behaviors related to retail payments, banking and investment services. The third study was a Web-based survey of 4,010 consumers aged 18 years and over in the U.S. (2,003 respondents) and in the U.K. (2,007 respondents) on consumer attitudes and behaviors related to media, retail, utilities, healthcare, insurance and government services. Results of both surveys were weighted and projected to be representative of the population of online adults aged 18 years and over and online households within these geographies.

This piece of research will highlight the results from the third survey, of consumers aged 18 years and over in the U.S. (2,003 respondents) on consumer attitudes and behaviors related to healthcare services. At times throughout the report, the data of this survey will be compared with data of prior consumer surveys that were conducted in 2001, 2002, 2003 and 2004. Of the 2,003 U.S. consumer respondents, 47% were female, and 53% were male. Figure 1 depicts the breakdown by age of respondents.

Health insurance coverage was also highlighted to determine the percentage of consumer respondents who currently have health insurance. Consumers were asked whether they had some form of health insurance coverage provided by or purchased through an employer or trade organization or directly from an insurance company. Seventy-two percent of consumer respondents indicated they have health insurance. This is a 16% decrease from the number of consumers who had health insurance in 2001 (see Table 1).

The number of U.S. consumers who do not have health insurance has consistently increased over the past eight years. Consequently, the total number of uninsured individuals in the U.S. grew by nearly 10 million. It is currently estimated that approximately 48 million U.S. individuals are uninsured. The current economic condition with massive layoffs has only exacerbated the situation. As the number of consumers with health insurance continues to decrease, healthcare insurers must adopt a mix of old and new communications channels to optimize and increase interactions with consumers.

The consumer survey listed three Web sites (healthcare insurer, physician and independent third-party Web sites) and asked, "Whose Web site would you most prefer to use to perform health-related Internet activities?" Table 2 shows the results.

There was a dramatic 32% increase in the preferred usage of the healthcare insurer Web site from 2001. However, the healthcare insurer Web site is still not the most preferred Web site that consumers will use for health-related Internet activities. Consumers trust physicians as a source of healthcare information, which reflects the 38% of consumer respondents who prefer to use their physicians' Web sites for health-related activities.

A lot has changed during the past seven years, particularly the types of information consumers seek on the Internet. In 2001, information that was sought through the Internet focused on finding information about a specific disease or condition and about a specific drug or treatment. This type of information was available through physician Web sites. In addition, in 2001, the survey revealed that the physician was rated the most trusted source for health information. Today, consumers are seeking more types of information (such as selecting a physician) and more-interactive capabilities (such as disease management tools and medical advice) from the Internet. Healthcare insurers continue to invest in these areas, which are leading to the increase in use by consumers. However, these investments have not been enough to overcome consumer preferences for using alternative Web sites for health-related activities.

The data is more revealing when consumers were given a broader list of Web sites to select from and specific health-related activities were provided. Consumers were asked, "The list below contains several health-related activities you might do on the Internet. If you were to do each of the following activities on the Internet, which one of the following types of Web sites would you most prefer to use to do that type of activity?" Figure 2 shows the results.

The most compelling data is related to the percentage of consumers who would not do the health-related activities described. These figures are highlighted in yellow under the "would not do this activity online" column, and they include:

• 64% would not participate in health-related chat rooms
• 54% would not participate in disease management support groups
• 51% would not read patient testimonials
• 48% would not get advice or support for people serving as caregivers
• 46% would not use prescription reminder features

These health-related activities involve clinical and medical information. Consumers do not want their medical data available on Web sites — even when there is a high degree of security. Health insurers must be aware of the relatively high degree of concern consumers have in using Web-based tools for healthcare-related activities and should therefore start their consumer contacts by focusing on less-sensitive information. Until consumers build up a higher degree of trust, health insurers should consider channels other than online communications for highly sensitive information, such as the telephone and postal mail.

General healthcare information sites dominate in terms of consumers getting information about diseases, conditions, medicines, treatments, healthcare products, wellness, fitness or lifestyle (see the yellow boxes in the "general healthcare information site" column in Figure 2). Except the health-related activities consumers were not willing to perform online, general healthcare information sites ranked high on all of the other health-related activities. If consumers are using commercial Web sites for information access, then it is simpler to stay on the Web site to perform other health-related activities, such as entering a chat room and using medication reminders and other health management tools. It is true that most consumers do not view their insurers as partners in healthcare but rather administrators of insurance and are less likely to turn to insurers to support their healthcare needs. Consumers are hesitant to provide their insurers with sensitive information that might someday be used against them in future underwriting.

Using tools to help find or choose a doctor was the only health-related activity that consumers preferred to use the healthcare insurer Web site over any other Web site. The healthcare insurer Web site had the second-lowest percentages above only the lowest-preferred Web site, the drug company Web site. Consumers need information to help them manage their choices of health benefit plans, provider networks, treatment decisions and self-care. How to provide this information is one of the biggest conundrums facing health insurers. Virtually all health insurers have a consumer view for information on their corporate Web sites. The functionality typically is administrative — to order an enrollment card, check on a claims status or access clinical content. The functionality is not robust, and based on the consumer survey results, these Web sites are not being used to support healthcare information requirements.

Consumers have preferences about how they wish to receive information. Often, the way information is presented and the channel through which information is communicated are determining factors in improving the participation of consumers in healthcare management activities. This is particularly important when behavior change is the objective. In almost all cases where communication is important, health insurers should deploy a multichannel strategy to cover all the bases.

• Adopt a multichannel strategy to govern communications with your consumers. Don't rely on the Internet as the only means to communicate with consumers, but have it integrated tightly with offline channels like the call center. Evaluate the purpose of each communication, and identify the most appropriate technology channel for that purpose (for example, placing a critical public health message only on your Web site may be ineffective if your membership includes low-income or elderly people). Don't ignore traditional communications channels such as the telephone and postal mail.
• Evaluate communications channel options in terms of the sensitivity of the data and consumer preference. Consumers are reticent about providing sensitive and personal information on health insurer Web sites. The biggest challenge is learning about consumer preferences. If you have limited knowledge of your members, invest in market research and business intelligence to understand communications preferences, along with other attributes, to design effective communications programs.
• Routinely conduct competitive assessments of noninsurance Web portals to understand what consumers expect from best-of-breed sites, regardless of the industry. Also, recruit early-adopter consumers to test-drive early-release Web portals.

"North American Life Insurers Deliver Essential Portal Functionality and Continue to Introduce Innovative Capabilities to Their Agents"