From patients to shoppers: How consumerism is reshaping health care

Consumers who book travel in seconds, compare products instantly, and manage their finances from their phones now expect the same from health care.^1,2 Speed, clarity, and choice are no longer differentiators—they’re baseline expectations.² And that shift is already reshaping how people engage with health care, according to multiple industry analyses.^1,2

The implication for consultants and brokers is straightforward: Health plans built for a passive patient model are becoming out of step with how people want to navigate care today.¹

The consumer shift has already happened

Across industries like retail and banking, digital experiences have trained consumers to expect:

• Upfront information
• Simple comparisons
• Personalized recommendations
• Confidence before making a decision⁴

Health care is now being measured against that same standard.²

PwC describes the system as entering a “consumer-first era,” where patient expectations for choice, personalization, and digital engagement increasingly shape care delivery and plan design.¹

In parallel, McKinsey & Company notes “consumers are more motivated than ever to choose health care options that offer a better experience, higher quality of care, and greater value. As the shift to consumerism continues, organizations that embrace it most successfully will emerge as leaders of the health care ecosystem.” ²

That expectation is not theoretical. It’s behavioral.

• Health care consumers of all ages have become accustomed to using digital products and services and are eager to see them incorporated into their health care²
• Consumers want tools that provide a “single source of truth” about projected costs before they receive care.² This may:
  • Simplify the decision-making process
  • Ensure transparency, reduce downstream frustration, and
  • Increase the likelihood that patients will receive the care they need²
• Sandwich-generation populations balancing multiple care responsibilities are using or interested in navigation tools that recommend the right provider or care setting¹

Increasingly, consumers are no longer approaching health care as passive recipients. They’re approaching it—when given the opportunity—as decision-makers.

What’s driving the shift?

Sustained cost burden

The move toward consumerism isn’t just about expectations—it’s being accelerated by economics.³

Employers are facing some of the highest cost increases in over a decade:

• Business Group on Health reports projected health care cost trend increases for 2026 will reach a median of 9%, offset to 7.6% with plan design changes, continuing a multiyear trend of elevated growth³
• On a compounded basis, costs in 2026 are expected to be more than 60% higher than in 2017³

Rising costs are pushing employers to rethink not just how much they spend on health care, but how their plans actually function for employees who use them.^3,5

Employer pressure to rethink strategy

Traditional levers—like across-the-board cost shifting—are reaching their limits.^3,5

According to WTW:

• One in three employers is considering significant changes to their health programs in the next three years⁵
• Employers are moving away from absorbing costs, but also avoiding aggressive
  cost shifting due to its impact on employee experience and retention⁵
• Instead, they are prioritizing alternative plan designs, improved navigation, and more effective steerage or behavioral requirements⁵

Nearly half of employers are planning or considering adopting plan designs that emphasize:⁵

• Price transparency
• Digital engagement
• Navigation support
• High-performance provider networks

That’s a meaningful shift from managing cost “after the fact” to influencing decisions before care occurs.^3,5

Rising expectations for digital, personalized experiences

PwC projects a future health system that is:

• Preventive
• Personalized at scale
• Digital-first
• Accessible anywhere¹

Consumers are not just open to that future—they’re expecting it.¹ And that expectation is shaping how they evaluate health plans today.

Why traditional health plans aren’t built for this

Despite these shifts, traditional health plans still operate on a model designed for a different kind of consumer—one who:

• Relies on provider direction
• Has limited visibility into cost
• Makes decisions after care is initiated

Challenges with this traditional health plan structure have become more apparent and don’t support a consumer-centric approach:

Cost-sharing does not equal consumerism

Raising deductibles or increasing copays shifts more financial responsibility to members, but it doesn’t equip them to make informed decisions about care, value, and
cost options^{7, 8} —while the ability to make these choices signals consumerism.

Without clear, actionable information, higher cost-sharing can lead to:

• Delayed care^{2, 7}
• Confusion about out-of-pocket costs⁷
• A frustrating health care experience⁷

Consumerism requires informed choice, not just financial accountability.

Transparency alone has not delivered

Progress has been made in making price data available. But usability remains a challenge.^6,9

Research from Kaiser Family Foundation highlights persistent issues with how pricing information is structured and interpreted.⁶

“The vast troves of price data required under federal transparency rules include misleading and unlikely prices, inconsistencies, and other oddities that complicate efforts to use the data for their intended purposes.”⁶

The government-mandated price information is rarely used by consumers. One analysis found that only about 2% of eligible members actually used price transparency tools, and many weren’t aware of the tools.⁸

The health plan challenge

Even when transparency exists, it’s often disconnected from how traditional health plans are structured. Members may be able to find pricing information, but it rarely translates into clear, immediate choices at the point of care.^6,8,9

By contrast, the Surest health plan integrates pricing directly into the member experience, embedding cost and value signals into the decision itself, rather than requiring members to interpret them separately.

What true health care consumerism requires

If consumer behavior is the goal, industry experts assert the model needs a change.^2,5 Across research and emerging plan designs, a consistent set of requirements is taking shape:

1. Upfront, understandable pricing
   Consumers need to know what they will pay before they receive care—not after.^2,6
2. Cost and value together
   Price alone is not a decision tool. Consumers need context around outcomes, efficiency, and provider performance.²
3. A simple, guided experience
   Navigation, recommendations, and digital tools need to reduce friction—not add to it.^1,2

The opportunity for employers

For employers, this shift creates a different path forward.

Rather than relying primarily on:

• Cost shifting
• Administrative controls
• Broad plan changes
• Point solutions

There is an opportunity to:

• Enable better decision-making
• Guide members toward high-value care
• Improve experience while helping to address cost trend

The Surest health plan aligns with these priorities. The app/website displays actual copays, not estimates, in advance of care, through a digital-first design that works like a consumer shopping experience. The interface is intended to help members make informed care decisions and may provide opportunities to save money.

Surest Care Ratings evaluate provider services based on past effectiveness and cost-efficiency performance. Higher Care Ratings — and lower copays—are assigned to higher-value providers. Copays vary by provider (practitioner or location) and condition/procedure.

Members who shop and obtain quotes* prior to care are 57% more likely to choose providers evaluated as high-value¹⁰—an example of how consumer-centered design can influence behavior at the point of decision.

Members who shopped for more than half of their care had 27% lower costs than members who shopped less often.¹¹

The Surest plan’s adoption suggests growing demand for this type of experience. After nearly a decade in market, Surest now serves 1.3+ million members¹² with 88% member retention YOY¹³, reflecting sustained interest in a simpler, more navigable health plan model.

This is the first of a series of articles on consumerism. Stay tuned for the next installment when we dig deeper into price transparency in health care.

Ready for a change? See how the Surest plan is leading the way.

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Check out other blog posts.

¹PwC, US Healthcare Consumer Insights Survey (2025).

²McKinsey & Company, Capturing Growth with a Consumer-Centric Healthcare Experience (2024).

³Business Group on Health, 2025–2026 Employer Health Care Strategy Surveys.

⁴Mercer, National Survey of Employer-Sponsored Health Plans/Health Trends 2026.

⁵WTW, Benefits Trends Survey (2025).

⁶Kaiser Family Foundation, Challenges with Effective Price Transparency Analyses.

⁷Kaiser Family Foundation, Survey of Consumer Experiences with Health Insurance (2023)

⁸JAMA Network, Price Transparency in Health Care Has Been Disappointing.

⁹KFF Health News, Hospital Prices Must Now Be Transparent. For Many Consumers, They’re Still Anyone’s Guess.

¹⁰Surest 2024 book-of-business YTD.

¹¹Surest 2025 member-level shopping and total cost of care analysis.

¹²Surest BOB internal analyses as of Jan 2026.

¹³2026 Surest book-of-business enrollment analysis.

* Complete quotes defined by matching on both services and provider (practitioner or location)