Member engagement: a “must-have” for health plans today

The turbulent market dynamics reshaping the healthcare industry open new opportunities for health plans. Long pigeon-holed as coordinators of provider networks and administrators of claims processing, health plans are morphing into consumer-focused entities.

As the pace of change picks up speed, new models of provider reimbursement, care delivery and system access are taking shape. These shifts on the provider side represent good news for millions of Americans that need better support from the healthcare system, especially since many of those with chronic disease aren’t currently getting recommended care.

Coupled with the fact that most patients do not adhere to their medication and treatment regimens or recommended lifestyle and health behavior changes, and it’s easy to spot some of the challenges that lie ahead.

Despite the growth of Healthcare Consumerism, many individuals can’t easily navigate the new landscape on their own. Here’s where health insurance plans can really help.

Member health improvement 

Health plans have ready access to claims data and other relevant medical information plus a direct line to their members for targeted messaging and clinical interventions. And privacy is not an issue in the same vein as it is for employers trying to deliver health improvement interventions with their workforce.

In this new environment, health plans have a significant opportunity to help drive behavior change, reduce risk, and produce positive health outcomes for their members.

Most plans already provide online member portals, and many have begun to focus on enhancing them to improve their value and impact. This can create new efficiencies and help direct members to appropriate resources and more effective care.

Consumer power

After a decade of slow growth, Healthcare Consumerism has begun to take hold. Participation in high deductible health plans (HDHPs) is at a record level with 23% of all those with employer-sponsored insurance now enrolled in an HDHP. Other emerging factors such as price comparison tools, quality ratings, and retail health alternatives will continue to put more power into the hands of consumers.

Health plans need to respond to this trend and design strategic solutions or partner with best-in-class service providers for their member populations. This puts a greater importance on member engagement outreach and interactions that are positive, relevant and trust-building.

Member engagement

Member engagement is new territory for most health plans, and with Medicaid expansion, the influx of age-in Medicare members and the newly insured, it is increasingly important to provide consumer-oriented communications interactions, and interventions.

As Star Ratings and other quality metrics rise in prominence health plans will find themselves striving for excellence in consumer experience though outstanding member engagement.

Here are some thoughts on areas that need to be addressed in developing an effective member engagement strategy:

1. Understand how consumers think and operate in their own health and healthcare world.
Health plans need to conduct a thorough and honest review of the outreach that goes to members, along with any and all on-going interactions; the member services function, and all related areas. It’s essential to understand the communications stream that reaches members from the multiple source points.  Additionally, areas such as behavioral economics can help uncover insights about the consumer decision process and can be a good guide for creating a messaging strategy to members.

2. Adopt a member-focused marketing system designed around their concerns and interests.
Using a consumer marketing mindset in establishing the communications strategy and identifying measurable actions, health plans need to become be valued partners. Strategic messaging needs to be incorporated into all member touch points and areas of outreach. Too many health plans still rely on dated letters from their Chief Medical Officer as the introduction to any number of health enhancement initiatives. Scrap them and find ways to make the content relevant and credible to the recipient.

3. Strategically align and integrate all health improvement service offerings.
Most health plans can check all the boxes relative to their service offerings in wellness, care management, disease management, pharmacy coordination, and an array of other health improvement services – but bringing them all together in a seamless solution is what members truly want and need. And with an overlay of measurement and feedback, plans can help ensure members receive what is most meaningful to them.

These are a few ways health plans can think about advancing their capabilities and become more member-focused and engagement-oriented. There’s a lot they can do to actually change member behavior, lower risk and contribute to better overall health outcomes – which should also produce stronger margins and returns.

In a consumer health plan market, the winners that emerge will likely be those that excel in member engagement. Healthx now offers three levels of engagement strategy support to help our customers achieve greater success. For more information please contact Frank Hone at