Smarter member engagement: What health plans must do next

Summary

• Member engagement is a key driver of cost savings and revenue for health insurers. Actively engaged members lead to medical cost savings through preventive care and better use of point solutions. It also results in operational cost savings by reducing costly member service calls. For Medicare plans, high engagement improves Star Ratings, directly impacting reimbursement. Prioritizing engagement helps health insurers build a healthier member population while improving their bottom line.
• Health plans that focus on getting the basics right—providing seamless transactions and convenient digital experiences—effectively close trust gaps. Persistent trust gaps threaten member loyalty, but health plans embracing unified data, predictive analytics, and personalized communication achieve dramatically higher engagement rates, improved health action completion, and greater satisfaction.
• Omnichannel strategies, continuous support, and intelligent incentives amplify outcomes: Consistent member messaging across digital and traditional channels reduces operational costs, while proactive support and tailored incentive programs drive lasting behavior change, strengthen loyalty, and enable ongoing measurement for optimized business and clinical results.

Member engagement isn’t just a satisfaction play — it’s a retention and revenue imperative. Health plans are losing member trust, underutilizing technology, and failing to meet the expectations of today’s digitally fluent members. But organizations that build personalizedand continuous engagement programs are see higher interaction rates and significant improvements in cost control, care compliance, and member satisfaction.

The numbers tell a stark story. Only 25% of members view their health plan as a trusted partner. With acquisition costs ranging from $75-$200 for commercial members and $400-$800 for Medicare members, retention has become paramount for financial sustainability.

Organizations that master member engagement programs see dramatic results. They’re turning episodic touchpoints into high-impact digital health journeys that drive real outcomes.

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Why Member Engagement Matters More Than Ever

The trust gap between health plans and members has reached critical levels. Recent research shows that 60% of privately insured members received no guidance during the COVID-19 pandemic, with 48% reporting their health plan showed no concern for their health.

This disconnect creates massive financial risk. High churn rates combined with steep acquisition costs create a retention imperative that can’t be ignored. Medicare plans face particularly acute pressure, with member acquisition costs reaching $400-$800 per member.

Consumer expectations have shifted dramatically. Members now expect the same seamless, personalized experiences they receive from retail and tech companies. They want instant access to information, proactive support, and technology that actually makes their healthcare simpler.

Engagement is the key to bridging this gap. By offering proactive support and technology that simplifies their healthcare journey, health plans can meet these new expectations and build lasting trust. The organizations that succeed in this are building deeper relationships, reducing administrative costs, and creating a competitive advantage that drives sustainable growth.

Build a Member-Centric Culture of Trust

Trust forms the foundation of every successful member relationship. Health plans must treat engagement as a full-journey commitment, not a series of disconnected touchpoints.

• Embed empathy into every interaction. The goal is to create a seamless careexperience that anticipates member needs. This means using AI to analyze a member’s history, predict their challenges, and offer tailored solutions based on their needs. The most successful plans implement a combination of human expertise and AI-driven insights working together to engage members with genuine care and connection.
• Focus on building intuitive digital experiences. By offering a digital experience where members can easily find the information they need about their coverage, you can dramatically increase satisfaction. Clear, jargon-free communication builds confidence and reduces the confusion that often leads to frustration.
• Enable shared decision-making. Empower members to participate actively in their healthcare choices. This means providing decision support tools, clear cost comparisons, and easy access to quality information about providers and treatments.

Accenture’s April 2024 research highlights that trust is a significant driver of engagement and loyalty in healthcare. Their study found that patients are:

• 3x more trusting when the insurer gives consistent and accurate information,
• +50% cite a poor experience as the main reason for switching insurers,
• Poor experiences with trust directly escalate switching rates and disengagement.

Use Data & AI to Personalize the Member Experience

The shift from broad segmentation to true 1:1 personalization represents the biggest opportunity in member engagement today. Health plans that leverage unified data and AI-powered insights are seeing remarkable results.

• Create a unified member view. Combine claims data, clinical information, digital interactions, and social determinants of health data into a single, actionable profile. This enables you to understand each member’s unique needs, preferences, and barriers to care.
• Deploy AI to predict next-best actions. Machine learning can identify the right intervention at the right time — whether that’s a medication refill reminder, preventive care scheduling, or care gap closure outreach. Organizations using AI-powered personalization report engagement rates 6x higher than industry averages and 54% increases in health action completion rates.
• Segment by socioeconomic factors. Move beyond demographics to understand social determinants that impact health behaviors. Target interventions based on factors like food insecurity, transportation barriers, or broadband access. This level of personalization drives meaningful behavior change.

Plans that implement true personalization see reduced call center volume, higher digital adoption, and improved member satisfaction scores across all demographic segments.

Design an Omnichannel Member Engagement Strategy

Members want to engage with their health plan across multiple touchpoints, but they expect consistency and context preservation across every channel.

• Meet members where they are. Deploy coordinated outreach across email, SMS, mobile apps, member portals, and phone channels. Research on omnichannel member experiences shows that consistent messaging across touchpoints dramatically improves engagement and reduces member confusion.
• Maintain persistent context. When a member starts a conversation via chat and switches to phone, the context should follow. This seamless experience reduces member frustration and improves resolution times.
• Prioritize digital self-service tools. Members want 24/7 access to ID cards, claims status, provider lookup, and benefits information. Highmark Health’s partnership with League, for example, created a unified digital front door that simplified member access and reduced support calls by enabling self-service for routine requests.
• Ensure accessibility and health literacy. Design communications using plain language, visual aids, and formats that work for members with varying levels of health literacy and digital comfort.

The most successful omnichannel strategies reduce administrative costs while improving member satisfaction. Plans report significant reductions in call center volume when members can easily access information and complete tasks digitally.

Incentivize Healthy Behaviors That Close Care Gaps

Well-designed incentive programs drive meaningful behavior change while aligning member actions with plan quality goals.

• Align rewards with care outcomes. Offer incentives for health risk assessments, preventive screenings, vaccinations, and chronic disease management activities. Research shows that 91% of members are interested in incentive programs, creating significant opportunities for engagement.
• Use gamification thoughtfully. Points, badges, and leaderboards can make healthy behaviors more engaging when designed properly. The key is connecting these elements to meaningful health outcomes rather than just activity completion.
• Tie incentives to quality metrics. Align member rewards with CMS Star ratings and quality measures that matter to your organization. This creates win-win scenarios where member engagement directly supports plan performance.
• Make participation simple. Complex enrollment processes kill participation. One-click signup, clear program rules, and immediate reward processing drive higher engagement rates.

Plans that implement effective incentive programs see significant improvements in preventive care utilization and member satisfaction. The investment in rewards typically pays for itself through improved quality scores and reduced medical costs.  In fact, our data indicates the potential: 14x higher value creation from a digitally engaged member ($800+) vs. a non-digitally engaged member ($55/member).

Embed Continuous Support Into the Member Journey

Moving from episodic contact to ongoing care partnership transforms member relationships and health outcomes.

• Deliver proactive outreach. Use data to identify members who need preventive care, medication refills, or care coordination support. Timely, personalized outreach prevents small issues from becoming costly medical events.
• Address social needs alongside clinical needs. Members facing food insecurity, transportation barriers, or housing instability need support that goes beyond medical care. Partner with community organizations to provide resources that address these social determinants of health.
• Provide ongoing education. Regular health tips, condition-specific guidance, and wellness coaching help members make informed decisions about their care. The key is delivering relevant information at moments when members are most receptive.

Continuous support programs create lasting relationships that drive loyalty and improve health outcomes. Members who feel supported throughout their health journey are significantly more likely to renew coverage and recommend your plan to others.

Use Feedback Loops to Measure, Iterate, Improve

Successful engagement strategies require continuous measurement and optimization based on member feedback and outcome data.

• Collect feedback continuously. Deploy micro-surveys, Net Promoter Score assessments, and digital analytics to understand what’s working and what isn’t. Real-time feedback enables rapid course corrections.
• A/B test everything. Test message content, delivery timing, channel preferences, and reward structures to optimize engagement. Small improvements in open rates or click-through rates compound over time.
• Track meaningful KPIs. Monitor engagement rates, satisfaction scores, health outcomes, and operational efficiency metrics. Connect member engagement activities to business outcomes like retention and medical cost trends.
• Create rapid-cycle improvement. Implement a test-learn-refine-redeploy cycle that enables quick optimization. The fastest-improving plans update their engagement strategies monthly based on performance data.

Organizations that prioritize measurement and optimization see steady improvements in all engagement metrics. They build competitive advantages by continuously refining their approach based on real member feedback.

What Leading Health Plans Are Doing Right

The most successful member engagement programs share common characteristics that drive results.

For example, Highmark Health partnered with League to create a unified digital health experience that simplifies member access to care and benefits. Their integrated approach connects insurance, providers, pharmacy, and social services through a single platform.

These organizations succeed because they focus on simplicity, trust, personalization, and smart channel strategy. They treat engagement as a strategic priority rather than a tactical activity.

The lessons are clear: start with member needs, leverage technology thoughtfully, and build genuine relationships that extend beyond transactional interactions.

Ready to Power Smarter Member Engagement?

Member engagement strategies that drive real results require the right technology foundation, behavioral insights, and continuous optimization. The health plans that master these elements will build competitive advantages that compound over time.

League helps health plans deliver personalized, connected, and cost-efficient digital health experiences that boost engagement and retention. Our platform enables the strategies outlined above through AI-powered personalization, unified member experiences, and continuous optimization capabilities.

Explore our member engagement solutions to see how we can help transform your member relationships and drive sustainable growth.

Frequently asked questions

What is the ROI of member engagement strategies for health plans?

Member engagement strategies deliver measurable ROI through improved medical cost savings and reduced operational costs. Digital self-service tools reduce live customer support volume by 20-40%. AI-powered personalization increases health action completion by 54%, directly impacting quality scores and medical cost management.

How do health plans measure member engagement success?

Successful measurement requires tracking both engagement metrics and business outcomes. Key performance indicators include digital platform usage rates, program participation levels, Net Promoter Scores, member satisfaction scores, and retention rates. Leading plans also monitor health outcomes like preventive care utilization, medication adherence, and care gap closure rates.

What technology infrastructure do health plans need for effective member engagement?

Effective member engagement requires AI-powered analytics engines predict next-best actions, while omnichannel communication platforms ensure consistent messaging across touchpoints. Mobile apps and member portals should offer self-service capabilities and real-time access to benefits information.

How can health plans personalize member experiences without violating privacy?

Personalization relies on using existing health plan data (claims, enrollment, digital interactions) to create relevant experiences while maintaining HIPAA compliance. Members should understand how their data improves their experience and have opt-in choices for different types of engagement. Transparency about data use builds trust and actually increases member willingness to share information for better care.

What are the most effective member incentive programs for health plans?

The most effective programs align member rewards with health outcomes and plan quality goals. Successful incentives include premium credits, gift cards, or health savings account contributions for completing wellness activities, preventive screenings, and chronic disease management programs. Programs should be simple to understand and participate in, with immediate reward processing to maintain engagement momentum.