While all health plans seek to engage their members in meaningful ways, enrollees with insurance through Medicare Advantage and Medicaid can be particularly challenging, especially those in dual eligible special needs plans (D-SNPs). They are often difficult to contact, likely to receive care in expensive settings like the emergency department, and likely behind on preventive screenings.
While a member might read a mass text, listen to a phone message, or open a piece of mail, there is scant evidence that these actions move the needle on engagement. When contacted by mail to enroll in Medicaid, for example, the response rate was less than 2%. A health survey that included a raffle for multiple iPads brought a total response rate of 7%, with less than 4% fully completing the survey.
So, what does work? It’s the personal touch, especially when communications can solve multiple health or access challenges, including social determinants of health (SDOH) needs.
Let’s say, for example, a care coordinator spoke to Maria, a 61-year-old Spanish-speaking member, about the need for breast cancer and cervical cancer screenings. But Maria’s main issue was that her primary care provider (PCP) no longer accepted the insurance, and she had spent six months trying to find a new one to help manage her thyroid problems and renew her medications. Although not part of the responsibility of the health plan to close screening gaps, the care coordinator helped Maria find a new PCP, who also performed the cervical cancer screening on the initial visit. The coordinator then helped Maria find a convenient location for her breast cancer screening, closing Maria’s screening deficits and addressing her immediate care needs.
What is meaningful engagement anyway?
Health plans of all types suffer from lack of member engagement. Even among commercial plans, 37% of members had no engagement, according to 2021 metrics. Pre-Boomer and Baby Boomers, those born between 1928-1964, had the least engagement, at 44%.
These statistics underscore the overwhelming need for insurers to connect with members, which is why member engagement companies exist. But finding commonalities among member engagement strategies is an apple-to-oranges proposition, because each vendor defines engagement differently. Since few people respond to mass texts, voice messages, or emails, receipt of such communication should not be an engagement metric.
A better definition of engagement would be a member participating actively in his or her health, keeping up with required physician visits and recommended screenings while accessing care in lowest-cost health settings.
When employed correctly, technology can enhance the member experience and lead to higher engagement. However, most vendors believe that throwing technology at any problem is the answer, a proposition not supported by facts. For example, a 2023 study found that Medicaid and Exchange plan members in California receive as many as 20 automated messages a week from various vendors, contributing to information overload. Similarly, a 2022 study of more than 428,000 adults found that patients who received 10 or more text messages or 2 or more automated phone calls were significantly more likely to opt out of future outreach — a clear sign of message fatigue.
Programs that embrace human-to-human contact may cost more per member than automated reminders. However, the full benefits to the health plan through improved quality metrics such as CMS Star ratings or performance against HEDIS (Healthcare Effectiveness Data and Information Set) measures, not to mention increased member engagement, loyalty, and retention, can bring a far superior return on investment (ROI) versus technology-only schemes.
Hallmarks of a person-to-person program
Based on personal experience running engagement programs, these are the hallmarks of a successful program:
- Accessible communication – Members respond best when they feel the outreach is approachable and convenient, rather than impersonal or automated.
- Genuine connection – Conversations should feel authentic and tailored to the members’ needs, creating trust and opening the door to future interactions.
- Address priorities – Before tackling long-term health goals, effective programs recognize and respond to what matters most to members in the moment, such as an immediate SDOH need. Nearly 50% of families reported a diaper need in 2023, a 42% increase since 2010. A child can’t attend daycare without spare diapers, a huge problem among members struggling to make ends meet.
- Take care of the family, not just the member – Health needs often extend beyond the member, and programs that recognize the broader family context can make a greater impact, while improving member satisfaction.
- Local people, local resources – Programs that reflect local culture and resources naturally build stronger member relationships and increase follow-through.
Conclusion
Meaningful engagement in healthcare requires authentic, person-to-person connections. Members respond when care coordinators listen, solve SDOH and other urgent issues while guiding them to recommended screenings and/or care in the right setting. While technology can support these efforts, it cannot replace trust, empathy, and human problem-solving.
Programs that combine personal outreach with smart use of technology close more care gaps, improve quality measures, build member loyalty and improve retention. Ultimately, investing in the human touch delivers stronger health outcomes and better returns than tech-only approaches, ensuring members feel supported, valued and empowered to manage their care.
Photo: ipopba, Getty Images
Dan McDonald is co-founder and CEO of 86Borders, a human-first care coordination and member engagement company that helps health plan members overcome obstacles to care – especially among hard-to-reach populations.
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