While all health plans seek to engage their members in a meaningful way, enrollees with insurance through Medicare Advantage and Medicaid can be particularly challenging, especially those in dual-eligible special needs plans (D-SNP). They are often difficult to reach, are likely to receive care in expensive settings such as the emergency department, and are likely behind on preventive screenings.
While a member may read a mass text, listen to a phone message, or open an email, there is little evidence that these actions drive engagement. When contacted by mail to enroll in Medicaid, for example, the response rate was less than 2%. A health survey that included a drawing of several iPads yielded a total response rate of 7%, with less than 4% completing the survey completely.
So what works? It’s the personal touch, especially when communications can solve multiple health or access challenges, including social determinants of health (SDOH) needs.
Say, for example, a care coordinator spoke with Maria, a 61-year-old Spanish-speaking member, about the need for breast cancer and cervical cancer screening. But Maria’s main problem was that her primary care provider (PCP) no longer accepted insurance and she had spent six months trying to find a new one to help her manage her thyroid problems and renew her medications. Although it is not the health plan’s responsibility to close screening gaps, the care coordinator helped Maria find a new PCP, who also performed cervical cancer screening at the initial visit. The coordinator then helped Maria find a convenient location for her breast cancer screening, closing Maria’s screening gaps and addressing her immediate care needs.
What is a meaningful commitment anyway?
Health plans of all types suffer from a lack of member participation. Even among commercial plans, 37% of members had no commitment, according to 2021 metrics. Pre-Boomers and Baby Boomers, those born between 1928 and 1964, had the lowest participation, at 44%.
These statistics underscore the overwhelming need for insurers to connect with members, which is why member engagement companies exist. But finding common ground among member engagement strategies is an apples-to-orange proposition, because each provider defines engagement differently. Since few people respond to text messages, voicemails, or mass emails, receipt of such communications should not be an engagement metric.
A better definition of engagement would be a member actively participating in their health, keeping up with required medical visits and recommended exams while accessing care in lower-cost healthcare settings.
When used correctly, technology can improve the member experience and drive greater engagement. However, most vendors believe that throwing technology at any problem is the answer, a proposition that is not supported by facts. For example, a 2023 study found that members of Medicaid and Exchange plans in California receive up to 20 automated messages per week from various providers, 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 robocalls were significantly more likely to opt out of future communications, a clear sign of message fatigue.
Programs that embrace person-to-person 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 deliver far superior return on investment (ROI) compared to technology-only schemes.
Characteristics of a person-to-person program
Based on personal experience running engagement programs, these are the characteristics of a successful program:
- Accessible communication – Members respond better when they feel that communication is accessible and convenient, rather than impersonal or automated.
- Genuine connection – Conversations should seem authentic and tailored to members’ needs, building trust and opening the door to future interactions.
- Address priorities – Before addressing long-term health goals, effective programs recognize and respond to what matters most to members right now, such as an immediate SDOH need. Nearly 50% of families reported needing diapers in 2023, a 42% increase from 2010. A child cannot attend daycare without spare diapers, a big problem among members struggling to make ends meet.
- Caring for the family, not just the member – Health needs often extend beyond the member, and programs that recognize the broader family context can have greater impact while improving member satisfaction.
- Local people, local resources – Programs that reflect local culture and resources naturally build stronger relationships with members and increase following.
Conclusion
Meaningful engagement in healthcare requires authentic person-to-person connections. Members respond when care coordinators listen, resolve SDOH and other urgent issues while guiding them toward recommended screenings and/or care in the appropriate 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 technology-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 barriers to care, especially among hard-to-reach populations.
This post appears via MedCity Influencers program. Anyone can post their perspective on business and healthcare innovation to MedCity News through MedCity Influencers. Click here to find out how.