A personal touch drives member engagement more than pure technology

While all health plans strive to engage members in meaningful ways, it can be particularly challenging for enrollees purchasing coverage through Medicare Advantage and Medicaid, especially those enrolled in a dually qualified special needs plan (D-SNP). They are often difficult to reach, may receive care in expensive settings such as emergency rooms, and may fall behind on preventive screenings.

While members may read large amounts of text, listen to phone messages, or open an email, there is little evidence that these actions increase engagement. For example, when contacted by mail to enroll in Medicaid, the response rate was less than 2%. A health survey that included a multiple-iPad raffle had an overall response rate of 7%, with less than 4% fully completing the survey.

So, what works? It's a personal touch, especially when communication can address multiple health or access challenges, including social determinants of health (SDOH) needs.

For example, a care coordinator talked to Maria, a 61-year-old Spanish-speaking member, about the need for breast and cervical cancer screening. But Maria's main problem was that her primary care provider (PCP) no longer accepted insurance, and she spent six months trying to find new coverage to help manage her thyroid issues and renew her medications. Although closing the screening gap is not part of the health plan's responsibility, 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 breast cancer screening site that filled Maria's screening gaps and addressed her urgent care needs.

What exactly is meaningful participation?

Health plans of all types suffer from a lack of member engagement. Even within the business plan, 37% of members are not participating, according to 2021 metrics. Baby boomers and baby boomers born between 1928 and 1964 had the lowest participation rate at 44%.

These statistics underscore the critical need for insurance companies to connect with their members, which is why member engagement companies exist. But finding commonalities among member engagement strategies is an apples-to-oranges proposition, as each provider defines engagement differently. Since few people respond to bulk text messages, voice messages, or emails, receipt of such communications should not be used as an indicator of engagement.

A better definition of engagement is that members actively participate in their own health, complying with prescribed physician visits and recommended screenings, while receiving care in the lowest-cost health environment.

When used correctly, technology can enhance the member experience and increase engagement. However, most vendors believe that using technology to solve any problem is the answer, but this assertion is not supported by facts. For example, a 2023 study found that members of Medicaid and Exchange plans in California received as many as 20 automated messages per week from different providers, causing information overload. Likewise, 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 more likely to opt out of future outreach — a clear sign of message fatigue.

Plans that include person-to-person contact may cost more per member than automated reminders. However, delivering the full benefits to health plans through improved quality metrics such as CMS star ratings or performance on HEDIS (Healthcare Effectiveness Data and Information Set) measures, not to mention increased member engagement, loyalty and retention, can deliver a much higher return on investment (ROI) than purely technology-based plans.

Characteristics of person-to-person programs

Based on personal experience running engagement programs, here are the hallmarks of a successful program:

1. Barrier-free communication – Members respond best when they find outreach activities approachable and convenient, rather than impersonal or automated.
2. Real connection – Conversations should feel authentic and tailored to members’ needs, building trust and opening the door to future interactions.
3. Addressing priorities – Effective programs identify and respond to what matters most to members today, such as immediate SDOH needs, before long-term health goals are achieved. Nearly 50% of households report needing diapers by 2023, a number that has increased 42% since 2010. Without spare diapers, children can't go to day care, which is a big problem for families struggling to make ends meet.
4. Take care of your family, not just your members – Health needs often extend beyond membership, and programs that recognize the broader family context can have a greater impact while improving member satisfaction.
5. local people, local resources – Programs that reflect local culture and resources naturally build stronger membership relationships and increase follow-through.

in conclusion

Meaningful healthcare engagement requires real human connections. As the Care Coordinator listens, members respond to address SDOH and other urgent issues while guiding them to recommended screening and/or care in the correct setting. While technology can support these efforts, it cannot replace trust, empathy, and human problem-solving abilities.

Programs that combine personal service with the use of smart technology can close more gaps in care, improve quality measures, build member loyalty and increase retention. Ultimately, investing in the human touch can lead to stronger health outcomes and better returns than purely technical approaches, ensuring members feel supported, valued and empowered to manage their care.

Photo: ipopba, Getty Images

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