As member experience becomes a greater driver of health plan performance, the payer organizations best positioned for success will be those that can create a more complete view of every member.

Medicare Advantage plans are operating in an environment where member experience, engagement and health outcomes are increasingly influencing performance. The Centers for Medicare & Medicaid Services (CMS) continues to emphasize person-centered care, quality improvement and better health outcomes across its quality initiatives and Medicare Advantage programs.¹

As these priorities evolve, health plans have an opportunity to shift from a compliance-focused approach to a member-centered strategy. Success starts with understanding members as individuals.

A stronger identity foundation can help health plans create a more complete view of each member, enabling more effective engagement, improved access to care and better support for quality initiatives.

Better Outcomes Start With Better Member Understanding

Member information is often fragmented across systems, creating challenges for engagement, care management and population health efforts.

A more complete view of each member can help payer organizations:

• Improve member outreach and engagement efforts
• Support care coordination initiatives
• Enhance population health strategies
• Deliver more personalized member experiences
• Drive more informed decision-making across the organization

When health plans know more about the people they serve, they are better equipped to support positive health outcomes.

Engagement Begins Before Enrollment

The member journey starts long before enrollment.

During the awareness and consideration phase, health plans have an opportunity to build trust and establish meaningful connections with prospective members.

Identity resolution, audience development and profile enrichment can help payer organizations:

• Better understand target populations
• Improve audience segmentation
• Deliver more relevant outreach
• Create more personalized engagement strategies
• Build stronger relationships from the first interaction

The strongest member experiences often begin before someone becomes a member.

Reaching the Right People Drives Better Outcomes

Many quality initiatives depend on a health plan's ability to connect members with the right programs, services and resources.

More accurate member data can help health plans:

• Improve contact ability
• Strengthen care gap outreach efforts
• Support preventive care initiatives
• Increase engagement with care management programs
• Enhance behavioral health outreach

Effective engagement begins with the ability to reach the right person at the right time.

Access to Care Influences Member Experience

For many members, the provider search experience shapes their perception of a health plan.

Accurate provider data can help payer organizations:

• Improve provider directory accuracy
• Simplify provider searches
• Reduce member frustration
• Improve access to care
• Support a more seamless member experience

Helping members find care quickly and confidently can strengthen trust and satisfaction.

Digital Experiences Have Become Part of Healthcare

Members increasingly expect secure and convenient digital experiences. At the same time, health plans face growing pressure to reduce the risk of identity fraud while ensuring the right individuals can access sensitive healthcare information.

Identity verification and authentication capabilities can help health plans:

• Strengthen protections against identity fraud and unauthorized access
• Streamline enrollment and onboarding
• Reduce friction during account creation
• Enable passive authentication experiences that make it easier for members to securely return to and engage with digital portals
• Protect sensitive information

By balancing security and convenience, health plans can help encourage ongoing portal adoption and engagement while creating a more seamless digital experience for members.

The Future of Quality Outcomes Is Personal

As health plans seek to improve member experience and health outcomes, the ability to understand and engage members effectively will become increasingly important.

A strong identity foundation can help organizations:

• Create a more complete member view
• Improve engagement strategies
• Enhance access to care
• Support better health outcomes
• Strengthen member experiences across the lifecycle

As member experience becomes a greater driver of organizational success, better member understanding may prove to be one of the most valuable investments a health plan can make.

Beyond improving operational and quality objectives, a more connected and personalized experience can help health plans build trust with members. When members can easily access care, receive relevant communications and interact seamlessly across digital and physical touchpoints, they are more likely to develop confidence in their health plan. Those experiences can influence how members perceive their health plan, shape long-term satisfaction and help strengthen loyalty over time.

CMS may be signaling the shift, but the implications extend far beyond Medicare Advantage. As healthcare becomes increasingly focused on member experience, engagement and outcomes, the payer organizations best positioned for success will be those that know their members best. Creating a more complete view of every member can help health plans deliver more personalized engagement, improve access to care, strengthen member trust and support better outcomes across the healthcare journey. 

Take the Next Step

The shift toward more personalized member experiences and improved outcomes is already underway. Health plans that act now can position themselves to better engage members, improve care access and support quality performance across the member journey.

Connect with a LexisNexis® Risk Solutions health plan identity expert to explore how a stronger identity foundation can help your payer organization create a more complete view of members, strengthen engagement strategies and support better outcomes.

Ready to elevate member understanding? Contact our team today to start the conversation.



References:
Centers for Medicare & Medicaid Services. CMS National Quality Strategy. 2022.  https://www.cms.gov/medicare/quality/meaningful-measures-initiative/cms-quality-strategy