Remove Communication Barriers With Data

The Importance of Engaging New Health Plan Membership

Open enrollment has ended, and a new calendar year has begun. It’s time to start engaging with new members, to help them fully understand and use their benefits. Effective member engagement can lead to better health outcomes, increased member satisfaction and improved member retention rates. However, doing that can be a challenge given member contact data can be incorrect or dated even from the start of the relationship. Reaching those new and returning members is critical to member satisfaction, member retention and health outcomes. 

5 Benefits of Health Plan Member Engagement

1. Build Trust and Understanding

When new members join a health plan, they often have many questions and concerns. Engaging them early helps build trust and ensures they understand their benefits and how to use them. Clear communication about coverage, costs and available services can prevent confusion and frustration down the line.

 2. Promote Preventive Care

Engaged members are more likely to take advantage of preventive care services, such as vaccinations, screenings and wellness visits. These services are essential for detecting health issues early and maintaining overall health. By encouraging new members to use these benefits, health plans can help reduce the incidence of long-term health problems from undiagnosed conditions that can be successfully managed or even reversed with proper care.

3. Enhance Member Satisfaction

A positive onboarding experience can significantly enhance member satisfaction. When members feel supported and informed, they are more likely to have a favorable view of their health plan and may be more likely to stay when given a choice by their employer, or when open enrollment comes around again for Medicare and marketplace plan participants. About 50% of Medicare Advantage members change plans every 5 years¹. It is imperative to engage those members while they are with your plan to make the most of that relationship.

4. Encourage Healthy Behaviors

Member engagement strategies, such as personalized health coaching, wellness programs and digital health tools, can motivate members to adopt healthier lifestyles. By providing awareness about the resources available in their plan, health plans can help members set and achieve health goals, leading to better long-term health outcomes.

5. Reduce Healthcare Costs

Effective health plan member engagement can lead to more efficient use of healthcare resources. Educated members are more likely to make informed decisions about their care, avoid unnecessary emergency room visits and adhere to treatment plans. This can result in lower overall healthcare costs for both members and providers.

Barriers to successful outreach vary by line of business

Member data can be difficult to manage, and it can be out of date for a variety of reasons. However, accuracy varies among lines of business. But the impact is the same – it makes it difficult for health plans to engage members in programs that can benefit their health, improve loyalty and reduce costs. 

For commercial plans, data is often made available by employers to their payer through automated feeds. However, employees may not always tell their employer or the benefits vendor when something changes, especially if they consider it minor, or don’t see the value in updating their information. Delays can be a challenge too – employees may not make timely updates for their employers and employers take time to process those changes, especially when manual intervention is needed. 

For Medicare Advantage and individual marketplace plans, member demographic information comes through online enrollment portals or brokers. Either way can be subject to data entry errors or transcription errors prior to being loaded plan member enrollment systems. Further, it’s incumbent upon the member to update their insurance plan when something changes, and for many, their health insurance may be the last place they think to update their address, phone number or email. 

For Medicaid Managed care plans, the problem is even more complicated. State agencies manage demographic information for their eligible residents, and regulation restricts plans from making updates on their own. Lower income persons are often more likely to have life changes that impact their contact information, such as moving or economic instability that results in address and phone number changes^2,3   .  Updating a state agency with new contact information may not be a priority for members who need to focus on more pressing needs like securing housing or putting food on the table. State agencies often have delays in getting that information processed and over to the health plan. Health plans are then left with a challenge of outdated contact information and being confined by their state customers to information only they supply. Because information can change more often, those delays only worsen a plan’s ability to reach their Medicaid members to engage them fully in the benefits available. 

What can these plans do to help solve this problem?

Insights and updated contact data can offer a way for plans to reach members while they are waiting on updated contact information to come in from official sources like employers or state agencies. If they can reach that member, they can gently remind the member about the importance of updating their employer, or a state agency. Where permitted by contracts or regulations, plans may be able to provide feedback directly to their employer customers, state agencies or brokers to investigate the discrepancy and have the member confirm information for a future update. 

Conclusion

Onboarding and engaging new health plan members are about creating a supportive and empowering experience. But that requires reliable contact information and insights about members whose information may have changed. By prioritizing reliable demographic data, paired with proactive engagement efforts, health plans can foster trust, promote preventive care, enhance satisfaction, encourage healthy behaviors and reduce costs. Ultimately, this can lead to a healthier, more satisfied member, and a more successful health plan.

References:

1. Trends in Cumulative Disenrollment in the Medicare Advantage Program, 2011-2020 | Health Policy | JAMA Health Forum | JAMA Network
2. Exploring Residential Mobility among Low-Income Families on JSTOR
3. Lower-income Americans still less likely to have home broadband, smartphone | Pew Research Center