Member engagement is a key topic across the health insurance industry. Ongoing research and development initiatives – and significant sums of money – are poured into understanding how to best engage health plan members.

The emphasis on member engagement is not merely a matter of customer satisfaction. Highly engaged members show significantly improved health outcomes compared to those who are detached from their care plans.1 Engaged members are more knowledgeable and manage their care more effectively. Member engagement is directly correlated to improved health and reduced costs of care, two fundamental goals of any health plan.

There are various approaches to increasing member engagement, from reward programs to introducing the latest tech tools, each of which seek to reduce barriers and incentivize engagement.

Bob Bausmith, the recently retired CIO and Executive Technology Advisor of Blue Cross and Blue Shield (BCBS) of Kansas City, is confident that for health plans, “delivering a great member or patient experience is accomplished through advocacy.”

Mobile apps and intuitive UX and UI only get health plans so far. It’s not a better map that customers need; it’s a better guide.

Tackling Member Engagement

According to Bausmith, BCBS aims to improve member experience by reducing communication hurdles and increasing the ease of directly supporting customers. Some of their strategies include building features that connect members with customer service representatives through text messaging and improving the mobile experience of accessing benefits and claims history.

Improving accessibility to benefits, health history, and claims history, as well as increasing the ease of navigating the health system, reduces barriers for members. This in turn leads to improved engagement. For example, if a member cannot find their benefits information online and are put on hold when calling customer service for assistance, they may give up and make health decisions without all the data their health plan can provide. BCBS focuses on removing those hurdles so members can easily find the information they need. By reducing frustrations, members are more inclined to engage with their health plan, driving positive health outcomes.

BCBS rolled out a digital behavioral health solution to bring one-on-one, at-home support to members struggling with mental health challenges, encouraging them to take a more active role in their health with self-monitoring and interactive programs.2 Tools like this drive member engagement and improve member knowledge and involvement in their health.

Another trend that drives member engagement, satisfaction, and improved health is personalized care plans.

No two members have the same health experience or care journeys. Care plans need to be equally personalized to best address member needs. Not only is each person’s health unique, but how people engage with their health plans varies by individual. Some members actively seek guidance from their health plans while others tend to be more disengaged. Some members prefer to communicate directly with customer service representatives while others prefer to seek information independently. These factors impact the usefulness of user experience tools, and further support the case for personalized care plans and personalized avenues of engagement with health plans. This can be accomplished by transitioning from a focus on broad user experience transformations towards personalized member advocacy.

Member Advocacy

Bausmith’s vision for improved member engagement involves a shift from customer centricity to customer advocacy. Rather than reducing experiential barriers to engagement, advocacy focuses on uncovering how to provide guidance, resources, and tools so that a member is supported through every aspect of their health journey. This might look at how to empower members in the selection of their benefits, how to find the best course of care, or how best to manage a particular health condition.  

While reducing experiential barriers is an important step in helping members access support and information, it is a passive strategy for addressing patient engagement. Moreover, digital tools and user experience improvements are isolated tweaks with dwindling long-term impacts. Overcoming barriers, like a lack of health literacy, through patient advocacy propels member engagement and leads to improvements in health outcomes, while simultaneously improving member experience. Member advocacy is also a long-term sustainable engagement strategy that can guide decision-making on an ongoing basis and transform the organization.

This vision for the future of health plans is supported by recent research. According to a study conducted by McKinsey, consumers connect their care outcomes to their health insurance experience.3 That means poor health-related outcomes, like unexpected costs or hospital readmission, lead to poor consumer satisfaction and higher member churn. As if health plans needed another reason to reduce unexpected and costly care, they now must consider how those factors impact a patient’s experience with their insurance provider.

Improving user experience may contribute to higher rates of member engagement by reducing the factors that lead to disengagement, but personalized member advocacy can help members make care choices that directly improve health outcomes, reduce costs of care, and improve consumer satisfaction long term. To tackle member engagement, health plans need to stop thinking about member engagement and adopt an ethos of member advocacy instead.