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Member Engagement for Payers Should Focus on Simplicity

Effective member engagement strategies for payers should focus on locating member pain points and simplicity of communication for plan information

Member engagement strategies for insurers

Source: Thinkstock

By Jesse Migneault

- For payers, an effective member engagement strategy can lead to better member health, lower claims cost, and improved product loyalty. 

To achieve these goals, payers should start by identifying pain points and implementing processes that encourage transparency, clear communication, and patient-centered care delivery, says Heidi Sirota, Vice President of Marketing and Communications at ConnectiCare.

“This involves finding a way to flip the conversation with your members from being punitive to being enabling, from being overwhelming to being more simple and singularly focused in your interactions with them,” Sirota told

The first step in effective member engagement is disseminating clear and useful information to beneficiaries. Health benefits can be complicated and confusing for some consumers, which may put unnecessary stress on beneficiaries, their providers, and their payers.

“One of the pain points is that people, all kinds of people, lack an understanding of how insurance works,” observed Sirota.  And that's not just people who are new to insurance, or people that aren't educated in the terminology. Insurance is an inherently complicated product, so it's not like payers are being intentionally confusing.”

READ MORE: How Consumer Engagement Brings Better Coverage Decision-Making

“Most people lack a true understanding of their policy, and that makes it hard for them to get the care they need, and it certainly makes it hard for us to help them be healthy,” she continued. “For a member, there are fundamental misunderstandings of how to do that math, or understanding which services fit into which category. Is it under the deductible, not under the deductible? Do I need a copay or call insurance for this? Is this preventive?”

 To ensure that beneficiaries are receiving the information they need to make the best possible decisions, payers should engage in multi-channel outreach which encompasses mail, email, phone, community relations, and storefronts.  The use of multiple options allows a payer to reach the member where they are and deliver the information they need.

“It’s about creating a drumbeat so they hear the message over and over and can access it in different ways, whatever way works best for them and works with their life,” Sirota said.   “And most importantly, it’s making sure members know what's included and inherent in the plan and what comes with the premium they're already paying - such as preventive care.”
So even if a person says they prefer email, when you do email in combination with something else that they also see, it ups the chance that a member will take an action and pay attention.”

For members, an incomplete understanding of what their plans offer can lead to leaving important services on the table, Sirota added. 

“Everybody has preventive care covered at 100 percent but they're not getting it. Why aren't they getting it? It could be they don't realize it,” she said. “It could be they're fearful, it could be they don't have transportation, it could be a hundred reasons.”

READ MORE: Why Payers Should Include Consumer Engagement in Health Plans

“They aren't sure what they'll have to pay, is it some portion of the charge or all of it.  So, members may avoid care altogether, or if a member does understand what they're supposed to pay for a service they may avoid going because they can't pay,” explained Sirota.  “It's both the unknown and the known parts of coverage and payments that are challenging to people.”

Effective communication materials should be succinct and user friendly.

“Be as elementary as possible in your communication,” Sirota advised. “It's not necessarily because people don't know how to read or that you're pandering. It's because it makes it simpler. And everybody can benefit from simple.  Don't say ‘provider’ when you could say ‘doctor.’ Real people don't say provider; they say doctor.”

Sometimes, simplifying the message requires taking a second look at standard communication materials, such as member onboarding packages. 

“We used to have a welcome kit filled with all kinds of flyers and information and who knows what,” said Sirota. “What is a member going to do with all this stuff? We decided we were going to slim it down.”

READ MORE: Communication, Cost Transparency Impact Patient Engagement

ConnectiCare redesigned its payer ID cards and packaged the document with a very simple quick start guide including a few basics about their coverage.

“We then followed that with an email campaign that had a number of topics in a sequence. We sent an email every week or every other week where we'd say, ‘take this step today.’ And then two weeks later, ‘take this next step today,’” explained Sirota.  

The step-by-step approach helped produce quality member engagement.  By limiting calls-to-action to one at a time, such as paying a bill online or reading a benefits statement, the insurer began to see traction with member responses.

The results of the retooled onboarding kit, and the step-by-step email follow up materialized in quantitative results for ConnectiCare.

“People are taking action.  With our first welcome email that we sent out after the new onboarding kit and ID card, we saw 11 percent of members pay their premium from the link from that particular email,” Sirota recalled. “Which I thought was a pretty good return.”

A concerted effort by a payer to look at how they are engaging with members not only results in better member health, but also increased payer loyalty and lower claim costs.

I would say that the bottom line is everybody wins when a member is healthy or at least as healthy as they can be. It costs everybody less, whether it's the patients or the health plan or anybody in the system, when a member is on the path to better health and living a fuller life,” said Sirota.

“As insurers, we really need to elevate our messaging so members can get the most value out of their plans,” concluded Sirota.  “People buy health insurance and don't feel like they get value out of it, because they're not utilizing the inherent benefit in there.   The more we can engage our members, the better patients and members are going to feel about the insurance products they're buying and using.”


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