In the age of Affordable Care, individuals are playing a more active role in their own health. As a result, many members are finding themselves overwhelmed with complex information about everything from coverage and financial responsibilities to medical conditions and treatment options. To make better-informed decisions, members are looking for guidance. This new dynamic puts health plans in the position of becoming trusted resources and advisors to their customers. And that means wise health plans are learning to engage their members like never before.

Numerous studies show that consumers who are engaged least by their insurers represent the highest costs. In one survey of more than 31,000 patients, those reporting the lowest levels of engagement cost health plans 21% more than respondents reporting the highest engagement level., The good news: Studies have also shown that insurers with clear strategies and thoughtful tactics can improve engagement over time. 

Simply put, member engagement means treating the insured like individual customers rather than anonymous groups employed by larger entities. It means communicating with members about the things that matter to them — guiding and empowering them to make choices that can directly affect their outcomes and quality of life.

We Propose a Strategy

For health plan leaders, creating meaningful connections with members takes strategy and planning. Any good plan will address objectives, performance metrics, timelines, and budgets. When it comes to member engagement, it’s also important to set more focused goals. The right strategy will seek to foster education, guidance, and empowerment. It should:

  • Identify the decision(s) you want to influence
    • “We want each member to choose the best benefits plan for their health needs and financial situation”
  • Identify opportunities to engage members
    • Benefit plan selection
  • Choose an effective channel
    • Evaluate existing engagement channels for effectiveness
      • Marketing materials
    • Anticipate and create new channels for engagement
      • Decision wizard

Adapting to ACA is about more than changing tactics. It requires a fundamental shift in the way health plans see their members. Once that happens, you’ll discover there are multiple decision points where your organization can connect with your constituents.

Rules of Engagement: the Four Stages of the Customer Life Cycle

As a health plan administrator, you can think of the member customer life cycle as having four stages: Attract, Enroll, Manage, and Retain.

Here are some ways your organization can anticipate and respond to customer needs throughout the life cycle. We’ve identified some of the common decision points and opportunities for engagement, and then suggested a few appropriate channels (the means) through which payers can empower members to make more informed choices (the end).


Sasha Adams historically chose her insurance through her employer. In 2013 Ms. Adams was downsized and lost her health insurance coverage. She decided COBRA coverage was cost-prohibitive, so she has been uninsured for several months while she searches for a job. Now she is strongly considering coverage through the Health Insurance Exchange in her state. Sasha feels fortunate to be blessed with reasonably good health. However, she is concerned about a lump that she discovered during a recent breast self-exam. Sasha has perused the options, but she’s unsure about the best one. If the lump ends up being cancerous, what plan offers the best coverage? Can she afford coverage even if she’s still unemployed after several more months? Which health plan would be easiest to work with should she need to make multiple claims about the lump?

In the Attract phase of the customer life cycle, a key member decision point involves choosing the best benefits at the right price based on individual circumstances. But a survey of adult healthcare decision makers insured through an employer revealed confusion about the basic concepts of health insurance. In the study, 93% indicated they understood what “maximum out-of-pocket” means. But when they were questioned directly about the concept, 41% of the same respondents gave an incorrect answer. In fact, only 45% of the total sample correctly answered a comprehension question about “maximum out-of-pocket.” The findings were similar for the concepts of “coinsurance,” “deductible,” and “copay.”  In another study, 60% of those most likely to use the marketplaces to purchase coverage said they were “not too confident” or “not at all confident” in their understanding of at least one health insurance concept. 

To make it as easy as possible for prospects to choose their coverage, health plans must not only arm consumers with information, but also guide them to a decision.


Along with her family, Natalie Cooper is a new member to a health plan. The demands of a 60-hour-per-week job, an active family with a busy schedule, and her mother’s declining health mean her stress level is at an all-time high. On top of all that, she makes nearly all of the health decisions for the family. She was in the middle of a major project during the entire open enrollment period, so she isn’t convinced that the plan she chose is the best option. That’s frustrating, since she knows she’ll have to live with the decision for another year. To make things even more complicated, the family’s long-time primary care physician recently retired — so she has made a note to herself to carve out some time to find a new family doctor.

In the “Enroll” phase, your customer needs to choose a primary care physician and make other decisions based on their benefits package.


Walter Middleton considers himself to be fairly smart. He’s a successful man-ager of an engineering firm who’s highly regarded by his colleagues and respected in his community. But Walter was recently diagnosed with Type II diabetes. He’s had several tests, doctor visits, and even a stay in the hospital. Now Walter’s insurance company has started sending Explanation of Benefits statements — and he quite frankly finds them confusing. At the same time, he’s beginning to feel overwhelmed about managing his diabetes. He wants to regain his health, but he’s not sure whether he’s doing everything right.

During the “Manage” stage, members must act upon their knowledge and make decisions about preventive care, self-manage illness or chronic conditions, choose and purchase medications, and pay their portions of claims.


Alex Smith’s employer is currently in the open enrollment period for health insurance. As he reflects on the past year’s experience with his plan, Alex remembers being impressed with their customer service. First, the insurer helped Alex and his wife choose an obstetrician when the couple learned she was pregnant with their first baby. Through the plan, they also discovered a text messaging service that sent timely tips and other information for expecting parents. In fact, the service proved invaluable when Alex’s wife had some unusual symptoms. She read a text listing some common warning signs and decided to follow up with her specialist — who quickly diagnosed premature labor and ordered bed rest. What could have been a frightening and uncertain time was made more comfortable when a case manager for the plan checked in with the Smiths to answer questions and offer practical advice.

Alex was grateful to have insurance that covered the costs of the high-risk pregnancy. Still, as he managed the family’s obligations, he had questions about claims and coverage. Thankfully, the plan’s customer service center addressed his concerns quickly and accurately — typically with just one phone call to a dedicated representative.

So, with his wife’s pregnancy at 38 weeks and a full-term delivery of their baby boy imminent, Alex is confident he chose the best plan and provider for his young family.

In the Retain phase, a member must decide whether or not to continue with the health plan for another year. Since acquiring a new member costs about five times as much as retaining a current one, engagement at this stage is critical. What can the plan do to help ensure that a member will renew coverage?

Perhaps the most important thing a plan can do to retain members is to engage them during the other three phases — where customer service can have a huge influence on a member’s decision to stay with the plan. In other words, a healthy engagement program makes retention more effective because it makes the entire relationship more efficient.

Choosing Channels

How do plans decide which channels will foster the most effective engagement? In part, they can look to a wealth of available data on consumer habits. For example, more than 91% of American adults own a cell phone, and more than 81% of cell phone users send or receive text messages. It’s obvious there’s a tremendous opportunity to engage members via mobile technology — where they’re already staying connected. This insight led Johnson & Johnson to develop Text4baby, a free messaging service that delivers content on prenatal care, baby health, and parenting. In one of numerous analyses of Text4baby, California State University San Marcos and the University of California San Diego surveyed 626 unique Text4baby users in San Diego. Among their findings:

  • 65% reported that Text4baby helped them remember an appointment or immunization
  • 74% reported that Text4baby messages alerted them to medical warning signs they otherwise would not have recognized
  • 67% reported talking to their doctor about a topic they read about in a Text4baby message

Summing Up

Throughout the customer life cycle, health plans should guide members to a deeper understanding of the healthcare system — so patients can choose the providers, services, and other resources that offer the best possible effect on outcomes.

It’s not about inventing channels as a reaction to customer demand. Instead, the most novel (and not to mention the most effective) engagement programs come from a careful, thoughtful response to the needs of consumers. Not coincidentally, that’s also where the simplest ideas can be found — innovation for the sake of innovation can mean wasted effort. Sometimes a tried-and-true solution is all that’s needed.

Think of each member as an individual. Consider their hectic lives and busy schedules. Think about the decisions they’re facing, and look for ways to educate, guide, and empower them to make better choices. Members are people. Imagine how you can surprise and delight them with simple, useful tools that help them move through the process quickly and confidently.


Leveraging the Patient Centered Medical Home Model to Improve Member Engagement