Member retention is a pivotal focus for health plans. With a growing emphasis on member satisfaction and loyalty, for inside and outside of the Medicare population, health plans must adopt strategies that address retention by fostering deep, meaningful relationships with their members through relevant, personalized experiences.
Among the most common reasons why healthcare members switch plans, a lack of consistent personalization is frequently cited by members as a main reason for exploring alternatives, joining poor quality of care, lack of trust and ineffective pricing.
In a McKinsey study on the role of personalization in the healthcare journey, members were more than 2X likely to switch health insurance plans if their existing plan did not meet their expectations concerning their particular condition. In addition to higher potential churn, member dissatisfaction also had negative effects on Medicaid and Medicare Advantage payers’ Star ratings and Consumer Assessment of Healthcare Providers & Systems (CAHPS) scores.
According to Kathleen Ellmore, Co-Founder and Managing Partner of Engagys, a healthcare consumer engagement consulting and advisory services firm, several factors are increasing pressure on payers offering Medicare Advantage plans to focus on retention. Included among them are tighter operating margins that are predicted to result in a reduction in supplemental benefits, intense competition, and an expected increase in the number of members shopping for and eventually switching plans.
Ellmore counsels that it is wise for plans to think about every interaction as an opportunity to improve retention, and not just in the months and weeks leading up to the Medicare Annual Enrollment Period (AEP), which falls from Oct. 15 to Dec. 7.
“Plans need to get ahead of it,” she said. “You can’t just flip a switch and start retention. It has to be baked into every interaction that a plan has with a member.”
At a basic level, plans must proactively set expectations beginning with the onboarding process. There should never be any surprises, for example, about whether a provider is covered in-network, or that there is a provider shortage that might affect scheduling availability. Early transparency and forthrightness are essential for setting expectations, building trust and establishing a positive relationship, as studies show that likelihood of churn increases significantly if members are not engaged with effectively over the first three months.
A Personalized Member Experience
Being transparent about coverage and pricing is a good start, but an effective retention strategy must do more to personalize the experience for a member, aside from providing clear communication about coverage and benefits, which are largely the same for each member.
Member-centric personalization, by contrast, uses data to develop a full understanding of the member, and then applies that knowledge to provide relevant interactions across a member’s healthcare journey. Incorporating medical history from claims data, consumer behavior, preferences and even social determinants of health (SDoH) into a single view of the member is essential for tailoring communications and messaging at an individual level. Personalized communication, based on individual attributes and historical interactions, significantly enhances engagement and retention by building a relationship with the member.
In an Accenture study on patient loyalty in healthcare, 50 percent of members who switched health insurance plans did so because of a poor experience with their existing plan. And members are 3X more trusting when their plan provides them with “consistent and accurate information.”
An Engagys program for example used data-driven insights to power a year-long text messaging campaign for members with chronic conditions including diabetes, asthma and hypertension. As part of the program a member with high blood pressure received personalized texts based on the results of a weekly home test. Depending on the numbers, the text might be congratulatory, offer encouragement, provide recommendations or additional resources, etc. By the end of the program, 50 percent of members living with hypertension had brought their numbers under control, a significant improvement over traditional static campaigns.
Other examples of proactive communication relevant to a specific member include knowing that a member needs an MRI or lab work and providing a list of local facilities, or facilitating appointment scheduling. A personalized experience might include notifying the member of optimal times at a particular facility. Or, if a plan uses SDoH in a member profile, understanding that the member might have an issue with transportation and arranging for a shuttle pick-up or offering a telehealth option, if available. By using an updated member profile to deliver a consistent, relevant experience, healthplans not only drive better outcomes, they reduce costs by not sending wasteful, irrelevant or duplicative information such as reminders to schedule for members who have already scheduled.
The Technological Backbone of Retention
Many data-driven health plans are turning to a customer data platform (CDP) to power their retention strategies through the development and activation of a single member view, and for a good reason. A composable solution such as the Redpoint CDP enables member-centric engagement strategies and aligns efforts from different business and care navigation units to streamline the member journey.
A good CDP creates a robust data foundation by fully integrating all internal and external data sources and applying advanced identity resolution to create a unified member profile. Using AI and dynamic segmentation capabilities, users can build dynamic audiences that can be used across channels to personalize communication at scale. Using a GenAI-powered interface, users can create, visualize and test audiences without having to write a single line of code. This allows health plan leaders to give their undivided attention to what matters for members.
Member retention is a multifaceted challenge that requires a strategic approach structured around member-centric engagement and the right supporting technology. By addressing key challenges, staying abreast of trends, and implementing effective strategies, health plans can improve retention and build stronger relationships with their members. As the healthcare landscape continues to evolve, focusing on personalization, proactive service, and thoughtful engagement will be crucial for maintaining member loyalty and satisfaction.
For more on how Redpoint and Engagys can help you maximize member engagement, using your own data, click here.
