The Essential Element for Health Plan Member Engagement

Health plans face growing challenges in delivering a consistent and positive member experience. Disconnected systems, fragmented data, and inconsistent touchpoints leave members frustrated and disengaged. As expectations rise for real-time, personalized service across every channel, traditional infrastructures fall short. In this article, we’ll examine the root causes of these member experience gaps and show how integrated data and smart engagement strategies can transform how health plans connect with their members.

Members engage with their health plan through multiple channels such as mobile apps, call centers, provider offices, email, and text notifications. They expect each touchpoint to reflect the same information and context and be free of discrepancies in information across channels, such as conflicting benefit information, disjointed scheduling processes, and surprise billing. Health plans must eliminate information gaps and provide a consistent, personalized experience to remain competitive and earn member loyalty with each interaction.  

To meet member expectations and deliver a seamless experience, data sources must be integrated to create a real-time, 360-degree view of each member. This unified view becomes the foundation for every member interaction, regardless of channel.

Consider a common scenario: a member completes their enrollment, downloads the health plan’s mobile app, and attempts to view their benefits. The app shows incomplete or inaccurate data. The member calls customer service and waits on hold, only to be told their enrollment hasn’t been processed. Days later, they visit a provider only to discover their insurance cannot be verified. Each interaction delivers a different experience, none of which is helpful. The result is a confused, dissatisfied member.

Now, consider how the member interaction would be different with an integrated ecosystem: a member enrolls, and the system instantly confirms their eligibility. The mobile app reflects real-time status. A personalized message welcomes them and suggests nearby providers based on their zip code. If the member calls support, the agent sees their complete profile, recent interactions, and upcoming appointments. At the provider’s office, the front desk verifies coverage seamlessly. The experience is cohesive, informed, and frictionless.

An integrated ecosystem ensures seamless member interactions because data is consolidated and consistent across all operating systems of the health plan. Automation, AI, and business rules can be applied to support routine tasks such as appointment reminders, benefits verification, or follow-up communications can be handled automatically, improving efficiency and responsiveness. Next-best-action recommendations inform and support member channels to provide guided workflows to call agents or trigger preventative outreach. For example, if a member has not completed an annual wellness exam, the system can generate a personalized message through their preferred channel—app notification, email, or SMS—prompting them to schedule care. This message can include a list of nearby in-network providers, available time slots, and a one-click scheduling link. Automation and AI, fueled by integrated data, transform operational processes into member-centric engagement.

A seamless member journey starts with an integrated ecosystem. UST HealthProof has developed a solution purpose-built to provide health plans with a connected ecosystem informed by unified, near-real-time data. We prioritize automation where it adds value and maintain the human touch where empathy and expertise are required. Our technology powers next-best-action recommendations across channels, allowing plans to engage members meaningfully, consistently, and with confidence.

If you're ready to elevate your member experience and simplify your operations, it all starts with an integrated ecosystem—and we can help you implement it.