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Member engagement and outreach are critical in today’s healthcare environment as health plans are increasingly scored and held financially responsible based on their members’ feedback, outcomes, and perceptions. Engagement and outreach also help ensure members are receiving needed care, which increases the likelihood of positive health outcomes.

Purposeful and intentional engagement with health plan members on a regular basis can have a significant impact on member satisfaction levels, loyalty, and retention. 


Purposeful and intentional engagement with your members on a regular basis can have a significant impact on member satisfaction levels, loyalty, and retention.


Top performing plans have discovered the importance of member engagement to:

  • Welcome new enrollees and create a positive first impression
  • Assess member health and care management needs
  • Provide education and access to care
  • Improve member satisfaction and plan performance through continuous feedback
  • Build loyalty and retain life-long members

Welcome, Educate, Engage, and Retain

SPH Analytics advocates continuous member engagement and outreach with these four goals in mind: Welcome, Educate, Engage, and Retain. 

Each of these components plays an important role in the member’s overall experience and satisfaction. It is important to recognize and give the appropriate focus to each component and consider your plan’s effectiveness in these areas.


Welcome members and create a positive first impression

When a new member enrolls, plans have a unique and timely opportunity to create a positive first impression and begin to build satisfaction and loyalty. 


When a new member enrolls, plans have a unique and timely opportunity to create a positive first impression and begin to build satisfaction and loyalty.


A welcome call to members helps them feel connected to the plan. If the phone agent is warm and personable, this leads to a positive first impression which is the first step to building a long-term relationship.

New member welcome calls also provide an opportunity to assess the member’s health needs, get the member into a managed care program if needed, and start the member on the right track for the appropriate care, medication management, and compliance to care needed.

New member welcome outreach can include:

  • Warm welcome calls
  • Confirmation of ID cards, plan material, and understanding of benefits
  • Health assessments or a brief questionnaire to determine the member’s health needs
  • Assistance with PCP (primary care physician) selection, if appropriate

What is your plan currently doing to welcome and onboard new enrollees?


Educate members and build awareness

Educating members helps ensure they understand and have access to the care they need. It builds awareness of plan benefits, features, and requirements which are important aspects of overall member satisfaction.

Many member complaints can be traced back to a lack of understanding. A surprising number of health plan members are not aware of the specific benefits, features, and requirements of their plan.

By continually engaging with members and providing them with this needed understanding and awareness, plans are also helping to drive satisfaction with the plan.

A lack of understanding can cause confusion and frustration. It can also be costly and time-consuming, which in turn increases dissatisfaction. Member education leads to higher satisfaction. 


Member education and awareness programs lead to increased understanding and higher levels of satisfaction.


Plans can educate members with programs like:

  • Care management information and assistance
  • Awareness of wellness programs and care coordination
  • Medication adherence and medication therapy management outreach
  • Preventive care education and reminders such as prenatal care, mammograms, and
    flu shot reminders

These are just a few examples, but there are many opportunities to educate members and help build awareness.

How can your plan better educate members and promote awareness?


Regularly engage members and seek feedback

Continuous engagement helps drive satisfaction and allows plans to monitor the attitudes and perceptions of members.

As mentioned, continuous engagement with members is crucial in today’s marketplace. There are a multitude of choices, opportunities for confusion, and small or large events that can significantly impact satisfaction levels. 


Continuous engagement and outreach help drive satisfaction and monitor the current attitudes and perceptions of members.


Factors such as errors in the claims process, lack of training in an area of customer service, or difficulty with access to care can go un-addressed and begin to dramatically impact the satisfaction of health plan members.

However, if your plan is continuously engaging with members and collecting feedback, this will increase your ability to detect patterns of concern and address them in a timely manner.

A minor malfunction in a plan’s process can cause serious problems and/or frustrations for members, but if caught early, plans can reduce the negative impact on scores and member satisfaction.

Some examples of continuous engagement include:

How is your plan currently engaging members and monitoring perceptions?


Member retention and loyalty

A significant concern for most plans is the ability to retain members. The cost of acquiring new members can be considerably greater than the cost to retain current members. Top performing plans reach out and engage members throughout the year to continually drive satisfaction and build loyalty.

In addition, plan re-enrollment reminders and disenrollment surveys can be effective tools in member retention. Health plan re-enrollment can be challenging for consumers, and a member is generally more likely to change plans during this time. However, a reminder call from their plan can help make the re-enrollment process, and decision to stay with the plan, much easier for the member.

Sometimes the most honest feedback comes from those members who have left your plan. For this reason, disenrollment surveys can be very beneficial. This feedback can be highly valuable in making needed adjustments that could significantly increase member retention going forward. 


Consistently focus on member retention and loyalty throughout the year with ongoing member engagement and outreach.


Member outreach and retention programs include:

  • Thank you calls
  • Loyal member outreach and rewards
  • Plan re-enrollment reminders
  • Disenrollment surveys

Why did former members decide to leave the plan?

Are you are doing all you can to retain members?

Partnering with SPH Analytics
to build continuous member engagement

Many health plans realize the importance of continuous member engagement, but determining how and where to start can be a daunting challenge. 

SPH Analytics helps plans develop member engagement solutions by reviewing each area of outreach and engagement addressed above: Welcome, Educate, Engage, and Retain.

Once we have determined the plan’s greatest areas of need, we work closely with our clients to develop a high-touch, personal approach to member engagement.

SPH Analytics then manages the plan’s outreach and engagement programs throughout the member cycle. Everything is managed onsite through our full-service call center and mail fulfillment facilities. Our phone agents are highly trained and professional onsite employees to ensure friendly, courteous interaction with your members.

The plan receives ongoing results/feedback data to address areas of concern, initiate quality improvement initiatives if needed, and maintain a pulse on their members’ attitudes and perceptions.  Throughout the process, SPH Analytics partners with our clients, listening to their specific concerns and developing full-service solutions to fit their needs.

Continuous member engagement throughout the membership cycle

Continuous member engagement and outreach is critical in today’s healthcare environment.  Plans are increasingly scored and being held financially responsible based on member satisfaction levels, perceptions, and overall care received.

Regular communication and interaction help build member satisfaction and long-term loyalty.  It also helps ensure members understand and have access to needed care, which can improve the quality of healthcare received by members.

Member engagement is a continuous endeavor.  It is important plans create touch points throughout the membership cycle to Welcome, Educate, Engage, and Retain members.


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