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Driving Better Health Outcomes Through Tailored Member Engagement

Helping members through every stage of their health care journey


Today, there are numerous options for engaging members: digital channels, text messaging, mobile applications, retail interactions, community events, face-to-face consultations, and the tried-and-true direct mail and telephonic outreach, to name a few. Assuming you have a strong member activation program, you have probably even captured communication opt-ins and are armed with the knowledge of which channels each member favors.


While reaching members where they are, in the way they want, has never been easier, determining what to say seems a much more daunting task. Members have different challenges, needs, and wants depending on their health, so how do you engage members to drive better health outcomes?


Keep the healthy healthy


Young Invincibles with no known health issues use their benefits sporadically or very infrequently. Don’t mistake this to mean you should ignore this member group; after all, the goal is to keep them healthy and retain them as members. Instead, engagement efforts should focus on helping them maintain wellness and prevent disease development by decreasing lifestyle risk factors and promoting self-management strategies.


There are many ways to engage members and empower them to be proactive in maintaining their own health:


  • Make sure your new or renewing members complete a health risk assessment at the start of each plan year
  • Create a healthy lifestyle reward program
  • Drive them to your retail location events
  • Inform and educate them on overall health and wellness  
  • Encourage them to get their annual wellness checks


Preventive Engagement


Members in the at-risk segment range from pre-disease (e.g. pre-diabetic) to episodic. While this group may have no known health issues, they may be at a higher risk for a disease, use their plans more often, visit the ER for potentially avoidable reasons, or visit a specialist before going to their primary care provider for an initial diagnosis.


Engaging this group can help you identify at-risk members and those with pre-chronic conditions, deliver pre-disease programs, and minimize progression to a disease. You can also engage them through benefit education, advising on when a referral is required, explaining their prescription coverage, and emphasizing the high cost of ER visits. Providing cost comparison tools will empower members to make wiser care choices.


To engage this member group, your messages should emphasize prevention and wellness, focusing on proper care through preventive screenings. Your benefit education messages should be crafted to help members avoid incurring unnecessary medical expenses, especially with the proliferation of high deductible plans in recent years.



Chronic Care Management


For members with chronic conditions engagement goals shift to delivering on your plan’s chronic condition programs and minimizing disease progression. Engagement with this member group should focus on guiding members through proper care coordination based on their conditions.


Counseling (motivational interviewing) and actionable recommendations are a great option. You can also provide tools and tips that help members understand the importance of taking their medications as prescribed, as well as educate them about how to manage their existing conditions for improved health outcomes. Clinical steerage, through care consultants, can be used to assist members with care-specific questions.



Severe Chronic or High Acuity Members


For members with higher acuity conditions, such as cancer, congestive heart failure, neurological disorders or acute renal failure, engagement should be focused heavily on helping members improve their functional capacity and quality of life. Engagement messages should guide these members to participate in your health plan’s care management programs and help them navigate through your care system.


It is important to highlight the benefits of your program and help members get the most value from their plans. Driving members to your plan’s clinical resources or health advocates will allow you to engage members through personalized, face-to-face support on care navigation, symptom management, and disease progression prevention.





For members facing the final stages of life, engagement should focus on helping the member, their family, and treating providers to understand and accept the member’s end-of-life wishes and to coordinate care needs in the most appropriate setting.


Much like high-acuity members, engagement will need to become more personalized and high-touch:


  • Supporting advanced care planning
  • Stabilizing and treating chronic care conditions
  • Pain control and medication management
  • Provider collaboration and coordination
  • Caregiver engagement and support
  • Community support coordination



A Strategic Approach to Member Engagement


At GuideWell Connect, we help health plans define a strategic approach to engaging members at every stage of their journey. Our data-driven, personalized tactics present your members with relevant and impactful messaging to influence them to participate in their own health and encourage them to change unhealthy habits.


  1. Segmentation: We create data-driven segments and sub-segments in order to prioritize outreach based on the members’ health status and receptivity
  2. Impactful Outreach: We provide personalized and tailored messaging relevant to each member’s stage in their health journey 
  3. Communication Optimization: We utilize low-touch tactics, such as email and mobile push notifications, to deliver touchpoint specific content. When warranted, we use high-touch or telephonic outreach to engage members through meaningful conversations to assess needs, increase awareness, highlight relevant offerings, and support care navigation
  4. Integrated Solutions: We inventory plans’ comprehensive health, wellness, and care solutions and match them to members based on where they are in their journey. We then deliver the most appropriate health assets per each engagement initiative (i.e. incentives, discounts, rewards, health events, condition management programs, community resources, virtual-medicine, etc.)
  5. Proactive Behavior Change: We leverage indicators for progression and deterioration along the health status continuum to optimize outreach and influence positive behavior changes. Early indicators are collected during various member touch points, from claims data, and from plan utilization information, and are used to trigger appropriate engagement activities like departmental referrals, appointment support, clinical resource steerage, etc.


Want engagement advice specific to your health plan's needs and objectives? Set up a meeting with one of our Consultants to learn how we can help you engage your members for better health outcomes!


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