From Transactional to Transformational: AI's Impact on Health Plan Member Engagement

As they navigate the often-confusing health care landscape, health plan members are seeking intelligent, personalized experiences, and transformative engagement –– much like the consumer experiences they’ve become accustomed to in retail and finance. This demand presents a challenge for health plans, as member engagement is typically suboptimal. Traditional member portals and provider directories fall short of facilitating meaningful connections. However, technology, particularly Artificial Intelligence (AI), today is emerging as a game-changer in transforming the relationship between payers and their members.

The shifting landscape of health plan engagement

Traditionally, health plan membership has been wholly transactional, driven primarily by the necessity of insurance coverage for healthcare needs. Members who engage beyond paper mailings only log into their health plan portals for basic information, such as finding in-network doctors, without establishing a meaningful connection with their insurers, who typically don't directly provide care.

But times are changing. In the pursuit of cost control, health plans are branching into care delivery, acquiring telemedicine services, primary care clinics, and concierge medicine clinics. This strategic shift aims to establish a more robust connection between health plans and their members, offering a broader spectrum of care options.

This new approach means that members are no longer just subscribers to insurance policies; they are gaining access to the entire network of care services provided by their health plans. This paradigm shift makes the relationship between health plans and members less transactional and more about the accessibility and delivery of care. Those health plans embracing this approach aim to optimize care by ensuring that it's not only affordable but also convenient and accessible within their network.

AI's role in member engagement

Member engagement remains a formidable challenge. Individuals usually interact with their health plans during times of need, such as when seeking medical care. However, AI tools can create efficiencies and enable health plan member networks to engage with patients proactively.

Campaigns and outreach efforts can be designed to communicate with patients beyond these critical moments. For example, outreach campaigns can be used to stratify patient populations, identifying those with specific needs or behaviors. Members who frequently visit the emergency department can be enrolled in ED management programs, educating them about alternative care options and tools like telemedicine for self-triage at home.

Campaigns can also target specific demographics, such as new mothers or recent movers during open enrollment, offering them guidance on symptom checking before seeking care. These outreach efforts not only benefit members by reducing the burden of care but also ease the strain on health care providers by directing members to appropriate clinical resources.

AI's role in educating, empowering, and engaging members

AI plays a pivotal role in addressing the three Es of patient engagement:

• Education: Patients often lack the medical knowledge to determine the appropriate level of care. AI-powered tools can provide trustworthy information based on symptoms, risk factors, and conditions, empowering patients to make informed decisions about their health.
• Empowerment: Empowered patients are more likely to make the right choices regarding their health. AI-driven tools can enable patients to connect with care options and resources, putting their health care decisions in their own hands.
• Engagement: Engagement in health care has historically been limited to critical situations. However, AI-driven outreach and educational campaigns can help patients become more engaged in their health and care decisions.

AI doesn't aim to replace health care providers but rather to augment their capabilities. For instance, AI can streamline administrative tasks, reducing the need for patients to repeat information during telemedicine visits. This not only saves time, allowing providers to spend more quality time with patients, but also improves the efficiency of care delivery.

Moreover, AI can support communication between payers and providers, facilitating long-term care planning for patients with low-acuity conditions. By automating processes like prescription filling for common ailments, health care becomes more accessible and convenient for patients, leading to improved health outcomes and cost savings for both payers and providers.

Scaling engagement with AI

One of the most significant advantages of AI in member engagement is its scalability. AI-driven tools can efficiently reach millions of members and tailor their interactions based on individual preferences. Whether through text messages, email, or within member portals, AI ensures that communications are personalized and effective.

Health plans are increasingly recognizing the need to guide patients to appropriate care settings. AI, through its ability to process a multitude of data points, can automate this process, directing patients to the right level of care. By leveraging AI, health plans can reach patients on a massive scale, providing education, empowerment, and engagement to enhance health outcomes and reduce health care costs.

AI is revolutionizing health plan member engagement by making it more personal, efficient, and effective. It empowers patients to take control of their healthcare decisions, while also facilitating communication between payers and providers. As health plans continue to evolve, AI will play an increasingly crucial role in creating a healthcare system that is not only more affordable but also more patient-centered and convenient. Senior healthcare executives must embrace AI as a vital tool in enhancing member engagement and ultimately improving the health of their populations.