The Fix for the 3 Reasons Health Plan Members Make Bad Choices

Health plan members make bad choices, lots of them. Too often, those choices also adversely impact the health plans that insure them. Take smoking, seat belts, and the COVID-19 vaccine, for example.

  • Smoking: An estimated 34 million US adults choose to smoke yet cigarette smoking kills 480,000 people a year and is the leading cause of preventable disease and death.
  • Seat Belts: Similarly, seat belts save lives, but 10 percent of US adults don’t wear them. Almost half (47 percent) of the people killed in a passenger vehicle in 2019 were not wearing a seat belt.
  • COVID19 Vaccines: As I write this blog, we are in the worst of the Omicron surge yet only 62.4 percent of eligible Americans are fully vaccinated.

These members’ bad choices, and many more like them, mean higher costs and poorer health outcomes. Getting members to make better choices is one of the central challenges health plans face. It’s far from easy and it’s why you invest in chronic care programs, digital apps, and more.

Our decade of work with health insurers has revealed the three reasons why members make bad choices and how to fix them in 2022:

  1. Your members aren’t listening to you.

Health plans have relevant, impactful information to share with their members. For example, most health insurers have created transparency tools to help members find in-network providers and get cost estimates for care. Yet, when asked if their health plan offers healthcare transparency tools, only half of the members said yes (49 percent). In the same survey, 70 percent of members said they were unsure whether their plan had a phone number or email to contact them. Undoubtedly, having member contact information is necessary, but insufficient.

At the risk of stating the obvious, members are not one-size-fits-all. For starters, they have preferred modes and frequency of communication. Do you know who, for example, the seven percent of members are that prefer text communication, and of those members who prefer texts, the 52 percent who want to hear from you at least once a month?

Too often, health plans act on faulty assumptions about their members. For example, one plan assumed their Medicaid members would be less motivated to receive the COVID-19 vaccine. In fact, the opposite was true, and this insight caused the plan to change the way the plan approached this population.

Chances are you have heaps of data about your members, but if your health plan wants them to listen to you, you need to use your data to determine precisely which members to contact and the language to use to connect with them. For members to act on the information you share, you need to meet members where they are, using their social, physical, and behavioral dialect to ensure they understand the what, why, and how.

2. Your members don’t really care what you have to say.

Countless surveys have demonstrated that members are skeptical of the care offered by their health plan. Nearly 40 industries have higher customer satisfaction than health plans, including airlines, car rentals, and wireless carriers. At the same time, in 2019 Accenture research found that about 60 percent of Medicare Advantage members trust their plan, compared to only 45 percent with individual insurance and 37 percent with group insurance. A more recent survey fielded in late 2020 and early 2021 discovered only one-third of adults trust health insurance companies compared to more than 80 percent who trust doctors and nurses.




Chart Source: https://www.norc.org/PDFs/ABIM%20Foundation/20210520_NORC_ABIM_Foundation_Trust%20in%20Healthcare_Part%201.pdf (page 8)

To build trust, health plans need to communicate and engage with members in a way that makes the person feel known by their plan. Data-driven engagement can help. Our health plan clients find that starting with data guides member interactions and conversations. Even better, use a test-and-learn engagement strategy to amplify the results.

3. Your members don’t understand the value provided.

Consider this – A recognized and leading health plan in the northeast created an evidence-based diabetes prevention program. The plan’s program earned full recognition by the Centers for Disease Control and Prevention (CDC) for proving its ability to reduce the risk of type 2 diabetes. There is no requirement of a prediabetes or diabetes diagnosis to participate; instead, the program is offered at no cost to everyone in the community, meaning members can enroll with a spouse and a loved one for extra support. Even though more than 100 million Americans have diabetes or prediabetes and the increasing prevalence poses a challenge to every health plan. For this health plan, fewer than one-half of one percent of their members chose to participate in the program’s first three years.

I don’t know why participation in a proven diabetes prevention program wasn’t higher, but my work with plans suggests this health plan is not alone in low participation in their programs. There likely are many reasons. Did members understand the benefit of the program? Was the invitation to participate communicated in language that resonates? Did everyone get the same message or was there cohort-specific messaging for prediabetics, newly diagnosed diabetics, and people whose diabetes is not well-controlled?

In our experience, programs need motivators, incentives, and other factors to succeed as well as member-level data about what matters to them. Savvy health plans use all of this information to create tailored messaging and incentives then test what works across different segments and cohorts of members. They optimize what resonates and test alternatives when they do not achieve the desired outcome.

Influencing members to make better choices benefits them – and their health plan. It’s good business, often leading to better health outcomes, lower costs, and higher member satisfaction. It’s not easy and does require an investment of time and resources. But let me assure you connecting with members, building trust in your communications, and using messaging that resonates is worth the effort.

To learn more, download our health plan case study about tailoring member engagement to improve Medicare stars by clicking here.

Jeff Maxwell, Executive Vice President of Healthcare Solutions

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